Exam 4 Flashcards
what are some other things that need to be in the exam for acute care
Coordination
Balance
***only if needed or time
what is the set up for Spontaneous Nystagmus
Patient is arm’s length from PT, head stationary, looking straight ahead with PT standing off to side.
what are the directions for VOR – slow
“Look at my nose the entire time I’m moving your head.” or “Look at thumbs the entire time.”
what should glucose levels be like
70-110 mg/dl
what are postoperative complications renal
Acute renal failure
Decreased urine output
Fluid/electrolyte imbalance
what are some things to keep in mind (femoral line )
able to perform hip rom (check for md precautions)
what is a evd (external ventricular drain)
this is to let out pressure and the swelling of the lateral ventricle
what are some precautions for arterial line
try not to do BP but if you have to it is okay
what is the vascular supply of the inner ear
- labyrinthine artery
- anterior vestibular artery
- common cochlear artery
what is substitution
using other strategies to replace the lost function.
what is the hematorit rates in females
37-47%
what is the lab values for WBC males
5,000-10,000
what is low hematocrit
Low? Anemia, acute of chronic blood loss, trauma
why are lab values important
Daily Chart Reviews
Communication is KEY with healthcare team
Guidelines and general norms
Condensations depending on facility, patient and location
Therapy Considerations will drive your treatment
what is the problem with dizziness
vestibular system
what are the directions for Smooth-Pursuit
“Follow the visual target with your eyes, keep head stationary”. PT observes for any saccadic eye movements.
what is diplopia
The perception of two images of a single object seen adjacent to each other (horizontally, vertically, or obliquely) or overlapping
what is the BBQ position 5
Choose how to sit up
Keep head level - pitched down (cervical flex 30°)
what is other vascualr supply info for inner ear
The labyrinth has no collateral anastomotic network and is highly susceptible to ischemia. Only 15 seconds of selective blood flow cessation is needed to abolish auditory nerve excitability
what are the postoperative complications cardiovascular
High or low blood pressure
Dysrhythmia
Mytrial Infarction (MI)
Deep Vein Thrombosis (DVT)
Plumonary Emboli (PE)
Look at slide on vestibule (picture)
8
what is Leukopenia
<4,000
what is a + test for Spontaneous Nystagmus
Probable CNS problem, make sure referral source is aware of finding may be acute unilateral periheral vestibular hypofunction. Subjective complaints often include difficulty with reading and watching TV.
what happens with the disorders that affect spinal fluid
Disorders that affect spinal fluid pressure can also affect inner ear function.
Ex: Lumbar Puncture
what is position 1 for the side lying test
Patient short sits on the side of the treatment table
Turn Head 45° Horizontal away from side (ear) being tested
May modify to whole body movement - rotate body and head together.
what is the measurement for Ocular Alignment
+ if skew deviation observed, one eye is elevated in orbit (classified R/L hypertropia based on side elevated)
what are some therapy considerations for o2 saturation
<90% stop activity
reading is affected by nail polish, poor circulation, movement; make sure has good signal or may have false low reading
what is a + test for Gaze-Holding Nystagmus
Probable CNS problem or VOR involvement. End-point nystagmus is normal, pay increase with age. Problems w/ downgaze is NOT vestibular deficit, may be progressive supranuclear palsy.
what is habituation
reduction in symptoms produced through repetitive exposure.
what is the motor output
vestibular reflexes
what si the central vestibular system
Vestibular Nuclear Complexes (pons, medulla) Reticular Formation Thalamus Cerebral Cortex / Vestibular Cortex Cerebellum
Additional diagnostic testing needed to identify central deficits.
Team up with Neurologist.
