Final Exam Flashcards
Elements of Examination
Step 1: Examination
Chart review»_space; History»_space; Clinical Impression I (Determine PPP-precautions, priorities, plan)»_space; Systems Review (screening exams)»_space; Tests and Measures (physical exam)
Step 2: Evaluation
Step 3: Diagnosis - rehab related
Step 4: Prognosis and POC
Step 5: Interventions
Step 6: Outcomes
Step 7: Discharge
Arousal Levels
Hyperalert: system in overdrive
Alert: awake, attentive to normal levels of stimulation
Lethargic: patient drowsy and may fall asleep w/o stimulation, easily diverted, difficulty focusing
Obtunded: difficult to arouse from somnolent state, frequently confused when awake, repeated stimulation to maintain consciousness, interactions with provider unproductive
Stupor: semi-coma, responds only to strong noxious stimuli, returns to unconscious state when stimulation is stopped, unable to interact with provider
Coma: unable to arouse by any type of stimulation
Formal Cognitive Screens
MMSE-
MoCA- >26= normal
“Swelling”
Damage to tissue –> Acute Inflammation –> Edema (observable swelling caused by excess fluid trapped in tissues)
Rating of Pitting Edema
1+ Indentation barely detectable
2+ Returns to normal in 15 seconds
3+ Returns to normal within 30 seconds
4+ Indentation lasts for more than 30 seconds
Causes of Edema
> Heart Disease (CHF)
CVI
Liver/Renal Disease
Lymphedema
Trauma
Post Surgery
Chronic Wounds
Inflammation, infection, cellulitis
Anthropometric Measurement of Edema- Circumferential
Measurement of entire limb
-starts with reference point
-measure in circumferential rings at documented intervals
Anthropometric Measurement of Edema- Figure 8
Measurement over joints
-start and end at same bony prominence
Hand: radial styloid process > around to 5th metacarpal head > over to 2nd metacarpal head > ulnar styloid process > radial styloid process
Foot/ankle: medial malleolus > styloid process of 5th ray > base of first metatarsal > lateral malleolus > medial malleolus
When is full sensory exam warranted?
- Diabetes
- PVD
- Neurological dx
- History
General procedure for all sensory exams
- pt eyes closed
- compare bilaterally
- random over large surfaces
- UE and LE
- demonstrate on intact part of body (face, etc)
Kinesthesia and Proprioceptive Awareness
Kinesthesia= moving small joint through space, ask pt to identify if moving up, down, etc.
Proprioceptive Awareness= positional sense, move a joint and ask pt to reproduce using opposite limb
Barognosis, Sterognosis, Graphesthesia
Barognosis= placing an object in pt hand and have pt evaluate weight of each object
Sterognosis= place objects in front of pt, pt eyes closed, pt identifies common items
Graphesthesia= pt has palm up and determines whether therapist is writing a number or letter without input of vision
Clinical Impression I
- assessment following subjective
-1* goal to make hypothesis for care
-start differential diagnosis
-3 P’s
Three P’s
Priorities= important tests and measures you need to perform in your physical exam from history (pt biggest limitation)
Precaution= any tests to postpone, comorbidities that may affect exam, limitations
Plan= plan for physical exam, what tests and what order, usually save most painful/difficult test for last
S.I.N.S
Severity= how intense are symptoms as they relate to functional activity?
Irritability= how easily are symptoms brought on and how long do they last?
Nature= Nature of condition/symptoms (musculoskeletal-non musculoskeletal)
Stage= duration of symptoms (acute, sub-acute, chronic)
Examination of Integumentary System
Observation- dryness, color, turgor (plumpness), amount of hair, bruises
Palpation- temperature, edema, pain/tenderness, skin
Examination of Pressure Ulcers - Screening Risk Assessment Tools
Norton Scale
-physical, mental, activity, mobility, incontinence
Braden Scale
-sensation, moisture, activity, mobility, nutrition, shear/friction
Pressure Ulcer Stages
Stage I: skin still intact, changes in skin color/appearance/temperature, pain, skin feels boggy, over a pressure point
Stage II: skin broken, through the first few layers (epidermis and dermis)
Stage III: full thickness, subcutaneous, structures damages or necrotic
Stage IV: extensive damage, bone, tendon, muscle, or joint capsule exposed
Stages of Normal Healing
Stage I: Inflammatory phase
Stage II: Proliferation phase (new tissue fills wound) > day 3-3wk
Stage III: Remodeling or Maturation phase (true scar) > 3 wk and beyond
Pulse Rate and Rhythm
Normal= 60-90bpm
<60= bradycardia
>100= tachycardia
Newborn= 70-190
Children= 70-120
Regular= interval between beats
Regularly irregular= skip same beat each cycle
Irregularly irregular= skip beats randomly
Bigeminal= two beats occur in rapid succession
Pulse Quality
Absent (0)= no perceptible pulse
Thready (1+)= easily obliterated
Weak (2+)= difficult to palpate, obliterated with light pressure
Normal (3+)= easy to palpate, requires moderate pressure to obliterate
Bounding (4+)= very strong, not obliterated with moderate pressure
Respiratory Rates
Newborn: 30-60
Early childhood: 20-40
Late childhood: 15-28
Adolescence: 18-22
Adult males: 14-18
Adult females: 16-20
Rapid/tachypnea= >20
Slow/bradypnea= <10
Blood pressure categories
Normal: less than 120 AND less than 80
Elevated: 120-129 AND less than 80
HTN I: 130-139 OR 80-89
HTN II: 140 or higher OR 90 or higher
HTN Crisis: higher than 180 AND/OR higher than 120
Limitations to SaO2
Poor circulation or anemia
Not accurate enough with COPD
Temperature
Nail Polish
Ambient Light
Movement
CO Inhalation
