Exam I Study Guide Flashcards
Which of the following pain rating scale is MOST APPROPRIATE for non verbal patients, patients with communication impairment, or pediatric patients?
A) numeric pain rating scale (NPRS)
B) visual analog scale (VAS)
C) body chart image
D) mccill pain rating inventory
B) visual analog scale (VAS)
A physical therapist is planning to apply ultrasound to a patient’s L shoulder/anterior chest area. Which of the following modalities would be contraindicated if the patient has a pacemaker?
A) ultrasound
B) electrical stimulation
C) diathermy
D) all of the given options
D) all of the given options
Define nociceptive
- pain that is usually proportional to the forces involved
- mechanical/tissue based pain
Define peripheral neurogenic
- patient describes pain quality as “sharp, electric, shooting”
Define central nociplastic (central sensitization)
- pain that is disproportionate with disproportionate aggravating or easing factors, diffuse tenderness, and multiple psychosocial factors
Theremotherapy, intermittent traction, and motor level electrical stimulation are INDICATED to treat a musculoskeletal injury in the acute inflammatory phase of healing (True/False)
False
Which federal agency is known as the nation’s health protection agency and is responsible for developing and issuing guidelines for aseptic techniques (ex: standard precautions/transmission based precautions)
- Centers for Disease Control (CDC)
What are the 5 general contraindications for the use of ALL biophysical agents
- pregnancy
- tumor
- pacemaker
- impaired cognition
- impaired sensation
This type of precaution is designed for the care of all patients, particularly hospitalized patients, regardless of their diagnosis or presumed infection status (assumes all body fluids may contain infectious agents)
- standard precautions
Assuming a typical/expected timeline of recovery from a soft tissue injury, validate the following statement (True/False)
“As inflammation goes down a patient’s pain level should go down”
- True
During the remodeling/maturation phase of tissue healing (about 4 weeks after soft tissue injury) which of the following modalities would be MOST APPROPRIATE as an adjective intervention to improve e=range of motion (ROM)
- thermotherapy/hot pack
What are the stages of healing and the order the go in
1) hemostasis and degeneration
2) inflammation
3) proliferation and migration
4) maturation and remodeling
What is the MOST important procedure for preventing transmission of nosocomial infections?
Hint: Nosocomial infections are a fancy word for hospital acquired infection (HAI)
- hand washing
You are completing a patient interview and are interested in learning more about your patients pain quality. The patients reports the pain is intermittent and variable throughout the lower lumbar spine (points to L4-5 area). The pain is worse with bending to pick up things from the ground and better (just a dull ache) when laying down. The patient denies any electric or shooting pain quality.
What is the MOST LIKELY pain classification?
- nociceptive pain
What are the five main routes of microorganism transmission?
- vector borne
- airborne
- droplet
- common vehicle
- contact
A patient presents with a swollen elbow that is warm to touch, has a light pinkish/darker skin tone color and reports 8/10 pain at rest and with motion. She is unable to sleep through the night. The patient also reports she had an elbow surgery (fracture repair resulting in plates and screws) 5 weeks prior.
The patient presentation is not alarming and therapeutic interventions can begin without consolation with a physician. (True/False)
- False
What is the difference between standard and transmission based precautions?
