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PHYS REHAB > Exam 3 > Flashcards

Exam 3 Flashcards

Burns, Amputations, Muscle Strength, MMT, Cardiac and Pulmonary Dysfunction, Ethics/Scope of PAMS, Prosthetic Devices and How They Work

1
Q

causes of muscle weakness

A
  • lower motor neuron diseases
  • primary muscle disease
  • neurological diseases
  • disuse/ immobilization
  • secondary symptom
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2
Q

MMT contraindications

A
  • inflammation/ pain
  • fracture/ dislocation
  • myositis ossificans
  • bone carcinoma
  • other fragile bone disease
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3
Q

MMT limitations

A
  • cannot measure muscle endurance, coordination, or task performance
  • will not get accurate results with spasticity
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4
Q

MMT 3 and higher requires:

A

full ROM AGAINST gravity

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5
Q

MMT 2 and lower requires:

A

gravity ELIMINATED position

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6
Q

dynamometer assess:

A

grip strength

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7
Q

pinch meter assesses:

A

pinch strength
- three jaw chuck
- lateral pinch
- two-point pinch

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8
Q

factors to consider when planning intervention for muscle strength

A
  • degree of weakness
  • generalized or specific
  • imbalance between agonist/ antagonist
  • impact on occupations
  • orthosis needed?
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9
Q

general purpose of therapeutic exercise (documentation purposes)

A
  • develop awareness of normal movement patterns
  • aid in overcoming ROM deficits
  • develop strength/ endurance for function
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10
Q

types of exercises (5)

A
  • active-assisted
  • active
  • resistive
  • progressive resistive
  • isometric
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11
Q

for STRENGTHENING:

A

INCREASE load, DECREASE reps

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12
Q

for ENDURANCE/TOLERANCE:

A

INCREASE reps, DECREASE load

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13
Q

cause of MI

A
  • reduced blood flow to the heart for an extended period
  • leads to damage, necrosis or death of cardiac tissues
  • coronary artery disease - atherosclerosis
  • spasm of coronary artery
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14
Q

symptoms of MI

A
  • pain/pressure in chest that may radiate to teeth, jaw, ear, arm, or mid-back
  • nausea/ vomiting
  • SOB
  • diaphoresis
  • fatigue
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15
Q

risk factors of MI

A

modifiable vs. non-modifiable

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16
Q

medical management for MI

A
  • medication
  • balloon angioplasty
  • atherectomy
  • CABG
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17
Q

sternal precautions

A
  • avoid completing asynchronous UE movements
  • avoid activities that cause feelings of sternal clicking or shifting
  • avoid shoulder flexion beyond 90 degrees/ other excessive shoulder movements
  • no lifting 5-10 lbs+ (push/pull)
  • use small pillow held against sternum when coughing or mobility transitions
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18
Q

cause of CHF

A
  • chronic/ progressive condition in which the heart loses the ability to pump effectively
  • causes: CAD, hypertension, MI
  • results in: fluid in lungs, edema in LEs and abdomen, physiological changes
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19
Q

symptoms of CHF

A
  • sudden weight gain
  • SOB, wheezing/ coughing
  • fatigue
  • decreased appetite
  • changes in sleep patterns
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20
Q

risk factors of CHF

A

modifiable vs. non-modifiable

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21
Q

medical management for CHF

A
  • medication
  • lifestyle change
  • goals (maintain optimal cardiac function; reduce exacerbation)
    surgeries
  • valve replacement
  • defibrillator placement
  • LVAD
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22
Q

physical impact of CHF

A
  • fatigue/ decreased activity tolerance
  • decreased strength
  • decreased UE and LE ROM
  • SOB/ difficulty breathing
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23
Q

psychosocial impact of CHF

A
  • anxiety
  • depression
  • PTSD
  • anger/ hostility
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24
Q

cardiovascular conditions +

A
  • hypertension
  • cardiomyopathy
  • angina pectoris
  • arrhythmia
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25
Q

phases of cardiac rehab

A

1: Inpatient
- mobilization, ADL retraining, education/ HEP
2: Outpatient
- supervised exercise, education
3: Community-Based
- maintenance program

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26
Q

cardiac rehab interventions +

A
  • strength and endurance training
  • stress management and coping techniques
  • lifestyle modification education
  • addressing edema
  • addressing SOB
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27
Q

COPD includes:

A
  • emphysema - “pink puffers”
  • chronic bronchitis - “blue bloaters”
  • peripheral airway disease
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28
Q

medical management for COPD

A
  • medications
  • supplemental O2
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29
Q

physical impact of COPD

A
  • postural abnormalities
  • decreased strength & activity tolerance
  • fatigue/ SOB
  • postural control
  • cognitive changes
30
Q

psychosocial impact of COPD

A
  • anxiety/ depression
  • altered body image
31
Q

O2 safety tips!!

