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fall B 2024 > multi d midterm > Flashcards

multi d midterm Flashcards

1
Q

purpose of the guide to physical therapist practice

A

describes practice
describes setting and role
terminology
clinical making process
reviews interventions
describes outcome measures

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2
Q

biopsychosocial model

A

complete
not merely the absence of disease or infirmity

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3
Q

define acute

A

very serious or dangerous, requiring serious attention or action

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4
Q

acute care today

A

advancements and improvements in life support
rehab services now treating seriously injured

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5
Q

treatment goals

A

prevent adverse effects of PI
prevent contractures
improve general conditioning
prevent pressure ulcers
return pt to pre-hospital level

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6
Q

special considerations for acute care

A

monitor vitals
compression devices
encourage mobility
homework
isolation for infection
tubes
safety

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7
Q

define disability

A

inability or restricted ability to perform actions

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8
Q

define health condition

A

pathology
disorder
disease
injury
trauma
congenital anamaly

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9
Q

define PT diagnosis

A

how the condition causes disability

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10
Q

what is an activity?

A

task or action done by an individual

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11
Q

what is participation?

A

involvement in life situation

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12
Q

what are contextual factors?

A

personal and environmental factors may be positive or negative
may facilitate or impede functioning/recovery

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13
Q

what all does a review of systems include?

A

cardiopulm
endocrine
EENT
GI
neuro
reproductive
hematologic/lymphatic
integ
psych
msk

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14
Q

PT systems review

A

hands on
cardiopulm
integ
msk
neuro

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15
Q

what are tests and measures used for?

A

help establish diag, prog, treatment plan
what interventions to use

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16
Q

PT evaluation

A

putting it all together

diag
problem list
prog
goals
plan of care

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17
Q

define PT diagnosis

A

ID discrepancies between the pt’s level of function and what is desired
determine capacity of pt to achieve that level

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18
Q

define prognosis

A

optimal level of improvement
listing of goals

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19
Q

define problem list

A

impairments of body structure or function
activity limitations
participations restrictions

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20
Q

risks and causes of a hip fracture

A

osteoporosis
age over 60
any increase of fall risk
any increase in bone weakness
weakness in hip muscles due to PI

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21
Q

three types of hip fracture

A

intracapsular - break in capsule
intertrochanteric - between lesser and greater troch
subtrochanteric - within 5 cm below lesser trochanter

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22
Q

types of pelvic fracture

A

lateral compression
AP compression
vertical shear

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23
Q

favorable factors contributing to bone healing

A

early mobilization
early weight bearing
maintenance of fracture reduction
younger age
good nutrition
minimal soft tissue damage
patient compliance
presence of growth hormone
normal body weight
supportive environment
good general strength

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24
Q

unfavorable factors contributing to bone healing

A

tobacco use
comorbidities
vitamin deficiency
osteoporosis
infection
irradiated bone (exposed to radiation)
severe soft tissue damage
distraction of fracture fragments
multiple fracture fragments
disruption of vascular supply to bone
corticosteroid use

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25
Q

prognosis of total joint arthroplasty

A

fairly consistent positive outcomes with brief hospitalization
significant post op rehab in multiple levels of care

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26
Q

Total hip arthroplasty precautions (posterior)

A

no hip flexion greater than 90 deg
no hip adduction past midline
no hip internal rotation past neutral

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27
Q

Total hip arthroplasty precautions (anterior)

A

no hip extension past neutral
no active hip abduction
no hip external rotation past neutral

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28
Q

TKA recommendation

A

no twisting of LW in WB position
no sitting with legs crossed
avoid low soft chairs
do not forcefully bend operated knee
do not kneel on operated knee
use of walker as needed

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29
Q

total shoulder or rotator cuff repair

A

NWB and immobilized constantly unless PROM
no abduction or extension past neutral
AROM of elbow, wrist, hand
outpatient 5 times per week for 4 weeks is common

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30
Q

main causes of amputation

A

LE - vascular disease
UE - trauma

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31
Q

pain management focus in amputation

A

residual limb
phantom limb
musculoskeletal

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32
Q

residual limb and prosthesis focus in amputation

A

hygiene
fitting of prothesis
various types and uses

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33
Q

psychosocial focus in amputation

A

bereavement of lost limb
depression management
changes in social life
societal perceptions

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34
Q

daily needed focus in amputation

A

transportation
couple relationships
activities, return to work, sports
fall prevention

