Med Surg Test 1- Objectives Flashcards
Explain the relationship between health, wellness, illness, and disease.
Health- the world health organization has defined health as a state of complete physical, mental, and social well-being and not merely as the absence of disease or infirmity.
Wellness- one end of the healthy spectrum. “health is an individuals level of wellness.”
Illness- often defined as sickness or deviation from a healthy state. The perception and response of the person to not being well.
Disease- refers to biologic or psychologic alteration that results in a malfunction of a body organ or system. It can be objectively documented through tests and measures.
- health=wellness; illness=death; medium in between where one can fluctuate between health & illness
Relate patient information given in a physical therapy evaluation to the following categories of health: biologic, psychological, spiritual, and sociologic
Health reflects a person’s biologic, psychological, spiritual, and sociologic health.
biologic- or physical state refers to the overall structure of the individuals body tissues and organs and to the biochemical interactions and functions within the body.
Psychologic- includes the individual’s mood, emotions, and personality.
Spiritual- the individual’s religious needs, which may be affected by illness or injury.
sociologic- interaction between the individual and the social environment.
Provide examples of common variables that can affect a person’s overall health
Genetic influence, cognitive ability coping strategies, gender, environment and lifestyle, geographic location, standard of living, culture, religion, health beliefs and practices, previous health experiences, support systems.
Describe the role of homeostasis in overall health and wellness
- Begins on a cellular level by receiving vital nutrition from the environment, then progresses to maintain overall equilibrium through all systems.
- can be a domino effect once one system gets out of whack, or once all function properly.
Decipher a given patient description and appropriately categorize it using the Nagi disablement model as the patient’s: pathology, impairment, functional limitation, or disability.
Disease or pathology- describes the underlying pathogenesis and abnormal cellular processes. (ex. osteoarthritis)
Impairments- Examples of impairment include reduced PROM/AROM, reduced muscle force, pain, swelling, anatomically short lower limb, excessive anterior glide of gh jt, decreased strength. Objectively measurable data.
Functional Limitations- restrict that person’s performance or specific actions (ex. inability to reach in cabinets, inability to climb stairs)
Disability- limitation of physical of mental function in a social context. (ex. inability to work, inability to feed self)
Decipher between the characteristics of restorative, wellness, maintenance, and preventative therapies
Physical Therapy interventions are considered restorative therapy. This indicates that there is a medical need for the intervention of a PT/PTA to restore the patients function.
Wellness clinics provide wellness therapy, prevention therapy, and maintenance therapy.
This is usually provided via exercise physiologists, personal trainers, nutritionists, athletic trainers, etc.
Explain the importance of studying wellness as it applies to your job as a PTA.
you as a health care professional should be able to answer questions related to general health issues and to be current on recent trends and concerns so that you can apply your knowledge to rehabilitate your patients to their fullest potential.
Provide examples of primary, secondary and tertiary disease prevention
Primary- removing or reducing risk factors. example- health fair screenings
Secondary- early detection of disease and employ preventative measures to avoid further complications. THIS IS WHAT WE DO!
Tertiary- aimed at limiting the impact of the established disease. Goal is to return person to highest possible level of function.
Describe the PTA’s role in promoting health and wellness
Understanding how to optimize a patient’s health and wellness allows the PT/PTA to customize interventions that will:
Enhance function
Improve overall fitness
Address comorbidities and prevent additional onsets.
PATIENT EDUCATION IS EXTREMELY IMPORTANT!
Discuss why EBP has become the major focus on health professionals
Increased focus on documentation, Increased healthcare costs, Increased focus on medical errors, Improving/changing technologies, Required by insurance to approve reimbursement
Explain the relationship between EBP and a PTA’s clinical experience.
“evidence-based physical therapy practice is ‘open and thoughtful clinical decision making’ about the physical therapy management of a patient/client that integrates the ‘best available evidence with clinical judgment’ and the patient/client’s preferences and values, and that further considers the larger social context in which physical therapy services are provided, to optimize patient/client outcomes and quality of life.”
Discuss the term “patient-centered care” and how EBP utilization facilitates this philosophy.
