Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Special Pops > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What is bariatrics?

A

Field of medicine that offers treatment to overweight people with a comprehensive program

Includes diet and nutrition, exercise, behavior modification, and lifestyle changes

May be indicated for appetite suppressants and other appropriate meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define body composition

A

Ratio of fat-free (bone, muscle, and water) to fat mass (adipose)

Expressed as percentage of body-fat or percentage of lean body mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define BMI

A

Accounts for height and weight to determine obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What BMI determines obesity?

A

> 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why is BMI measurement flawed?

A

Does not separate body fat from other body tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What body fat % determines if a man is obese?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What body fat % determines if a woman is obese?

A

> 30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define body fat measurement

A

Take body fat compared to the other weight of the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What BMI is considered morbidly obese?

A

> 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What other comorbidities is obesity linked to?

A

MS disorders

Pain

Reduced cognitive performance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the BMI formula?

A

Mass (lb) x 703/height (in)^2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define overweight in terms of body fat

A

Excessive amount of body weight that includes mm, bone, fat, and water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is hydrostatic weighing?

A

Subtract body weight measured in water during submersion from body weight on land

= Displaced water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What variables must you know prior to hydrostatic weighing?

A

Residual volume

Density of water (altered with temp)

Estimated gas trapped in GI system

Dry body weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is important to do before submerging individual in water?

A

Exhale as much air as possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the reliability of hydrostatic weighing?

A

High reliability

Gold standard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define Archimedes’ Principle

A

Law of physics

Upward force (buoyancy) of body immersed in fluid EQUALS the weight of displaced fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Air Displace Plethysmography?

A

AKA BOD POD Sys

Subtracting volume of air in chamber when subject is in chamber from volume of air when chamber is empty

Thoracic gas volume is measured and subtracted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the reliability of the BOD POD?

A

High reliability, but not as high as hydrostatic weighing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is DEXA?

A

Use low-level radiation to determine masses of fat, lean tissue, and bone mineral content

Also used in osteoporosis and osteopenia patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the limitation of DEXA?

A

> 300 lbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the theory of bioelectrical impedance?

A

Lean tissue (mostly water and electrolytes) is a GOOD electrical CONDUCTOR (low impedance)

Fat is a POOR electrical CONDUCTOR and acts as impedance to electrical current

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does bioelectrical impedance work?

A

Subject stands or grasps onto stainless steel electrodes or analyzer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a drawback to bioelectrical impedance?

A

Underestimate body fat for those who are obese and overestimates for those who are lean

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What affects bioelectrical impedance?

A

Hydration level and exercise status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is a skinfold measurement?

A

Based on the principle that subcutaneous fat is directly proportional to the total amount of body fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What side of the body is skinfold measurement conducted on?

A

Right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How many sites are there in skinfold measurement?

A

7 sites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What determines reliability of skinfold measurements?

A

Specific to equation used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What do the equations of skinfold measurements indicate?

A

Body fat percentage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is waist to hip ratio?

A

Waist circumference divided by hip circumference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What does waist to hip ratio indicate?

A

Strong correlation to risk factors of heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Where do you measure in waist to hip ratio?

A

Waist - more inferior rib cage

Hips - around greater trochanters and iliac bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are common comorbidities to obesity?

A 
CAD
HTN
Certain types of cancer
Elevated cholesterol
Type II Diabetes
Gall bladder disease
Sleep Apnea
OA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the causes of obesity?

A

Cal consumption > cal burned

Genetic factors

Environmental and social factors

Illnesses that lead to weight gain/obesity - hypothyroidism or Cushings

Lack of sleep

Drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What drugs can cause obesity?

A

Steroids

Some antidepressants

Some meds for psychiatric conditions or seizure disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is Cushing’s Syndrome?

A

Body exposed to high levels of CORTISOL for a long time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are possible causes of Cushings?

A

Oral corticosteroid meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are sx/sx of Cushing’s?

A

Fatty hump

Rounded face

Pink/purple stretch marks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are bariatric surgical interventions?

A

Gastric bypass

Lap Band

Panniculectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is gastric bypass?

A

Create new routing system

Absorb less nutrients

Better for diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is a lap band?

A

Creates a smaller stomach by cinching a portion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is a Panniculectomy?

A

Getting rid of excess skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the precautions to think of when someone had a panniculectomy?

A

Reduce infections

Decrease secondary MS complications

Decrease weight of excess skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is apple ascites distribution?

A

More abdominal mass (high waist to hip ratio)

Ascites - fluid accumulation (firm or hard) and fluid does not move easily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is apple pannus distribution?

A

Extra skin and more moveable

High waist to hip ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is pear abducted distribution?

A

Narrow abdomen, but larger hip area.

More fat medially causing hips to ABD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is pear adducted distribution?

A

More fat laterally causing hips to ADD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What positions do those with apple ascites have difficulty staying in?

A

Flat or prone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What positions do those with apple ascites prefer?

A

Semi-fowler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are complications of apple ascites?

A

Very poor endurance

Activity limitations due to SOB with exertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What postural adaptations are common in those with apple ascites distribution?

A

Hypertrophy of respiratory accessory Mm

Convexity of cerv region

Jugular Vn distention

Elevated clavicles and seek postures to stabilize UE on surfaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are mobility patterns in those with apple ascites?

A

Supine to sit via supine on elbows - flat spin on bed until perpendicular and elevate trunk by virtue of pt moving hips to EOB. May require a wider bed

Immobile abdominal mass makes breathing difficult. Avoid flat postures - log roll

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Can those with apple pannus tolerate flat positions?

