Final Flashcards by Jett Velasco

What is PT

therap. exercise Pathokinisieology

Prevents and treatment of disorders of motion to restore or maintain function and quality of life

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What PT does

Exercise modalities (HP/CP)
     manual tech (gait  training)
     assistive devices, hydro theraphy, braces and splinthing
     Fitness testing, work hardening
     Edu and prev

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Where PT

out and in clinic, hosp, skilled nursing facilities (SNF), health club, school, rehab, priv homes, sports org, hospice

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Who do we Treat

Pediatrics, adults, peps, work related inj traumas, congenital, orthopedics, neurologic, cardio pulm, prego

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Diff in PT, PTA, D

Education and salary

Responsibilities

PT - doct,5h (NPTE), cal law exam, license,renewal 60-90k
PTA- aa,4h, license approval, con ed 40-60K
Aide – on job training 12/h

PT – eval/diag, set goals, treat plan, treat, doc, discharge, supervise everyone
PTA – implement and progress, treat plan, assess state/progress, document
AID – impl plan, non patient care duties

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APTA

serves needs of progession, communication, relations

STANDARDIZES/improves EDU and PROMOTE STANDARDS and Publication

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PT board of CA

part of ca dept consumer affairs
Purpose – protect public by making law – pt practice act under medical practice act
License PT and PTA and ADMINISTERS board exam
investigates complaints and disciplines

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PT PRACTICE ACT

writes laws depending on standard
defines scope of practice
minimum standards of practice and minimum standards education

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CAPTE

accreditation for PT Programs

bases judgements on APTA STANDARDS

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PT responsible for who?

Sees pt?

PTA can’t do anything until?

Documents for PTD from PT

PTA and PTD requirements to treat

responsible for PTA and D services
- PTA AND D must be supervised by PT in order to legally provide thera to pt. in cal
- PT must first see patient (“PT of RECORD”)
- doc dx, px, intervention, establish plan of care, follow progress and do re evals and D/C
PT – gives direction and PTA must communicate closely with PT while treating and must document and notify PT of unexpected changes in pt. condition
PTA cant do anything until seen by PT and cant change anything or D/C pt.
PTD – PT must document PTD competency, PT must be present at facility, and PT must see same day as PTD, and PT must doc Rex

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Supervision of interns

Who is the clinical instructor?

clinical instructor can be PT/PTA
PTAs must doc and sign chart notes
CL must co-sign notes
Update PT weekly on pt. seen

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Document

What we document

E- form standards

Written standards

DOCUMENT – permanent record to prove something
Provides evidence of whats done and to communicate with staff
legal issues, accountability
reimbursement based on document
WHAT WE DOCUMENT – Dx and PT problems, Rx Plan, goals and desired outcome, record of Rx, response to Rx, D/C, consent to Rx
E-FORMS – SOAP NOTES, narrative notes, flow sheet check, insurance medicare, reports and letterd to do, incident report.
IMPORTANT
E-FORM – accurate clear, nature of Rx, name date and sign, same day as Rx
Written – legible, no blank, black ink, no change, single line initial

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SOAP NOTES

S(Subjective) – what they said
pt. says, states, reports, complain, “my back hurts”

O(Objective) – what you did
Rx content
what you did, instructions, training, etc
what it did – demonstrated, performed, ambulated, exercises
measurements – ROM

OBSERVATIONS – limping, color changes, swelling
communication

A(Assesment) – how it worked
answering ?
hows it going, is it effective,
KEY – increased, decreased, improved, progressing, consistent, does best with , poor/fair/good
NO PERSONAL JUDGEMENTS – pt is angry, lazy, a bitch

P(Plan) – what to do next
cont. w/, add a new exercise, initiate, increase, D/C, call MD, instruct in, arrange family meeting

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Medical diagnosis

PT problem

MEDICAL DIAGNOSIS – the pathology or problem by MD

PT PROBLEM – pathokinesiology problem, movement problem caused by pathology

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Position

Draping

Hygiene

POSITION – Comfort, allow area to be treated, stabilization
DRAPING – temperature and conceal private
HYGIENE – spread of infection, Plinths should be clean, and pillow cases. New sheet for plinths or paper

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Sitting

Supine

Prone

Side lying

Semi-supine

Side-lying

Draping

SITTING – back rest and foot should touch the ground. Pillow on lap or plinth for hand rest. Pillow at neck if needed.

