Patient Care Flashcards
1
Q
Outcome Measure
A
Means to determine effectiveness of treatment or performance
–expressed in functional terms
2
Q
POMR
A
(Problem-Oriented Medical Record)
System that organizes medical record by using a common list of pt problems as its base
-SOAP notes
3
Q
SOAP
A
Component of POMR –> sections in note of pt’s status:
Subjective
Objective
Assessment
Plan
4
Q
Stereognosis
A
Recognition of shape/form of an object by touch
5
Q
Two-point Discrimination
A
Recognition/differentiation of two points when simultaneously applied to skin
6
Q
ICF Model
A
(Intl Classification of Function, Disability and Health)
System of coding used to classify health conditions and develop a common language in describing health conditions
Codes:
--Functioning and Disability
Body function (s)
Body Structure (b)
Activities / Participation (d)
--Contextual factors
Environment (e)
Personal
Numerical values
Qualifiers = describe magnitude, severity,
and level of function
7
Q
Nagi Model
A
Medical:
Active Pathology
Impairment
Social:
Functional Limitation
Disability
8
Q
Preferred Practice Patterns
A
Musculoskeletal
Integumentary
Neuromuscular
Cardiopulmonary
9
Q
Six Elements of Patient Management
A
Examination Evaluation DIagnosis Prognosis Intervention Outcome
10
Q
Impairment
A
Any loss or abnormality.
May necessitate functional mobility training (FMT):
- Weakness (MMT)
- Loss of ROM (Goni)
- Balance deficits
- Cognitive deficits (Name, DOB)
- Sensory loss
- Coordination deficits
- Pain
11
Q
Active Pathology
A
Interruption of normal processes + body’s efforts to restore itself to homeostasis.
May necessitate FMT:
- Orthopedic Surgery/Injury
- Pain condition
- Rheumatological condition
- Neurological condition
- Genetic/Congenital condition
12
Q
Functional Limitation
A
Decreased ability to perform physical task.
May necessitate FMT:
- SAFETY
- Bed mobility
- Ambulation around home
- Assistance going to bathroom
13
Q
Disability
A
Inability to perform task expected in sociocultural contexts
May necessitate FMT: -Unable to perform function at home, school or work -Unable to participate in recreational activities/hobbies
14
Q
Orthosis
A
Orthopedic appliance used to:
–Support, align, prevent or correct
deformities
–Replace function of parts of body
(Brace or splint)
15
Q
Body Structure (s)
A
ICF Code = Anatomical parts
Examples:
Gait - LE body parts
Eyes
Cardiovascular system
16
Q
Body Function (b)
A
ICF Code = Physiological function of body systems
```
Examples:
Gait - deviation, impairment
Seeing functions
Hypertension
Joint mobility
~~~
17
Q
Activities / Participation (d)
A
ICF Code = execution of task or action / involvement in a life situation
Examples:
(Gait - dist amb, moving using
equipment, ability to walk on various
surfaces)
Learning/applying knowledge
Mobility
Self-care, ADL's
18
Q
Environment (e)
A
ICF Code = surroundings of pt
Examples:
(Gait - public transportation services)
Products/Technology/Natural Surroundings
Support/Relationships/Attitudes
Services/Systems/Policies
19
Q
Vision 2020
A
Evidence-Based Practice Autonomous Practitioner Direct Access Practitioner of Choice Professionalism Doctor of PT
20
Q
Core Values
A
Accountability Altruism Caring Communication Excellence Integrity Professional Duty Social Responsibility
21
Q
Differential Diagnosis
A
Systematic process of comparing and contrasting symptoms associated with multiple conditions in order to determine what patient actually has.
–Limits possibility of inappropriate
treatment
22
Q
Intervention
A
5th of 6 Elements of Patient Management
= Purposeful, skilled interaxn of PT with pt
to improve or alter the pt’s condition /
disease.