To integrate clinical expertise with current research findings (evidence) to facilitate the optimum outcome for your patient. EBP allows patient-centered choices for treatment interventions. “If there is a better way to practice, therapists should find it.”
Provide examples of practical barriers that inhibit the use of EBP in today’s workplace
67% of therapists that were surveyed stated that the biggest hurdle with utilizing EBP is finding time to do the research. Productivity issues are stifling the process. Almost 50% surveyed sited lack of confidence in ability to find, assess and apply the research.
Discuss the goals of EBP and why it is now such an emphasis in today’s healthcare model.
To navigate away from “anecdotal” practice. Become less of a “knobologist”. Provide sturdy ground for therapists to practice upon without the fear of repercussions. To again differentiate between a PT tech and PTA. To validate the need for physical therapy services due to our level expertise and skilled interventions.
Provide a summary of required characteristics of a PTA that wants to pursue the use of EBP.
Willingness to challenge the norm, ability to design appropriate research questions, knowledge of where to find relevant current information time,willingness to practice and apply new material.
List the 4 basic steps to implementing the EBP process.
Form a question, find clinical evidence related to the specific question and assess its relevance to the patient’s problem, apply the evidence to your patient’s treatment sessions, evaluate the outcome… did it work as well as you thought it would?
Explain why the use of EBP is considered a self-directed learning model.
As PTA’s we need to be able to know how to formulate effective research questions, where to locate relevant research, and to be skilled in analyzing the research once we’ve found it. EBP is a self-directed learning model because you get out of it what you put into it as far as the research goes.
Describe how the following concepts are related to EBP: awareness, consultation, judgment, creativity.
Awareness- knowing that evidence is out there somewhere and how to find it
Consultation- educating yourself and your patient on why you are choosing the interventions and their expected outcomes
Judgment- knowing how to analyze the data and make sound judgment as to if it will work for your patient’s problem
Creativity- how to apply the evidence presented in the study to what tools you have available for your patient
Compare and contrast the four phases of professional development.
Preservice Experiences - the level that you are at now. More book knowledge than hands on experience.
Novice Professional - the level you will be at graduation and for the next few years. Building your “patient database.”
Experienced Professional - after many years of experience. Able to pull from a “patient database” and form generalizations about patient populations
Expert Professional - forming questions looking for new possibilities. Performing own formal research studies
Differentiate between background and foreground questions.
Background questions- serve to find general information regarding a certain topic; textbooks, informational articles, support groups with internet resources , CDC website, etc. Helpful to be familiar with background information prior to formulating a foreground question.
Foreground questions- serve to find a specific relationship between information pertaining to a patient, pathology or intervention.
Recognize the difference between a peer reviewed article and non-peer reviewed article; include how each is applied to your profession as a PTA.
Peer review ensures that an article-and therefore the journal and the scholarship of the discipline as a whole-maintains a high standard of quality, accuracy, and academic integrity. When you consult peer-reviewed sources, you are tapping into a wealth of established, verified knowledge. Citing such sources in your assignments gives your work credibility and demonstrates that you’re familiar with the issues and trends in the field of study.
Describe the desired characteristics of a good research article.
- The study addresses the specific clinical question the physical therapist is trying to answer.
- The subjects in the study have characteristics that are similar to the patient/client about whom the physical therapist has a clinical question
- The study was published in a peer-reviewed medium (paper, electronic)
- The context of the study and/or the technique of interest are consistent with contemporary health care.
Describe the following research designs to allow recognition and understanding of the levels of bias with each: RCT, systematic reviews, quasi-experimental, observational, physiologic, case studies, narrative reviews, historical.
RCT- randomized controlled trials , or randomized clinical trials. Highest probability to reduce bias. (Experimental designs)
RCT divides its subjects into two or more groups and the researcher has control over how each is affected. (Control and experimental groups, etc.)
Single System Design RCT- only one person is studied, but receives both controlled and experimental conditions to compare results
Systematic reviews- cumulative study of multiple research reports to find an answer. Will have its own inclusion/exclusion criteria.