what is the vascualr supply for the central vestibular system
vertebral basilar arterial system
what is the theory of Canalolithiasis
Theory: Otoconia are free floating in semicircular canal
what is the BBQ position 3
Roll head to the unaffected side
Affected ear is now up
what are the therpay considerations for hypoglycemia
Therapy considerations: low activity tolerance
Headache, shakiness, weakness, irritability, cold sweats, psychosis
pacemaker precaution
watch UE rom
no head above 90
no blood pressure on that side
what is teh duration of symptoms for Cupulolithiasis
Duration of symptoms > 60 seconds
what is the plan
Plan of care
Goals
what is a precaution of chest tube
below the heart level keep the drain and dont knock over
what are the postoperative complication for neurologic
Delayed arousal Agitation altered consciousness cerebral edema Seizure stroke peripheral muscle weakness altered sensation
what is the BBQ position 4
Roll head and body in the same direction until patient is prone
Face floor, nose in midline
Pt should be asymptomatic
(if they have symtoms you did the wrong side)
what is a chest tube
drain infection and blood out of the lungs
what is position 2 for the side lying test
Patient quickly lies down to the side being tested
Maintaining head turned 45° horizontal
Maintain this position #2 for 30-60 seconds
what is the measurement forVOR – rapid “Head-Thrust” or “Head Impulse” Test
+ if patient unable to maintain visual fixation, demonstrates corrective saccade. If + repeat with patient looking at a distant target >2m to reduce false +. Ability to accommodate to near target decreases with aging.
how do you monitor tolerance in therapy
- vitals
- observation (visual)
- response
what is the adaptation of vestibular nerve impairment
intact CNS, visual information, recalibration is approximately 2 weeks
what is high hematorit
High? Severe lung disease, heart defects, high altitude, history of smoking, polycythemia
what ar ethe symptoms of Mal de Debarquement
persistent rocking vertigo at rest
dizziness and imbalance
what is a must and do not with assessment problmes list
MUST have problem to justify need for treatment.
DO NOT treat or charge for “vestibular rehab” without documenting vestibular problem.
what is the physical therapy roles in the acute care setting
Examination
Assessment
Treatment
Discharge Planning
what needs to be looked at for chart review
Orders
**Precautions/ Tests/ Cleared for therapy
History of Present Illness (HPI)
Past Medical History (PMH)
Current Tests and Appointments Scheduled
what si the statistics of phobic postural vertigo
Individuals with psychiatric disorders report more disability with dizziness than individuals without.
what is the orientation of the semicirular canals of the
3 planes, 90* to each
structure is elevated 30* from horizontal
what is vestibular gain
Vestibular Gain = Eye Velocity / Head Velocity
Normal Gain = 1.0
what is the normal range for INR
1 (0.8-1.2) seconds
what is BPPV
most common cause of vertigo
what is bppv canalith re positioning
Maintain position until nystagmus stops
If no nystagmus, approximately 20 seconds in position
what is external fixation
this holds the bones together after injury
what are some things to keep in mind (femoral sheath )
NO ROM
what are some symptoms of motion sickness
Dizziness
Nausea or Emesis
Malaise after motion
what is the first step of transfers in acute care
this is the first step to mobility
what is intracranial pressure monitoring normal pressure range
5-15 mmHG
what make migraine different from meiere disease
Tinnitus: high-pitched
May have ear fullness (ache), phonophobia and photophobia
True spontaneous vertigo is rare, can occur for minutes
Short nap usually helps
Visual Auras are common
Motion Sickness is common
what are some things to keep in mind (fOther )
know diet restrictions
know swallow precautions
what is the precautions for evd
this HAS to be clamped
what is some other info about phobic postural vertigo
Anxiety and Panic => Natural Avoidance => Heightened Arousal => Conditioned Autonomic Response
why used the ICD 9 codes
Establish an evidence based connection between rehab therapy treatment and patient progress
Evaluation the effectiveness of the therapy treatment
Medicare reimbursement
what is the set up for Ocular Alignment
Patient is arm’s length from PT, head stationary, looking straight ahead.
what are the symptoms of phobic postural vertigo
Self-limit or exaggerate movements/imbalance
Loss of balance with simple tasks
No imbalance with complex tasks
is oxygen a med
yes
what are the therapy considerations for hemoglobin
decrease activity tolerance
<7: Hold therapy
8-10 g/dl, light exercise permitted; modify treatment
> 10 g/dl, resistive exercise permitted; monitor low levels for dizziness
what is thrombocytompenia and what causes it
<
Causes: disorders, viral/bacterial infection, drugs, Chemo/Radiation, HIV, heart valve disorders
what are some medications for clot combat
- heparin- is used for acute anticoagulation
- warfarin - is used for long term us
what is the info about migraines
Migraines can cause symptoms of dizziness and imbalance when no peripheral or central vestibular deficit is present.
