Final Exam Prep Flashcards
Arousal levels
-Coma
-Stupor
-Obtunded
-Lethargic
-Alert
-Hyperalert
What is alert?
Patient is awake and attentive to normal levels of stimulation
What is lethargic?
Patient is drowsy and may fall asleep without stimulation and has difficulty concentrating and focusing
What is obtunded?
Patient is difficult to arouse from a sleeping state and is confused when awake. Interactions with providers are largely unproductive
What is coma?
Patient is unable to arouse by any type of stimulation
What is hyperalert?
Patient is anxious, sympathetic nervous system in overdrive
Alert and oriented
- Name
- Where they are
- The date/day
- The “event” a.k.a. why they are there
What are two common formal cognitive screens?
-Mini mental state exam (MMSE)
-Montreal Cognitive Assessment (MoCA)
Which formal cognitive assessment takes education level into account?
MoCA
What is considered “good” posture?
A state of muscular and skeletal balance which protects the supporting structures of the body against injury
What is the plumb line of Kendall?
All of these points should be in one line for posture
-Tragus of ear
-Head of humerus
-Lumbar vertebrae
-Greater trochanter of femur
-Anterior to the middle of the knee
-Anterior to lateral malleolus
-Calcaneocuboid joint
What should the joints be during optimal posture?
-Not at end range
-Loose pack
-Neutral
What should the muscles be during optimal posture?
Balanced!
What muscles are tight and which are weak in upper crossed syndrome?
-Tight muscles are upper traps, levator scapula, and pectorals
-Weak muscles are deep neck flexors, rhomboids, and serratus anterior
What muscles are tight and which are weak in lower crossed syndrome?
-Tight muscles are erector spinae and iliiopsoas
-Weak muscles are abdominals and gluteus maximus
What defines and influences posture?
-Bony structure
-Habits
-Strength
-Mood
-Ranges and limits of muscles, fascia, joints, and neural tissue
-Pain
What is forward head?
Increased cervical lordosis
What is rounding of thoracic spine?
Increased thoracic kyphosis
What is flat thoracic spine?
Decreased thoracic kyphosis
What is sway back?
Increased lumbar lordosis
What is knee hyperextension called?
Genu recurvatum
What causes flat foot/dropping arches?
Over pronation
What causes high arches?
Over supination
When someone has scoliosis, which muscles are lengthened and which are shortened?
-Muscles on the concave side of the curve are shortened
-Muscles on the convex side are lengthened
What different pain scales are there?
-Verbal intensity scale
-Visual analogue scale (meter stick or ruler)
-Numeric pain scale (0-10)
-Wong Baker Faces scale
What is edema? What is it caused by?
-Swelling
-Caused by excess fluid that is trapped in body tissues
-One of the 5 cardinal signs of the inflammatory response
Where is edema most commonly seen?
-In the lower extremities, in the feet and ankles
-Hands
What is pitting edema?
-When a “pit” or indentation is seen from poking the area of swelling
What are the ratings of pitting edema?
-1: indentation is barely detectable
-2: slight indentation visible when skin is depressed, returns to normal in 15 seconds
-3: deeper indentation occurs and returns to normal within 30 seconds
-4: indentation last for more than 30 seconds
What are common causes of edema?
-Heart disease
-Chronic venous insufficiency
-Liver or renal disease
-Lymphedema
How can edema be measured?
-Tape measure (circumferential or figure 8)
-Volumetric measurement (water displacement)
What are the rules for circumferential edema measurement?
You must pick a bony landmark to start from and then measure in intervals of 3-4 cm apart
What are the landmarks for hand figure 8 edema measurement?
Radial styloid process, to fifth metacarpal head, to second metacarpal head, to ulnar styloid process, and back to radial styloid process
What are the landmarks for ankle and foot figure 8 edema measurement?
-Ankle: medial malleolus, to base of fifth metatarsal, to base of first metatarsal, to lateral malleolus, and back to medial malleolus
-Foot: same but instead of using the bases of the metatarsals, you will go to the head
What are ways to decrease the amount of edema present?
-Elevation
-Muscular activity
-Wrapping/taping
-Compression stockings
-Ice massage
-Manual drainage techniques
What is lymphedema? What is it caused by?
-A chronic disorder characterized by an abnormal accumulation of lymph fluid in the body tissues (not relieved by elevation)
-Caused by a mechanical insufficiency in the lymphatic drainage system
Who should get a skin inspection?
Everyone!!!
What should you observe during a skin assessment?
-Dryness
-Color
-Plumpness
-Amount of hair
-Bruising
What should you palpate during a skin assessment?
-Temperature
-Edema
-Pain/tenderness (subjective response)
-Skin over bony prominences or surgical site
What type of wounds are there?
-Pressure ulcers
-Vascular ulcers
-Neuropathic ulcers
-Surgical incisions
-Traumatic abrasions
-Skin tears
Where do pressure ulcers usually occur?
-Over bony prominences where someone is placing all of their body weight for long periods of time, which leads to ischemia and tissue necrosis
What are the two different types of skin tears?
-Shear: when the underlying tissue moves parallel to the support surface (sliding down in bed, transfers)
-Friction: when two surfaces rub together
What can cause pressure ulcers?
-Too much pressure over a long period of time that causes the capillaries to close and leads to necrosis
-Moisture which can lead to maceration and a weak epidermis
What are extrinsic causes of pressure ulcers?
-Cognition
-Equipment, seating, bed, etc.
-Family support and care
-Moisture
What are intrinsic causes of pressure ulcers?
-Body mass and atrophy
-Immobility, paralysis, joint contractures
-Impaired sensation and circulation
-Incontinence
-Meds
-Age
What are the two main screening risk assessment tools for pressure ulcers? What do each of them test?
-Norton scale tests physical amd mental activity, mobility, and incontinence
-Braden scale tests sensation, moisture, activity levels, mobility, nutrition, shear/friction
-For both tests, the lower the score, the more increased risk of pressure ulcers
What is a stage I pressure ulcer?
-Changes in color, appearance, and temperature
-Skin feels boggy, over a pressure point
-Skin still intact
What is a stage II pressure ulcer?
-Skin broken through the first few layers
What is a stage III pressure ulcer?
-Full thickness, subcutaenous structure damaged or necrotic
-Can be as deep as fascia
What is a stage IV pressure ulcer?
-Extensive damage
-Bone, tendon, muscle, or joint capsule exposed
What are the stages of normal healing?
-Stage I: Inflammatory phase
-Stage II: Proliferation phase
-Stage III: Remodeling or maturation phase
What is stage I of normal healing?
-Inflammatory phase
-24-72 hours after initial trauma through day 10
-Protects the body and promotes repair
-Central role in healing
-Increased blood flow
-WBC’s and enzymes released
What is stage II of normal healing?
-Proliferation phase
-New tissue fills in the wound
-WBC’s are decreasing
-Granulation and angiogenesis (weak, soft, red scar)
-Day 3 to 3 weeks
What is stage III of normal healing?
-Remodeling or maturation phase
-Begins when granulation tissue is forming
-3 weeks onward
-New skin has 15% tensile strength compared to normal
-Collagen stronger and more organized
What is the purpose of a sensory screen?
-Determine areas that are intact/not intact
-Assists with diagnosis and prognosis
-Guides POC and treatment
What senses are part of the superficial sensory system?
-Pain, temperature, light touch
What senses are part of the deep sensory system?
-Position sense (proprioception), kinesthesia, vibration
What senses are part of the combined sensory system?
-Sterognosis, two-point discrimination, barognosis, graphesthesia, tactile localization, recognition of tecture
What does a sensory screen include?
-One test from each of the three categories (superficial, deep, combined)
-Random, over large surfaces (both upper and lower extremities)
-Bilateral
What happens if impairments are identified in a sensory screen?
A full sensory exam must be conducted
When would you skip a sensory screen and go straight to a sensory exam?
-When it makes clinical sense such as when someone has diabetes, Peripheral Vascular Disease, or neurological diseases
-Make sure to follow a dermatome pattern
-Systematic and thorough
What are signs of a cardiac patient?
-Dyspnea
-Fatigue
-Chest pain or palpitations
-Cyanosis or clubbing
-Intermittent claudication
-Edema
-Overweight and out of shape
What is normal pulse for adults? What is tachycardia? What is bradycardia?
-60-90 bpm
- > 100 bpm
- < 60 bpm
What is normal pulse for newborns?
70-190 bpm
What is normal pulse for children?
70-120 bpm
What are the different qualities of pulse? What do they mean?
-Absent (0): no perceptible pulse
-Thready (1): easily obliterated, barely perceptible
-Weak (2): difficult to palpate, stronger than thready, obliterated with light pressure
-Normal (3): easy to palpate, requires moderate pressure to obliterate
-Bounding (4): very strong. not obliterated with moderate pressure
What factors effect pulse rate?
-Age
-Gender m<f
-Emotions and stress
-Body temperature
-Exercise
What are the pulse sites in the upper extremity?
-Radial artery at cubital fossa
-Radial artery at wrist
-Ulnar artery at wrist
What are the pulse sites in the lower extremity?
-Popliteal artery behind the knee
-Dorsalis pedis artery near the big toe
What is normal respiratory rate for adults? What is tachypnea? What is bradypnea?
-Females: 16-20
-Males: 14-18
- > 20
- < 10
What are the qualitative measures of respiratory rate?
-Depth (shallow or deep)
-Rhythm (regularity of breaths)
What are different sounds of respiration?
-Abnormal
-Wheezing
-Stridor (harsh, high pitched sound)
-Crackles/rales (rattling or bubbling sounds)
-Sigh
-Stertor (snoring sound)
-Absent
What is blood pressure?
The pressure exerted on arterial walls due to the contractile force of blood ejected by the ventricles each beat
What is systolic blood pressure?
Peak ventricular contractile force pushing through the arteries
What is diastolic blood pressure?
Ventricular filling
What is normal blood pressure?
Less than 120 and less than 80
What is elevated blood pressure?
120-129 and less than 80
What is hypertension stage 1?
130-139 or 80-89
What is hypertension stage 2?
140 or higher or 90 or higher
What is hypertensive crisis?
Higher than 180 and/or higher than 120
What are factors that affect blood pressure?
-Age (increases with age)
-Gender (women<men)
-Exercise, stress, anxiety, etc.
-Circadian rhythm
-Medications
-“White coat syndrome”
What is hypotension? What are signs of hypotension?
-Systolic < 90mmHg
-Tachycardia, dizziness, confusion, restlessness, clammy & pale
What is orthostatic hypotension?
-Positional changes in BP (laying down to sitting to standing)
-Characterized by changes in systolic greater than 20 mmHg or changes in diastolic greater than 10mmHg
What are possible causes of hypotension?
-Prolonged bed rest
-Pregnancy
-Decrease in blood volume
-Medications
-Bradycardia
-Heart attack
-Septic shock
-Hormonal issues
-Nutritional deficiencies
What are Karotkoff’s sounds? Which ones indicate systolic and diastolic bp?
-Phase I: first faint clear sound, first 2 successive sounds are systolic
-Phase II: swishing sound
-Phase III: crisp, more intense
-Phase IV: muffling, soft blowing quality
-Phase V: silence, disappearance of sound is diastolic
What are normal oxygen saturation levels? What is abnormal?
-92-99%
-100% indicates carbon monoxide poisoning
-88% or less indicates “desat”
What can affect oxygen saturation reading?
-Excessive ambient light
-Nail polish
-Poor circulation
-Movement
What are factors effecting muscle performance?
-Muscle fiber type and size
-Force-velocity relationships
-Length-tension relationships
-Muscle architecture
-Neural control
-Age
-Fatigue
-Cognitive training
-Corticosteroids
-Muscle pathology
-Disease
-Disuse atrophy
What are the different muscle fiber types?
-Type I: slow twitch
-Type II: fast twitch
What types of muscle assessments can you do?
-Functional strength tests (5 times sit to stand, glute bridge, push ups, etc.)
-MMT
-Dynamometry
-Isokinetic testing
What are indications for passive range of motion? When is it contraindicated?
When a patient is unable to perform any form of active contractions
-Paralysis
-Comatose
-Recovery from surgery or trauma
-Healing fractures
When passive movement significantly increases the patient’s symptoms
What are the benefits of passive exercise?
-Preserves and maintains range of motion
-Minimizes contracture formation
-Minimizes adhesion formation
-Maintains mechanical elasticity of muscles
-Promotes and maintains local circulation
-Promotes awareness of joint motion
-Evaluates integrity of joint
-Enhances cartilage nutrition
-Inhibits or reduces pain
What does PROM not do?
-Prevent muscular atrophy
-Increase muscle strength or endurance
-Assist in circulation as well as AROM
What are the goals of AROM?
-Maintain physiologic elasticity and contractility
-Provides sensory feedback from the contracting muscle
-Provides a stimulus for bone and joint tissue integrity
-Increases circulation and prevents thrombus formation
-Develop coordination and motor skills
What is the purpose of assisted AROM (AAROM)
To protect healing tissue
What modes of stretching are there?
-Static
-Dynamic
-Ballistic
What is an appropriate intensity of stretching that will induce changes in the tissue?
Slow, low load, prolonged stretch
What is an appropriate duration and frequency of stretching that will induce changes in the tissue?
-15-60 seconds for 2-5 reps
-3-5 times per week
How should two joint muscles be stretched?
-They should be stretched one joint at a time
-Progression would be stretching it at both joints
When is the most appropriate time to stretch? Why?
After exercise to reduce DOMS
What are the two types of isotonic contractions?
-Eccentric: lengthening contraction
-Concentric: shortening contraction
What are the benefits of isotonic contractions?
-Maintains or increases strength, power, and endurance
-Promotes local circulation
-Enhance cardiovascular efficiency
-Creates hypertrophy of muscles
-Maintains elasticity of muscles
-Maintains joint motion
-Maintains or enhances coordination
What is open vs closed chain?
-Open is unrestricted movement in space of the distal segment during the exercise (glute kick backs)
-Closed chain is when the distal segment is fixed during the activity (squat or step up)
What is an isometric contraction?
When a muscle contracts, but there is no joint motion
What is isokinetic exercise?
When the speed stays the same throughout the motion but the resistance is variable
What are contraindications to exercise?
-Pain with resistance
-Inflammation
-Severe cardiopulmonary disease
What are precautions for resistance exercise for patients?
-Avoid valsalva maneuver because it can cause an abrupt increase in blood pressure
-Avoid substitute motions/improper form
What are the components of exercise prescription?
-Mode
-Intensity
-Frequency
-Duration
-Progression/modification
What are motor skills?
Activities or tasks that require voluntary control over movements of the joints and body segments to achieve a goal
What is motor learning?
The acquisition of motor skills, the performance enhancement learned or highly experienced motor skills
What are the motor learning stages?
-Cognitive phase
-Associative phase
-Autonomous phase
What is the cognitive phase of motor learning?
-Movements are slow, inconsistent, and inefficient
-Large parts of the movement are consciously controlled
-Thinking
What is the associative phase of motor learning?
-Movements become more fluid, reliable, and efficient
-Some parts of the movement are controlled automatically
What is the autonomous phase of motor learning?
-Movements are accurate, consistent, and efficient
-Movement is largely controlled automatically
What is motor control?
How our neuromuscular system functions to activate and coordinate the muscles and limbs in the performance of a motor skill
What is motor development?
The combination of motor learning and motor control and the development from infancy to old age
What is a motor program?
A series of mini routines organized into the correct sequence to perform a movement
What is motor memory?
The recall of motor programs
What is the stages of motor function training?
-Stability (always comes first)
-Mobility on stability
-Mobility
-Motor skill