A

Depending on distribution of pannus patient may tolerate supine

If there is restriction from diaphragmatic excursion - pt will most likely prefer s/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What activity is more tolerable in those with apple pannus distribution?

A

May have better endurance and distance amb because of less trunk restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

How does someone with apple pannus distribution get from supine to sit?

A

Some use supine flat spin to perpendicular to sit up at EOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How does someone with apple pannus distribution get on/off bed?

A

Prone entry on 4-point

Scoop pannus with one hand and enter prone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are characteristics of those with pear abducted distribution?

A

Very low waist to hip ratio

Majority of tissue bulk is BELOW belt line and femurs are ABD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How do pt with pear abducted distribution position?

A

Supine tolerant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How is breathing for those with pear abducted positions?

A

Able to breath without much obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

How is the mobility in those with pear abducted positions?

A

Difficulty rolling d/t extreme ABD LE

Usually move from supine to long sit and then short sit over EOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are equipment implications of those with pear abducted distribution?

A

Narrower, lower bed, and wider w/c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What are characteristics of pear adduction?

A

Most tissue bulk below belt line and LOW waist to hip ratio

Majority of tissue bulk is on the lateral aspect of the thighs and femurs ADD

Easier access to pericare and hygiene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How is mobility in those with pear adduction?

A

Supine to long sit and then short sit

Able to log roll

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What are indications for treatment in those who are obese?

A

Weakness

Impaired functional mobility

CP implications

Decrease endurance

MS pain or injury

Gait training

Balance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What are contraindications/precautions for treatment in obese?

A

Monitor VS

Follow protocols

Use appropriate equipment and look at weight limits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Define Modified Eggress

A

Goes through getting up and out of bed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Define Original Eggress

A

Looks at a patient only already sitting EOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What should be included in documentation of bariatric patients?

A

VS, pain, strength, ROM, posture, body type, and sensation

Aerobic capacity, resp status, balance, and skin integrity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are common interventions in bariatric patients?

A

Wound care

Bed mobility

Transfer training

Gait/aerobic exercise

Strengthening

Pt education

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What are the 3 components of the Egress Test?

A

Sit to/from stand x 3 reps

Marching x 3 steps

Advance step and return each foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Define Average Daily Wage (ADW)

A

Calculation of an injured worker’s average daily earnings

Sometimes used to determine entitlement to wage loss benefits following injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Define Average Weekly Wage (AWW)

A

Similar calculation to ADW by determining entitlement to wage loss benefits by week for a fixed period of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Define Functional Capacity Eval

A

A comprehensive battery of performance based tests that are commonly used to determine ability for work, ADLs, and leisure activities

Determine percent of impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Define Independent Medical Exam (IME)

A

Determines compensability, the extent of disability, necessity of treatment and type of tx, and/or to eval permanent disability or loss of earning capacity

Typically performed by a MD that knows nothing about the pt in ordef or an objective assessment

Can see same MD if post-op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Who can request an IME?

A

Insurance company or employer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

How often is an IME performed?

A

Generally once every 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

How far away can IME be?

A

Within 100 mile radius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Define Permanent Partial Disability (PPD)

A

Benefits to employee who has sustained a permanent, but not complete disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Define Permanent Total Disability (PTD)

A

Benefits if an injured employee is permanently AND totally disabled from work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Define Temporary Partial Disability (TPD)

A

Benefits available to injured employees who are able to work despite their injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Define Temporary Total Disability (TTD)

A

Benefits available to employees whose injuries leave them totally unable to work for a period of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Define Statewide Average Weekly Wage (SAWW)

A

A computation of average wages paid to employees in a jurisdiction for set period of time

Used to calculate min and max amt of workers comp benefits that an injured employee will be entitled to receive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Define Social Security Disability Benefits (SSDI)

A

Benefits payable to disabled individuals through SS admin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Define Vocational Rehab

A

A variety of services that offered to injured employee to help them return to work

Part of work conditioning team

Help get pt back to work with restrictions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Define work hardening

A

Interdisciplinary, individualized, job specific program

Uses real or simulated work tasks and progress graded conditioning exercises specific to pt

Provide transitions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is the goal of work hardening?

A

Return pt to work

Designed to improve biomechanical, neuromuscular, CV, and psychosocial functions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What terms are more common to use now for work hardening?

A

Occupational or Worker’s Rehab

Interdisciplinary, outcomes focused, and individualized program to address medical, psychosocial, behavioral, physical, functional, and vocational components of returning to work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What does work hardening address?

A

Physical tolerances

Job specific physical rehab

Productivity

Workplace safety

Job performance and injury prevention

Worker behaviors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Define work conditioning

A

Intensive, work-related, goal-oriented conditioning program designed specifically to restore systemic neuromuscular functions, muscle performance, motor function, ROM, and CV and pulm function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is the goal of work conditioning?

A

Restore physical capacity and function to enable patient/client to return to work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Who provides work conditioning?

A

May provided by one discipline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What are the 7 components of work hardening?

A
  1. Strength and endurance
  2. Simulation of critical work demands
  3. Education
  4. Job modifications
  5. Individualized written plan
  6. Safe work environment
  7. Reporting system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is involved during strength and endurance in working hardening programs?

A

Individualized program

Use equipment and tools to measure strength and conditioning - IE. Ergometers, dynamometers, and treadmills

Use strength and exercise devices, free weights, and circuit training

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What is the goal of strength and endurance during work hardening?