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35
Q

pt management for amputations

A

education
- positioning for edema control
- positioning to avoid contractures
benefits of early ROM, strength, mobility training
discussion of pain management, phantom pain

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36
Q

most common neck/back pain diagnosis requiring hospitalization

A

spinal nerve compression related to disk
compression fracture

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37
Q

what can a PT do for neck/back pain diagnosis

A

relieve, stabilize, strengthen, educate

NO bending, lifting, twisting of spine

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38
Q

describe a discectomy

A

removal of disc fragments that compress spinal nerve root

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39
Q

describe a laminectomy

A

removal of part of lamina to depress spinal canal

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40
Q

describe a fusion

A

use of instrumentation and/or bone grafting to stabilize vertebral segments

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41
Q

describe a vertebroplasty

A

injection of bone cement to stabilize a vertebra with a compression fracture

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42
Q

describe a kyphoplasty

A

insert inflatable balloon to restore height prior to injection of bone cement

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43
Q

what type of exercise is best for a spinal surgery pt?

A

walking

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44
Q

describe an acute care setting

A

inpatient with unstable medical conditions
24 hrs/day highly skilled services

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45
Q

PT role in discharge from acute care

A

reducing length of stay
communication with whole team

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46
Q

what are considered post acute care?

A

IRF
SNF
LTACH

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47
Q

inpatient rehabilitation facility

A

relatively medically stable
min 3 hours of therapy a day
must need 2/3 therapies
sees physician once a week

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48
Q

average length of stay for IRF

A

12-14 days

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49
Q

13 diagnostic categories that must make 60% of IRF pts

A

stroke
SCI
congenital deformity
amputation
major multiple trauma
fracture of femur
brain injury
neurological disorders
burns
arthritis
joint inflammation
severe OA
bilateral knee or hip replacement

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50
Q

skilled nursing facilites

A

require medical services
at least 1 hour of therapy a day
one service
sees physician every 30 days

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51
Q

average LOS for SNF

A

around 30 days

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52
Q

what is the discharge % from SNF to home

A

45%

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53
Q

long term acute care hospital

A

very close medical supervision, but considered stable
might get PT

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54
Q

example of who needs LTACH

A

cannot get off a ventilator
ongoing dialysis
intensive respiratory care
multiple IV meds
burn care

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55
Q

average LOS in LTACH

A

greater than 25 days

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56
Q

what is the discharge % from LTACH to home

A

27%

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57
Q

assisted living with respite care and home health services

A

temporary
private pay for respite
can perform in home setting but just not their normal home due to architectural barriers

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58
Q

home health care

A

delivered in home setting
must be homebound
could be eligible for several weeks
45-60 min sessions

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59
Q

outpatient therapy

A

ambulatory care environments
broad range of clinical problems
varying complexity
least expensive
2-3x / week for 4-12 weeks

60
Q

long term care facilities

A

varying levels of supervised living arrangements
unable to safely manage independent living
“nursing home”
may not have regular PT
physician sees pts as needed

61
Q

clinical test of sensory interaction on balance (CTSIB)

A
  1. normal, eyes open
  2. normal, eyes closed
  3. normal, conflict dome
  4. foam, eyes open
  5. foam, eyes closed
  6. foam, conflict dome

timed for 30 seconds each

62
Q

cut off score for CITSIB

A

< 260 seconds for all 6 condition

63
Q

specificity of CTSIB

A

90%

64
Q

berg balance scale

A

14 items that assess sitting and standing balance
each item scored 0-4
< 47 indicating patient is a fall risk

65
Q

stats on berg balance

A

sensitivity = 94.4%
MCID = 13.5, 15 for goals
cut off score: <47

66
Q

dynamic gait index (DGI)

A

assess ability to modify balance while walking in presence of external demands

67
Q

timed up and go (TUG)

A

stands up, walks 3 meters, turn around and sit back down
timer starts once clinician says go

68
Q

what is the cutoff for fall risk in the TUG?

A

> 13.5 seconds

69
Q

what is the average MCID for TUG?