*Quasi-experimental designs - may not divide into subject groups, or may not randomize selection of groups.
*Observational / non-experimental designs - same as quasi-experimental but additionally does not include experimental manipulation of the subjects.
*often limited due to ethical issues
Physiologic studies- focus on cellular, physiological or anatomical effects. Do not incorporate e person into the research.
*Case studies- describe how one patient responded to an intervention.
*Narrative reviews- summarize prior research.
*Lack systematic approach to the topic
*Can be utilized to stimulate further research
Historical design - retrospective: looks at previous patients that have been discharged over a period of time. Prospective: looks at new patients over a period of time.
Based on EBP found in research, assess validity and effectiveness of interventions and outcomes presented.
Sample questions- Did investigators randomly assign subjects to group?
Were subjects masked to the subjects group assignment?
Was this a study with more than 1 group?
Were standardized person-level outcomes instruments used?
Define acute care.
“acute care, a pattern of health care in which a patient is treated for a brief but severe episode of illness, for the sequelae of an accident or other trauma, or during recovery from surgery. Acute care is usually given in a hospital by specialized personnel using complex and sophisticated technical equipment and materials, and it may involve intensive or emergency care. This pattern of care is often necessary for only a short time, unlike chronic care.”
Explain how and when physical therapy is initiated in acute care.
Once patient is medically stable
Orders for a PT evaluation
*Length of stay (LOS) is ↓, Earlier PT interventions required to decrease sequelae, EBP encouraging early mobility for improved outcomes, interventions must be highly effective, MUST have comprehensive understanding of patient’s pathology to prescribe effective treatments.
List and describe the 6 elements required for any physical therapy evaluation.
Examination = history, systems review, tests and measures Evaluation Diagnosis = medical and Physical Therapy Prognosis/Plan of Care Interventions Outcomes
List the normal metabolic panels for the following elements: acid/base ABG levels, sodium, potassium, chloride, phosphate, bicarbonate, partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂)
Acid/Base ABG levels: ph of 7.35-7.45 Sodium: › 147 mEq/L Potassium: › 5.5 mEq/L Chloride: 104-110 mEq/L Phosphate: 2.4-4.8 mg/dL Bicarbonate (HCO₃-) 22-28 mEq PaO₂ 80-100 mmHg PaCO₂ 35-45 mmHg
Describe the following conditions, including their etiology and clinical manifestations: respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis, hypernatremia, hyponatremia, hyperkalemia, hypokalemia, hypovolemia, hypervolemia
Respiratory Acidosis- Commonly caused by Chronic Obstructive Pulmonary Disease (COPD), thoracic trauma, drug overdose
Period of irritability & restlessness followed by lethargy, headache, muscle tremor/convulsions, vertigo, tachycardia, peripheral vasodilation, possible coma
pH ‹ 7.35; PaCO₂ › 45 mmHg (CO₂ retention!)
(acidic) (high CO₂)
Respiratory Alkalosis- Commonly caused by pain, fever, hyperthyroidism, meningitis, brain tumor, psychogenic, Dizziness, confusion, paresthesia, convulsions, coma, sweating
pH> 7.45; PaCO₂ 7.45; PaCO₂ ≥/ ≤normal ; HCO₃- > 27 mEq/L (basic) (? PaCO₂) (high bicarbonate)
Compare and contrast the components for the 7 mechanisms of cellular injury, including: ischemia, infectious agents, immune reactions, genetic factors, nutritional factors, physical/mechanical factors, and chemical factors.
- Ischemia- critical reduction of oxygen supply to the cell due to a blood supply that is less than the minimum required for homeostasis.
