Sectional1 Part Deux Flashcards
If a patient has any of the risk factors of CAD you should reconsider? Though risk is?
Should reconsider doing a cervical manipulation
Though risk is still low
The _ _ _, can be asked of the patient or filled out by the patient to assess risk for CAD
The MARBURG HEART SCORE can be asked . . .
What is the scale for the Marburg Heart score? How is it assigned?
Scale is 0-5
Patient receives one point for each of the questions he/ she answers yes to.
5 predictors of the Marburg heart score: patients _ and _ (_ _ or _, _ _ or _); known clinical _ _; pain worsens _ _; patient assumes pain is _ in _; pain not _ _ _.
- patients AGE and GENDER (FEMALES 65 OR OLDER, MALES 55 OR OLDER)
- known clinical VASCULAR DISEASE
- pain worsened WITH EXERCISE
- patient assumes pain is CARDIAC IN ORIGIN
- pain not REPRODUCIBLE WITH PALPATION
What is the range considered to be low risk on the Marburg Heart scale? Intermediate risk? High risk?
Low risk: 0-2
Intermediate risk: 3
High risk: 4-5
Precautions/ Contraindications for CAD: typical _ precautions, __ mobilizations (on or about involved structure), - _ _ pressures, and _ _ (mechanical or manual)
Typical CARDIOVASCULAR precautions
SOFT TISSUE mobilization (on or about involved structure)
A-P UNILATERAL VERTEBRAL pressures
CERVICAL TRACTION (mechanical or manual)
End range _ or _, _ is also a precaution/ contraindications for CAD
End Range PROM OR STRETCHING, and MANIPULATION is also precaution/ contraindications for CAD
Women tend to have different sensations than men when it comes to ANGINA, these include: _ or _ sensation, _ to the _ in the _, _, _, or _, _ or _ and often have no _ _ at all
These include:
- HOT OR BURNING sensation
- TENDERNESS to the TOUCH in the BACK, SHOULDER, ARMS OR JAW
- DIZZINESS or LIGHTHEADEDNESS
- and often have NO CHEST DISCOMFORT at all
DVT- thrombus formation due to: blood _; _ _ injury; and blood _.
Blood STASIS
VESSEL WALL injury
Blood COAGULABILITY
DVT- thrombus primary site: _ (posterior _ veins, _ veins, and _ _ of the _ muscle); _ _(more likely to cause _ _), and _ (rarer- _ _ catheter).
CALF
-posterior TIBIAL veins, PERONEAL veins, and VENOUS SINUSES of SOLEUS muscle
ABOVE KNEE
-more likely to cause PULMONARY EMBOLISM
UE (rarer- SUBCLAVIAN VEIN catheter)
Bed rest, immobilization, elderly, surgery, trauma, oral contraceptives, venous catheters, pregnancy, and cancer are all?
Risk factors for DVT
Above the _ DVT is more common, upper _ DVT is more deadly
Above the KNEE- more common
Upper arm- MORE DEADLY
Dull ache, tightness, intense pain in calf/ LE, claudication aggravated with walking*, edema, Homan’s sign, and cyanosis are all?
Clinical manifestations of DVT
Pitting Edema vs. back of the calf cramp/ swelling after running?
Pitting edema- DVT
Back of calf pain/ swelling- Ortho
Using the _ criteria for DVT, you give one point for each _ _. Score of 0 _% likelihood of a DVT. Score of 1-2? Score of 3 or greater? If there is a alternate diagnosis as likely or greater than a DVT you _ _ _.
Using WELL’S criteria for DVT, you give on point for each YES ANSWER
Score of 0= 3% likelihood
Score of 1-2= 17% likelihood
Score of 3 or greater= 75% likelihood
If there is an alternate diagnosis as likely or greater than DVT you SUBTRACT 2 POINTS
Well’s criteria for DVT: active _; _, _, or recently _ of LE; recently _ _ (greater than 3 _ or up to 4 _ post major _); localized tenderness along distribution of _ _ _; entire _ _; calf _ (greater than _ when compared to _ _); _ edema (greater than _ _); collateral _ _.