-Uses PT procedures and techniques:
Procedural (Restorative/Compensatory/Preventative)
Patient instruction
Coordination / Communication / Documentation
-Look out for:
Safety
Environment
Pt privacy (draping/positioning)
Body Mechanics
Motor planning
23
Q
Functional Mobility Training
FMT
A
Primary Intervention provided for pts with:
- Pathologies - Impairments - Functional/Activity Limitations - Disabilities
Includes:
- Bed Mobility - Positioning - Transfers - Wheelchairs - Gait Training - Exercise
24
Q
ADL’s
A
(Activities of Daily Living) - Independent vs dependent/needs assistance
May necessitate FMT:
Basic: Instrumental:
- Grooming -Money mgmt
- Bathing/showering -Funct Commun.
- Dressing -Health maintenance
- Feeding -Community mobility
- Toileting
25
Clinical Reasoning
Wide range of cognitive skills used by PT to process info, make decisions, and take action.
Show how PT's bring value to setting:
* Skilled
* Purposeful
26
Examination
1st of 6 elements of Patient Management
= Gathering data and ID problems
- History
- Systems Review
- Tests & Measures
27
History
| Hx
Component of Examination (Pt Mgmt)
=Systematic gathering of past and present data
about the pt
- Chief complaints
- PLOF
- Pt goals
- Medical background
- Medications
- Diagnostic/lab tests
- Pain patterns
- Demographics
- Employment
- Living environment
- Assistance
- Equipment
- Stairs
- Social/health habits
28
Systems Review
Component of Examination (Pt Mgmt)
=brief exam of anatomical/physiological
functions of MINC
--> PT uses to assess pt's ability to
initiate, sustain and modify
interventions for maximum functional
potential
- Communication ability
- Affect
- Cognition
- Language
- Learning Style
- Red flags
29
Tests and Measures
Component of Examination (Pt Mgmt)
=gathering data to rule in/out links between
probs/impairments and functional limitations
-->Establish diagnosis, prognosis, goals, and
interventions.
Examples:
- Strength testing
- Balance/Gait analysis
- Endurance testing
- Neuromotor/sensory integration
30
Evaluation
2nd of 6 Elements of Patient Management
= Assessment based on exam and ID of
problems list
-Enablement vs Disablement terms
31
Diagnosis
3rd of 6 Elements of Patient Management
| = ID impact of condition on function
32
Prognosis
| Px
4th of 6 Elements of Patient Management
= Precicted optimal functional improvement
attained by intervention and time to reach
that level
-->POC
33
POC
(Plan of Care); part of Prognosis (Pt Mgmt)
=Determination of anticipated goals and
expected outcomes + interventions to
achieve them
-Goals/Outcomes:
Short-term
Long-term
Specific / Measurable / Time-Frame / Functional
34
Outcome
6th Element of Patient Management
= ongoing process of reexamination of pt to
assess efficacy of treatment
35
Discharge Planning Components
```
Patient Education
Follow-up / Referral
Home Education Program (HEP)
Home modification
Equipment recommendation
```
36
FIM Levels of Assist
(Functional Independence Measure)
= Scale indicating pt independence level and
necessary amount of assistant from clinician
```
7 = Independent (100%, no equip)
6 = Mod Independent (100%, addtl time/equip)
5 = Supervision (100%, SBA / verbal cueing)
4 = Min Assist (>75%, CGA)
3 = Mod Assist (>50%)
2 = Max Assist (>25%)
1 = Dependent (<25%, 1 or more assistants)
```
37
Positioning
Treatment intervention used to prevent tightness, contractures, and pressure ulcers
Principles:
1. Support
2. Stabilization
3. Alignment
38
Positioning Guidelines
```
Introduction
Rationale
Motor Planning
Draping
Support materials/equipment
```
*See Fairchild p. 87
39
Positioning:
| Rationale
1. Prevent pressure ulcers
2. Prevent contractures
3. Support/stability
4. Access to area of treatment
5. Optimal function of organ system
40
Contracture
Shortening or tightening of skin, muscle, fascia or joint capsule that decreases ROM and function
41
Orthopedic
Branch of medicine dealing with musculoskeletal system
42
Pressure Ulcer
Bed sore caused by breakdown of skin and tissue.
