Geri Flashcards
specific form of delirium and agitation that occurs in the final weeks, days or hours of life.
Terminal restlessness
specific form of delirium and agitation that occurs in the final weeks, days or hours of life.
Terminal restlessness
occurs in the final days or hours and involves observable signs of systemic failure.
active death
__ care is a medical specialty focused on aggressive symptom management.
Palliative care
Palliative visits tend to focus __ on the actual disease and __ on what impact it has on the patient’s life
less
more
__ is a medical insurance benefit, with its own set of regulations
hospice
Hospice care is typically provided in the __ whereas palliative tends to be __
home,
hospital /clinic based
Hospice care for patients with terminal conditions where survival is typically __
__ : provides: exercise and functional training during each weekly or biweekly visit.
rehabilitation light
__ utilization of skilled patient training and instruction to caregivers as a person moves through the transitions from an independently mobile level to a more dependent one as the disease progresses and as strength and balance decrease.
rehabilitation in reverse
__long term ongoing care for challenging and changing conditions.
case management
__ care that might under usual circumstances be taught to a caregiver now requires the skill of a PT because of complexity.
skilled maintenance
__ often provided throughout the occurrence of care and is comprised of the psychosocial support associated with end of life process as well as physical measures.
supportive care
__ Legal document that provides a clear statement of the patient’s desires for care in the event of imminent death (a living will) an the appointment of a person to make decisions on their behalf should they become incapacitated (medical power of attorney)
Third element includes an optional DNR document, which is usually printed on bright orange paper and displayed in a prominent place.
advance directives
IRF - patient must receive at least __ a day of PT, OT, or SLP
daily is defined as __
3 hours/day
5 days/week
Skilled Care requires that patients be in an appropriate __payment group to be considered a “skilled” patient.
RUGs
IRF services must be __ and __ for the treatment of the patient’s condition
reasonable & necessary
Services IRF must provide?
Rehab nursing, rehab services (OT, PT, SLP) audiology Orthotic and prosthetic social and psychological services
services SNf must provide
nursing restorative services rehab services (PT, OT, SLP) audiology orthotic & prosthetic emergency dental social and or psychological services
IRF = \_\_ day per spell of illness SNF = \_\_ days per spell of illness
90
100
IRF pays for first __ days then day _-__ co pay
60
61-90
SNF – first __ days fully covered if meets RUGs criteria; co-pay for the ___ day; 3-day pre-qualifying hospital stay required.
20
21-100 day
__ =The period which begins when a patient is furnished inpatient hospital care
ends when the patient has neither been an inpatient of the hospital or skilled nursing bed for__ consecutive days.
spell of illness
60
SNF has a __ day qualifying stay in the rehabilitation unit would qualify a patient for skilled care
3
13 diagnosis for IRF
Stroke Spinal cord injury Congenital deformity Amputation Major multiple trauma Fracture Polyarthritis, including rheumatoid arthritis Neurological disorders, including multiple sclerosis, motor neuron diseases, polyneuropathy, muscular dystrophy and Parkinson’s disease Burns
IRF rehab diagnosis has __ case mix groups
95
__ % of patients admitted into the IRF must fall into one of the 13 specified diagnosis.
60%
SNF
The pt. must be certified and recertified as requiring skilled care by the MD on admission, the __th day and every __ days thereafter.
14th
30 days
Rug LEvels
In the last 7 days:
Received 720 or more minutes of therapy
At least 2 disciplines, 1 for at least 5 days, and the 2nd for at least 3 days
ultra high
RUG levels
In the last 7 days:
Received 500 or more minutes of therapy
At least 1 discipline for at least 5 days
very high
RUG level
In the last 7 days
Received 325 or more minutes
At least 1 discipline for at least 5 days
high
RUG level
Rehabilitation Rx 150 minutes/week or more
5 days any combination of three rehabilitation disciplines.
medium
RUG level
Rehabilitation Rx 45 minutes/week or more
3 days any combination of three rehabilitation disciplines and restorative nursing, two or more services, 6 or more day/week.
low
RUG group
__ group Any one of the following services received within the last 14 days with an ADL sum >=7:
IV Feeding/parenteral feeding (within last 7 days)
Suctioning
Tracheostomy Care
Ventilator/Respirator
IV Medication
extensive services grou[
RUG group \_\_Group Any one of the following: Multiple Sclerosis with ADL sum >= 10 Quadriplegic with ADL sum >= 10 Cerebral Palsy with ADL sum >= 10 Respiratory Therapy = 7 Ulcers (2+ sites over all stages ), with treatment Any stage 3 or 4 pressure ulcer with treatment surgical wounds radiation therapy tube fed+ & aphasia fever
Special Care group
RUG Group \_\_ group Any one of the following: Burns Coma and not awake and completely ADL dependent Septicemia Pneumonia Foot Lesions or Infections w/dressings Internal Bleeding Dehydration Hemiplegia with ADL sum >=10 tube feeding oxygen therapy chemo therapy
