Exam 1 Flashcards
1
Q
Interview Questions
A
- open ended
- neutral questions
- therapist responses (follow up, eye contact)
2
Q
Content of Initial Exam
A
- demographics
- employment and work history
- social history
- growth and development
- living environment
- family history
- medical history
- surgical history
- general health status
3
Q
Objectives of Interviewing Patient
A
- assists in formulating a working hypothesis
- gives clinical signs/symptoms
- assists with making examination plan
- helps with setting goals
- *clinical decision on KEEP, REFER, CONSULT
4
Q
Patient Specific Functional Scale
A
- patient names 5 activities that they have trouble with and rate their functional limit from 0 (unable to do at all) to 10 (able to do same as injury/issue)
- minimal detectable change = 2 points
5
Q
Sudden vs. Gradual onset
A
- sudden = 24-48 hours after traumatic event (often musculoskeletal injury)
- gradual = don’t know much mechanism of injury
6
Q
Musculoskeletal vs. Systemic pain
A
- musculoskeletal = generally gets better over time, pain intensity lessens
- systemic = stays same or increases over time
7
Q
Nerve Pain descriptors
A
- sharp, burning, shooting pain, pins & needles, numbness
8
Q
Bone Pain descriptors
A
- aching, deep, boring, stiffness
9
Q
Vascular Pain descriptors
A
- throbbing, pulsating
10
Q
Muscle Pain descriptors
A
- soreness, stiffness, twinges with active movement or passive stretch
- ligament painful when something put across it, giving it tension, not when in movement/stretch
11
Q
Musculoskeletal Pain
A
- lessens at night generally
- sharp or superficial ache
- decreases when activity stopped
- can be continuous or intermittent
- aggravated by mechanical stress
- no associated constitutional signs/symptoms
12
Q
Systemic Pain
A
- usually disturbs sleep
- deep aching/throbbing
- reduced by pressure
- constant or waves of pain/spasm
- not aggravated by mechanical stress
- associated constitutional signs/symptoms
13
Q
Review of Systems
A
- QUESTIONS asked in the history interview to determine if the cause of the patients pain is within scope of PT practice
14
Q
4 systems
A
- integument
- musculoskeletal
- neuromuscular
- cardiorespiratory
15
Q
Systems Review
A
- PHYSICAL test of measures taken
- taking vitals, resp, pulse, etc
16
Q
Red Flags with patient symptoms
A
- fevers, chills, night sweats
- nausea, vomitting
- shortness of breath, malaise, fatigue
- weight changes
- bowel/bladder dysfunction
- paresis or parasenthia
- insidious onset of pain
- multiple levels of neurological symptoms
- pain at night
- increase in pain intensity over time
17
Q
Advantages vs. Disadvantages of Electronic Documentation
A
- Advantages = don’t have to write out or dictate so much info, & uniform data base
- Disadvantages = someone else may have computer, may not have all the boxes exactly as you want
18
Q
Writing Tips for Documentation
A
- SOAP = subjective, objective, assessment, plan
- be specific
- use objective statements
- write complete sentences
- write eligibly
- only use standardized abbreviations
- no empty or open lines between entries or within entry
19
Q
Advantages vs. Disadvantages of Written documentation
A
- Advantages = can be done right with patient
- Disadvantages = time consuming, and send the info out to be typed…takes time to come back and must be reviewed
20
Q
Clinical Reasoning
A
- cognitive process/thinking process used in the eval and management of a patient
- involves interaction of individuals in collaborative exchange to achieve mutual understanding of problem
- involves inductive, deductive, and abductive reasoning
- is complex, non-linear, and cyclical in nature
21
Q
Inductive reasoning
A
- broad generalization from specific observation
- pattern recognition
- allows for false conclusion
- used to form hypothesis or therory
- *SPECIFIC TO BROAD
22
Q
Deductive reasoning
A
- general statement or hypothesis
- examines possibilities to reach specific/logical conclusion
- testing of hypothesis and thesis
- to be sound, hypothesis must be correct
- *BROAD TO SPECIFIC
23
Q
Abductive reasoning
A
- incomplete set of observations and proceeds to the likeliest possible explanation for the group of observation
- making and testing hypotheses using the best info available
- educated guess after observing something for which there is no clear explanation
- used by medical personnels (PT, physicians)
- diagnosis based on test results
24
Q
Expert Learners
A
- know great deal about a domain and understand how discipline is organized
- ability to comprehend and contribute to methodology
- performance is intuitive and automatice
- understands critical aspects of given situations
- uses abilities to build broad base/organized system
- recognize patterns of info
25
Q
Novice Learners
A
- limited or no experience in their domain
- understanding based largely on rules
- rely on faces and features of domain to guide behavior
- inflexible and limited performance
- don’t organize growing knowledge / don’t categorize info acquired into meaningful units
- biomedical knowledge
- hypothetico-deductive reasoning
26
Q
Theories on reflection
A
- knowing in action: knowledge and skills a professional has and uses within given context
- surprise: unexpected or novel problem encountered
- reflection in action: ongoing meta-cognition about what’s occurring
- experimentation: arises when solution to a problem is attempted
- reaction on action: look back at what occurred allowing to broaden/change decision-making
27
Q
Clinical Reasoning Strategies
A
- algorithms
- forward reasoning
- backward reasoning
- interactive reasoning
- conditional reasoning
28
Q
Algorithms
A
- logical sequence of activities, focused on process - not outcomes
- move from generalized to specifics
- independent of treatment philosophies
29
Q
Forward Reasoning