A

Each worker is dependent on the demands of respective jobs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

How do we simulate the critical work demands?

A

Progression in frequency, load, and duration

Must be work related and include a variety of work stations that offer opportunities to practice work related positions and motions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Why is education important in work hardening?

A

Body mechanics, work pacing, safety and injury prevention, and promote worker responsibility and self-management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What components are required during education of work hardening?

A

Direct clinician/work interaction

Program should cover A&P, back care, posture, and pain management

Role of exercise and worker’s responsibility in self-treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What adaptations may be needed for job modifications?

A

Added equipment

Change in work position/ergonomics

Change in/at work place environment

Adaptations should be trialed/practiced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What is part of the individualized written plan?

A

Observable and measurable goals

Methods to reach goals

Projected time necessary to accomplish goals

Expected out comes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What component helps to write individualized written plan?

A

FCE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Define FCE

A

Standardized and validated advanced levels of testing

Determines safe job matches to return to work

Assess levels of reasonable accommodations

Assignment of level of disability for permanent or partial impairment status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Who determines the level of disability for permanent or partial impairment status?

A

Medical provider

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

When is FCE performed?

A

Completed within the first 2-3 days of program

Results compared to critical demands stated on job description/analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is included of the safe work environment and atmosphere in work hardening?

A

Need a designated, separate, work-hardening area - at least 100 square feet per patient

Appropriate to vocational goal and the worker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What is included with the reporting system of work hardening?

A

Documentation of initial plan

Meeting with the worker and essential team members after the first 5 working days of the program

Discharge summary

Record of daily attendance including # of days and hours per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What are the 4 criteria components of admission to work hardening?

A
  1. Physical recovery sufficient for a progressive program and participation of min 4 hr/day for 3-5 day/wk
  2. A defined RTW goal
  3. Worker must be able to benefit from program
  4. Worker can be no more than 2 years post injury date
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What kind of exceptions are there to the amount of time spent in work hardening?

A

Hand injuries and other specialized diagnoses - may begin at 2-3 hr/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What other components are needed for being admitted for the full time of work-hardening?

A

Must have no severe psychopathology

Must have motivation to RTW

Non-related medical probs stabilized

Physician referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What components are included in the RTW goal?

A

Documented specific job to return to with job analysis OR documented on-the-job training OR a job title

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

How do you know if a worker will benefit from work hardening?

A

Screening process that includes file review, interview, and testing

Determines success in program

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Why is progression in work hardening so important?

A

Strong evidence predicts people will begin to develop a disability mindset at 4 weeks away from work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What is a work hardening timeline?

A

Should be completed in 4 weeks or less (usually more like 4-12 weeks)

Some may RTW on modified, light and/or part-time basis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What are exceptions to work hardening timelines?

A

Must be preauthorized (Every 4 weeks)

Must be justified by diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What is the criteria for discharge from work hardening?

A

Goal(s) achieved

Lack of achievement/participation - has not met interim goals or has been absent for more than allowed or non-adherence to schedule

Goal(s) discovered not feasible

  • Unknown med prob discovered
  • Clinician decides the physical goals are not attainable
  • Job not available
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What kind of supervision is needed during work hardening?

A

Must be a licensed PT or OT

Ratio of NO LESS THAN 1 licensed therapist to every 6 patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Define Level I acute management

A

Acute stage of rehab

Days 1-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Define Level II of acute management

A

Sub-acute stage of rehab

Days 4 to 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Define Level III of acute management

A

Chronic stage of rehab

3 weeks to months/years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What are other levels of management?

A

Acute Injury Management

Work conditioning

Work hardening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What other components are important in acute injury management?

A

Determine hx of current condition or injury

Eval occupational/job performance demands

Perform physical exam

Determine gaps in existing performance and job demands

Remediate the difference in timely manner with a focus on case resolution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Define levels of involvement in work conditioning

A

Systematic approach used to the restoration of work performance skills of injured workers recovering from long-term injury or illness

Single discipline involvement

Focus on restoration of musculoskeletal, CV, and safe work demand performance

Circuit training and work simulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Define levels of involvement in work hardening

A

Multidisciplinary, systematic approach used in restoration of work performance skills of injured workers recovering from long-term injury or illness

Identical to work conditioning design with addition of PSYCHOMEDICAL counseling, ergonomics, and job coaching/transitional work

Typically 5 days/week for 2-4+ hours

May progress to transitional work programming with actual performance of job duties at their site of employment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What is involved during a progress note in work hardening?

A

Min every 2 weeks

Always prior to MD visit

Includes comparison of previous assessment of musculoskeletal functional abilities to current

Indicates progress or lack of

Outlines goals met and goals to be achieved

Recommendations and summary to include reasons for continuing or discharging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What are the payer sources for work hardening?

A

Workers comp

State agencies (Bureaus of Vocational Rehab)

Legal settlements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What are the codes used in work hardening?

A

97545

97546

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What is 97545 in work hardening?

A

Work hardening/conditioning for the initial 2 hours

Does NOT require direct 1:1 contact; however, needs individualized programs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What is 97546 in work hardening?

A

Used for each additional hour after 97545

Can be utilized without 97545

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What if only 1 hour of care is provided in work hardening?

A

Can be argued that you are not at the level of work hardening/conditioning

Then, can use 97110 or 97530

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What is Phase I of Amputee Rehab?

A

Acute/protective healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

What is Phase II of Amputee Rehab?