Clinically complex group
__ is not a disease but rather a combination of a variety of medical problems.
Frality
Someone should be considered Frail if has __ or more of the following 5 characteristics:
3
Fraility characteristics (5)
Unintentional weight loss (10 lbs or more in a year)
General feeling of exhaustion (self-report)
Weakness
Slow walking speed
Low levels of physical activity
Normal frequency of urination is once every __ during daytime
__voids during nighttime hours
once every 2 hours
1-2 voids @ night
\_\_ bladder capacity \_\_ residual urine \_\_ involuntary bladder contractions \_\_ outlet resistance (female) \_\_ ability to inhibit contraction \_\_ outlet resistance (male)
decreased increase increase decrease decrease increase
Risk factors for UI
immobility medications obesity smoking stroke low fluid intake diuretics diabetes estrogen depletion
\_\_ Loss of urine that occurs during activities that increase intra-abdominal pressure: Coughing Sneezing Laughing Physical activity Caused by pelvic muscular weakness as a result of: Pregnancy Obesity Surgery Medications Aging
Stress UI
Risk factors for Stress UI (12)
age, estrogen loss Caucasian family history obesity smoking chronic cough pelvic surgery chronic constipation neurological disorders
intervention for stress incontinence
Kegels 2-5 sets several times a day
feedback
Physical or psychological impairment that results in incontinence when the urinary tract is healthy.
Causes:
Decreased mobility
Pain
Clothing that is restrictive
Psychological factors
Ability to put on and take off clothing.
Sequence of tasks involved in toileting.
Mobility – ability to ambulate, use an assistive device or transfer to/from toilet.
Access to toilet/device (urinals, bedside commodes, etc.)
Functional UI
Psychological message that UI is expected.
Chairs are plastic
Beds are protected
Pads are available and applied “just in case”.
Architectural design
Long corridors
Poorly marked bathroom doors
Caregiver attitudes
“Go ahead and go, I’ll clean you up later”
“She/he does that on purpose”
Environmental Incontinence
a loss of urine with an abrupt and strong desire to void.
“I’m unable to make it to the bathroom on time.”
caused by an overactive detrusor muscle, resulting in excessive involuntary bladder contractions that may be initiated by:
cancer (bladder / prostate)
infection
spinal or nerve damage
Urge UI
URge UI treatment options (3)
Behavioral therapy
estim
medications
Urgency perception score
0-4
0 = convenience no urge 1 = mild urge (Can hold more than 1 hour) 2 = Moderate urge (can hold for 10-60 seconds) 3 = severe urge (can hold
Loss of urine related to the over distention of the bladder. frequent or constant dribbling; may include urge or stress UI
least common; hard to diagnosi\e
overflow UI
2 scales used for female pelvic floor muscle function
Brink - (3-12) intensity of contraction, vertical displacement, muscle contraction duration
Modified oxford - simpler/easier 0 (lack of muscle) -5 (strong contraction)
drug distribution changes include __ cardiac output
__ total body water
__ serum albumin
__ body fat
decreased
decreased
decreased
increased
With aging, liver mass \_\_ hepatic blood flow \_\_ renal mass is \_\_ \_\_ glomerular filtration \_\_ tubular secretion and absorption \_\_ creatinine clearance
decreased decreases decreased decrease decreased decreased
__ Defined as an unpleasant sensory and emotional experience.
Whatever the experiencing person says it is;
Existing whenever he/she says it does
pain
__ defines pain that results from injury, surgery, or trauma. It may be associated with autonomic activity, such as tachycardia and diaphoresis. Acute pain is usually time-limited and subsides with healing.
acute pain
__ defines pain that lasts for a prolonged period (usually more than 3–6 months) and is associated with chronic disease or injury (e.g., osteoarthritis).
persistent pain
__ Refers to pain caused by stimulation of specific peripheral or visceral pain receptors.
This type of pain results from disease processes (e.g., osteoarthritis), soft-tissue injuries (e.g. falls), and medical treatment (e.g., surgery, venipunctureand other procedures).
It is usually localized and responsive to treatment
nociceptive pain
__ Refers to pain caused by damage to the peripheral or central nervous system
neuropathic pain
__ is the gold standard for pain assessment
self-report
__ Pain Results from an injury, surgery, or disease-related tissue damage.
Usually associated with autonomic activity, such as tachycardia and diaphoresis.
acute pain
__ pain Usually last more than 3-6 months.
May or may not be associated with a disease process.
Autonomic activity is usually absent
chronic / persistent pain
__ Pain Results from disease processes (osteoarthritis, soft tissue injuries (falls or trauma), and medical treatment (surgery and other procedures
Nociceptive pain
__ pain Caused by pathology in the peripheral or central nervous system.
Neuropathic pain
Orthotics have a __ pressure principle located __ and __
3 point pressure principle
1 area of deformity or angulation
2 counter forces acting in opposite direction
__ opening: has stitched down vamps, not suitable for orthotic wear.
bal (balmoral)
__ opening: has vamps (the flaps contain the lace stays) that open wide apart from the anterior margin of the shoe for ease of application.
blucher opening
When foot cannot attain neutral, FO may shim the gap to that fixed position-Accommodative = __ FO
accommodating FO
__ FO May help the foot attain a neutral position-Corrective
Corrective FO
FO Longitudinal Arch supports Prevent depression of the subtalar joint and correct for __
pes planus (flat foot)
University of California Biomechanics Laboratory Insert (semi-rigid plastic molded insert to correct for flexible __
pes planus
scaphoid pad is used to support __
longitudinal arch
__is a heel wedge with an extended anterior medial border used to support the longitudinal arch and correct for flexible pes valgus-pronated feet).
thomas heel
rear foot posting
varus post limits __
valgus post limits __
eversion/pronation
inverted/supination
forefoot posting
medial wedge prescribed for forefoot __
lateral wedge for ___
varus
valgus
Heel lifts or heel platform accommodates for __ & accommodates for limitation in __
leg length discrepancy;
ankle joint DF