A
- tendency to look for, notice, and remember info that fits with pre-existing expectations
- specifics observations and data lead to generalization
- “if, then” pattern recognition
30
Q
Backward Reasoning
A
- relies on detailed, biomedical concepts for hypothesis development
- inefficient due to demand on clinicians working memory
- used by novice and experts outside their own domain
31
Q
Interactive Reasoning
A
- interactions between clinicians and their patients
- working to better understand patient, collaboration, teaching, ethical practice
32
Q
Conditional Reasoning
A
- “thinking about thinking”
- reflection on own thinking process
- reflection on overall encounter with patient
- critique own reasoning process
33
Q
Errors in Clinical Reasoning
A
- framing errors
- confirmation bias
- outcome bias
34
Q
Framing Errors
A
- forming wrong initial concept to problem
- failure to generate plausible hypothesis & inadequate testing of hypothesis
- premature acceptance of hypothesis
- failure to attend to features that are missing
35
Q
Confirmation Bias
A
- over-emphasis on features which support the “favorite” hypothesis
- tendency to look for, notice, and remember info that fits with pre-existing expectations
36
Q
Outcome Bias
A
- over-reliance on outcome information to indicate the accuracy or quality of the clinical reasoning that occurred when the interventions were chosen
- good outcome = good clinical reasoning (don’t think it is due to anything other than what you’ve done)
37
Q
Ways to overcome errors
A
- develop an awareness of cognitive processes or reasoning used to come to clinical decisions
- understand common clinical reasoning errors
- always include in exam Qs, physical screening and tests and measures that would disprove your hypothesis
- try to understand why your reasoning might be wrong
- don’t jump to pattern recognition too soon
38
Q
Body Mechanics
A
- using all body parts efficiently to safely lift and move
39
Q
Body Alignments
A
- correct positioning of head, back, limbs
40
Q
Base of Support
A
- area on which an object rests, and provides support for the object
41
Q
Center of Gravity
A
- mass of a body or object is centered
42
Q
8 Rules for good body mechanics
A
1- have broad base of support 2- bend from hips and knees to get close 3- use strongest muscles to do job 4- use weight of body to help push/pull object 5- carry heavy objects close to body 6- avoid twisting of body as work 7- avoid bending for long periods of time 8- get help with mechanical lifts
43
Q
Ergonomics
A
- adapting environment and using techniques to avoid injury
- correct placement of furniture/equipment
- training in required muscle movements
- efforts to avoid repetitive motions
- awareness of environment to prevent injuries
44
Q
Short term positioning
A
- supine, prone, sidelying, sitting, long-sitting
45
Q
Long term positioning
A
- SAFETY
- prevent negative effects of mobility
- supine, prone, sidelying, sitting, 3/4 prone, 1/4 supine
46
Q
Checklist before leave patient alone
A
- is patient safe?
- can they call for help?
- comfort? as long as safe…
47
Q
Supine positioning
A
- treat cervical, shoulders, anterior thigh or knee, medial knee, anterior ankle
- pillows at head, behind humerus, under knees and ankles
48
Q
Prone Positioning
A
- treat posterior cervical, upper traps, posterior shoulder, back, buttock region, posterior thigh/knee/ankle/foot
- pillows at head, under stomach/ankles/shoulder
- want head to be straight down - no twisting neck
49
Q
Sidelying Positioning
A
- treat shoulder, upper traps, back, SI joint, hip, lateral thigh, knee, ankle
- pillows under superior arm, between knees/ankles
- make sure head, trunk, hips aligned
50
Q
Sitting Positioning
A
- treat neck, upper back, anterior and posterior shoulder, UE
- supported sitting-forward with head supported = arms supported, head straight, pillows in lap at chest…use stool if short legs
- supported sitting-head upright = pillow in lap, behind back, UE supported
51
Q
Fowler’s Position
A
- semi-reclined, patient supine, head of bed 45-60 deg
- common after abdominal surgery
- position of comfort
52
Q
Trendelenburg
A
- patient supine, head of bed lower than feet
- used during abdominal and gynecolic surgery, hypotensive patients
- used for short-term repositioning and postural drainage of lungs
53
Q
Patient attire for acute setting
A
- usually only a gown
54
Q
Patient attire for rehab, OP, home
A
- primarily clothing, may use gowns as needed
55
Q
Vital Signs
A
- provide critical info regarding patients physiological status
- they measure body’s core ability to stay alive
- APTA guidelines = heart rate, BP, respiration temp
- gait speed often an extra one to take into account
56
Q
Sign vs. symptom
A
- sign = observable, objective measure that can often be quantified by using valid and reliable measures
- symptom = how a person experiences a condition
57
Q
Observable signs of change in physiological status
A
- changes in mental health, mood, appearance
- slow to respond/react
- fatigue/lethargy/exhaustion
- decrease response to verbal or tactile stimuli
- pupil constriction/loss
58
Q
Pulse Rate
A
- heart beats per minute
- each time left ventricle heart contracts, pushes blood through aorta and increases blood volume
- helps determine the patients physiological response to activity, especially energy expended
59
Q
Neonates (1-28 days) Normal pulse rate
A
120-160 beats/min
60
Q
Infants (1-12 month) normal pulse rate
A
100-120 beats/min
61
Q
children (1-8 yr) normal pulse rate
A
80-100 beats/min
62
Q
adults normal pulse rate
A
60-100 beats/min
63
Q
tachycardia
A
over 100 beats/min
64
Q
bradycardia
A
less than 60 beats/min
65
Q
Bounding HR
A
- high pressure on artery walls
- easy to find HR
- (+3)
66
Q
Regular HR
A
- beats occur repeatedly at fixed intervals
- (+2)