- active CANCER
- PARALYSIS, PARESIS, OR recently PLASTER IMMOBILIZATION of LE
- recently BED RIDDEN (greater than 3 DAYS or up to 4 WEEKS post major SURGERY)
- localized tenderness along distribution of DEEP VEIN SYSTEM
- entire LE SWELLING
- Calf SWELLING (greater than 3 CM when compared to OTHER LE)
- PITTING edema (greater number than OTHER LE)
- collaterals SUPERFICIAL VEINS (non- varicose veins)
What is the classic triad of PE?
CHEST PAIN, DYSPNEA, TACHYCARDIA
Sense of malaise, gray skin hue, and cold, clammy and sweaty skin are all examples?
OTHER SIGNS AND SYMPTOMS OF PE
_ in _ people diagnosed with PE will die
1 IN 3
_% of people who experience the first symptom sudden death.
25% of people . . .
What is the common prescription treatment for PE?
WARFARIN (COUMADIN)
Severe bleeding, black stool/ bleeding from the rectum, skin conditions, swelling of the face, throat, mouth, legs, feet or hands, bruising that comes without and injury you remember, or Che’s pain or pressure are all _ _ of _ (_) that require _ _ _
. . . Are all SIDE EFFECTS OF ANTICOAGULANT (WARFARIN) that require IMMEDIATE MEDICAL ATTENTION
Nausea/ vomiting, fever/ flu like symptoms, joint or muscle aches, diarrhea, difficulty moving, numbness/ tingling in any part of your body, and painful erection lasting for four hours or longer are all _ _ _ of _ that require _ _
. . .are all ALSO SIDE EFFECTS OF ANTICOAGULANTS that require IMMEDIATE MEDICAL ATTENTION
The _ _ _ _ is used to evaluate a patients risk of PE, each item listed has a _ _ _ associated with it.
The REVISED GENEVA SCORING SYSTEM is used to evalusate PE, each item listed has a SPECIFIC NUMBER POINT associated with it.
What is the clinical probability of having a PE according to the Revised Geneva Scoring system if you have a score of: 0-3? 4-10? 11 or higher?
0-3 LOW PROBABILITY
4-10 INTERMEDIATE PROBABILITY
11 OR GREATER HIGH PROBABILITY
If patient comes to you with numbness should sound like a _ _ . If they also say they have urination problems might want to start thinking about _ _. Asking about color- dark? Heart symptoms?
Numbness- should sound like a NEUROLOGICAL PROBLEM
Urination problems- start thinking about the KIDNEYS
Could have done long run
If they start to add more think about other organ systems or more serious medical system
Sacrum is a common referral site of most of the _ and _ _ systems/ organs. What other sites can pain be referred to? (3)
Is a common referral site of most of the MALE AND FEMALE GENITAL systems/ organs.
HeLP
-pubic symphysis, lumbar spine, hip joint
The number one side effect of pharmaceuticals tends to be the? Example.
The opposite of why you are taking it
- high blood pressure- side effect is low blood pressure
If someone has hypertension you should avoid the _ manuever and _ or _ _ exercise.
Should avoid
- VALSALVA Manuever
- ISOMETRIC OR HEAVY RESISTANCE exercise
_ can be caused by antidepressants, pregnancy, posture/ position changes, and can be a side effect of hypertension medicines.
HYPOTENSION can be caused . . .
If a patient is on a new medication (HTN/ Viagra), it is better to put them on a _ _ than have them do unsupervised _ _ or _ _.
It is better to put them on a RECUMBENT BIKE than have them do unsupervised POOL EXERCISE OR TREADMILL EXERCISE
What might be the diagnosis: African American woman, jaundiced for 2 months. Recent pruritus for the past 2-3 days, change in urine (tea colored) and BM’s (pale in color), and lost 30 pounds in one year. Is taking antiantiflammatory, family history of HTN, quit drinking and smoking 40 years ago, otherwise healthy?
Drug induced hepatitis- caused by NSAIDS
Approximately _ of adults 20-59 hold multiple drug prescription.