Migraines may be comorbid with peripheral vestibular lesion.
Migraines w/ aura (classic migraine), increased occurrence of vertigo w/ headache.
what are some alternative interventions before restraint use
Family at beside, move patient closer to nursing station, medication review, physiologic assessment, orientation, verbal intervention, diversions, environmental modification
what are some activity and exercise guidelines when dealing with HR
Pulse: HR should increase with increased workload intensity
A deconditioned person has a higher resting HR, and the HR increases more rapidly for the same workload as in a healthy individual.
what is functional mobility
Transfers, Ambulation, Stairs, Curb/Ramp
what are the examination components of an acute care
Chart Review
History/Patient Interview Neuro: Cognition Sensory Motor Balance Functional Mobility Discharge
what are the high levels for INR
> 3.5 = longer for the blood to clot
Increased risk for bleeding, activity modification recommended
> 5 = hold therapy, bedrest, check with MD
what is position 1 of hallpike
Position #1
Patient is long sitting on treatment table
Turn Head 45° Horizontal towards side (ear) being tested
what are some thearpy considerations for thrombocytompenia
minor trauma can cause bleeding (nose, GI tract, uterus, respiratory tract), bruising
what is the most common virus for Viral Infection
Upper respiratory tract infection Gastritis Herpes Zoster Bacterial Meningitis Syphyllis
what are some things to keep in mind (oxygen )
need order form md
if patient is on high flow ox ( green tube) use portable ox tank
what is the central processing itmes
brain
what are some other ICP info
Brief elevations will occur normally – continue therapy
Sustained elevations (alarm will sound) should be reported and therapy temporarily held to allow decrease in pressure.
what si remove or change periphearl input
Eyes
Fogged Glasses, Dark Glasses, Dark Room, Eyes Closed
Ears
Head Position Changes, Ear Plugs
Muscles / Joints
Compliant or Unstable Surfaces
—-foam, balance board, dynadisc, trampoline, bosu ball
Changing base of support
Look at slide of the exam pp
18
what is the position 2 of hallpike
Patient quickly lies down
Maintaining head turned 45° horizontal
Head hanging approximately 30° below horizontal
Maintain this position #2 for 30-60 seconds
why are the effect of immobiliazation are scary
“Muscle wasting occurs early and rapidly in the critical care setting with up to 30% of muscle mass lost within the first 10days of an ICU admission”
“Stroke volume has been shown to be reduced by 30% within the first month of bed rest”
“Increase in resting heart rate, and signs of orthostatic intolerance can develop within 72h of inactivity “
“atrophy of the anti-gravity muscle groups such as soleus, back extensors and quadriceps musculature “
what is a + test for VOR – suppression or cancellation
CNS problem; parietal lobe.
what ar the special test for rom and strength
Cervical if c/c is dizziness
LE’s if suspicious of imbalance
UE’s if using an assistive device for imbalance
what are some therapy considerations for sodium
Therapy Considerations: mental status changes, confusion, hemorrhage
Hyperkalemia
Hypokalemia
what is the onset of Viral Infection
Dysfunction up to 2 weeks after illness
what are the symptoms of TBI
dizziness and imbalance
peripheral vestibular hypofunction
BPPV due to intense acceleration of utricular otolith membrane
what is position 3 for the toll test
Slowly return to Position #1, head in midline
Maintain 20° cervical flexion
what are the highest level of restraints
1 0n 1 sitters,
enclosure bed,
what is the FIM score of 5
.supervision (subject =100%)
what is the cardiovascular considerations with anesthesia
anesthetic agents create potential for arrhythmia, decrease B/P, decrease heart contractility, decrease peripheral vascular resistance
what is the vertebral basilar arterial system
Posterior-Inferior Cerebellar Arteries (PICAs)
Basilar Artery
Anterior Inferior Cerebellar Artery (AICA)
Superior Cerebellar Artery (SCA)
Posterior Cerebellar Artery (PCA)
what is the precautions for central line
dont dislodge this
what is the theory of Cupulolithiasis
Theory: Otoconia are adhearing to and/or affecting ampula / cupula
what are some precaution for external fixation
no wb and has ↑ infection rate
what is oscillopsia
Visual instability with head movement, images appear to move or bounce; may have blurring or diplopia
what is a + test for Saccadic Eye Movements
1-2 saccades with eye movement is normal, > 2 saccadic eye movements is abnormal. Probable CNS problem.