A
  • avoid open flames
  • store cylinders properly and safely
  • turn off valves when not in use
  • avoid products with petroleum; use water-based around the nose instead
  • always follow instructions of the company for safe use
  • tubing can become a falls risks!
32
Q

pulmonary conditions +

A
  • idiopathic pulmonary fibrosis (hardening of lungs)
  • cystic fibrosis (thick mucus)
  • kyphoscoliosis (restricts lung expansion)
33
Q

general goals of pulmonary rehab

A
  • increase ADLs, func. mob., other occs.
  • increase strength, activity tol., balance, and use of breathing patterns
  • increase QoL, and occ engagement
  • improve coping skills to manage SOB
  • decrease anxiety and symptoms
    educate clients/ caregivers to support carryover of recommendations
34
Q

pulmonary rehab interventions +

A
  • strength and endurance training
  • breathing techniques (PLB, DB, AE)
  • coughing techniques
  • EC, WS
  • stress management/ coping techniques
35
Q

breathing techniques

A
  • pursed-lip breathing (PLB)
  • active expiration
  • diaphragmatic breathing
36
Q

EC & WS tips:

A
  • sit when possible
  • rest breaks
  • spread heavy/ light tasks throughout day
  • keep items in easy reach, work at own pace
  • use AE
  • minimize movements
  • support elbows
  • push/pull items on counter rather than lifting
  • allow time to prevent rushing
  • prioritize what is most important
37
Q

interdisciplinary teams

A
  • PT
  • SLP
  • dietician
  • psychologist, counselor, social worker, pastoral care
  • RT
38
Q

skilled OT interventions: vital signs

A
  • create daily vital signs diary
  • develop self-awareness strategies
  • teach compensatory techniques
  • teach self-advocacy
39
Q

signs & symptoms of exercise and activity intolerance

A
  • chest pain (angina)
  • pain radiating to teeth, jaw, ear, or UE
  • severe SOB
  • extreme fatigue
  • nausea/ vomiting
  • weight gain of 3-5 lbs in short time
40
Q

SUPERFICIAL BURN: skin layers affected; symptoms; healing; scarring

A
  • epidermis only
  • painful, no blisters, red, blanches to touch
  • heals in 3-5 days
  • no scar
41
Q

SUPERFICIAL PARTIAL-THICKNESS BURN: skin layers affected; symptoms; healing; scarring

A
  • epidermis and top of dermis
  • painful, blisters, moist, red, blanches to touch with brisk capillary refill
  • heals before 21 days
  • risk of pigment change (color difference)
42
Q

DEEP PARTIAL-THICKNESS BURN: skin layers affected; symptoms; healing; scarring

A
  • epidermis and deeper into dermis
  • less painful sloughed skin, dryer, pale red, may blanch with slow to no capillary refill
  • heals in greater than 21 days, usually needs surgery via skin grafting to heal
  • scarring, risk for hypertrophic scarring and contractures
43
Q

FULL-THICKNESS BURN: skin layers affected; symptoms; healing; scarring

A
  • epidermis and entire dermis
  • no pain, pale, brown, white, red, leather-like, dry, no blanching, thrombosed vessels
  • will not heal (unless small), requires surgical skin grafting to heal
  • high risk for hypertrophic scarring and contracture
44
Q

severity of burns (3)

A
  • total surface area
  • age
  • premorbid health
45
Q

burn complications

A
  • capillary leak
  • burn edema
  • burn shock
  • hypo/hyperthermia
  • increased metabolic rate
  • vascular compromise
  • respiratory compromise
  • compartment syndrome
46
Q

burn infection protection

A
  • wound excision/ debridement
47
Q

burns: stages of wound healing

A
  • hemostasis
  • inflammation
  • replication/ proliferation
  • synthesis/ remodeling
48
Q

burn wound healing factors

A
  • age
  • nutrition
  • infection
  • other illnesses
  • medications
49
Q

types of burn wound coverage

A

temp. skin substitutes
- xenograft
- homograft/ allograft
permanent coverage
- split thickness sheet skin grafts (STSG)
- full thickness sheet grafts (FTSG)

50
Q

burn scar management overview

A
  • scar contracture
  • hypertrophic scarring
  • interventions essential before scar matures
51
Q