SUPINE – pillow under head and behind patella to prevent curvature on lower back. Towel behind neck if needed or heels.

PRONE – must be nearest to edge for easy access for PT. Feet hanging at end of plinth, pillow on stomach to avoid excess curvature of spine. Hole on plinth or face pillow. Also towel to on top for infection control.

SIDE LYING – Pillow under side of head, knees and hips at 60-90 degrees with pillow between to relieve pressure and to avoid adduction of top of LE. Pillow on top torso for UE to rest on

SEMI-SUPINE – to avoid pressure ulcers.

LONG-SITTING – back against plinth with pillow and feet must be rested on plinth

DRAPING – doors closed so others cant see. Proper clothing, don’t have to remove bra or underwear. Also keep private and only area being treated exposed. Draping should be secure and not too tight.

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Anterior-posterior, 
ventral-dorsal, 
medial-lateral, 
proximal-distal, 
superior-inferior, 
superficial-deep, 
contralateral-ipsilateral, 
cephalic-caudal, 
infrapatellar-suprasupination-anterolateral
Sagittal/midsagittal plane, 
frontal plane, 
transverse plane
abd-add (frontal plane)
med-lateral – horizontal plane
plantar flexion – dorsiflexion

🍺

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Common measurements

Goniometry and tool

AROM – 
PROM – 
AAROM – 
FROM – 
EROM – 
WNL – 
WFL – 
GIRTH

Common Measurements – ROM, GIRTH, MUSCLE STRENGTH
Goniometry – measurement of joint position or movement (GONIOMETER) measure in degrees

AROM – assistive rom
PROM – Passive
AAROM – Active assistive
FROM – functional
EROM – end
WNL – Within normal limits
WFL – within functional limits
GIRTH – circumference of body part in cm or in.
measures mm bulk or edema

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MMT

MANUAL MUSCLE TEST – manual technique estimates relative strength of specific muscles or muscle group by own manual force of PT by manual resistance for tolerance.
mm strength grades
5/5=normal mm can take normal/max amount resistance
4/5=Good mm can take some/moderate resistance
3/5= fair can move body part against gravity
2/5=Poor “ “ “ with gravity eliminated
1/5=Trace, mm can contract but not move body
0/5=absent, no visible contraction

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Massage

Benefits

Circulation of blood and lymph

Reduce edema

Skeletal muscle - increase ROM and circlulation

Control of pain

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2 basic strokes

Effleurage - light long strokes with palms of hands (towards heart and along muscles

Petrissage - kneading

Body mechanics

Neutral spine -

Body mech -

Ergonomics
Work hardening

Good posture of spine

Body mech - use of kine for body in ADL to prevent inj

COG must remain over BOS
More poc means more stability
Lower cog means more stable

Hold obj close to cog over BOS 
Tight abs, knees unlocked
DONT TWIST TRUNK
Push rather than pull
Use assistive devices for heavy

Erg - fitting work place to worker
Work - prepping pt for work situation to build up return

Indications

Contraindication - worsen

Ind -

Contra - abnormal body temp
Acute infection
Cancer
Diabetes
Epilepsy
High blood pressure
Medication
INTEG - sores etc
Circulatory - thrombosis, aneurysm 
Skeletal - dislocation, arthritis
Ligamental - sprains

What’s pain and why

3 types of pn

Unpleasant sensory and emotional experience associated w/ tissue damage
- a warning and a protector

Acute - source is known, goes away

Chronic - cause uncertain or uncorrectable
Rx ineffective
Longer than 1 month

Referred or radicular
Arises from deep body structures and felt distally
Afferent nerve fibers

Other - breakthrough, phantom

Pain locations Affects of pain

Cutaneous - skin sub cute Deep somatic - arises from bones, jts,mm Visceral - organs ``` - mm spasm Weakness and fatigue Decrease rom and appetite Inability to sleep Increased irritability ```

2 responses to pain Pain receptors called Gate theory

Locally, systemically (where it's at) Mm spasms to immobilize, withdrawal from stimulus, edema, Release of endogenous pain producing chems ``` Systemic response - f or f response to sns Increase hr, rr - bronchioles expand Sweating, dilate Blood goes to brain and mm Sphincter contract ``` Nociceptors - sensory GT - melzack and wall 1965 Pn signals by nocs can be overridden by another signal (rubbing, shaking)