A

3.4 seconds

70
Q

four square step test (FSST)

A

use canes to make the square
once clockwise then once clockwise
both feet touch each square
“try to complete as fast as possible and face forward the entire time”

71
Q

cut off scores for FSST

A

> 15 seconds is at risk for falls

72
Q

function in sitting test (FIST)

A

for those who cannot walk to evaluate sitting balance
seated balance
14 items scored 0-4

73
Q

cut off for FIST

A

<41.5 cannot go home

74
Q

30 second sit to stand

A

hand crossed over chest
feet flat on floor
on go rise to full standing and sit back down

75
Q

MCD and MCID for 30SSS

A

MDC = 2.96
MCID = 2.0 or 2.6 so take larger number

use ~3 for both

76
Q

5X sit to stand test

A

time until the fifth full up

77
Q

cutoff for fall risk for 5XSST

A

> 12 seconds - needs assessment for fall risk
15 seconds - recurrent falls

78
Q

mini best

A

14 items
10-15 minutes

anticipatory section:
~ sit to stant
~ rise to toes
~ stand on one leg

reative postural control:
~ stepping correction forward
~ stepping correction backward
~stepping correction lateral

sensory orientation:
~ CTSIB
~ eyes closed on incline

dynamic gait:
~ change in gait speed
~ walk with head turns
~ walk with pivot turns
~ step over obstacles
~ TUG with dual task

79
Q

MCID for mini best

A

4 points out of 28

80
Q

6 min walk test

A

start timing once pt starts walking
do not walk with the pt
after 30 meters turn around to make another lap

81
Q

what is a small meaningful change for 6 min walk test?

A

20 meter improvement

82
Q

what is a large meaningful change for 6 min walk test?

A

40 meter improvement

83
Q

timed 10 meter walk (gait speed)

A

2 meters acceleration
6 meters fast walking
2 meters deceleration

84
Q

timed 10 meter walk test cut off scores

A

less than .8 m/s is at risk for sarcopenia and frailty
greater than 1 m/s are likely to be independent
greater than 1.2 m/s is a normal ambulator

85
Q

2 minute step test

A

measure .5 the distance between iliac crest/patella
only count how many times the right knee reached the required height

86
Q

primary indications for cardiac rehab

A

acute coronary syndrome
MI
CABG
heart or lung transplant
heart valve repair
heart failure

87
Q

cardiac rehab phase 1

A

referral when pt is medically stable
education
self care eval
low level exercise

88
Q

goals of inpatient CR

A

prevent another event
recover from event
evaluate response to self care and ambulation
increase knowledge

89
Q

what to monitor during ambulation and ADL eval

A

hemodynamic, symptomatic and ECG response
need to know every change

90
Q

benefits of early mobilization in CR

A

improves HR, arterial BP, myocardial O2 uptake
improves peripheral circulation, pulmonary ventilation, ANS

91
Q

expected outcomes of CR

A

prevent harmful effects of bed rest
walk 5-10 min continuously or 1000 feet 4x/day
1 flight of stairs independently
know safe limits for exercise
recognize abnormal S&S
promote more rapid and safe return to ADLs
prepare for home

92
Q

modifiable risk factors for cardiac disease

A

smoking
hypertension
hypercholesterolemia
PI
diabetes
obesity
on meds for a risk factor

93
Q

discontinue exercise in CR if any of the following happen

A

outside of max HR ranges
resting HR > 120
post op > 30 bpm above resting
post MI > 20 bpm above
DBP >/equal to 110mmHg and/or SBP > 210mmHG
decrease in SBP > 10mmHg or increase in > 40 mmHG in response to exercise

94
Q

contraindications for CR

A

unstable angina
resting SBP > 200 mmHg or resting D > 110 mmHg
orthostatic BP drop > 20 mmHg with sympotms

95
Q

4 ways to diagnose orthostatic hypotension

A

SBP decrease of 20 mmHg or more
DBP decrease of 10 mmHg or more
SBP decreases under 90 mmHg
HR increase of 10 bpm or more

96
Q

most common cause of right heart failure

A

left heart failure

97
Q

chronic stable angina

A

predictable episodes
controllable (lower exercise, nitro)
could be known or unknown

98
Q

unstable angina

A

unpredictable
poor alleviation efforts
requires immediate medical attention

99
Q

angina scale

A

1: mildly, barely noticeable
2: somewhat strong
3: moderately severe, very uncomfortable
4: very severe, most intense pain ever experienced

100
Q

claudication scale

A

1: initial pain, minimal
2: moderate discomfort or pain; attention diverted
3: intense pain; attention cannot be diverted
4: excruciating and unbearable pain

can exercise up to grade 3

101
Q

pulse 4 point scale

A

0: absent
1+: palpable, thready and weak, easily obliterated
2+: normal, easily identified, not easily obliterated
3+: increased, moderate pressure of obliteration
4+: full, bounding, cannot obliterate