A

Pre-prosthetic training

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

What is Phase III of Amputee Rehab?

A

Prosthetic training

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

What is Phase IV of Amputee Rehab?

A

Advanced prosthetic training

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What phase of amputee rehab training is most important?

A

Phase II

135
Q

What are the advantages of rigid dressing for amputees?

A

Allow early amb

Promote circulation and healing

Stim proprioception

Provide protection

Provide soft tissue support

Limit edema

Ability to use IPOP

136
Q

What is an IPOP?

A

Immediate post-op prosthesis

Not common

137
Q

What are the disadvantages of rigid dressing for amputees?

A

Immediate wound inspection is not possible

Does not allow for daily dressing change

Require professional application

138
Q

What are the advantages to semi-rigid dressing for amputees?

A

Reduce post-op edema

Provide soft tissue support

Allow early amb

Provide protection

Easily changeable

139
Q

What are disadvantages to semi-rigid dressing for amputees?

A

Does not protect as well as rigid

Requires more changing

May loosen and allow for edema development

140
Q

What are advantages to soft dressing for amputees?

A

Reduce post-op edema

Provide some protection

Relatively inexpensive

Easily removed for sound inspection

Allow for active joint ROM

141
Q

What are disadvantages to soft dressing for amputees?

A

Does not protect as well as rigid

Requires more changing

May loosen and allow for development of edema

142
Q

What are common types of soft bandaging for amputees?

A

Ace wrap and shrinker

143
Q

What occurs during PT exam with amputee?

A

History

Systems review

Skin

Residual limb length and shape

Emotional status

Vascularity

ROM

Mm strength

Neuro

Functional status

144
Q

What are the functional treatment techniques for amputees?

A

Residual limb care

Limb wrapping

Positioning

Management of contractures

Therapeutic Ex

Transfer training

Balance

Amb

W/c management

145
Q

How to properly care for residual limb?

A

Proper skin and hygiene care

Keep clean and dry

Provide pressure relief

Avoid cuts, abrasions, and other skin irritants

Self inspection of limb using mirror, visually, consider decreased sensation, and impaired vascularity

Bathe normally once incision has healed and sutures are removed

Night bathing encouraged - limb becomes a little edematous after

Dermatological conditions to be aware of that are contraindication

146
Q

What dermatological conditions are contraindicated with limb wrapping?

A

Eczema
Psoriasis
Dermatitis

147
Q

What occurs with desensitization of amputees?

A

Phantom pain

148
Q

How to treat desensitization of amputee?

A

STM, pressure, various textures, lotions, massage with washcloth, etc

Mirror therapy

Psych considerations

149
Q

Where does phantom pain come from?

A

Signal from brain

150
Q

Why does mirror therapy work?

A

Thoughts of movement initiation normally come through SC (descending path) and synapses at the level of muscle

CNS is still working to map sensation and does not know it is missing the distal synapse. No information is ascending but is still descending

151
Q

What are the two types of limb wrapping?

A

Shrinkers

Elastic wrap

152
Q

What is the purpose of limb wrapping?

A

Reduce size of residual limb for those not fit with rigid, removable rigid, or temp prosthesis

153
Q

What are the pros to shrinkers?

A

Easier to apply

Option for pt who are unable to properly limb wrap

154
Q

What are the cons to shrinkers?

A

Cost

Need to purchase smaller sizes as limb size changes

Not able to use until incision is healed and sutures removed

155
Q

What are socks used for?

A

May go on prior to shrinker

Different plies to accommodate changes to residual limb

156
Q

What are disadvantages to socks?

A

May be creased or wrinkled and cause skin irritation

157
Q

What are the precautions to shrinkers?

A

Avoid rolling edges or slipping of shrinker - could cut off circulation

158
Q

What is the definition of suspension?

A

Ensures the prosthetic part will suction to the residual limb properly and effectively

159
Q

What is suspension of transtibial residual limb?

A

Self-suspending

Heavier thighs may require more

160
Q

What is the suspension of a transfemoral residual limb?

A

May include hip spica. Good suspension for most pt. Not adequate for obese

161
Q

What is the benefit of hip spica?

A

Keep hip more ABD to prevent contractures

162
Q

What are the pros to elastic wrap?

A

May be applied over post surgical dressing

Pt or family members can be instructed in wrapping as soon as wound care is no longer necessary

163
Q

What are the cons to elastic wrap?

A

Need frequent wrapping

Manual coordination/dexterity

164
Q

Would you use velcro or metal clip with elastic wrapping?

A

Velcro - metal clip could cause secondary injuries especially those with neuropathy

165
Q

How to apply elastic wrap?

A

Do not go circumferentially

Move in figure 8 pattern

166
Q

What are the precautions of elastic wrap?

A

Avoid any wrinkles or folds

Avoid adductor rol

167
Q

Who can perform elastic wrap on pt?

A

Pt, family, PT/PTA, and nurse

168
Q

What position should a transtibial amputee be in when applying elastic wrap?

A

Sitting

169
Q

What position should a transfemoral amputee be in when applying elastic wrap?

A

Sidelying

If standing is good they could balance in standing

170
Q

What position is NOT recommended for transfemoral elastic wrapping?

A

Sitting

171
Q

What is important about positioning with amputee patient?

A

Improper position can result in contractures

Need full hip extension for future prosthesis

172
Q

What are precautions of positioning with amputee patients?

A

Avoid elevating residual limb (hip flex contracture)

173
Q

What position should a transtibial amputee focus on?