What do we monitor on patients. 5 vital signs What tools do we use to monitor HR and BP Adult HR? ?/? BP and what is it Norm BP HTN

Monitor physiological response to Rx HR, BP, RR, 02 sat, temp Stethoscope, sphygmomanometer 60-100 Higher in children Systolic, diastolic (mm of mercury) Amount of pressure exerted by blood flow on blood vessels walls and can be venous/arterial Norm 90-120/60-80 HTN 140/90

RR Normal temp. What controls Normal 02 sat Physiological signs to monitor

15-20 37 Celsius 98 f 92% above ``` Color Sob Eyes Nausea Commit Response to commands Dizzy Passing out Pain Fatigue, weak shaking ```

Objectives - vitals and appearance of skin Monitor skin before and after modality Color of skin Mottling Blanching Integrity of skin

Spotty Pressure applied how long it turns back to color Flaky, shiny etc

Inpatient goals 1st goal 2nd Basic goals

To get out! To do things they're suppose to do before discharge Basic ther ex. Gt or w/c Transfers and safety and balance

``` Assist levels I S SBA CGA min A mod A max A Total/dep ```

``` PT no help Requires supervision (cues or verbal) Within arms reach Keep contact with patient Patient provides 75-99% of effort 25-75 1-25 0 effort ```

Transfers Sup sit Sup to prone Sit to sup Sit stand Sit to side lying Transport according to assistance Min A Max x 2 (2 ppl) Max A x 1 with sba on another

``` Trans according to method Logroll Stand pivot Squat pivot Slide board Mech lift Tilt table Standing frame Transfer pole ```

Consideration for gait ``` Distance Device Brace/splint Shoes Wb Pattern Surface Cadence Balance Safety ```

Cues Obstacles Chair in tow Deviation - not normal Like one long foot Walking weird Not swinging arms while walking

Inpatient etiquette ``` Care with things Never hurry transfers Pull covers slowly because of gown Allow bathroom assistance as needed Monitor feelings during treatment PT confidentiality ``` Comfortable with PT condition No negativity or surprised comments Don't laugh Make sure patient comfy after treatment Warm, blanket, water GIVE CALL BUTTON, phone and tv RAILS UP

``` It's their temp home Allow them to control their environment Knock, announce why and who you are Address formally and their title Polite with visitors and family ```

What is infection 3 types Required? Can be. And. Transmission can be Or. also by b. Or. d

Invasion of body with pathogens Bacteria - cell org Virus - rna/DNA Fungi - veg or plants Portal of entry in host Active - spreadable symptoms present Inactive - inactive asymptomatic Direct or indirect (another person or obj) Bloodborne contact with body fl Droplets contact with mucosal or mengi

Bloodborne HIV, hep a (fecal oral) b and c Mrsa - staph bac resistant to antibacteria Vre - bacteria resistant to antibacterial med C diff - fecal oral Pathology in body fl

``` Blood Urine Feces Wound drain Semen Pericardial Pleural Peritoneal Amniotic Gastric go Sputum Synovial go ```

Droplets Influenza SARS Rhinovirus Streptococcus Airborne TB Measles Chicken pox Signs and symptoms of infection

``` Fatigue Fever Nausea Diarrhea Mm aches Decreased appetite Swollen lymph nodes ```

Standard precautions Avoid ❓ Assume ❓ All fluid ❓ Wash hands before and after Minimum ❓ Cough ettiquette Ppe Precautions for

Spreading Infected Infectious 20-30 sec Cover everything ``` Gloves gown mask giggles Housekeeping. Wipe everything Hazardous waste Sharps Food storage Patients door closed ``` Health care workers. Family. Visitors. Other staff

Heat - decrease ❓and ❓ Increase ❓ Speed ❓ Cold - decrease ❓❓❓ Decrease e, I, s What is edema, inflammation spasm and spasticity

Pain and spasm and guarding Rom Speed healing process Pain spasm guarding Edema infection and spasticity Edema - fluid accumulation (water) Infl - response of immune system (swelling) Spasm - involuntary mm contractions Spas - abnormal mm contractions

