EEO Midterm - Intro + Subjective Lecture Flashcards
Body language makes up what percentage of communication?
55%
If a patient has low back pain, what is the proper way to seat them?
With their back supported and feet flat on the floor
What is the biopsychosocial model?
A framework for assessing patients based on how their body works (biology), what their mindset is (psychology) and what their environment is (social).
When should you use open-ended questions? What are the drawbacks?
Use:
-at the beginning of the eval
-when a patient has a hard time opening up
Drawbacks:
-Can take up too much time
-patients can give over-the-top answers
When should you use closed-ended questions? What are the drawbacks?
Use:
-To clarify answers from open-ended questions
-to obtain specific information
-to narrow down a talkative patient
Drawbacks:
-can “cut off” a patients response
-potentially limits knowledge you would get form an open-ended question
When should you use graded-response questions? What are the drawbacks?
Use:
-to quantify a patient’s experience
-to clarify obscure answers like “a lot”
Drawbacks:
-have to ask follow-up questions
An example would be a pain scale from 0-10
When should you use multiple-option questions? What are the drawbacks?
Use:
-when patients have difficulty coming up with a description
-When trying to clarify information
-To help a patient remember
Drawbacks:
-can be used as a shortcut and become a bad habit
Aching pain
Muscular problem
Burning pain
Neural or muscular problem
Shooting, lightning, or electrical pain
Nerve root irritation
Coldness
Lack of blood flow
Hotness
Localized inflammation or infection
Clicking, snapping, or popping
Ligament or tendon dysfunction
Joint locking
Cartilage tear, loose body, or joint malalignment
Global weakness or fatigue with no clear pattern
Cardiovascular dysfunction
Whole body pain
Central somatization, or “chronic pain”
What five areas in the interview help to find out the chief complaint/s?
-Onset
-Description
-Location
-Intensity
-Behavior
Joint paint or stiffness that is worse in the morning is indicative of what?
An inflammatory condition like RA. RA will affect the whole body!
Joint pain that is fine in the morning but gets worse with activity is indicative of what?
Degenerative diseases like OA. OA will only affect specific joints
Back pain that is worse in the morning but better after a few hours is indicative of what?
Disc pathology
Pain that varies throughout the day or with changes in activity or position is indicative of what?
Muscular issues
Constant, intense pain that gets worse in the night and waking up without relief is indicative of what?
Malignancy. Red flag!
Note: For some conditions, like a rotator cuff tear, in the night the patient may be less distracted from pain, so it may. not actually be malignancy ¯_(ツ)_/¯
Why is sleep health important?
-Sleep disorders are associated with increased risk for chronic pain, HTN, DM, obesity, depression, heart attack, and stroke
-Sleep impairments are a strong predictor of pain
-Poor sleep = poor recovery
What is pain neuroscience education? (PNE)
Essentially asking a patient how often they think about their pain, and what are their thoughts towards their pain.
Patient’s reactions to pain can make the condition worse! PNE tries to adjust the patient’s mindset to reduce the negative impact of the injury or condition
What is question funneling?
Only ask questions if they confirm something. Ex. If patient says that they have fallen in the past 6 months, ask more questions about falling.
True or false. Referred pain is reproduced with movements or position changes.
False! It is NOT reproduced with these changes
True or false. Finding one red flag during the evaluation is a cause for immediate medical attention.
False! They should be fine. Probably ¯_(ツ)_/¯
Red flags that require IMMEDIATE medical attention
-anginal pain not relieved in 10-20 minutes
-patient w/ angina who has nausea, vomiting, or profuse sweating
-patient with DM who is confused, lethargic, changes in mental alertness and function
-Onset of incontinence or saddle anesthesia
-Anaphylactic shock symptoms (hives, asthma, tachycardia, hypotension, etc.)
What does a yellow flag represent?
Something atypical with presumed condition but doesn’t need immediate investigation or action
Cognitive or psychosocial risk is a yellow flag!
What are the ABC’S of a radiographic evaluation?
A = Alignment
-General skeletal architecture and alignment with nearby bones. Ex. would be dislocation of a bone
B = Bone density
-also texture abnormalities, like osteoporosis or bone tumors
C = Cartilage spaces
-joint space width and presence of epiphyseal plates
S = Soft tissues
-fat pads and joint capsules
What are some considerations for a patient’s prior level of function?
-Helps to determine what interventions to do and what will motivate the patient
-Helps to understand patients goals
-Helps to create realistic a expectation or prognosis for therapy
Why is it important to note a patient’s current level of function?
-It helps to establish a baseline for therapy
-Important for documentation and insurance purposes
What mental health screen should be performed in every evaluation?
Depression screen
What does AOx3 mean?
Alert orientation x 3
Patient knows:
-Who they are
-Where they are
-What year/month we are in
What question should be included at the end of an evaluation?
“Is there anything else you would like to share with me?”
Also double check to make sure you recorded everything accurately!
Questions to ask for follow-up appointment
- How did the patient tolerate the first day of therapy?
- Any changes since I last saw you?
- Have you been doing your HEP?
- Reassess the pain scales
How often is a re-evaluation done for a patient?
About every four weeks of PT. Can be done sooner or later though
What questions should you ask a patient during a re-evaluation session?
-Ask about perceived improvement and put on a 0-100% fully recovered scale
-ask about their goals and update accordingly
-update pain numbers
-give self-report outcome measures again
-update HEP (progressively more difficult)
-update/modify the POC
What is motivational interviewing?
Asking the patient from their perspective of what they need to recover. Basically trying to get the patient to be invested in their recovery and increase participation.
Can also ask them why they believe they are NOT improving.
Ex. “I noticed you answered 50% improvement since the start of physical therapy visits. I would love to hear from your perspective what is left to get you to 90%.”
What is considered the cutoff value to discharge a patient based on their goals?
If a patient hits 90% of their goals, they can be discharged.