A

Full range of hips and knees

Esp EXT

174
Q

What position should a transfemoral amputee focus on?

A

Full ROM in hip in ext and ADD

175
Q

How to prevent contractures in amputee patients?

A

Stretching techniques

Position for prolonged mm lengthening

176
Q

What therapeutic exercises are good for amputee patients?

A

OKC/CKC, progressive resistance to improve function, and gait

Core strengthening - deep abs for stability

UE resistance and sound limb resistance

Rolling, transfers, prone on elbows, prone on hands, supine on elbows, pull-ups, sitting (long and short), quadruped, kneeling, and bridging

Prep exercise for locomotion

Sitting, sit-to-stand, modified plantigrade, standing, // bar training and progression

CV conditioning

177
Q

What positions are included in core strengthening for basic stabilization?

A

Hooklying, bridging, prone, quadruped, sitting, and standing

178
Q

What progressions should be made with core strengthening in amputee patients?

A

Stable and unstable surfaces

Large simple movements to smaller more complex

One plane to multiplanar

Short lever to long lever

No weights to weights

Slow to fast speed

Relate to functional tasks

179
Q

What 3 things do the beginning of resistive exercise training depend on?

A

Post-surgical dressing

Degree of post-op pain

Healing stage of incision

180
Q

Define myodesis

A

Suturing of distal muscle or tendon to bone in residual limb

181
Q

Define myoplasty

A

Muscle is sutured directly to other muscle, placed over end of bone

182
Q

Which technique is preferred? Myodesis or myoplasty?

A

Myoplasty

183
Q

How is TFA typically sutured?

A

ADD Magnus is brought across the cut end of the femur and sutured to lateral femur through drill holes

184
Q

How is TTA typically sutured shut?

A

Gastroc is brought anteriorly and around tibia

185
Q

What are the precautions of myodesis and myoplasty?

A

No CKC strengthening for 4-6 wks in TFA

No aggressive HS stretches for the first few weeks in TTA

186
Q

What are the precautions in TFA myodesis?

A

No active ADD strength ex for 4 wks

No active ABD strength past neutral for 2 wks

No forward flex for 2 weeks

187
Q

What positions is allowed after a myodesis or myoplasty?

A

Bridging

188
Q

How do you perform transfer training/bed mobility WITHOUT prosthetic?

A

Scoot to get from supine to sit. Then sit EOB

Sit to stand

  • Must get used to one sided WB
  • Progress from AD to I
189
Q

What should the pt be cautioned when transfer training/bed mobility WITHOUT prosthetic

A

Protect limb from trauma

DO NOT push on or slide the limb against chair or bed

190
Q

What is important to work on with sitting balance?

A

Sitting EOB esp for TFA because no HS for balance

191
Q

What is important to work on with standing balance?

A

Must get used to WB on one side

Progress from AD to I

192
Q

How should amputee pt amb WITHOUT prosthesis?

A

Crutch training preferred if safe (walker if not safe)

Need ongoing ability to amb w/o prosthesis

193
Q

How should a B amputee manage w/c?

A

Only option

TFA may use w/c for certain activities.

Consider anti-tip bars for w/c to compensate for lack of LE weight

194
Q

Define temp prosthesis

A

Basic socket and pylon to allow early amb on two legs

195
Q

What is another term for pylons?

A

Connectors

196
Q

When is temp prosthesis fitted?

A

When wound is healed

197
Q

What are the pros of temp prosthesis?

A

More effective than elastic wrap to shrink residual limb

Can help eval pt rehab potential

Can use to return to more active life

Those who cannot afford a definitive prosthesis can use temp one to amb

198
Q

What are the cons to temp prosthesis?

A

Special training to fabricate temp socket

Need ongoing skin care checks and limb care as size of residual limb changes

199
Q

What are contraindications for prosthetics?

A

Significant depression

Significant dementia

Significant cardiopulm disease

B amputees who are unable to transfer independently or don pants independently

200
Q

Define the liner

A

Covering

Not necessarily moisture wicking

201
Q

How often should you change the sock?

A

At least 1x/day

202
Q

What is important to do with the shrinker?

A

Change out to prevent excess stretching

203
Q

What are the different socket interfaces?

A

Liner/lock - low activity

Suction - medium activity

Vacuum - high activity

204
Q

What are the main components of a prosthetic?

A 
Shank
Pylon
Socket
Suspension system
Liner
Shrinker
Sock
Elastic wrap
205
Q

What components of the prosthetic does a transtibial amputee need?

A

Require suspension and shank

206
Q

Define Syme’s Amputation

A

Amputation at the level of ankle joint and the heel pad is reserved

207
Q

What is allowed with Syme’s Amputations?

A

Allow WB without prosthesis

208
Q

Define SACH

A

Solid ankle cushion heel

209
Q

Define SAFE

A

Stationary attachment flexible endoskeleton

More M-L motion at hindfoot

210
Q

Define Carbon Copy II

A

Energy storing/releasing

211
Q

Define Seattle Foot

A

Energy storing/releasing

212
Q

Define Flex-Foot and Springlite Foot

A

Band of carbon fiber acting as a leaf spring for more energy for running and sports

213
Q

What motions do a Single Axis Foot allow?

A

DF/PF

214
Q

What motion does a Multi-Axis Foot allow?

A

Triplanar ROM

215
Q

What are the two types of shank?