look at slide of documentation
8 and 9
what are vestibular reflexes
VOR
VSR
VCR
what is the RBC count for males
4.5-5.5
what is the assessment
Prognosis
Summary of barriers and impairments
what is vestibular rehabilitation
An exercise approach to decrease or alleviate symptoms of dizziness, imbalance or nausea. Includes the facilitation of the central nervous system to compensate for vestibular deficits.
what is the objective
Patient history, systems reviews
Tests & Measures
Results of examination
what i the normal range for PT and PTT
PT 10-12.5 seconds (adults)
PTT 40-60 seconds
what are the precautions of the PICC
no BP
what is position 3 for the side lying test
Patient is assisted to sitting on side of treatment table (position #1)
Maintain head turned 45° horizontal away from side (ear) being tested
Tip: Patient may use arms on side of treatment table to help achieve position #3
what are some differential diagnosis mimicking bppv
Migraine CNS Issues Perilymphatic Fistula Hypermobile Stapes Labyrinthine Hypofunction Orthostatic Intolerance
what is statistics for menieres disease
Frequency: Men = Women
Onset: usually between 40-60 years of age
Genetics: 15% familial connection
what is increased in endolymphatic fluid pressure
Endolymphatic sac dysfunction or blockage
Dehydration
Temporal bone lesions
Infiltrates w/ leukemia
what does the internal auditory canal contain
Vestibular Nerve
Cochlear Nerve (hearing)
Facial Nerve
Labyrinthine Artery
Travels through the petrous portion of the temporal bone.
what is fluid problem in the endolymphatic hydrops
Change in sodium/potassium concentration
what are the directions for Optokinetic Nystagmus
“Look at each and every line as I move this cloth”.
what are the therapy considerations for hyperglycemia
Therapy considerations: At risk for diabetic ketoacidosis
dehydrations, weak/rapid pulse, coma
what are some s/s of increased ICP
Headache. Nausea, Vomiting, ocular palsy, altered mental status and conscious
what are some red flag
Numbness Tingling Weakness Slurred Speech Progressive Hearing Loss Tremors Poor Coordination Babinski Sign / Spasticity / Clonus Loss of consciousness Rigidity Visual Field Loss Memory Loss Cranial Nerve Dysfunction Spontaneous Nystagmus (room light after 2 weeks) Vertical Nystagmus w/o torsional component (not BPPV)
what is our assessment problem list for vesti
Subjective Complaints Problems Observed Comorbidities BPPV Somatosensory Deficits Vestibular Deficits Ocular Motor Deficits VOR Deficit CNS Deficits Decreased Balance Decreased Gait Decreased Function
how do the canals working
Canals work in pairs Left/Right using push/pull mechanism.
what causes leukoctosis
Causes: Infection, trauma, tissue injury
what are the symptoms of menieres disease
attacks of dizziness, loss of balance, fluctuating hearing loss and tinitus
what is PE
Pulmonary Thrombosis
Increased Heart Rate
what are the types od dialysis
- hemodialysis
- peritoneal dialysis
what are some examples of restraints
1 0n 1 sitters, enclosure bed, full side rails, hand mitt, poesy vest, soft wrist /ankle, belt
what is position 2 for the toll test
Patient’s head is quickly rolled to one side, maintaining 20° cervical flexion
Maintain Position #2 for 30-60 seconds
what should O2 saturation
98%-100%
what is the canaith repositioning technique position 4
Roll to Side-lying position with head turned 45° down (toward the floor)
Tip: “ Look at your shoulder” or “Look at my shoe”
Frequently patient symptoms increase with moving to Position #4
what is pacemaker
this is something that helps pace the heart
what is a central line
long term apparatus
this is an access point for
iv meds
draw blood
fluids
what are the directions for Ocular Alignment
PT observes for any skew deviation or eyes “not level” in obit.
what is dysequilibrium
Sensation of being off balance
what are the directions for Saccadic Eye Movements
Have patient quickly change gaze from PT nose to visual target. “Follow my instruction to look at the object (nose/target) when I tell you too.” Pt needs to follow PT instructions and not anticipate or increase tempo.