- Interfere with functional recovery
- Cause pain & Infection
- Lead to excess length of stay
```
Blood/lymph flow obstructed
Ischemia + Edema
Redness
Open Sores
Muscle/bone destruction
```
43
Ischemia
Lack of oxygen delivery to organs
44
Pressure Ulcer Predisposing/Risk Factors
```
Poor nutrition
Dry skin
Immobility
Weight loss
Decreased sensation
Impaired circulation
```
45
Erythema
Redness or rash
46
Lymphopenia
Decreased WBC count
47
Stages of Pressure Ulcer
I: Intact skin with non-blanchable erythema over
bony prominence
II: Partial thickness with loss of dermis
III: Full thickness of tissue loss; bone, tendon,
muscle not yet exposed
IV: Full thickness of tissue loss; bone, tendon,
muscle exposed
48
AIDET
Communication tool for improving patient compliance and improving clinical outcomes:
```
Acknowledge
Introduce
Duration
Explanation
Thank you, is there anything else I can do for you?
```
49
Bed Mobility
Component of FMT --> activities for patient independence
Increases: Decreases:
- Confidence -Tightness
- Independence -Contractures
- Safety -Pressure ulcers
Ability to:
- Supine movements
- Roll
- Scoot
- Bridge
- Supine to sit
- Sit edge of bed
50
Body Mechanics
Use of one's body to produce motion that is safe, energy conserving, and anat/phys efficient to maintain balance and control
- Motor planning
- Reduce adverse effects of gravity/friction
- Keep patient/object close
- CoG close to patient/object
- Increase stability (widen stance)
- Use major muscles
- Avoid trunk flexion/rotation
- Know your own limits
51
Lifting Techniques
Maintain neutral lordosis in lumbar spine
-reduces stress on lumbar ligaments and
interverterbral discs
52
Orthostatic HTN
Sudden increase in BP after sitting up / standing
53
Morbidity
Incidence of disease
54
Pre-Mobility Screen
Checkpoints to assess in patient before getting them out of bed:
1. Able to follow commands?
2. Hemodynamically stable?
3. Perform straight leg raise against gravity?
4. Able to sit unsupported in midline?
55
Vital Signs
1. Respiratory Rate
2. Heart Rate
3. Blood Pressure
4. Temperature
5. O2 Saturation
6. PT/INR (clotting ability)
56
RR
(Respiratory Rate)
= Breaths per minute (R/min)
Normal:
Adults: 12-18
Infants: 30-50
57
HR
(Heart Rate)
= Beats per minute (BPM), measured by taking pt's pulse
-Increases with activity
-Gradual return to normal at rest
(Fitness increases speed of return to normal)
Normal:
Adults: 60-100, (Avg = 75BPM)
1-7yrs: 80-120
Infants: 100-130
Max: 220 - Age
Target: Within 50-85% of Max
58
Locations to measure HR
```
Neck: Carotid A
Ventral elbow: Brachial A
Ventral wrist: Radial A
Groin: Femoral A
Behind knee: Popliteal A
Medial Malleolus: Tibial A
Dorsum of foot: Dorsal Pedis A
```
59
Auscultation
Listening to cardiovascular, respiratory and GI sounds using a stethoscope
60
BP
(Blood Pressure)
= Force of blood against walls of arteries
-Measured as Systolic/Diastolic mmHg
Normal:
Adults: 120 / 80
Elderly: (120-140) / (80-90)
Children: 60-100
61
Temperature
Normal: 96.8 - 99.3, (Avg: 98.6)
Pyrexic: >100
Hyperpyrexic: >106
62
Pyrexia
= Fever, temp > 100
63
O2 Sat
(Oxygen Saturation)
= Level of oxygen dissolved in blood and carried by
RBCs/hemoglobin to systemic organs
-Measured by pulse oximetry
Normal: 97-99%, can be as low as 95%
Hypoxemia: <95%
64
Hypoxemia