A

Exoskeletal and Endoskeletal

216
Q

Define an exoskeletal shank

A

Rigid material, shaped to simulate the anatomical leg

217
Q

Define endoskeletal shank

A

Often a central aluminum pylon

218
Q

What are sockets of a prosthesis?

A

Made to disperse contact and load throughout residual limb

Assist in venous return

Provide tactile feedback

Relief over bony prominences

219
Q

What are patellar-tendon bearing sockets?

A

Prominent indentation over patellar tendon

220
Q

What are the knee unit components?

A

Axis system
Friction mechanisms
Extension aid
Stabilizers

221
Q

Define axis system

A

Single axis or polycentric linkage

222
Q

Define friction mechanisms

A

Constant friction or variable friction

223
Q

Define extension aid

A

Elastic webbing on anterior knee or internal extension aid

224
Q

Define stabilizers

A

Alignment, manual lock, or friction brake

225
Q

What are the characteristics and functions of transfemoral sockets?

A

Total contact

Distribute load

Reduce pressure

Assist in venous return

Prevent distal edema

Enhance sensory feedback

Flexible plastic allows for feedback from external objects

226
Q

What is a quadrilateral socket?

A

Emphasize loading on gluteal muscles, sides of thigh, and ischial tuberosity

227
Q

What are ischial containment sockets?

A

Narrow M-L width

Walls cover the ischial tuberosity, WB on the sides and bottom of limb

228
Q

What are common problems with the fit of sockets?

A 
Too big
Too small
Too tight
Too loose
Rotation/twisting
229
Q

What are consequences of improperly fitted sockets?

A

Skin breakdown

230
Q

What are the top two causes for pediatric amputations?

A
  1. Congenital limb deficiencies

2. Acquired limb deficiencies

231
Q

What are congenital limb deficiencies?

A

Occurs in utero

All or part of the bone fails to develop

232
Q

Define amelia

A

Entire bone or segment is missing

233
Q

Define hemimelias

A

All or part of bone is missing longitudinally

234
Q

Define phocomelia

A

Absence of proximal segment of limb

235
Q

Define amniotic band syndrome (ABS)

A

Common cause of congenital amputations

Believed to occur secondary to fetus getting entangled or ruptured amniotic bands

Typically sporadic and not hereditary

236
Q

What occurs during acquired limb deficiencies?

A

May occur secondary to trauma, vascular disease, tumors, infections, or burns

Twice as many amp from trauma vs disease

May be partial or complete removal of limb

237
Q

What are the interventions for pediatric amputations?

A

Surgery

Therapeutic - limb prep, exercise, functional training for age level, prosthetic training, and education

238
Q

What are general intervention rules for peds?

A

For UE - prosthetic wear can occur as early as 3 months - helps child to continue with developmental skills

Components should match child development phase

239
Q

What is the main cause of adult or adolescent UE amputation?

A

Trauma

240
Q

What are the two most common UE amputations?

A

Transhumeral and Transradial

241
Q

What are the three levels to transhumeral amputation?

A

Very short above elbow

Standard above elbow

Long above elbow

242
Q

What are the three levels of transradial amputation

A

Very short below elbow

Short below elbow

Long below elbow

243
Q

What interventions occur in the post-surgical phase of UE amputation?

A

Residual limb care

Residual limb wrapping

Skin desensitization and prep for prosthetic

244
Q

What are common PT interventions for UE amputations?

A 
Strengthening
ROM
Functional training
Control training
ADLs
Task specific training
Don/doff
Integration of device into daily life
245
Q

What are the basic components to UE amputation prosthetic?

A

Socket
Suspension
Control - cable system
Terminal device

246
Q

Define terminal device

A

End piece

Depends on amp level

247
Q

What is a cable system?

A

Controlled by pt muscle movement

248
Q

What are the types of UE prosthetics?

A

Cosmetic
Body powered
Myoelectric (battery powered)
Hybrid

249
Q

What is a cosmetic UE device?

A

Lightest

Least functional

Provide simple aid in balance and carrying

Simple in use

Easy to maintain

Passive function

250
Q

What is a body powered UE device?

A

Most durable

Operated by a harness system and controlled by specific body movements

Medium weight

Conventional device

Least appealing in appearance

251
Q

What is a myoelectric UE device?

A

Heaviest

Battery powered

Controlled by EMG signals during mm contractions

Reduced harness system

Grip force up to 20-30 lbs

Cosmetically appealing

252
Q

What is a hybrid UE device?

A

Combines body power and external power

253
Q

What are the two types of hybrid UE devices?

A

Excursion to elbow/battery powered TD

Excursion to TD/battery powered elbow

254
Q

What is an excursion to elbow/battery powered TD Hybrid UE device?

A

Body power controls elbow, battery powered controls TD (stronger pinch)

255
Q

What is a excursion to TD/battery powered elbow?

A

Battery controls elbow, body power controls pinch (weaker pinch)

256
Q

What is a recreational or adaptive UE device?

A

Customized for specific function or recreational activity

Available for activities such as skiing, golf, fishing, construction work, shooting pool, playing guitar, and more

257
Q

What is the function of the lymphatic system?

A

Transport lymph from periphery to venous system to maintain fluid balance

Immune function, to help protect body from infection

258
Q

Where does lymph come from?

A

Originate in blood plasma

Travels to capillaries from Aa

Some fluid diffuses out of blood circulation into tissue

259
Q

Where is lymph found?

A

90% of fluid is returned via venous system

Remainder contains proteins and by-products (lymph) returned to circ system via lymph system

260
Q

What is lymph made of?

