PT (CH 6-14) Flashcards
What are Diagnostic-Related
Groups?
a system where a provider is paid a pre-established amount based on the patient’s diagnosis
The ____________ was passed to allow insurance companies to explore new ways to minimize rising health costs
It required employers with more than 25 employees to offer it as an option in order to ______
Health Maintenance Organization Act (HMO)
Lower health care costs
A model in which the health insurer or employer negotiates a lower fee with networks or ‘preferred’ health care providers in return for promising a certain volume of patients
Preferred Provider Organizations (PPOs)
(less restrictive than HMO)
The 3 types of Manages Care Organizations (MCO’s)
HMO, PPO, POS
Which type of MCO only covers in network care unless the care you need is not in network due to speciality or distance
HMO
Which type of MCO is very restrictive
HMO
Which MCO allows in and out of network care
POS
Which MCO prefers in network care
PPO
The type of manages care plan determines how consumers access their …
Health care
Traditional HMOs require participants to choose a ____ from a panel of providers
PCP (Primary Care Provider)
What are Pharmaceutical formularies
a list of drugs (usually generic) that limits the number of drugs a practitioner can choose from
Utilization Review
the evaluation of medically necessary, appropriate, or efficient use of health care services, procedures, and facilities
a newer managed care model that allows employees to have more choice while taking more responsibility for their health care costs
Consumer-driven health plans
The aim of Affordable Care Act / ObamaCare was to
increase access, quality, and affordability of health care, lower uninsured rate / provide income based subsidies to assist with affordability
Per Diem rates meaning
the company pays a pre negotiated per/day fixed rate which encompasses all included services so, you are not billing for time spent with patient but getting a flat rate for all services provided
PT is often considered a specialty service and is affected by cost control measures of MCOs , so direct access is not enough to overcome ______ deficits
Reimbursement
What provides monitoring and coordination of treatments provided to patients to control costs and utilization
Case Management
As with PPO plans, choosing to use an out-of-network provider brings higher …
higher out of pocket costs (usually there is an annual out of pocket deductible / fixed % co insurance)
PTs have often been considered a specialty service and have been significantly affected by the cost control measures of MCOs so _______ is not enough to overcome these reimbursement deficits
Direct Access
“Body language that can affirm/contradict verbal message”
Is which form of communication
Nonverbal
“Communication that occurs within an individual. “Self-Talk” “
Is which form of communication
Internal
“Reading charts, professional literature”
Is which form of communication
Reading
“Active process where re-statement, clarification, Summaries assist”
Is which form of communication
Listening
True listening helps build _____ and trust with patients and other professionals
Rapport
What are the 3 steps of active listening?
Restatement, Reflection, Clarification
What are the 3 domains of learning?
Cognitive, Psychomotor, Affective
Verbal components of communication include?
Language, speed, intent, tonality, pacing
Non verbal components of communication include?
Gesture, posture, touch, personal space, eye contact
What is Rapport?
an interaction marked by mutual collaboration and respect but not necessarily indicating agreement
Why is it important to adjust your communication style to each patient?
To build rapport, so that patients do not have to adjust to you, to match a patients vocal tone, pace and intent and build comfort
What are the 3 types of rapport?
Cultural, verbal, behavioral
What does cultural rapport involve?
Following the standard protocol for a given environment (dress, greetings, touch)
What does verbal rapport include?
Using similar phrases and conversational styles as the person you are talking to
What does behavioral rapport include?
Postural and body movements (hand gestures, standing or sitting posture)
True or False
There are times when breaking rapport is appropriate.
True
Occasionally patients may be inappropriate, so PTs can break rapport to become assertive or withdraw touch
What are the 6 levels of cultural understanding?
