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Geri > Geri Midterm > Flashcards

Geri Midterm Flashcards

1
Q

Alzheimer’s Disease

A
  • most prevalent type of progressive dementia
  • lifespan = 4-8 years after receiving dx
  • probs with remembering names of individuals and recent events
  • lack of interest/depression
  • decline in communication ability
  • decline in judgement
  • disorientation/confusion (*especially in new environment)
  • off-set circadian rhythm (sleep/wake cycle)
  • change in behaviors
  • end stage: probs with gait, speech, swallowing
  • most die from secondary cause of aspirating pneumonia
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2
Q

Vascular Dementia

A
  • insufficient O2 blood getting to the brain
  • common causes are: stroke, TIA, untreated high BP
  • disease tends to plateau to huge decline
  • impairments in executive functions
  • confusion/disorientation
  • loss of vision
  • lang probs
  • impaired decision making and judgement
  • decrease in ability to plan and organize
  • daily fluctuations in cognition
  • sx can be similar to AD (Alzheimer’s) or be more localized
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3
Q

Dementia with Lewy Bodies

A
  • probs with attention
  • impairments in memory
  • sleep disturbances (violent)
  • visual hallucinations (often small children and animals)
  • thinking and reasoning probs
  • confusion and varied alertness
  • memory loss
  • Parkinsonian type mvmnts
  • Probable dx, has to be definitive by autopsy
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4
Q

Dementia with Lewy Bodies: Parkinson’s dementia

A

-starts with motor component then cognitive issues (pt has Parkinson’s)

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5
Q

Dementia with Lewy Bodies (parkinsonian onset)

A

-starts with cognition probs then motor component

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6
Q

Frontotemporal Dementia

A
  • common with 45-65 years old
  • frontal and temporal lobe affected
  • changes in personality and behavior
  • lang probs
  • alterations in muscle and/or motor functions
  • changes in behavior
  • “drunk like” behavior (slurring, uncoordinated, impulsive)
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7
Q

Mixed Dementia

A
  • Two or more types of dementia
  • More than one type occurring together
  • Often Alzheimer’s and Vascular
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8
Q

Stage 1 Dementia

A
  • normal
  • NO cognitive changes
  • NO decline in functioning
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9
Q

Stage 2 Dementia

A
  • normal age related changes
  • NO dx
  • subjective deficits in word-finding or recalling location of objects
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10
Q

Stage 3 Dementia

A
  • mild COGNITIVE impairment
  • mental age = 12+ years
  • aware of deficits
  • try to hid deficits
  • own strategies to compensate
  • can become angry when asked questions they have difficulty with (hiding deficit)
  • forgets if they do not write it down
  • usually still driving
  • trouble with directions in new places
  • home is stills safe
  • independent in ADL, IADL (may question judgement)
  • slight judgement issues
  • descriptions lack detail
  • unable to recall names of people and objects
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11
Q

Stage 4 Dementia

A
  • mild dementia
  • mental age = 8-12 years
  • challenges set in
  • things are difficult (i.e. forget to pay bills)
  • repeating stories
  • having trouble staying on topic in conversations
  • distracted by surrounding environment
  • can still learn
  • good stage for implementing new learning (i.e. mobility device, checklist)
  • assistance in IADLs
  • still independent in ADLs
  • supervision in cooking
  • assisted living, suite in fam home
  • asks questions over and over
  • impaired comprehension
  • greater effort to perform tasks
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12
Q

Stage 5 Dementia

A
  • moderate dementia
  • mental age = 5-7 years
  • cross over of being aware to not being aware
  • caregiver responsibility
  • NOT safe living at home alone
  • live in caregiver, supervised institution
  • can dress but not aware of weather outside
  • disheveled look
  • will not remember to wash clothes
  • can bathe and toilet but hygiene is questionable (i.e. wash front but not back)
  • changes can become evident in tone, reaction time, movement time, and gait
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13
Q

Stage 6 Dementia

A
  • moderate to severe dementia
  • mental age = 2-5 years
  • same level of assist for BADLs
  • difficulty with utensils
  • toileting program
  • assistance in dressing, help with getting clothing on
  • 24 hour supervision for safety
  • assistance in basic tasks (dressing, eating, toileting)
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14
Q

Stage 7 Dementia

A
  • severe dementia
  • mental age = 2 months-1.2 years
  • primitive reflexes come back
  • incoherent
  • incapable of speech
  • completely disoriented
  • cannot recognize relatives
  • incontinent in both bowel and bladder
  • dependent on others for ALL tasks
  • will not remember to breathe
  • cannot sit up and hold head up
  • trouble swallowing
  • primitive reflexes: rooting, palmar, babinski
  • contractures are most common in this stage
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15
Q

ARMD (amacular degeneration)

A
  • inability to see centrally
  • central vision loss
  • straight lines look wavy
  • corrective lens surgery
  • special vitamins and healthy diet can help with dry management to less the change of sx worsening
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16
Q

Dry ARMD

A
  • common
  • macula gets thinner with age
  • tiny clumps of protein growing
  • can develop into wet form
  • can learn to read out of periphery
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17
Q

Wet ARMD

A
  • less common
  • more serious
  • new abnormal blood vessels grow
  • scarring of macula
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18
Q

Cataracts

A

C=Cloudy

  • cloudy lens
  • common dx
  • decreased color sensitivity and glare
  • alot of sunlight is too bright
  • surgical procedure
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19
Q