- standard precautions are the minimum infection prevention practices used for all patients
- transmission precautions are used when standard precautions are not enough and the patient has a known infection
Pseudomonas aeruginosa manifestations
Manifestations: infections involving urinary tract, respiratory system, dermatitis, soft tissue, blood, bones & joints, gastrointestinal organs, & multiple organs
Pseudomonas aeruginosa at risk populations
- patients with severe burns
- cancer
- immunosuppression
- patients supported by mechanical ventilation
Staphylococcus aureus manifestations
Manifestations: boils, pneumonia, phlebitis, meningitis, urinary tract infections, osteomyelitis, endocarditis, food poisoning, & toxic shock syndrome
Staphylococcus aureus at risk patients
- patients who have undergone surgical procedures
- invasive techniques
- immunocompromised patients with disruption of skin integrity
- anyone who has ingested contaminated food
Clostridium difficile (Cdiff) manifestations
Manifestations: antibiotic-associated diarrhea, colitis, & pseudomembranous colitis
Clostridium difficile (Cdiff) at risk patients
- patients who have prolonged use of antibiotics
- are immunocompromised
- have undergone gastrointestinal surgery
- are older
Escherichia coli (E. coli) manifestations
Manifestations: pneumonia, urinary tract infections, & diarrhea
Escherichia coli (E. coli) at risk patients
- patients that have severe burns
- have undergone surgical procedures
Norovirus manifestations
Manifestations: gastroenteritis
Norovirus at risk patients
- patients with an impaired immune system
- living in a place where food is handled with unsanitary procedures
- living with a child who attends preschool or a child care center
- living in close quarters
- staying in hotels, resorts, cruise ships or other destinations with many people in close quarters
Contact transmission precautions PPE (personal protective equipment)
- preform hand hygiene
- wear gloves
- wear gown
Droplet transmission precautions PPE (personal protective equipment)
- perform hand hygiene
- wear surgical mask
- wear gloves
- wear gown
Airborne transmission precautions PPE (personal protective equipment)
- perform hand hygiene
- wear N95 respirator
- keep door closed at all times
What contact precaution would you be required to wash your hands instead of hand rubbing?
- C. Diff (clostridium difficile)
Proper order for donning PPE (personal protective equipment)
- perform hand hygiene
- don gown
- don mask
- don goggles/face shield
- don gloves
Proper order for doffing PPE (personal protective equipment)
- remove gloves & discard them
- remove goggles/face shield
- remove gown
- remove mask
- perform hand hygiene
What are blood borne pathogens and what should you do if exposed
- disease and infection causing microorganisms carried by the blood and other body fluids
- if exposed you should wash area immediately, cover area, report to manager/CI immediately, & go to the ER after contact with manager/CI without delay
How long should you wash your hands for and what is the proper procedure
- wash hands for 20-30 seconds
Procedure: - turn on warm water
- tear paper towel to dry hands
- wet hands first then get soap
- wash above wrists & pay attention to knuckles, sides if the fingers, and under the nails
- rinses thoroughly
- dry hands with pre-torn towel
- use paper towel to turn off water
- dispose of towel
Timelines for acute pain, sub acute, and chronic
Acute: 24-48 hours
Sub Acute: 3-14 days
Chronic: >3-6 months
Characteristics of mechanical pain
- constant or intermittent
- acute or gradual onset
- directly proportional to activity (i.e. tissue loading)
- movements in one direct may increase vs. movements in another direction may decrease pain
Characteristics of chemical pain
- constant
- acute onset
- inflammation signs: edema, rubor, calor, tenderness
- all movements are painful
- no activity, movement, or position decreases pain
Define gate theory
- basic concept: if we stimulate large fibers we close the gate to the small nociceptive fibers
When interviewing a patient with pain what features of the pain must a PT appreciate (SINSS)
Severity: intensity related to pts. functional ability
Irritability: amount of activity to stir up symptoms & time for them to go away
Nature: location & MOI
Stage: is it acute, sub acute, chronic, or acute on chronic
Stability: is it getting better/worse or staying the same
What tests & measures do PT’s use to learn about a patient’s pain
Numeric pain rating scale: tell me what your pain is from zero to ten
Visual analog scale: for non-verbal patients or children (line with no numbers or drawn faces scale)
Define allodynia
- pain due to a stimulus that does not normally provoke pain
Define hyperalgesia
- increased pain from a stimulus that normally provokes pain
Pain interventions for nociceptive pain
- Estim gate theory
- Estim endogenous opioids
- ice
- heat
- ultrasound
Pain interventions for peripheral neurogenic pain
- neurodynamics & traction
- motion is lotion & circulation
- desensitization
Pain interventions for central nociplastic pain
- graded motor imagery