Destructiveness
Incapacity
Neutral
Pre-competence
Competence
proficiency
(Levels of cultural understanding)
Dehumanizing, denying services due to culture
Destructiveness
(Levels of cultural understanding)
patient is treated with bias and stereotypes
Incapacity
(Levels of cultural understanding)
assumption that all cultures are the same, services are ethnocentric
blindness
(Levels of cultural understanding)
use of appropriate response to cultural differences
Pre-competence
(Levels of cultural understanding)
Differences are accepted and respected. Knowledge, resources and services are continually adapted
competence
(Levels of cultural understanding)
differences are highly regarded, new approaches are developed to promote competence practice
Proficiency
Acknowledges differences, limited behavior change
Cultural Awareness
Lifelong commitment to change, gains respect and trust
Cultural Humility
Implicit Bias
Attitudes or Stereotypes that impact our understanding in an unconscious manner.
In communication, you can’t react comfortably to something different if you …..
Don’t fully understand yourself
Context in a conversation refers to ….
what gives meaning during communication
High context assumptions assume that the group is….
the group is more important than the individual
People who follow high context assumptions generally use:
- Indirect communication
- Circular logic
- Nuance is important – eye gaze, gestures, etc.
- Communication is influenced by the listeners knowledge and less by what the speaker is saying
Low context assumptions assume that …
the individual is more important than the group.
People who use low context assumptions generally use …
- Direct communication
- Linear, logical thinking
- Influenced by the words of the speaker not the listener
- Less nuanced
Western medicine generally follows the ___ Context assumptions
Low
What are the 4 LAMP Skills in communication?
Leadership, Administration, Management, Professionalism
“Spoken/Signed that is usually perceived via auditory canals”
Is which form of communication
Verbal
A PT must adjust to every patient’s cultural need in order to …
Avoid stereotypes and treat each person as an individual
When a patient speaks little to no English, it is always best to use a qualified medical interpreter when at all possible because …
This helps to avoid miscommunication and reduces the chance of offending someone
Though it is important to include family in decision making for a patient, due to HIPPA laws a PT must make sure family member is …
the Power or Attorney and is legally allowed to make decisions regarding the patient and their care
The 5 primary generations
Traditionalists - Before 1946
Baby boomers - 1946 to 1964
Generations X - 1965 to 1980
Millennials -1981 to 1996
Generation Z - 1997 to 2012
Over __ million people in the US have visual impairments
These impairments can include?
What questions should you ask patients who are visually impaired?
26
Cataracts, Glaucoma, Macular Degeneration
How much assistance do they need when moving around & how visual material can be presented so that they can read it appropriately
__% of people in the U.S. have some form of auditory impairment.
What questions should you ask a patient that has an auditory impairment?
What may help improve their understanding?
15%
How best to assist them in hearing or understanding you
Good articulation and lower tones will help to improve understanding
Having the patient repeat your instructions will help to ensure your instructions
When first meeting family members make sure to introduce yourself and …
explain your roll in the healthcare team
When working with a team as a PT, what is the SBAR technique ?
Situation
(Concise statement of the problem)
Background
(Brief summary of pertinent information)
Assessment
(Analysis and Considerations of Options)
Recommendation
(Actions you recommend)
For student communication, It is important to begin modeling the professional behaviors you will be expected to demonstrate. Professional interactions should be ______ and ______.
respectful and positive
When trying to create a good first impression remember ….
Your appearance speaks volumes
Communication is …
is the transference, transmission or exchange of ideas and information
What are the 3 prevention categories and their definitions
Primary - Preventing injury/illness/disease before they start
Weightbearing exercise to prevent osteoporosis
Secondary - Interventions provided after the onset of pathology with the intention of minimizing progression/severity
Exercise for those with high blood pressure and high cholesterol to prevent heart attack
Tertiary - Slow the progression and increase quality of life
Patient who had a stroke rehabbing to regain function
Balance and growth across physical, spiritual, emotional, intellectual, social, and psychological domains
Wellness
A resource leading to well-being physically, mentally, and emotionally
Health
Enabling people to increase control and improvement over their health
Health Promotion
An action or activity taken on for the purpose of promoting, protecting, or maintaining health without objective metrics regarding effectiveness
Health Behavior
Health Related Quality of Life (HRQOL)
An individual or groups perceived physical and mental health over time
Which form of nutritional advice can PTs give to patients?
Which form of nutritional advice cannot be given by PTs to patients?