Diabetic Retinopathy

A
  • vision loss in diabetes
  • spots or blotches
  • blood vessels in retina bleed
  • injections
  • laser tx
  • eye surgery
  • important to control blood glucose level
20
Q

Glaucoma

A
  • progressive optic nerve damage
  • loss of peripheral vision
  • headaches
  • tunnel vision
  • surgery
  • open angle
  • closed angle
21
Q

Glaucoma: closed angle

A
  • not as common
  • medical emergency
  • increase in pressure
  • bad headache
  • halo around lights
  • pain in the eye
22
Q

Visual Acuity

A
  • the smallest high contrast detail that one can resolve
  • decline in near vision is inevitable by age 40-45
  • cataracts affects acuity
23
Q

Contrast Sensitivity

A
  • ability to see larger low-contrast objects
  • measures how faded or washed out an image can be before it becomes indistinguishable
  • cataracts affected the most with contrast
  • impairments in: driving, mobility, face recognition, additional ADLs
24
Q

Visual Field

A
  • the amount an individual can see while looking straight ahead while fixated on one point
  • when closing one eye it opens up the visual field more
  • Amsler grid test (dot test, ARMD = if lines are contured or distorted it has become the WET form of ARMD)
25
Q

Medicare

A

health insurance for:

  • over the age of 65 years
  • under the age of 65 years with a specified disability
  • federally funded health insurance
  • pays for health care services
  • end stage renal disease
  • ALS
26
Q

Medicare: Automatic Eligibility

A
  • over 65 years and older and receives social security benefits or railroad retirement board
  • younger than 65 years with certain disability if receiving social security benefits or railroad retirement board for 2 years
  • ALS (within the month that disability benefit starts)
  • paid into social security for a certain amount of years
27
Q

Medicare: Requires Enrollment

A
  • over 65 years and not current getting social security benefits or railroad retirement board
  • has end stage renal disease
  • is not eligible and wants to buy in
28
Q

Medicare Part B: Durable Medical Equipment (DME) Coverage

A
  • w/c
  • walker
  • 3 in 1 commode
29
Q

Therapy: Medicare Part A

A
  • has to have a minimum of 3 day stay at the hospital
  • 100 day per benefit period
  • day pt gets to the SNF is when benefits start
  • re-access if readmitted to SNF within 30 days
  • inpt hospital care
  • surgical procedures
  • lab tests
  • skilled nursing facility
  • hospice care
  • home health care
30
Q

Therapy: Medicare Part B

A
  • has a therapy cap every year
  • once cap is up there is a kx modifier for justification of services
  • preventative services
  • MD and other health care services and tests
  • outpatient care
  • DME
  • ambulance services
31
Q

Therapy: Medicare Part C

A

-health coverage option run by private insurance companies approved by and under medicare contract

32
Q

Therapy: Medicare Part D

A
  • D = Drugs
  • prescription drug coverage option run by private insurance companies approved by and under contract with Medicare
  • helps to cover cost of prescription drugs
33
Q

Individual

A
  • treatment of one pt at one time by one therapist
  • the pt is receiving the therapists full attention
  • Medicare part A and B: tx session mins may be billed in full
  • what we should be planning for
34
Q

Co-treatment

A
  • only one pt
  • 2 different disciplines treating pt as a team
  • both disciplines have different treatment focus
  • identify why we provide co-treatment (justification)
35
Q

Co-treatment: Medicare part A

A

-both disciplines with different focus can bill tx in full

36
Q

Co-treatment: Medicare part B

A
  • entire time billed for day cannot exceed actual time the pt got
  • time must either be divided by disciplines or one therapist may bill for the entire time
37
Q

Concurrent

A
  • tx of 2 pts by same therapist at same time performing DIFFERENT TASKS with one therapist
  • OT splitting attention between pts
38
Q

Concurrent: Medicare part A

A

-bill full time under concurrent tx

39
Q

Concurrent: Medicare part B

A
  • does NOT exist

- have to bill as group

40
Q

Group: Medicare part A

A
  • tx of 4 or more pts by one OT

- tx of 4 ore more pts at the same time who are doing the same or similar activities with one therapist

41
Q

Group: Medicare part B

A
  • tx of 2 or more pts (no more than 4) by one OT

- tx of 2 or more pts at the same time who are doing the same, similar, or different activities with one therapist

42
Q

Skilled Services (Billable)

A
  • set up time if it proceeds tx
  • rehab aide bringing over equip
  • education if pt is present and involved
  • re-eval as long as pt is involved and it is part of tx process
  • attended modalities (i.e. ultrasound)
  • development of maintenance program and caregiver training with the pt present in preparation for d/c
  • time spent incorporating documentation into tx if pt is involved for educational purposes
  • point of care services (iPad, computers)
43
Q

Non-Skilled Services (NOT Billable)

A
  • actual time on modality that is unattended
  • demonstration and performance of HEP
  • initial eval
  • time spent talking to pt if they refuse tx
  • non-therapeutic rest break (i.e. bathroom)
  • working outside requirements of the therapy mode
  • services requested by family
  • documentation when pt is not present
  • non-skilled portion of administering modality
44
Q

Medicare Part B (8 min rule)

A
  • reimbursement based on 8 min rule
  • bill for whatever modalities (CPT codes) we are providing for exact amount of mins
  • reimbursement is based on value of CPT codes
45
Q

Medicare Part B: Untimed Codes

A
  • group
  • modalities
  • evaluation

Geri (10 decks)

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