- graded exercise/exposure
- relaxation breathing
What are biophysical agents
- materials and energy applied to patients to assist in rehabilitation
Define Arndt Schultz Principle
- no changes will occur if energy supplied is insufficient to stimulate the tissues
Define Cosine Law
- goal is for continuous energy application at 90 degrees to surface (perpendicular)
Define Grotthus-Draper Law
- if the therapeutic energy is not absorbed by one tissue it is transmitted to deeper tissues
Difference between contraindications and precautions
Contraindications: are factors where the biophysical agent should not be applied to that patient
Precautions: are factors where the biophysical agent can be applied to the patient but with extra safety measures
What are the components of a treatment note when documenting biophysical agent use
- SOAP Note
- Subjective (S): what the pt tells you
- Objective (O): pretreatment measures, intervention used, post treatment measures
- Assessment (A): outcome of the treatment
- Plan (P): continued/discontinued use of treatment
What modalities can be used in the inflammation phase
- cryotherapy
What modalities can be used in the proliferation phase
- heat/thermotherapy
What are the 5 mechanisms of heat transfer and example of modality
- conduction (hot pack)
- convection (fluidotherapy/whirlpool)
- conversion (ultrasound/diathermy)
- radiation (infrared lamp)
- evaporation (vapocoolant spray)
What are the physiologic effects of heat
- vasodilation & increased blood flow
- increased pain threshold
- increased nerve conduction velocity
- increased metabolic rate
- increased collagen extensibility
What is effective tissue temperature rise for thermal modalities
104-113 degrees F
Contraindications for thermotherapy
- recent or potential hemorrhage
- thrombophlebitis/DVT
- impaired sensation & mentation
- malignant tumor
- IR irradiation of the eyes
Precautions for thermotherapy
- acute injury or inflammation
- pregnancy
- impaired circulation & poor thermal regulation
- edema
- cardiac insufficiency
- metal in the area
- over an open wound
- over areas where topical counterirritants have recently been applied
- demyelinated nerves
Contraindications for ultrasound
- malignant tumor
- pregnancy
- CNS tissue
- joint cement
- plastic componentry
- pacemaker
- thrombophlebitis
- eyes
- reproductive organs
- impaired circulation
- impaired mentation
Precautions for ultrasound
- acute inflammation
- epiphyseal plates
- fractures (big fractures)
- breast implants
Advantages of infrared lamps
- does not require skin contact
- decreased risk of infection
- improved comfort
- easy inspection
Disadvantages of infrared lamps
- not easily localized to a specific treatment area
- difficult to ensure consistent heating in all treatment areas
Advantages of contrast bath
- may promote a more vigorous circulatory effect vs heat/cold alone
- good contact to contoured extremities
- pain control without aggravating edema
- allows for movement in the water
Disadvantages of contrast bath
- dependent positioning
- some pts won’t tolerate cold
- lack of evidence
Indications for cryotherapy
- pain
- acute swelling or contusion
- myofascial trigger points, muscle guarding, & spasm
- acute muscle or ligament strain
- bursitis or tendonitis
- delayed onset muscle soreness (DOMS)
- reducing temperature
- best with acute injury
Contraindications for cryotherapy
- allergy
- Raynaud’s disease or phenomenon
- hypersensitive/cold intolerance
- paroxysmal cold hemoglobinuria
- anatomical
Precautions for cryotherapy
- over the superficial main branch of a nerve
- over an open wound
- hypertension
- poor sensation or mentation
- very young & very old patients
What are the predictable stages of cryotherapy
- intense cold
- burning
- aching
- analgesia
- numbness
Indications for heat
- pain management
- improve ROM
- improve tissue healing
Indications for heat
- pain management
- improve ROM
- improve tissue healing
Non Thermal effects of ultrasound (pulsed)
- cavitation: the formation, growth, & pulsation of gas-filled bubbles caused by ultrasound
- increase calcium levels & tissue permeability
- promotes healthy cell function
- increases nitrous oxide formation to promote increased blood flow
What are the possible adverse effects of cryotherapy
- tissue death from improper application (~59 deg F)
- frost bite damage (39-50 deg F)
- reflex vasodilation by cooling for over 20 minutes
What are the hemodynamic responses to cryotherapy
- decreased blood flow first 15-20 minutes
- vasoconstriction
- decreased edema through reduction in local hydrostatic pressure
- decreased delivery of nutrients & phagocytes
How does cryotherapy increase pain threshold
- gate control theory
- decreased muscle spasm
- decreased sensory nerve conduction velocity
- decreased edema (pressure)
What should the water temperature in the hot pack hydrocollator be
158-167 degrees F
Therapeutic temperatures for paraffin wax
126-134 degrees F
Therapeutic temperatures for fluidotherapy
100-118 degrees F
Temperature for pain control in a whirlpool
99-104 degrees F
Temperature for increased ROM for a whirlpool
104-110 degrees F