what is the FIM score of 1
total assistance (subject less than 25%)
what is the inner ear responsible
Responsible for Balance + Hearing
what is the fistula
An opening allowing fluid to pass between structures
what are some general guidelines for documentations
Chart must match charge
Avoid extraneous verbiage
Avoid using abbreviations not understood university be all providers
Patient stated goals related to prior level of function
what, why, how , when
how to use the ICD 9 codes
Initial Evaluation, 10 days after initial evaluation, discharge
what is helper- modified dependence FIM
5
4
3
what is coagulation profiles
Determines ability to initiate clotting sequence
Used to diagnosis clotting disorder
Used to monitor anticoagulant therapy
what are the icd 10 codes
slide 92
what is the measurement for Dynamic Visual Acuity
Note number of errors in line read. If greater than 2 errors when reading must go to larger print type. If difference between baseline (line#) and movement (line#) is greater than 2 test is (+).
what are some tumors of the ear
Glomus Tumors Schwann Cell Tumors Meningiomas Medulloblastomas Metastatic neoplasms Gliomas Acoustic Neuroma
what type of movment is the smooth pursuti
Smooth Pursuit are “slow” movements
when head velocity is < 60 degrees/second, <1Hz
what is hypoglycemia
<60 Hold therapy
why are we are skilled therapist
Services require complex and
sophisticated therapy procedures.
We provide:
- *Professional expertise
- *Knowledge
- *Clinical judgment
- *Decision-making
We have the skill set of a qualified professional to assure safety and effectiveness of the service
how is teamwork is essential
Teamwork is ESSENTIAL for Maximum, Efficient Outcomes:
Correct Diagnosing Pharmacological Interventions Surgical Interventions Comprehensive Vestibular Rehabilitation Treatment Modifications for Home/Work
what is non invasive vent
Positive airway pressure (CPAP)
what is statistics ofOtotoxicity
Onset: within 2-4 weeks of medication delivery
what is BPPV
bign postural ….
what is invasive vent
Assist-Control Ventilation (ACV)
Synchronized Intermittent – Mandatory Ventilation (SIMV)
what are some things to keep in mind (EVD )
must be clamped prior to mobilization as it goes right into the brain
what is a + test for VOR – slow
Could be a unilateral or bilateral VOR problem.
what is the set up for VOR – suppression or cancellation
PT holds pt’s head with aprox. 30* cervical flex. Slowly rotate pt’s head from 30* R to 30L with PT moving in same direction. If cervical problems, pt can clasp hands, extend arms, rotate entire trunk with 30 cervical flex.
what do you need to do also with roll test
Repeat to Opposite Side
Patient’s head is quickly rolled to opposite side, maintaining 20° cervical flexion
Maintain Position #2 for 30-60 seconds
what is the VOR and what kind of movements do they have
Eye movements opposite head movement direction
VOR are “fast” movements
when head velocity is > 60 degrees/second, >2Hz
what are the scores
score range 1-7
what is 80,000-150,000 platelet level
moderate resistance exercise, ambulation and ADLs
what are some contingent vestibular loss
Intrauterine Infection Cytomegalovirus (CMV) Intoxication Anoxia Rubella Thalidomide
what can play a role in altering baseline O2
PMH can play a role with altered baseline 02 saturations
what are the directions for Gaze-Holding Nystagmus
“Look at visual target”. PT observes for any nystagmus (eye movement).
what is something that is important to remember wth ocular motor testing
O HEAD SHAKING if patient has a DETACHED RETINA
what is the diuretics
@ risk for orthostatic hypotension
what is the labyrinthine artery for inner ear
Originates from the Anterior-Inferior Cerebellar Artery (AICA) or the Basilar Artery
what are the type of documentation
- narrative (handwritten, typed)
- template (handwritten, typed, electronic health records)
- acronym (soap)
what are the fx outcome measure for vest.
Dizziness Handicap Index (DHI)
Motion Sensitivity Quotient (MSQ)
Activities Specific Balance Confidence (ABC)
Positive and Negative Affective Scale (PANAS)
Disability Scale (0-5)
what are some response with the monitoring tolerance in therapy
diaphoresis, cyanosis, nasal flaring, increase accessory muscle use, weakness, fatigue, dizziness, lightheadedness, angina, palpitations, dyspnea