Who should a PT refer to regarding nutrition if needed?
Generalities of healthy eating and weight management
Specific diets or specific nutrients
A dietitian
5 As Framework (addressing health behaviors with patients)
Ask-Advise-Assess-Assist-Arrange
Tobacco Use Can impair …
Impair tissue healing and injury recovery
Good stress is also known as
Eustress
Bad stress is also known as
Distress
What can reduce stress ?
exercise, sleep, relaxation, deep breathing etc.
(Behavioral Change Theories)
Trans Theoretical Model includes 3 constructs which are:
The 5 stages of change in this theory are:
Decisional Balance – pros and cons
Self-Efficacy – confidence
Process of Change – stages
Precontemplation – unaware or past failures
Contemplation – pros and cons-deciding
Preparation – making plans to change
Action/Change – engaging in new behaviors
Maintenance – continue new behavior for 6 months
(Behavioral Change Theories)
The Social Cognitive Theory includes (4):
Behaviors are interactions between environment, personal factors, and behaviors
Self-efficacy or confidence that change can be successful in many situations impacts effort and determination
Need to set folks up for success by addressing barriers proactively
Self-efficacy assessments are crucial
(Behavioral Change Theories)
The Social Determination Theory includes:
Supportive environment is crucial for folks to thrive
Behavior change is sustainable when motivating factors are for intrinsic reasons
Motivation must be assessed and supported
Rationales for change by PT’s must support intrinsic value for behavior change
Must address patients competence, autonomy, and relatedness to the things you are asking them to do so patients feel respected, heard, and well cared for
In order to assess health or health behaviors a PT can ask questions about:
Activity level
Healthy eating
Smoking
Sleep
Stress
In the intervention process goal setting is important, what does SMART stand for in regards to this process
Goals should be challenging but _______
specific, measurable, action-based, realistic, time-referenced
realistic
True or False
Behavioral change is impossible.
False.
It is difficult but not impossible.
The largest practice area in PT
Musculoskeletal
Dysfunction
The loss of functional abilities
Damage to MSK system can result in changes in the body which include
ROM, pain, edema (swelling), muscle weakness, fatigue
Overuse injuries are caused by …
Examples?
Repeated stresses to the same body part
Running, repetitive work activities, throwing, overhead sports
(Common overuse injury)
inflammation of bursae, bursae often get pinched or rubbed by repetitive motion
Bursitis
Runners often get ____ of the hip when running with overly tightened tensor fasciae latae muscles
Bursitis
(Common overuse injury)
What is tendinopathy?
Tendon injuries can be due to what 2 factors
Repeated overuse or overstretching of muscles that can cause stress and injury to tendons
inflammation (tendonitis)
Degenerative changes due to overuse (tendinosis)
(Common overuse injury)
What is nerve entrapment?
Pressure on a nerve from the neighboring structure
(Common Traumatic Injuries)
What is a ligament sprain?
over stretching a ligament that can cause pain and instability of a joint
(Common Traumatic Injuries)
Direct trauma, rotational force or sheer forces that can cause a bone to break is?
Who is at increased risk of this?
Fracture
The elderly
(Common Traumatic Injuries)
A sudden muscle contraction or a sever stretch that can cause tearing of muscle fibers is?
Muscle Strain
(Common surgical Injuries)
____ ____ ___________ are used to put in new joint surfaces and decrease pain caused by degenerative changes
total joint arthroplasties
When a patient’s own tissue can not be repaired so tissue from a different area of the body or a cadaver is used
Reconstruction
Transplanting living tissue from one site to another
Graft
the patient’s ability to move their limb independently
AROM
the therapist moving a patient joint through a range of motion without help from the patient
PROM
When a joint has less motion than it should
When a joint has more motion than it should
What is used to measure a patient’s ROM
Hypomobile
Hypermobile
Goniometer
The amount of force produced during a voluntary contraction
Strength
Testing a specific muscle to look for weakness
MMT
The ability of a limb to move through a range of motion
flexibility
Therapists use _____ of the skin to determine what is occurring in MSK system
palpation
(physical agent of intervention)
Thermal Agent?