Can be:
hypoxia (partial loss of oxygen circulation) or
anoxia (complete loss of oxygen circulation) - Infectious Agents- Can be:
Bacterial: invade cells and release endotoxins and exotoxins that result in cell lysis and breakdown of the cell’s extracellular matrix. OR
Viral: can disrupt the integrity of the nucleus, or become encoded proteins that embed into the cell membrane and alter its permeability. Also can encode foreign proteins in the cell surface that set the immune system into action to destroy the now “foreign” cell. - Immune Reactions- allergies cause histamine reactions that can be mild or severe. Can cause anaphylactic shock, or full body allergic reaction
- Genetic Factors-
a) altered structure or # of chromosomes that include abnormalities. (Example: Down’s Syndrome)
b) single mutations that cause changes in
amount or function of cell proteins (Example: Sickle Cell Anemia
c) multiple mutations that interact with environmental factors to cause abnormalities (Example: Type 2 Diabetes) - Nutritional factors-
a) when a person’s diet lacks essential
nutrients, will disrupt homeostasis
(Example: lack of iron = anemia)
b) when a person’s diet has too many
nutrients, will disrupt homeostasis
(Example: increased iron = increased free radicals) - Physical / Mecahnical Factors- Direct or indirect trauma to the cells. Or exposure to extreme temperature changes, radiation, electricity.
(Example: Mechanical factors include repetitive stress injuries. ) - Chemical Factors- Two types of injury etiology
a) direct injury when exposed to the
chemical. (Example: mercury)
b) a metabolic transformation must occur to make the chemical toxic. Example: free
radical formation
(Example: Antioxidants neutralize the unstable oxygen radicals and thereby promote healthy tissues)
Describe the processes involved with the three stages of healing after soft tissue injury: inflammation, proliferation and maturation.
Three phases of healing: inflammation, proliferation, and maturation. *Each phase has 3-4 stages within itself.
The sequelae depend on injury site, injury etiology, current state of homeostasis, and level of recovery.
What is the inflammation phase?
Inflammation = the “itis” words Starts immediately after injury. Is a protective response Its purpose is to destroy, dilute, or isolate the affected cells. Lasts approximately 1 week.
4 Cardinal Signs Heat (calor) Redness/Erythema (rubor) Swelling/Edema (tumor) Pain (dolor)
“Complex sequence of interactive and overlapping events including: vascular, cellular, hemostatic and immune processes.”₂
- Vasoconstriction – to minimize blood loss; first 5-10 minutes after injury.
- Vasodilation – of the surrounding, noninjured tissue blood vessels. Stimulates release of chemical mediators.
- Clot formation- to stop the bleeding. Hageman Factor is the stimulus.
- Phagocytosis – by the neutrophils and macrophages
What is the proliferation phase?
Purpose is to cover the wound and add strength to the site of injury.
Involves epithelial cells and connective tissues.
Usually lasts approximately 20 days.
Epithelialization
Fibroplasia/collagen synthesis
Wound contracture
Neovascularization
- Epithelialization – re-establishment of the epidermis. Provides an initial protective barrier to prevent fluid and electrolyte loss
- Fibroplasia/Collagen Production – fibroblasts make collagen. Collagen is the most abundant protein in the body and provides increased strength to the tissues. Granulation tissue is red beefy dots, indicative of healing. The dots are new capillary growths
- Wound Contracture – pulls the edges of the wound together. Myofibroblasts similar to fibroblasts except also have properties of smooth muscle. “Picture Frame Theory”- a ring of myofibroblasts moves inward from the wound margin.
- Neovascularization – creation of new blood supply. (through development of granulation tissue)
What is the maturation phase?
Purpose is to change the size, shape and strength of the scar tissue.
Longest phase in the healing process.
Ultimate goal is to return to prior level of function.
Scar tissue on skin appears to fade from red/purple to white.
Chronic inflammation lasts for months or year
Three Stages:
1. Collagen Synthesis/Lysis Balance 2. Collagen Fiber Orientation 3. Healed Injury
Explain how the ”Picture Frame Theory” of healing affects wound closure; include what shapes heal most easily and quickly to most complicated and lengthy.
a ring of myofibroblasts moves inward from the wound margin.
*Shape makes a difference! Linear- heals fastest, followed by square or rectangle shape, and circles heal slowest.
Epithelial cells stay connected to their “parent” cells, causing the epidermis to move over the wound.
HOWEVER- can have contact inhibition if epithelial cells from one edge meet cells from another edge, then they stop moving.