OTs role in burn and scar management

A
  • orthoses
  • ADLs
  • family/ caregiver involvement
  • functional mobility
  • standard precautions
  • proper wound/ skin care
52
Q

burns: acute phase

A
  • depends on burn severity
  • goal - prevent deformity
53
Q

burns: acute phase; OT interventions

A

manual therapy
- scar management/ massage
- AAROM
- edema reduction
- positioning
- composite stretching
therapeutic activity/ exercise
- ADL retraining
- functional mobility
- endurance activities
neuromuscular reeducation
orthosis fabrication
- preventative
- protective
- contraindications/ precautions
strengthening
positioning

54
Q

burns: rehabilitation phase

A
  • inpatient/ outpatient
  • after burns heal
55
Q

burns: rehabilitation phase; OT interventions

A

scar management
- scar massage
- gels/ gel sheets
- silicone products
corrective orthosis
premature rupture of membranes (PROM)/ AAROM/AROM
strengthening
HEP
nerve reeducation
desensitization
modalities
- compression therapy
- sun protection
- skin care

56
Q

OTA role in burn scar management

A
  • scar massage
  • client and family education
  • silicone products
  • scar remodeling
  • compression
57
Q

psychological factors in burn rehabilitation (5)

A
  • cognition
  • pain
  • anxiety
  • depression
  • self-image
58
Q

common OT goals in first few week post burn

A
  • Client/family will verbalize understanding of burn
    rehabilitation process
  • Client will be independent in HEP for ROM
  • Client will increase AROM/PROM of upper
    extremities in order to be independent with ADLs
    and reduce potential for burn scar contracture
  • Client will maintain proper positioning for edema
    control to optimize wound healing
59
Q

common OT goals after meeting functional ROM post burn

A
  • ADLs
  • IADLs
  • rest/sleep
  • leisure
  • return to work
60
Q

causes of amputations

A
  • traumatic
  • congenital
  • disease process
61
Q

psychosocial factors of amputations

A
  • self awareness
  • performance skills and patterns
  • social interactions
  • stages of grief
  • depression and anxiety
62
Q

phantom pain vs. phantom sensation: treatment

A
  • medication
  • TENS
  • mirror therapy
  • biofeedback/ behavioral treatment
  • surgical intervention
    changes in sensation
63
Q

components of prosthesis (3)

A
  • socket
  • suspension
  • terminal device
64
Q

types of UE prostheses (5)

A
  • passive
  • body powered (voluntary opening; voluntary closing)
  • myoelectric
  • hybrid
  • activity specific
65
Q

prosthetic application

A

suspension
- liner
- pin
prosthetic socks
donning
- transtibial
- transfemoral
- UE
knee locking

66
Q

Phase 1: early management and wound
healing (amputations)

A
  • ROM
  • limb care - shrinking and shaping (shrinker/ wrapping)
  • wound management
  • immediate postoperative prosthesis (IPOP)
  • early postoperative prosthesis (EPOP)
  • skin care
  • limb shrinking and shaping
  • desensitization
67
Q

Phase 2: preprosthetic program, preparation, training (amputations)

A
  • increasing general endurance and stamina
  • limb strengthening and ROM
  • participation in ADLs
    • use of affected/ unaffected limbs
    • AE
    • education/ training
    • one-handed/ cross-dominance training
  • myosite training
68
Q

Phase 3: prosthetic training (amputations)

A
  • donning/ doffing prosthesis
  • controls training for elbow, wrist, and terminal device
    • body-powered
    • myoelectric
  • proportional control
  • ADL activity using affected UE as an assist
  • ADL activity with a LE prosthesis and mobility device
69
Q

Phase 4: advanced prosthetic training (amputations)

A
  • incorporating UE prosthesis use into ADLs, IADLs, health management, work, and leisure
  • minimizing compensatory movements and biomechanical stress to uninvolved limb
  • participation in ADLs, IADLs, work, and leisure activities with LE prosthesis
  • bilateral high complexity prosthetics
70
Q

reasons for limited prosthetic use

A
  • age
  • comorbidities/ medical history
  • cardiovascular tolerance
  • skin integrity/ circulation
  • UE strength
  • condition/ strength of intact LE
  • fitness level
  • body weight and type
71
Q

8 parts of prosthesis

A
  • terminal device
  • wrist unit
  • wrist flexion unit
  • forearm
  • elbow
  • triceps cuff
  • harness
  • control cable
    + turntable

PHYS REHAB (11 decks)

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