A

Protein, immune cells, fat, and waste products from cellular processes

261
Q

What is the lymphatic system?

A

Network of tubes

Drain protein rich lymph from tissues

Returned to blood via subclavian vein

262
Q

Where is lymph filtered?

A

Spleen, thymus, and lymph nodes

263
Q

Where is lymph located?

A

All parts of the body EXCEPT CNS and cornea

264
Q

Where does lymph travel through?

A

Tissue - lymph caps - pre-collectors - collector vessels - branches - nodes - trunks - subclavian veins

265
Q

What is the function of lymph nodes?

A

Phagocytosis and direct lysis

266
Q

What are the components of lymph nodes?

A

B and T lymphocytes

267
Q

Define lymphatic loads

A

What goes back into the blood via lymphatic system after being cleaned by nodes

268
Q

What are the components of the lymphatic loads?

A

Protein
Water
Long chain fatty acids
Cells - metabolic waste, bacteria, cancer cells, dust, and foreign material

269
Q

What are the two parts of the lymphatic system?

A

Superficial system and deep system

270
Q

What is the function of superficial system?

A

Drain skin and subcutaneous tissue

271
Q

What is the function of the deep system?

A

Drains muscles, bones, joints, and viscera

272
Q

What happens if deep system is damaged?

A

Fluid may overflow into the superficial system

273
Q

Where does the lymphatic system drain in the R upper quadrant?

A

Empties into R lymphatic duct and then into R subclavian vein

274
Q

Where do the LE drain into?

A

Cisterna chyli and then thoracic duct

275
Q

Where does the L upper quadrant and trunk drain into?

A

Directly to thoracic duct

276
Q

Where does the thoracic duct drain into?

A

L subclavian vein

277
Q

What occurs during the filling phase of lymph transport?

A

Pressure outside lymph caps is greater than inside

Walls open

Fluid moves into lymph cap

278
Q

What occurs during the emptying phase of lymph transport?

A

Pressure outside and inside are equal

Walls close

Open valves to pre-collectors

Pumps in pre collectors and propels fluid to venous system

279
Q

What are the fluid dynamics of lymph?

A

Colloid osmotic pressure

Ultrafiltration

Reabsorption

Balance b/t intravascular and interstitial volumes depending on pressure

280
Q

Define ultrafiltration

A

When blood capillary pressure is GREATER than COP plasma protein

281
Q

Define reabsorption

A

When blood capillary pressure is LESS THAN COP plasma protein

282
Q

When does a pathology occur in the lymph system?

A

System overloaded with too much fluid or not enough functioning capillaries/collectors

Lymph accumulates in interstitium

Proteins degrade and lead to inflammation

283
Q

Define lymphedema

A

Transport malfunction - accumulation of protein-rich fluid in the interstitial tissues

Results in symptoms of swelling and edema

Valvular incompetence

May progress to inflammation - fibrosis

Environment ripe for infection

284
Q

What is the process of lymphedema?

A

Lyphostasis - high protein edema - accumulation of immune cells - fibrosclerosis - proliferation of adipose tissue

285
Q

Pathophysiology of lymphedema

A

Valve incompetence - accumulation of fluid - constant inflammation - creation of fibrotic state of tissues - macrophages become ineffective

286
Q

What is primary lymphedema?

A

Caused by a condition that in congenital or hereditary

Malfunction of lymph nodes or vessels at birth

287
Q

What is the most common type of primary lymphedema?

A

Hypoplasia - fewer lymph vessels and are smaller than normal

288
Q

What is secondary lyphedema?

A

Caused by injury to one or more components of the lymph system

289
Q

What are the common causes of secondary lymphedema?

A

Surgery/radiation therapy for breast cancer

Liposuction

Hernia repair

Crush injuries

Chronic venous insufficiency

Disuse (CRPS)

Filariasis

290
Q

What is filariasis?

A

Tropical disease caused by filarial worm

Most common worldwide

291
Q

What are the highest incidences of lymphedema?

A

Breast cancer and post prostate surgery

292
Q

What is Stage 0 of lymphedema?

A

Reduction in lymph transport

May feel heaviness/achiness

No increase in volume

293
Q

What is stage 1 of lymphedema?

A

Protein-rich edema present

Measurable in volume

Soft and doughy

Pitting edema

Edema reversible

294
Q

What is stage 2 lymphedema?

A

Increased volume

Tissue fibrosis

Positive Stemmer’s sign

Less pitting

Tissue is stiffer

295
Q

What is Stage 3 lymphedema?

A

Fibrosclerosis, hyperkaratosis, papillomatosis

May have less edema than stage 2

296
Q

Define papillomatosis

A

Benign tumors form along aerodigestive tract

297
Q

What kind of data collection should you take with lymphedema?

A

Anthropometrics - girth and volumetrics

ROM and strength

Pain

Sensation

Pitting scale

Skin texture, hyperkeratosis, fibrosis

Wounds

Functional mobility and independence

298
Q

What does 1+ on the pitting scale?

A

Identation barely detectable

299
Q

What does 2+ mean on pitting scale?

A

Slight indentation

Returns to normal withing 15 sec

300
Q

What does 3+ mean on pitting scale?

A

Deeper indentation

Returns within 30 sec

301
Q

What does 4+ mean on pitting scale?

A

Indentation lasts for more than 30 sec

302
Q

Define Stemmer’s Sign

A

Difficulty in picking up skin fold on 2nd toe in clearly swollen set of toes

303
Q

What are the types of skin texture in edema?