102
Q

acute coronary syndrome

A

myocardial oxygen deprivation causing angina and potentially tissue ischemia
treatments: PTCA, stent, CABG

103
Q

percutaneous coronary interventions (PCI)

A

PTCA
stent
atherectomy

104
Q

PTCA

A

balloon to squish plaque out of the way
often done with stent placement

105
Q

CABG

A

single through quadruple

106
Q

valve disease

A

over time pumping dysfunction
sternotomy precautions

107
Q

sternal precautions

A

no pushing, pulling, lifting over 8-10 lbs
no raising arms above the shoulder
no arms behind the back
do not push up from a chair
do not carry children, pets, groceries

108
Q

what do inefficiencies from arrhythmias lead to?

A

heart having to work harder for the same output

109
Q

S&S of chronic heart failure

A

weight gain
dyspnea
orthopnea
paroxysmal nocturnal dyspnea
tachypnea
cough
fatigue
cyanotic extremities
peripheral edema
decreased activity tolerance

110
Q

when does a pt need supplemental oxygen?

A

<88% on room air

111
Q

nasal canula rates

A

1-6
above 4 causes dryness

112
Q

INR

A

time for blood to clot

113
Q

troponin

A

will be elevated in MI

114
Q

BNP

A

identify CHF when over 100

115
Q

d-dimer

A

blood clot breakdown
identify embolism/DVT

116
Q

goals of PT in the ICU

A

prevention of secondary complications
promote weening from ventilators
optimize oxygenation
restoration of function
decrease length of stay
improve progression of mobility
improve QOL

117
Q

when do PTs communicate to interdisciplinary team in ICU?

A

daily prior to intervention

118
Q

risks of under sedation

A

ventilator asynchrony
increased O2 consumption
inadvertent removal of devices, IV’s, catheters
PTSD

119
Q

risks of over sedation

A

pneumonia/lung injury
neuromuscular dysfunction
delirium

120
Q

critical illness polyneuropathy/mypathy

A

overlapping syndromes of diffuse, symmetric, flaccid muscle weakness occurring in critically ill pts

121
Q

occurrence of ICU delirium

A

60-80% of ventilated pts
20-50% non-ventilated pts

122
Q

ICU delirium management

A

pain, agitation, delirium
sedation vacation
discontinue asap
initiate mobility asap
minimize sleep disruption

123
Q

national institute of health stroke scale

A

0-42 scoring
lower score is better
tells how severe, not the location
<5: 80% discharged to home

124
Q

richmond agitation scale

A

combative - unarousable
figure out how to adapt treatment

125
Q

glasgow coma scale

A

used before entering room to check pt status

126
Q

PT focus in pt skills

A

communicate plan
access # of people to assist
obtain safety devices
vital signs
plan to return to safe position
explain plan
proceed and reassess for tolerance

127
Q

aterial line

A

access in arterial system

128
Q

central venous pressure catheter

A

large vein access

129
Q

indwelling right arterial catheter (hickman)

A

right atrium

130
Q

intravenous system

A

superficial vein access

131
Q

pulmonary arter catheter

A

access to pulmonary artery via a vein

132
Q

intracranial pressure monitor

A

against skull

133
Q

precautions from access and pressure monitors

A

discuss POC with nurses
do not disconnect without permission

134
Q

nasogastric tube

A

nostril to stomach

135
Q

gastrostomy tube PEG

A

to stomach

136
Q

jejuonstomy tube PEJ

A

to jejunum

137
Q

IV (nutrition)

A

for fluids, meds, electrolytes

138
Q

nutrition precautions

A

not in flat if receiving

139
Q

external catheter

A

male: condom
female: purewick (suction)

140
Q

foley catheter

A

indwelling for continuous drainage

141
Q

suprapubic catheter

A

surgically inserted

142
Q

urinary catheter precautions

A

bag below bladder
purewick may be removed
gaitbelt not over insertion of suprapubic

143
Q

cardiac leads

A

stickers
battery or wall

144
Q

chest tube

A

incision in chest
suction or water seal

145
Q

cardiac lines precautions

A

maintain continuous monitoring
chest tube canister below insertion point
gait belt above chest tube insertion point

fall B 2024 (12 decks)

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