Exam 2 Flashcards
4 facts from orders section
WB status, activity restrictions, PT orders, vital sign parameters (can we titrate oxygen)
3 facts from physician/nursing notes
PMHx, HPI (history of present illness), social history
what do we know from the medical record
imaging, labs, surgery, medications
normal MAP
70-100
unstable MAP
60-65
normal PWP
8-10 mm HG
how much leg flexion with arterial line
strictly less than 90
Don’t put BP cuff over what
IV line or fistula
head of bed angle for ng tube
30 degrees
types of open drains
Penrose, Foley, Malecot
types of closed drains
Hemovac or JP drain (Jackson-Pratt)
minimum o2 saturation
88%, goal is 90-92%
how long to wait between BP attempts
3-5 minutes
ECG rhyme
R (W/G), L (B/R), Center (B 4 ICS), don’t put electrodes over pacemaker
Summarize the goal of the APTA’s Core Competencies for Entry Level Practice in Acute Care Physical Therapy
entry-level acute care PT, guided by sound acute care clinical decision-making, will be able to assist patients with achieving their optimal heath outcomes as part of physical therapy best practice in acute care
5 domains involved in the APTA’s Core Competencies
1 – Clinical Decision-Making (an integral component of all of the sections); 2 – Communication; 3 – Safety; 4 – Patient Management; and 5 – Discharge Planning
3 components required of a clinician in the acute care environment according to the APTA’s Core Competencies for Entry Level Practice in Acute Care
Safety, skills, D/C planning
scalene nerve blocks can inhibit the action of what
the diaphram
how should we breathe with COPD patients
pursed lip breathing
how to calculate MAP
MAP = SBP + 2 DBP / 3
calculate pulse pressure
SBP - DBP
how is oxygen handled
titrate but do not discontinue
line that monitors blood gas
swan ganz
5 stages of the transtheoretical model
precontemplation, contemplation, preparation, action, maintenance
% of those with mild cog impairment who get dementia
10-15%
3 most common types of dementia
Alzheimer’s, Lewy, Vascular
etiology of AD
buildup of amyloid protien => plaques
stages of AD
1- nothing, 2-very mild/typical aging, 3-noticeable deficit, 4-mild dementia (detect in interview), 5-mod assistance required, 6-forgets name of caretaker, 7-severe dementia, incontinence
delirium
rapid change in mental state,
what is sundowning
symptoms of dementia get worse at the end of the day
items in mini-cog
3 item recall, clock draw, 0-2 positive for dementia, 3-5 negative for dementia
MoCA
Includes tests for executive function, naming, memory, attention, language, abstraction, delayed recall, and orientation
Scores > 26 = Normal
MMSE
11 questions to assess:
*
Orientation, registration, attention, calculation, recall, language, and visual construct
*
Scoring
*
24-30: no impairment
*
18-24: mild impairment
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0-17: severe impairment
best practice for dementia
massed, constant, blocked, cannot transfer, no mental practice,
score for geriatric depression scale
Score greater than 11, need referral or follow up
*
0
10 normal, 11 20 mild depressive, 21 30 severe depressive
what type of joint is the GH joint
ball and socket, covered by hyaline cartilage
what is the angle of scaption
30 degrees from straight side (HH in retroversion, scapula in anteroversion)
how many bands of the GH ligament
3 (superior, middle, inferior)
joint type of SC
saddle
for shoulder flexion which way does proximal end of clavicle move
inferiorly
AC joint type
plane synovial joint
2 parts of the coracoclavicular ligament
trapezoid and conoid
resting position
55 AB, 30 AD from horizontal
CPP for GH
full abduction and lateral rotation
GH capsular pattern
ER > ABD > IR
landmark for superior angle of scapula, inferior, spine
T2, T7-T9, T4
motion from GH vs. scapula
2/3 GH, 1/3 Scapula
innervation of serratus anterior
long thoracic nerve
how is the GH joint stabilized
balance, convacity/compression, adhesion/cohesion, capsule/ligaments
are outcome measures used enough
NOPE
high risk for a DVT
3-8 points
most likely direction for a shoulder dislocation
anterior 90%
Type 1 v. Type 2 AC pathology
sprained vs. torn AC lig, CC normal
type 3 vs. T4 AC pathology
disruption of AC and CC; p. displacement into Trap
type 5 AC pathology
rupture of delto-trapezoid fascia
type 6 AC pathology
clavicle displaced into conjoined tendon
where does a painful arc often occur
170-180 abduction
test item cluster for AC joint
crossbody, resisted extension (horizontal crossover), O’Brien’s
which types of AC pathology are rare
4-6, immobilize for up to 6 weeks
common position of arm for AC injury
adduction, landing on arm
classifications of instability
traumatic, atraumatic, acquired
subluxation v. dislocation
subluxation will auto-reduce
4 types of shoulder dislocations
Hill-Sachs, Boney Bankart, Labral Tear, Axial nerve injury
location of bankart lesion
anterior gelnoid, reverse is posterior glenoid
what is a Hill-Sachs lesion
compression fracture, humeral head as a result of anterior dislocation (posterolateral humerus, reverse is anteromedial humerus)
which muslce is a slap lesion associated with
biceps tendon (anterior dislocation)
conditions which cause atraumatic instability
Ehler’s danlos syndrome and Marfan’s
test item cluster for anterior instability
relocation, surprise, apprehension
test item cluster for posterior instability
jerk
labral tear
kim test, biceps load test
risks for recurring instability
young age, men, less risk with having a fracture such as a bony bankart or greater tubercle
phase of recovery from SH dislocation with intervention
acute: PROM, intermediate: AROM (AB to 90), advanced: full ROM, sport specific: return to sport activities
will using large muscles make smaller not rotator cuff muscles not work
NOPE
mobilization direction for shoulder internal rotation
posterior
mobilization direction for shoulder external rotation
anterior
mobilization direction for shoulder abduction
inferior
mobilization direction for SH adduction
superior
dynamic constraints to GH mobility
rotator cuff muscles, scapular stabilizers
precautions with reverse SH arthroplasty
no hand behind back, no extension past neutral
key words for elder abuse
intention to act, failure to act, trust, harm to older adult
types of abuse
physical, emotional, sexual, financhial, verbal, neglect/abandonment
where to report elder abuse
adult protective services
three components of a good death
people, location, pain
physiological signs of death
confusion, restlessness, more time sleeping, less eating, fatigue, irregular HR, loss of BP, rapid breathing/apnea, cool distal extremities, irregular bowel/bladder
what covers hospice
Medicare Part A (terminal condition, less than 6 months, no longer seeking treatment)
what is rehabilitation light
1-2x/week, slow progression
rehab in reverse
PRN, assistive devices, bed mobility, education
skilled maintenance
help with ambulation or transfers
what are advanced directives
legal, desires in event of death, appoints power of attorney (medical) - makes decisions if patient can’t, do not resuscitate orders