A

Brawny
Woody
Lobular

304
Q

What functional mobility and ADLs should you focus on with lymphedema?

A

Pain/heaviness/feeling of fullness

Weight

Balance

May lead to deficits of skills and mobility

305
Q

What are the goals of PT in pt with lymphedema?

A

Educate pt and caregivers on self-management and protection

Reduce edema to enable fitting pt with compression

Successful long term edema control

306
Q

What is part of treatment of lymphedema?

A

No cure

Daily management

Complete decongestive therapy

307
Q

What is complete decongestive therapy?

A

Skin and nail care

Manual lymph drainage

Multi-layer compressive bandaging

Remedial exercises

308
Q

What are the two treatment phases of lymphedema?

A

Intensive phase

Self-management phase

309
Q

What is part of intensive phase of CDT?

A

Skin and nail care - treat and/or prevent secondary infection

MLD - light skin stretch only

Compression (limb wrapping) - bandages

Decongestive exercises

310
Q

What is important in skin and nail care for someone with lymphedema?

A

Edema stretches pores of skin so bacteria can enter and lymph can leak out

Be careful of any break in skin

311
Q

Why is lymph more prone to infections?

A

Bacteria thrive on the stagnant protein-rich lymph

Can spread quickly

312
Q

What is part of meticulous skin and nail care for lymphedema?

A

Use mild emollients and lotions

Low pH soaps and lotions - maintain normal acidic levels of skin

Wash the tissue gently and thoroughly with warm (NOT HOT) water

Never share washcloth or towel - change out each wash

Remove all soap with thoroughly rinsing

Dry skin by patting and thoroughly - can use hair dryer on very low setting

Moisturize skin with low pH lotion

Protect against sunburn

313
Q

Why is low pH moisturizer important?

A

Help restore normal protective bacteria

Help skin retain elasticity to avoid cracks/breaks

314
Q

What is manual lymph drainage?

A

Additional training needed

Feel fluid move out of involved area into healthy tissues

315
Q

What are the effects of MLD?

A

Increase lymph transport capacity

Increase lymphangion contractions

Redirect lymph flow

Mobilize excessive lymph fluid

316
Q

What is the technique of MLD?

A

Proximal to distal

Session for 40-90 min

Most effective when used with compression

317
Q

What is contraindicated with MLD?

A

Those with renal failure, CHF, DVT, acute infections or pregnancy

318
Q

How do you apply compression for lymphedema?

A

Use short stretch bandages

Apply over cotton padding

Low resting pressure/high working pressure

More rigid materials provide higher working pressure

Apply with greatest pressure distally

319
Q

What are the effects of compression?

A

Decrease ultrafiltration

Increase tissue pressure

Increase efficiency of mm pump

Prevent refilling of decongested limb

Break-up scar and CT deposits

Support tissues that have lost elasticity

320
Q

How to use a pneumatic compression pump?

A

Recommended 30 sec compression to 5-10 sec rest

Pressure 45 mmHg (UE)

Pressure 60 mmHg (LE)

Considered multichambered

321
Q

What are the precautions of pneumatic compression?

A

Impaired sensation

Pain, redness, and numbness

Lymphatic vessel dilation

Increased swelling

Changes in skin texture

322
Q

What are the contraindication of pneumatic compression?

A

Brachial plexus injury

Radical breast surgery with radiation

Bilateral mastectomy

After pelvic surgery

Primary lymphedema

Edema in abdomen

ABI <0.8

DVT

Infection in limb

Malignancy

Ongoing radiation

Renal or cardiac insufficiency

Uncontrolled HTN

323
Q

What are the effects of decongestive exercises?

A

Increase lymphangiomotorcity

Improve lymphatic and venous return via increased action of mm pump

Breathing exercises increase volume of lymph transported via thoracic

324
Q

What is lymphangiomotoricity?

A

Lymph angions have an autonomic contraction frequency of 10-12 contractions per min at rest - increases with speed of lymph fluid flow

325
Q

How to incorporate exercise/breathing in lymphedema?

A

Mod exercise and avoid overuse

Gradually build strength

Rest 20-30 min b/t MLD ad exercising

Including deep abdominal breathing before and after every exercise program

Warm up and cool down

Wear compression bandage during exercise except when in water

326
Q

What are the precautions of exercise with lymphedema?

A

No tight restrictive clothing

Exercise in a slow, controlled manner

Decrease number of reps or stop if pain increases

Watch for overheating

Keep hydrated

Stop exercise with signs of increased swelling or pain

After exercising rest and elevate limb for 15-20 min

327
Q

What is part of self-management phase in lymphedema?

A

Pt performs own skin care

Apply custom-sized compression during daytime

Apply compression at night

Exercise while wearing compression

328
Q

What are lymphatic insufficiencies?

A

Due to chronic venous insufficiency or undiagnosed primary/secondary lymphedema

329
Q

What can exacerbate lymphatic insufficiencies?

A

Trauma

Surgical intervention

Needle sticks

Taking BP on affected limb

330
Q

What is best for lymphedema treatment?

A

Early intervention

Can use MLD and bandaging or MLD alone

331
Q

When will pt be fitted for compression stocking/sleeve?

A

When the extremity has been evacuated

332
Q

What is the most beneficial intervention during acute/intensive phase?

A

MLD

333
Q

What indicates need for a new socket?

A

When pt has to use 15 ply socks

334
Q

What does PDC stand for and what does it relate to?

A

Physical demand category and relates to FCE and overall FCE goals

Special Pops (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions