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DPT 629: Cardio > General Medicine and Neuro > Flashcards

General Medicine and Neuro Flashcards

1
Q

what is the joint commission?

A

the accreditation of many healthcare facilities that sets the standards for quality of care

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2
Q

who surveys accredited hospitals every 3 years?

A

the joint commission

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3
Q

t/f: the joint commission can show up randomly during a specified 3 month period every 3 years for inspection of hospitals

A

true

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4
Q

what are some national patient safety goals that are pertinent to PT?

A

ID the pt correctly

use alarms safely

prevent infection

reduce risk for suicide

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5
Q

how do we ID pts correctly?

A

use at least 2 pt identifiers (name and DOB)

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6
Q

t/f: room and location can be used as pt identifiers to confirm ID

A

false, room/location do not count

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7
Q

t/f: we need to ensure that alarms on medical equipment are heard and responded to

A

true

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8
Q

how do we prevent infection?

A

hand hygiene

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9
Q

how do we reduce risk for suicide?

A

any equipment brought in must be brought out with suicide watch

we are often the ones to pick up on suicide risk, so we must communicate this with the team

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10
Q

what are some complications of hospital admission?

A

acquired infectious disease

delirium

disuse atrophy

decreased CV reserve and endurance

hospital acquired pneumonia

falls

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11
Q

what is the #1 way ppl get hurt in the hospital?

A

falls

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12
Q

what is delirium?

A

acute onset of severe confusion

rapid changes in brain fxn

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13
Q

t/f: delirium is a cluster of symptoms resulting from another disease/clinical process

A

true

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14
Q

is delirium constant or transient?

A

transient

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15
Q

is delirium treatable?

A

yes!

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16
Q

what are the diagnostic criteria for delirium?

A

disturbance in attention and awareness develops acutely and tends to fluctuate in severity

at least one additional disturbance in cognition

disturbances that aren’t better explained by pre-existing dementia

disturbances that don’t occur in the context of a severely reduced level of arousal or coma (I’m coming out of anesthesia)

evidence of an underlying organic causes

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17
Q

t/f: the a pt with dementia can have delirium on top of it

A

true

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18
Q

how can we differentiate if cognitive deficits are the dementia or delirium in a pt with dementia?

A

get an idea of the pt’s baseline cognition from family members

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19
Q

does delirium or dementia have an acute onset?

A

delirium

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20
Q

does delirium or dementia have chronic decline?

A

dementia

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21
Q

is delirium or dementia persistant?

A

dementia

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22
Q

is delirium or dementia fluctuating?

A

delirium

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23
Q

does delirium or dementia primarily affect attention?

A

delirium

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24
Q

does delirium or dementia affect any cognitive domain?

A

dementia

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25
Q

is dementia or delirium more age independent

A

delirium

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26
Q

is dementia or delirium a neurodegenerative disease associated w/aging?

A

dementia

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27
Q

what are the risk factors for delirium?

A

age >70

male

dementia

meds (polypharmacy)

acute illness

infection

exacerbation of chronic illness

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28
Q

what are some causes of delirium?

A

illicit drugs, dehydration, detox, deficiencies, discomfort

electrolytes, elimination abnormalities, environment

lungs (hypoxia), liver, lack of sleep, long ED stay

infection, iatrogenic events, infarction

restraints, restricted mobility, renal failure

injury, impaired sensory input, intoxication

UTI, unfamiliar environment

metabolic abnormalities, metastasis to brain, meds

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29
Q

t/f: anytime you take someone out of their typical living environment and put them somewhere different, they are at risk for delirium

A

true

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30
Q

a stay in the ED longer than ______ b4 getting on the hospital floor is a risk for delirium

A

12 hours

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31
Q

what are iatrogenic events?

A

harm caused by medical interventions

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32
Q

how do restraints create a cycle of delirium?

A

pts are put in restraints bc delirium makes them a danger to themselves and others but then being in restraints creates further risk for delirium

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33
Q

what are some prevention strategies for delirium?

A

address contributing factors

re-orient them

promote circadian rhythm

encourage the presence of familiar care-givers

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34
Q

how can we re-orient pts to prevent delirium?

A

when they get A&O questions wrong, correct them

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35
Q

how can we orient pts to day time?

A

open windows

turn on lights

do activities

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36
Q

how can we orient pts to night time?

A

turn off screens

turn off lights

close windows

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37
Q

t/f: infectious disease can be the reason for admission or acquired during admission

A

true

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38
Q

how can infectious diseases be acquired during admission?

A

pt to pt

provider to pt

pt to provider to pt

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39
Q

what factors can increase risk for infectious disease?

A

longer LOS

surgery

invasive procedures

wounds

immune status

comorbidities

age

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40
Q

why do invasive procedures put a pt at risk for infectious disease?

A

bc it bypasses the body’s natural mechanisms for fighting infection (skin, resp, Foley)

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41
Q

what comorbidity especially puts a pt at risk for infectious disease?

A

DM

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42
Q

t/f: increased age puts pts at risk for infectious disease

A

true

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43
Q

what is the reference range for WBCs?

A

5,000-10,000

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44
Q

what is leukocytosis?

A

increased in WBCs

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45
Q

what is leukopenia?

A

decrease in WBCs

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46
Q

when would we look at a pt’s absolute neutrophil count (ANC)?

A

when they are very compromised

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47
Q

what are the causes of leukocytosis?

A

infection

inflammation

bone marrow disease

immune system disorder

severe stress/pain

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48
Q

how would a pt with leokocytosis present?

A

fever

fatigue

bleeding

bruising

frequent infections

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49
Q

t/f: high WBCs are not usually dangerous unless >100,000

A

true

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50
Q

pts with WBCs >100,000 are at risk for complications in what systems?

A

cardiac

pulmonary

renal

neuro

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51
Q

when would high WBCs be a good thing?

A

when a pt has a known infection, it can tell us their body is fighting the infection

can tell us that a pt has an infection b4 they have any outward signs

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52
Q

what are the causes of leukopenia?

A

chemo

radiation

marrow infiltrative diseases

infections

dietary deficiency

autoimmune disease

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53
Q

how would a pt with leukopenia present?

A

frequent/persistant infections

inflammation/ulcers in/around the mouth

headache

stiff neck

sore throat

fever/chills

night sweats

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54
Q

t/f: pts with leukopenia may be on neutropenic precautions

A

true

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55
Q

what are the clinical implications of leukopenia?

A

neutropenic precautions

monitor s/s of infection

monitor fatigue using RPE

there is an increased falls risk

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56
Q

leukopenia is typically associated with _________ or __________

A

bone marrow cancer; chemo/radiation

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57
Q

what are the most numerous WBCs and 1st line to fight an infection?

A

neutrophils

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58
Q

what is an absolute neutrophil count (ANC)?

A

the total neutrophil granulocytes present in the blood

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59
Q

ANC <______ indicates severe immunocompromised and increased risk of infection

A

1,000

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60
Q

ANC of <_____ indicates the highest risk for infection

A

500

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61
Q

ANC of _______ indicates moderate risk for infection

A

500-1000

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62
Q

ANC of >_____ indicates low risk for infection

A

1000

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63
Q

t/f: there are universal standards for neutropenic precautions

A

false, they vary

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64
Q

what are the environmental precautions for neutropenic precautions?

A

no plants/flowers

damp dust only

no room manintanence

no foods that can’t be washed (ie. berries)

65
Q

what are the equipment precautions with neutropenic precautions?

A

must be dust free

disinfect w/disinfectant wipes bw pts

66
Q

t/f: the door should be kept closed with neutropenic precautions

A

true

67
Q

what are the transportation precautions for neutropenic precautions?

A

transport for essential purposes only

have the pt wear N95 respiratory if severely immunocompromised

68
Q

if a pt is on neutropenic precautions all ppl recovering from respiratory illness must wear a mask

A

true

69
Q

when entering/leaving the room of a pt on neutropenic precautions, what should we do?

A

use waterless foam of wash hands

70
Q

if gloves are not needed, why should we not use them?

A

bc they make it less likely that we will follow hand hygiene

71
Q

when should we use gloves?

A

when there is a chance of coming in contact with bodily fluids

72
Q

what are standard precautions/universal precautions?

A

precautions used for all pts in the hospital

hand hygiene

clean pt care areas and equipment

handle laundry carefully

proper handling of sharps

treat all body fluids as if there were infected

wear gloves when reasonable suspicion of coming in contact with bodily fluids

73
Q

when are contact precautions used?

A

for infectious disease spread by direct or indirect contact

MRSA, CRE, C.diff

74
Q

what are contact precautions?

A

private room/others with the same infection

gloves and gown (removed b4 leaving the room)

limit transportation

single use equipment where possible

75
Q

when are droplet precautions used?

A

for infectious diseases that create particles that can be spread in the air but don’t travel far (no more than 3 feet)

spread by coughing, sneezing, vomiting

flu, RSV, adenovirus

76
Q

what are droplet precautions?

A

private room/others with the same infection

surgical mask

limit pt transport

77
Q

when are airborne precautions used?

A

for infectious diseases that create extremely small particles that remain suspended in the air

varicella (chicken pox)

zoster

COVID-19

tuberculosis

78
Q

t/f: all PT must be done in the pt’s room with airborne precautions

A

true

79
Q

who is not allowed in the room with a pt with varicella/zoster?

A

pregnant people

80
Q

what are airborne precautions?

A

private room (neg air pressure)

door closed

N95 respirator

limited pt transport

restrict entry of susceptible ppl

81
Q

what is the purpose of negative air pressure?

A

to prevent air from getting out of the room when the door is opened

82
Q

what neuro health conditions are treated in the hospital?

A

stroke

TIA

TBI

neuromuscular diseases (PD, MS, GBS, ALS, myasthenia gravis, chronic idiopathic demyelinating polyradiculoneuropathy)

83
Q

why do we want a CT scan taken within 30 minutes and read within 45 minutes of arrival for a stroke?

A

to determine if it is hemorrhagic or ischemic bc they are treated differently

84
Q

if a CT scan shows an ischemic stroke, that can be given?

A

fibrinolytic therapy

85
Q

when should fibrinolytic therapy be given?

A

within an hour of arrival and 3 hours of symptoms onset

86
Q

what is the most common stroke we will see?

A

ischemic stroke

87
Q

what causes an ischemic stroke?

A

blockage of blood flow (embolic, thrombotic, atherosclerotic) causing tissue damage

88
Q

what is the core infarct of a stroke?

A

an area of irreparable damage

89
Q

what is the penumbra?

A

the area around the corner infarct that has low blood flow at high risk for cell death

90
Q

what is the focus of treatment of stroke in the first 24 hours?

A

preserving stability of cells within the penumbra

91
Q

what are the medical interventions for ischemic stroke?

A

intravenous thrombolysis

mechanical thrombectomy

assess for course of emboli

92
Q

what is intravenous thrombolysis?

A

tPA (an IV med given to breakdown a blood clot)

93
Q

what is mechanical thrombectomy?

A

a catheter threaded into the cerebral artery and clasps the clot to remove it

94
Q

how do we assess for the source of an emboli?

A

do an EKG for a-fib

do an echocardiogram (US of the heart) for vegetations (buildup of bacteria with collagen fibers laid around it that can become an emboli) on heart valves and endocardium

carotid US for carotid stenosis

95
Q

how is endocarditis treated?

A

with IV antibiotics for 6 weeks then may need to go undergo open heart surgery for valve replacement

96
Q

> 70% occlusion of the carotid indicates need for what?

A

carotid endarterectomy

carotid artery stenting

97
Q

what are the PT considerations with ischemic stroke?

A

typically 24 hours bed rest

early mobilization leads to better fxnal outcomes

BP may be purposefully higher to increase perfusion of brain tissue

98
Q

why are ischemic stroke pts typically put on 24 hour bed rest following the event?

A

to prevent hypotension w/upright positioning that would lead to hypo-perfusion of the brain

99
Q

what is permissive HTN?

A

purposefully high BP to promote cerebral blood flow and preserve as much brain tissue as possible

100
Q

permissive HTN keeps BP around what?

A

220/120 mmHg

101
Q

how long are BP control meds paused with permissive HTN?

A

24-48 hours

102
Q

what is the purpose of permissive HTN?

A

to maintain cerebral perfusion

103
Q

t/f: after 24-48 hours of permissive HTN BP is returned to normal immediately

A

false, BP should very slowly be brought back down, not all at once

104
Q

how should we treat pts in PT with permissive HTN?

A

use a symptom based approach and monitor their response to activity

105
Q

what is a hemorrhagic stroke?

A

abnormal bleeding of cerebral vessels

106
Q

what are the different types of bleeds in hemorrhagic stroke?

A

intracerebral hemorrhage (ICH)

subdural hemorrhage (SDH)

subarachnoid hemorrhage (SAH)

107
Q

in which type of stroke is there tissue damage in the area distal to the bleed and other tissues due to buildup of pressure?

A

in a hemorrhagic stroke

108
Q

pts with a hemorrhagic stroke are typically admitted to the ICU for what medical management needs?

A

ICP monitoring and management

airway protection

BP management

surgery

109
Q

what is the BP goals post hemorrhagic stroke?

A

SBP <140 mmHg

110
Q

what kinds of surgeries may be done for hemorrhagic stroke?

A

hematoma evacuation

decompressive hemicraniectomy

clipping

endovascular coiling

111
Q

what is a clipping surgery for hemorrhagic stroke?

A

clipping off an aneurysm causing weakness in the vessels to it can’t rupture can cause further bleeding

112
Q

what is endovascular coiling for hemorrhagic stroke?

A

when wire is coiled into an aneurysm to prevent blood from entering it and causing a rupture and further bleeding

113
Q

what are the PT considerations for hemorrhagic stroke?

A

strict BP control (SBP <140 mmHg)

HOB elevated >30 deg

114
Q

why should the HOB be elevated >30 deg post hemorrhagic stroke?

A

to prevent a sudden rush of blood to the brain where there is an area of weakness that could rupture and cause further bleeding

115
Q

what are the general stroke considerations in acute care?

A

shoulder protection (educate pt and family)

dysphagia (reinforce SLP recommendations)

116
Q

if SLP confirms dysphagia in a pt post stroke, where should the HOB be?

A

elevated to >30 deg to prevent aspiration

117
Q

what outcome measures are used in acute care for stroke?

A

Orpington prognositic scale (OPS)

postural assessment scale for stroke (PASS)

stroke rehab assessment of movt (STREAM)

118
Q

what does a higher OPS score mean?

A

more impaired

119
Q

what does an OPS score of <3.2 mean?

A

high likelihood of returning home

120
Q

what does an OPS score of 3.2-5.2 mean?

A

respond better to rehab

121
Q

what does an OPS score of >5.2 mean?

A

typically dependent w/increased risk of institutionalization

122
Q

what are the subcategories of the PASS?

A

maintaining a posture

changing a posture

123
Q

what activities are involved in a PASS?

A

sitting w/o support

standing w/support

standing w/o support

standing on nonparetic leg

standing on paretic leg

supine to paretic side

supine to nonparetic side

supine to sitting EOB

sitting EOB to supine

sitting to standing

standing to sitting

standing, picking up a pencil from the floor

124
Q

to predict ambulatory ability ability at 30 days post stroke, the PASS maintaining posture score must be >___, the changing posture score must be >_____, and the total PASS score must be >_____

A

3, 8, 12

125
Q

what are the 3 subsections of the STREAM?

A

upper limb mov’t

lower limb mov’t

basic mobility

126
Q

what does BE FAST stand for?

A

Balance
Eyes (blurred vision)

Face (drooping)
Arms (weakness)
Speech (slurred)
Time

127
Q

what are the indications for intracranial surgery?

A

elevated ICP

brain biopsy need

hemorrhage evacuation

aneurysm embolization (coils)

brain tumor removal

AVM repair

128
Q

what is a Burr hole?

A

a small hole made in the cranium w/specialized drill to evacuate hematoma, clot, intracranial pressure management, brain biopsy, or to place a stereotactic device

129
Q

what is a craniotomy?

A

surgical opening in the skull to provide access to the brain to remove a tumor, clip an aneurysm, or repair damage to the cerebrum

130
Q

what is a craniectomy?

A

similar to a craniotomy except the bone flap is removed to decompress the brain tissue or fight infection

131
Q

t/f: the bone bank is stored in the lining of the stomach following a craniectomy

A

true

132
Q

what is a cranioplasty?

A

replacing the bone flap the was excised during a craniectomy

133
Q

t/f: the bone replacement in a cranioplasty may be the og bone, a graft, or acrylic material

A

true

134
Q

what are the craniotomy precautions? (used for all brain surgeries)

A

HOB > 30 deg

avoid valsalva

no head below level of shoulders

135
Q

what precautions is taken following a craniectomy?

A

protective helmet is to be worn for mobility

136
Q

why is are pts very symptomatic following acoustic neuroma removal?

A

bc of the resultant edma and trauma to the area

137
Q

what are some other considerations post intracranial surgery?

A

light sensitivity

visual disturbances

sensory overload/concentration issues

138
Q

why do visual disturbances sometimes occur following intracranial surgery?

A

bc edema tends to buildup around the optic nerve

139
Q

bc pts post intracranial surgery may have sensory overload/concentration issues, what should we do during our treatment?

A

split up treatment and education

provide written instruction bc not much of what is said to the pt will be taken in

140
Q

what are the indications for spinal surgery?

A

unstable spine

cauda equina syndrome

tumor decompression

spinal stenosis

disc herniation

nerve root compression

spinal deformity

141
Q

what is a discectomy?

A

excision of protruding disc material done via laminectomy or microdiscectomy

142
Q

what is a laminectomy?

A

excision of post vertebral arch to access disc for a discectomy

143
Q

what is a microdiscectomy?

A

incision made in the inf aspect of the lamina to extract disc material

144
Q

what is a foraminotomy?

A

surgical enlargement of the intervertebral foramen to remove stenosis

145
Q

what is a spinal fusion?

A

bone graft placed to join and fuse adjacent segments

may or may not use fixation

146
Q

what is a posterolateral lumbar fusion (PLF)?

A

excision of lamina and other structures to place bone grafts to fuse adjacent segments

147
Q

what is a posterior lumbar interbody fusion (PLIF)?

A

similar to PLF except it also replaces the disc w/an intervertebral body cage

148
Q

what is an anterior lumbar interbody fusion (ALIF)?

A

similar to PLIF except via an anterior approach

retroperitoneal incision for lumbar spine

149
Q

what is a vertebroplasty?

A

IR guided injection of cement into a vertebral body to repair a compression fx

150
Q

what are the lumbar spine precautions?

A

no lifting >10lbs
no spine flexion

so spine rotation

avoid sitting >30 min

fusions may require braces

151
Q

what are the lumbar bracing options?

A

lumbar spine orthosis (LSO)

thoracic and lumbar spine orthosis (TLSO)

152
Q

t/f: lumbar spine braces should be loose enough for two fingers to slide bw the brace and skin but tight enough that you cant twist them

A

true

153
Q

what are the spinal bracing considerations?

A

appropriate fit

independent in donning/doffing

skin protection

wearing schedule

154
Q

when is a clamshell TLSO used?

A

for more extensive fusions or unstable spines

155
Q

what are the cervical spine precautions?

A

no lifting >10 lbs

no spine flexion

no spine rotation

fusions may require braces

156
Q

t/f: cervical collars are often worn all the time (including to bed), esp for fusions

A

true

157
Q

when switching cervical collars for showering, how should it be done?

A

remove only the front or back at a time

158
Q

t/f: cervical collars should be snug w/the head in neutral

A

true

DPT 629: Cardio (11 decks)

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