2 aspects of heat Degree tissue - mildly or really warm (vigorous heat) Depth a superficial and deep HP and par are vig and superficial Vig heat elevates tissue temp to 40-45c Superficial heat - depth 1 cm Takes 6-8 min for skin to rise 5-6 degrees remains for 30 min 15-30 min for mm tissue to rise 1 Celsius at 3cm

Cold ther - cryotherapy Cools tissue to 15c at 1-4cm Rx time 10-20 min Damaging to tissue 10c over 20 min of direct exposure

``` Influencing factors mod ❓ difference to start with ❓ of modality ❓ of exposure thermal conductivity of tissue (mm vs adipose) Fat - insulator ```

Temperature Intensity Time

Physiological effects of heat ``` ❓ Increase c Increase m to increase h Decrease mm spindle firing -> ❓-> ❓ Decrease p Increase tissue ❓ Decrease viscosity of joint flexion ```

``` Vasodilation Circulation Metabolism and healing Mm relation Mm spasm Pain Extensibility ```

``` Cold ❓ Decrease e Decrease m -> dec chemical irritant -> ❓ Decrease ex Increase viscosity of joint fluid Decrease pain by decrease pain impulses ```

``` Vasoconstriction Edema Metabolic rate Inflammation Extensibility ```

Indication Contraindication Precaution

Condition or circumstance for treatment is appropriate and helpful *sprained ankle is an indication for Ice Ice is indicated for sprain Treatment is inappropriate and will be damaging Condition where extra care should be taken before and during and after a treatment

Heat ind, contra, pre ``` Subacute (injury after 4 days) Mm injury Mm guarding/spasms Tight tissue Osteoarthritis and pain ``` Contra Acute infl (injury up to 3 days) Malignancy. Cardiac insufficiency. Pvd. Fever Acute hemorrhage l. Skin lesions

Precautions Fragile skin MS (multiple sclerosis) eating of nerve ending Pregnancy

Cold indi, contra, pre Indi - acute inj, inflammation/edema. Pain. Spasm. Spasticity mm Contra - Raynaud's disease. Hives and welts. Rheumatoid arthritis. Systemic lupus. Multiple myeloma. Cold sensitivity ``` PRECAUTIONS FOR H AND C impaired sensations. -altered mental state Thermoregulatory problems Impaired circulation ```

``` Appearance Erythema - redness Pallor - pale Mottling l Blanching - normal response to pressure ```

Methods of heat exchange ``` Conduction Convection conversion Radiation Evaporation ``` Specificity of modality depending on advantage and disadvantage. Like how big is the body part being treated. So you use hp paraffin or whirlpool. For cold. Coldpack vs ice massage for small areas Also PT response or reference and compliance Stage of injury and treatment goals and medical conditions for contraindications.

``` Direct contact Movement of air and fluid One for of energy to another Transfer through air Liquid to gas ```

Pre cautions Wash hands before and after patients. If no sink, hand sanitizer. But asap wash hands Gloves must be worn when touching patients and or in contact with body fl. Cannot re-use or wash. Utility gloves can be disinfected if not compromised. Glasses not considered goggles. Unless side shields Masks must be worn if potential splashes. Sprays. Aerosols. Droplets. Sharps must be disposed off in non puncture places. And cannot. Reused or capped once seal broken.

Sharps container must be labeled. And must be only 3/4 full. Wear gloves to handle sharps.

Pain to be asked patient. Quality Intensity Location Duration Triggers Effects Response to pain therapy

How does it feel Pain scale Where When does it hurt How has it affected your life What medication works

Elder abuse. What age consider elder? Majority of perpetrators? Maj of victim? Inst. elder abuse? Where

60+. (65) Male Female Residential, nursing homes, foster homes, group homes, private boarding houses.

Elder abuse 5 types. Ph Ps F N D

Physical - pushing shaking hitting, confinement, rough handling, misuse of medication, sexually molesting. INDICATION - unexplained physical injuries, bruises, grip marks, pain bruises in privates Physiological - restraining on decisions, name calling, threatening, bullying, humiliating. IND - fear, nervousness, low self esteem, care giver answers for them. Financial - withholding money, change in will, force to sell, stealing pension checks. IND - lack of money loss of assets Neglect - failure to provide care or food, lack of concern over safety, isolation IND - bad appearance, no glasses, bad hygiene, unattended for long periods, malnourished Denial of civil rights - restriction on CR IND - restricted access to service providers, difficulty visiting, calls