Examples?
What is used to alter the temperature of a specific body part to assist with tissue healing
Hydrotherapy, Hot/Cold pack, parafin treatment
(physical agent of intervention)
electrical stimulation is?
why is it used
Uses electrodes to stimulate nerves, muscles, and other soft tissue
Improve ROM, reduce swelling
What is manual therapy?
hands on treatment and manipulation of a given body part or joint
The 3 forms of resisted exercise
Isometric
Isotonic
Isokinetic
Muscle contraction without visible movement
isometric
Muscle contraction that controls joint and causes shortening OR lengthening
isotonic
Concentric or eccentric muscle contraction that occurs at a constant speed
isokinetic
What activities do PTs use for endurance training?
cycling, swimming, running, climbing etc.
True or False?
PTs almost always assign a home exercise program to a patient at the initiation of therapy
True
Injury resulting from the disruption of blood flow
CVA (aka stroke)
What % of patients die within a month of having a stroke?
30
What causes a TBI?
Methods of TBI?
a significant external trauma to the brain and its surrounding structures
accidents, falls, violence
What is the leading cause of death and disability in children and young adults?
TBI
___ is usually the result of a motor vehicle accident, falls, and sports
SCI
The job of the _______ ______ is to detect head position and movement
Vestibular system
Patches of demyelination of the CNS which causes disturbances in the conduction from the CNS to PNS
MS
3 primary symptoms of Parkinson’s disease
Tremors- alternating contratcion of muscle groups
Rigidity - resistance when limb are passively moved
Bradykinesia - slowness of movement
True or False
There is a cure for Parkinson’s Disease.
False
ALS is also known as
ALS is caused by
Lou Gehrig’s disease
Degeneration of motor nerve cells
True or False
There is a cure for ALS.
False
The largest organ in the body
Skin (integument)
The 3 phases of wound healing
inflammatory, proliferative, remodeling
Treatment of the inflammatory phase of wound healing include
These activities should only be performed if …
wound care, active ROM exercises, positioning etc.
they do not cause pain
Factors that influence wound healing
Wound depth - size - location
Healing time
Reason for wound
Common integument conditions
dermatitis, skin cancers, shingles, burns, pressure ulcers
Bluish skin may indicate
Red skin may indicate
Lack of hair growth may indicate
poor circulation
inflammation
poor circulation
Arterial Wounds are usually on ….
The pain is usually severe with an ______ shape and pale base
the lower leg
irregular
Venous Ulcers are usually on ….
The pain is usually mild with a ___ base and irregular shape
on leg
pink
Neuropathic Ulcers usually are on …..
they are often painless but may ____ easily
bottom of foot, heel or bony prominences
bleed
Pressure Ulcers are usually on …. but can occur anywhere there is excessive prolonged pressure
bony prominences
superficial wounds are painful and ___
red
partial thickness injuries are painful, ___, and blistering
there is significant _____
red, drainage
Full thickness ____ are not usually painful
burns
The 2 layers of integument
epidermis, dermis
A lot of pediatric therapy revolves around play in the natural environment such as:
home, school, daycare, community centers, parks
EHCA became IDEA, which is
Education of All Handicapped Children
Individuals with Disabilities Act -
law that makes available a free appropriate public education to eligible children with disabilities throughout the nation and ensures special education and related services to those children.
Examples of Neuromuscular conditions in pediatrics
autism, CP, spina bifida
examples of MSK conditions in pediatrics
scoliosis, club foot, osteogenesis imperfecta
examples of cardiovascular conditions in pediatrics
asthma, cystic fibrosis
Examples of systemic/metabolic health conditions in pediatrics
diabetes type 1 and 2, fetal alcohol syndrome, obesity
the __ model helps look at the child globally and holistically and within the situational context
ICF
5 questions that should be asked when evaluating interventions for pediatrics
Does the intervention encourage the child to initiate a program of lifelong fitness activities, including proper nutrition, exercise, weight control, and stress management?