Low concentration of dissolved O2 in blood (O2 Sat)
-->Cyanosis
65
Pulse Oximeter
Device for measuring level of O2 Sat and HR
| -Uses sensor of 2 light sources --> hgb --> photodector
66
Cyanosis
Bluish skin color due to lack of O2 in blood
67
Raynaud's Phenomenon
Condition in which cold temperatures or strong emotions cause blood vessel spasms that block blood flow to the fingers, toes, ears, and nose
-->Cyanosis
68
Coagulate
Clot
69
Anticoagulant
Blood-thinning medication
| Heparin
70
PT/INR
(Prothrombin Time / Intl Normalized Ratio)
= Measures ability of blood to clot and how long it
takes
-Increased = bleeding
-Decreased = clot
Normal:
PT: 11-16 sec
INR: 0.8 - 1.3
71
Recumbent
Long sit position
72
LRAD
(Least restrictive assistive device)
73
Bed Mobility:
| Assistive Equipment
Bed rails
Overhead bar/frame
Loops
Draw sheet
74
Bed Mobility Principles
```
Raise bed
Reduce friction
Use gravity to help
Lock bed
Body mechanics
```
75
Supine Movements
Bed mobility activities:
- Side to side
- Upward
- Downward
*Can use draw sheet / equipment
76
Anoxia
Absence of O2 in tissues
77
Apnea
Absence of breathing
78
Arrhythmia
Abnormal heartbeat
79
Bradycardia
HR < 60bpm
80
Tachycardia
HR > 100bpm
81
Cardiac Output
| CO
Volume of blood pumped out of heart during contraction (systole)
82
Diaphoresis
Excessive perspiration/sweating
83
Dyspnea
SOB, labored breathing
84
Expiration
Exhalation
85
Inspiration
Inhalation
86
Intubation
Insertion of tube into larynx to maintain open AW
87
Occlusion
Obstruction or blockage
88
Pulse
Palpable wave of blood in walls of arteries with each heart beat / contraction
89
SOB
Shortness of breath, dyspnea
90
Rale
Abnormal "crackle" sound heard on auscultation of chest
91
Stridor
Abnormal shrill, harsh sound heard during inspiration on pt with laryngeal obstruction
92
Syncope
Fainting
93
Prosthesis
Artificial replacement of body part
| Artificial Limb
94
Valsalva Maneuver
Increased pressure in chest due to forced exhalation against closed epiglottis
95
Spasticity
Resistance to stretch bc of abnormal increased tension/stiffness
96
CoG
(Center of Gravity)
| Located in center of pelvis ~ level of S2
97
How to Increase Stability
Increase BoS
Lower CoG
Maintain vertical gravity line + feet positioning
98
Rolling Progression for Treatment
Quarter roll --> Full supine
Legs: Bent --> Crossed at ankles --> uncrossed
UE: Adds resistance & increases momentum
Head
Amputees: Avoid compression of residual limb
CVA: Roll either side but position weaker UE appropriately
Post-Op Spine: Log roll only
Post THR: Avoid rolling *Hip Precautions*
99
THR Precautions
```
(Total Hip Replacement)
AVOID:
1. Hip internal rotation (toes in)
2. Hip adduction (crossing legs)
3. Hip flexion
```
100
Log Rolling Steps
1. Supine - Bend pt's knees
2. PT's hands at opp shoulder and hip --> roll to
side-lying
3. Drop pt's legs using your thigh as support
4. Reach under trunk/neck to support scapula
5. Have pt push up with opp arm or rest it on PT's
shoulder
6. On 3, drop legs and swing trunk up at same time.
* Bed height
* Draw sheet
101
Phlebitis
Inflammation of a vein
102
Hemiparesis
Weakness on one side of body
103
Hemiplegia
Paralysis of arm, trunk and leg of one side of the body
104
Paraplegia
Paralysis of the lower body
105
Tetraplegia
Paralysis from neck down
