Final Exam

Question 1

Elements of Examination

Answer 1

Step 1: Examination
Chart review&raquo_space; History&raquo_space; Clinical Impression I (Determine PPP-precautions, priorities, plan)&raquo_space; Systems Review (screening exams)&raquo_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

Question 2

Arousal Levels

Answer 2

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

Question 3

Formal Cognitive Screens

Answer 3

MMSE-
MoCA- >26= normal

Question 4

“Swelling”

Answer 4

Damage to tissue –> Acute Inflammation –> Edema (observable swelling caused by excess fluid trapped in tissues)

Question 5

Rating of Pitting Edema

Answer 5

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

Question 6

Causes of Edema

Answer 6

> Heart Disease (CHF)
CVI
Liver/Renal Disease
Lymphedema
Trauma
Post Surgery
Chronic Wounds
Inflammation, infection, cellulitis

Question 7

Anthropometric Measurement of Edema- Circumferential

Answer 7

Measurement of entire limb
-starts with reference point
-measure in circumferential rings at documented intervals

Question 8

Anthropometric Measurement of Edema- Figure 8

Answer 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

Question 9

When is full sensory exam warranted?

Answer 9

• Diabetes
• PVD
• Neurological dx
• History

Question 10

General procedure for all sensory exams

Answer 10

• pt eyes closed
• compare bilaterally
• random over large surfaces
• UE and LE
• demonstrate on intact part of body (face, etc)

Question 11

Kinesthesia and Proprioceptive Awareness

Answer 11

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

Question 12

Barognosis, Sterognosis, Graphesthesia

Answer 12

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

Question 13

Clinical Impression I

Answer 13

• assessment following subjective
  -1* goal to make hypothesis for care
  -start differential diagnosis
  -3 P’s

Question 14

Three P’s

Answer 14

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

Question 15

S.I.N.S

Answer 15

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)

Question 16

Examination of Integumentary System

Answer 16

Observation- dryness, color, turgor (plumpness), amount of hair, bruises

Palpation- temperature, edema, pain/tenderness, skin

Question 17

Examination of Pressure Ulcers - Screening Risk Assessment Tools

Answer 17

Norton Scale
-physical, mental, activity, mobility, incontinence

Braden Scale
-sensation, moisture, activity, mobility, nutrition, shear/friction

Question 18

Pressure Ulcer Stages

Answer 18

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

Question 19

Stages of Normal Healing

Answer 19

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

Question 20

Pulse Rate and Rhythm

Answer 20

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

Question 21

Pulse Quality

Answer 21

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

Question 22

Respiratory Rates

Answer 22

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

Question 23

Blood pressure categories

Answer 23

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

Question 24

Limitations to SaO2

Answer 24

Poor circulation or anemia
Not accurate enough with COPD
Temperature
Nail Polish
Ambient Light
Movement
CO Inhalation