Does the intervention encourage the child to assume responsibility for personal health, including knowledge of the condition?
Is the child encouraged to become personally involved in decisions on rehabilitation?
Does the intervention motivate the child to foster self esteem?
Does the intervention promote meaningful pursuits that will foster the prevention of secondary conditions?
The ability to receive and interpret input through peripheral sensory nerves
Sensation
Perception
the ability to integrate and respond to sensory input appropriately
Functional Recovery
Accomplish tasks in the same manner they were performed previously
Accomplish tasks through alternative means using strategies or substitutions
Compensation
Using both functional recovery methods and compensation methods for BEST outcomes
Blended
The Brain and Spinal Cords ability to adapt and remodel themselves as they learn new behaviors and skills
Neuroplasticity
Physical agents might be incorporated to improve flexibility and strength. Examples include:
Biofeedback
Neuromuscular electrical stimulation (NMES)
Functional electrical stimulation (FES)
Older adults need help staying independent with _____ and _____
Activities of Daily Living (ADL’S) and Instrumental Activities of Daily Living (IADL’S)
Some changes associated with aging are now thought to be associated with
Inactivity and sedentary lifestyle
_______ ________ does not decline with normal aging but memory and conceptualization can be reduced.
Cognitive function
True or False
Psychosocial changes are not common in older adults.
False
Common conditions in older adults include
arthritis, osteoporosis, hip fractures, diabetes
______ can have an influence on interventions with older adults
Medications
What should always be incorporated in prevention for older adults
balance and fall prevention
1 in __ adults have diabetes
5
The number 1 cause of death in the US
CVD
The 3rd leading cause of death in the US
(more woman and non hispanic blacks have this disease)
symptoms include
COPD
shortness of breath (dyspnea), and productive cough
a process of inspiration drawing air in and expiration which is pushing air out
ventilation, or breathing
the process of exchanging oxygen and carrying carbon dioxide between the air we breathe and the blood passing through the lungs
respiration
Congestive Heart Failure (CHF) is
the onset can be ___ or ___
it can cause problems in the body such as
when the heart is damaged to the point that it can not move blood effectively
chronic or acute
fatigue, decreased breathing
a result of the trapping of air in the lungs which causes hyperinflation
COPD
What is caused by the decreased ability of the lungs to expand which results in a decrease in air volume in the lungs
Restrictive Lung Diseases
Cardiac Catheterization is a ________ _________ that requires passing a flexible catheter into an artery of the leg and guiding it up to the heart to the coronary arteries or veins
Invasive procedure
Examples of Noninvasive Procedures
Echocardiography (ECHO) (ultrasound to asses heart chambers, walls, valves)
Electrocardiogram (ECG)
exercise stress testing (determine how cardiov and pulm system respond under increased stress loads)
One of the most commonly used noninvasive tests
ECG
Diseases affecting the lungs can limit….
limit the amount of oxygen available for consumption
Ischemia is…
It can result in…
Ischemia is the loss of blood flow and results in decreased oxygenation due to arteriosclerosis
Heart failure is …
Heart failure is when there is a decrease in the pumping function of the heart
Exercise stress tests can be performed using …
treadmills or stationary bikes
Non-invasive procedure that examines the lung structures
X-ray, CT, and MRI
MRI uses ____ waves while CT uses ___ waves
magnetic, radio
Tests the effectiveness of the respiratory system and respiratory musculature. The test helps to classify the lung disease pattern and seriousness
Pulmonary Function Tests (PFTs)
An electronic device is inserted near the clavicle and wires are attached to the heart to control the pulse of the heart
This is used for patients with chronic arrhythmia
Cardiac Pacemaker
Heart Transplantation
is performed when
generally the patient must be ….
when the heart does not respond to any other treatments
younger than 60, free of other health issues and is emotionally stable
FITT parameters are sometimes used to determine exercise guidelines. This stands for?
F - Frequency - How Often
I - Intensity - How Hard - Use target HR or rate of perceived exertion
T - Time - How Much
T - Type - What type of activities
removal of excess mucus created by an obstructive pulmonary disease
Secretion Removal