Approximately 28%
Slowed or labored breathing, slowed heart rate, difficulty walking, loss of consciousness , unusually small pupils and cold and clammy skin are all?
Are all accidental overdose warning signs
What are the 3 colors your body should never turn?
Blue Nails- lung or heart disease
Yellow skin patches- high cholesterol (below eyelids, Achilles, and elbows)
Orange- hypothyroidism (lack of hormone)
Long term oral corticosteriod can cause which 3 symptoms?
AGO
- adrenal insufficiency
- glaucoma
- osteoporosis
Fragile bones, pitting edema, increase in high/ low blood pressure and muscle weakness are all _ _ of _ that can affect PT treatment.. Serious _ _ _ _ include: masking infection, weight gain, GI distress, euphoria, and insomnia.
Fragile bones- muscle weakness are all SIDE EFFECTS OF CORTICO STERIODS THAT CAN AFFECT PT
SERIOUS SHORT TERM EFFECTS include . . .
Adrenal crisis due to corticosteriod use can cause?
Can cause death
_ in _ women, and _ of _ men are on anti depressants, however 2 out of 3 are _ _.
1 in 4 women, 1 of 7 men are on . . .
However 2 out of 3 are STILL DEPRESSED
If a patient has night pain and/ or constant pain that is only eased by sleeping in recliner: if they also have RUQ pain? If they have LUQ pain?
RUQ- gall bladder
LUQ- pancreas
Mid-thoracic pain (center or right sided), scapular pain (typical right sided at or below scapula), right shoulder pain, RUQ pain and associated GI signs and symptoms are associated with?
Gall Bladder disease/ stones
Fatty diet, high calorie/ very low calorie diet, rapid weight loss, prolonged fasting and low calcium diets are all at risk for?
Gall Stones
All asthma medications need to be _ _ to _, time will vary. Need to ask patient? (2)
All asthma medications need to be TAKEN PRIOR TO EXERCISE time will vary
Need to ask the patients if they HAVE TAKEN THEIR MEDS and/ or DO THEY HAVE THEIR INHALER
COPD patients should be in _ position, or _ position. Will not tolerate _ _ .
Need to be in RECUMBENT position or SITTING POSITION
Will not tolerate LAYING DOWN
COPD patients should probably not be walked over _ _
Over 3 MPH
If a COPD patient is doing aquatic therapy they should not?
Go deeper than waist height into the water, deeper the water the more pressure in lungs/ oxygen exchange will be impaired.
MS risk _ the farther the distance away from _ _
MS risk HIGHER the farther the distance away from THE EQUATOR
Change in sensation, thoracic symptoms, gait unsteadiness, vision loss/ problems, clinical depression, muscle spasms, fatigue, numbness, tremor and loss of muscle function are all?
Are all common symptoms of MS that might be affected by PT treatment
With MS patients you should avoid: _, _ application or -. Should also avoid tests such as: _ _ _ test, _ test, _ sign.
Avoid FATIGUING, HEAT APPLICATION or OVER-HEATING
Avoid tests (PaLS): PASSIVE NECK FLEXION, LHERMITTE SIGN, AND SLUMP TESTS
Kidney disease, Cervical myelopathy (central cord stenosis), and MS can all cause _ _ and _ symptoms.
BILATERAL ARM and LEG symptoms
Normal blood sugar range? Where would you prefer people to be? Children?
Normal 60-120 mg/ dl
Prefer: approx. 90 mg/dl
Children: 70-140 mg/ dl
If patient checks Blood sugar (has diabetes and it is 60 or below what should you do before exercising them? Above 200?
Below 60- give them a snack
Don’t exercise, it can spike it if above 200
If patient has _ or _ disorder should not exercise in pool unsupervised.
Has DIABETES OR SEIZURE DISORDER SHOULD NOT BE UNSUPERVISED
If your patient has DM and does not have _ monofilament sensation they are at risk for injury, RED flag.
5.07
Dim light is better for _ _, Full light did better in _
Type I full light\ then no light then dim light
type II dim light