Give examples of tissues that are capable of regeneration.
Epidermis Lining of intestine Bone marrow Liver Bone tissue May possibly regenerate if conditions are right: lung, skeletal muscle, peripheral nerves
Give examples of tissue that cannot regenerate.
CNS neurons Cardiac muscle Tendons Ligaments Cartilage
Explain the healing process for bone, including all 5 phases as outlined in your lecture
Hematoma formation- clotting with inflammation stage
Cellular proliferation- fibroblast activity and granulation tissue form a protective “splint”
Callous formation- hardening of the fibroblastic “splint”, not strong enough to bear weight.
Ossification (calcification)- osteoblasts replace fibroblasts
Remodeling- callus is reabsorbed and remodeled into strong bony material strong enough to bear weight.
Indicate the expected fracture healing times for children, adolescents and adults.
Children- 4-6 weeks
Adolescents- 6-8 weeks
Adults- 10-18 weeks
Factors include: type of fracture, location, blood supply, comorbidities, age, levels of health.
Explain the difference between open and closed reduction methods for stabilizing a fracture.
Open reduction- cuts into the skin, OPENS the tissue to get inside and insert rods/screws, etc.
Closed reduction- casting, splinting, etc. Skin in fractured area remains intact (CLOSED)
Describe the possible complications associated with fracture healing.
Muscle spasm may cause malunion Infection Ischemia Compartment Syndrome- Fat emboli Nerve damage Non-union Subject to osteoarthritis or stunted growth
Give examples of what therapeutic interventions are appropriate during the healing phase after a fracture.
Can do ther ex above and below fracture site. Do not mobilize a fractured joint!
Train patient in use of assistive device
Train patient in use of assistive equipment
Educate patient on condition and expected healing time/outcome
Reinforce precautions (WB, etc.)
Give examples of therapeutic interventions that are NOT appropriate during the healing phase after a fracture.
Mobilizing a fractured joint
Breaking weight bearing precautions
State the role of the immune system
To distinguish self from non-self. Wants to destroy “non-self.”
Differentiate between the following types of immunity: innate, acquired, passive and active. Give examples for each.
Two basic types of immunity: innate and acquired
a) Innate – the body’s first line of defense. Nonspecific responses to invaders. Same response every time. Lacks a memory. Gene specific.
Examples:
1. Skin 5. Stomach acids
2. Tears 6. Vaginal secretions
3. Ear wax 7. Acidic urine
4. Nasal hairs
Acquired – has specificity and memory.
Two types:
1. Active (Cell Mediated) –the antigen is introduced to the body via natural or artificial means. Long term effects.
a) natural – direct exposure through environment;
example: chicken pox. Once had them, will
not return.
b) artificial - vaccination; example: flu shot
2. Passive (Humoral)- the antibody is introduced to the body via natural or artificial means. Temporary effects.
a) natural – antibodies passed from mother to child
b) artificial – antibodies given via injection, example:
rabies shot after exposure.
Define antigen.
foreign body that does not have the characteristics of “self” cell surface markers. Each body’s “self” surface markers are unique like a handprint. Mine is not the same as yours. They may look the same, but when examined more, each has a different line pattern or characteristic that makes it unique.
Explain the significance of HLA’s.
(HLA’s) histocompatibility markers to identify as “self.”
Explain the role of an antibody (immunoglobulin) in the immune system.
proteins known as immunoglobulins that link to specific antigens and destroy them.
Distinguish between the roles of the 5 main types of immunoglobulins: IgM, IgG, IgD, IgE, IgA.
IgM- Initial immune response. Largest size. Activates the
complement system. Responsible for blood type matching
IgG- Found in blood. Crosses the placenta to protect newborns by
passive immunity. Activates the complement system.
IgA- Innate Immunity: found in saliva, mucus membranes, tears, etc. Defends external body surfaces.
IgD- Antigen receptor. Found on B-lymphocytes.
IgE- Eliminates parasitic invaders. Releases histamine. Normal response until becomes excessive due to allergies and causes anaphylactic shock. (Link the “E” to the role of epi-pens)
