review questions Flashcards
What is the difference between a precaution and a contraindications ?
With a contraindication we would not want to use the modality because it would be likely to harm our patient. However a precaution is something that could potentially be an issue therefore we ask more questions about it, may consider another option, or may just do more continuous skin checks/talking with our client to make sure the modality is not uncomfortable. Contraindications rule out modalities and precautions make us pay closer attention and we may reconsider. For example: If someone has significant edema due to a recent injury this would be a contraindication for heat modalities, so we would not use heat. But if someone has had cancer in the past but no longer has it this would be a precaution, so we would ask more questions: where was the cancer, how long have you been cancer free, etc. -if the cancer was previously existent in the area to apply heat and has only been gone 2 years I wouldn’t use it, if it was very far away from the area and they have ben cancer free for 25 years it would probably be okay.(Jess B) Excellent ! great understanding (nancy)
If a client on lab practical or in clinic says they have frostbite and we are planning to apply an ice pack what should you do or say next?
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What is cryoglobulonemia? What is Raynauds?
Cryoglobulinemia is when there is abnormal proteins in the blood. When the body gets cold the blood thickens due to these proteins that are present. This can cause damage to the blood vessels because it could cause blockages. Raynauds is when the body is exposed to cold it limits the blood circulation through the body. It causes discoloration of the fingers and toes because the body is not sending enough blood to them. This can be in response to the cold or stress. (Shawna B) Yup ! Good research! Sometimes we have to look things up when we don’t know what they mean…thanks for doing that for us Shawna (nancy)
When do you choose low intensity TENS? And when conventional ?
I would choose conventional TENS if a person had sharp pain in a specific area such as pain in the upper traps or lateral epicondylitis. While low intensity TENS is good for people who are experience a wide area of throbbing or pain such as the lower back because it diffuses over the area. (Jess S) Can you tell me more…Im not sure I know when in the treatment (during, before, and when I would choose one over the other? I would choose to use conventional TENS as my first response. When using conventional TENS the person could start this before treatment to get the pain under control prior to therapy for 15-30 minutes or during treatment. If the sharp pain was only managed by using the TENS they could receive conventional TENS all day. Low intensity frequency is used if conventional TENS does not work and is especially useful before therapy and is not used all day. This tries to change trigger points so the placement should be right on them. We give this 30-45 minutes before treatment. If the patient was still in too much pain to do therapy we would then switch to conventional TENS. (Jessica S)
Identify two ways you can you increase the intensity of cold modality
You can increase the intensity of a cold modality by either adding compression, such as with the cryocuff, or by using a thin moist towel between the application site and (i.e.) a cold pack. Both these ways should intensify cooling to the tissue. (Nora H.) Yes Nora..def these are two ways to increase the intensity. Great Job..looking forward to seeing you back this week!! (Marybeth H)
Which modality is a concern for clients with respiratory issue? How can you reduce the impact to the client?
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Why is impaired mental status a precaution ? And how would you manage a hot pack for someone with impaired mental status?
Impaired mental status is a precaution, especially with a thermotherapy agent such as a hot pack, because if the client is unable to understand or communicate with the therapist, they may not be able to express that the heating process is becoming uncomfortable or painful for them. If you are treating a client with impaired mental status with a heat pack, you want to make sure that you check if their sensation is impaired, that there is enough toweling in between the hot pack and the client’s skin (6-8 layers), and that you monitor the client’s skin for color changes and/or burns. (Carly V) good example, but this is just as true for cold and electrical modalities, if someone is not a reliable reporter we have to take extra precautions and probably sit with them during the treatment. (nancy)
I work in a sub-acute rehab facility do I begin my treatment with a modality most of the time ? Where and how often do you think modalities are used in the field of OT?
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I’ve had an ultrasound when I was pregnant. How do you explain to me the difference between that and the ultrasound we are providing in this course?
Ultrasound is considered anything above 20 kHz and will usually fall between .8 MHz and 3 MHz. There are three types of Ultrasound and they can be categorized by their intensities. A low intensity ultrasound would be the ultrasound used when having a sonogram done to look at a growing baby inside a woman’s uterus. A medium intensity ultrasound would be used in a therapeutic way in a clinic such as what we as OT’s will administer. The final category is a high intensity ultrasound which can be used for tissue destruction. The ultrasound you would have had during pregnancy would have been used to create an image to see the baby and to watch the growth inside of the uterus, this type of ultrasound can also be used to create an image of other pats of the body including the heart. Therapeutic ultrasound can be used to help with tissue healing in a short time and is often used because it is very localized. Therapeutic ultrasound causes a mechanical vibration which causes the action on the body which can help to increase cellular metabolism, cellular permeability and pain threshold when not using heat and it will cause increase extensibility and blood flow when using heat. (Allison) Allison…You nailed it!!! Great job now memorize that because once you start using US in your clinic you will be asked that 100 times smile..they may even ask you if you can see something smile (Marybeth H)
Your client has dry skin and tends to have more hair than some. (hint we saw this in Andrew as compared to Carly). Discuss the concept related to electrical modalities and pad usage and intensity as it relates to this person’s skin?
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Explain intensity. What are some synonyms. Explain in relation to two modalities.
Intensity is the strength at which the modality is measured and is a crucial setting. It could be referred to as dosage when working with the ultrasound modality or it could be referred to as rate or frequency when working with the NMES (Neuromuscular Electrical Stimulation). In terms of ultrasound, the intensity is the strength of the acoustic energy at the site of application. The intensity of the unit is one of the most important settings and is measured in power per unit area of the sound head in watts/centimeter squared. When using ultrasound for therapeutic purposes the intensity or dosage must be placed within 0.1-2.0 w/cm2 however most occupational therapists would not get to 2.0 because that would be for bigger muscle groups in which many do not work with. In order to produce a thermal effect, the dosage must be greater than 1.0. Another modality in which setting an intensity is important is the NMES unit. The rate or frequency is measured as the current in pulses per second (pps). A rate of 25 pps allows for stimulation only, whereas a rate of 35 pps allows for the actual contraction of smaller muscles. A rate of 50 pps is used for contraction of larger muscle groups and is also used when little to no response is visible at 35 pps. (Kara H.)
Explain pulse duration in relation to two different modalities.
Overall, pulse duration is defined by the amount of time that a stimulus or pulse is on, or the time that each pulse is occurring for. When looking at the general guidelines for electrical modalities this is measured in milli-seconds, usually fixed between 200-400 m-sec. dependent upon the modality being used. The pulse duration can also be called the width in certain modalities such as neuromuscular electrical stimulation. In looking at two different modalities such as NMES and TENS, we see the pulse duration to differ drastically. When using NMES, the pulse width(duration) is always to be set at 300 milliseconds, where as with TENS the pulse duration is specific to the type being applied. If conventional TENS is being applied the pulse duration would fall between 50 -100 micro-seconds where if the Low Frequency TENS is being applied the pulse duration would be set between 150-200 micro-seconds. We see this difference because we are not looking for the same reaction when using these two modalities. In the case with NMES we are looking for a muscle contraction, where as in using TENS we are targeting specific sensory receptors or painful areas. (Michelle)
