Skills 110 Finals Written Exam Flashcards
Signs
Objective and related to the
health condition. Observable
conditions
*Rashes
*Wheezing
*Red, scaly inflamed skin
*Edema
*Joint tenderness
*Cloudy lenses in eyes
Symptoms
Subjective feelings or
sensations experienced by the
patient.
- Shortness of breath
- Headache
*Fatigue
*Congested
*Itching
*Joint pain and stiffness
*Blurry vision
Wave of blood in an artery created by the contraction
of the ventricles in the heart
pulse rate
normal pulse rate levels
Adults (11+) 60-100 bpm
Children (1-10) 80-100 bpm
Infants (1-12 mon) 100-120 bpm
Neonates (1-28 days) 120-160 bpm
points of assessment for pulse rate
Apical
Temporal
Brachial
Carotid
Radial
Femoral
Popliteal
Pedal
counting and documenting PR
15 seconds x 4
◦ OR
30 seconds x 2
◦ OR
Full 60 seconds if pulse is irregular
◦ (or if it is your first time taking this patient’s pulse)
If a pulse is irregular, how long do you measure the pulse?
60 secs
how to find target heartrate
maximum HR = 220 - age
THR = 50-85% of Max. HR
pulse rate red flags
o Irregular pulse (Arrhythmia)
o Weak pulse
o Resting pulse rate below 60 (Bradycardia)
o Resting pulse rate above 100 (Tachycardia)
o Recovery heart rate after cardiac exercise is <12 bpm
The measure of breathing, Each cycle has one inspiration and one expiration
respiratory rate
RR pain ratings
“0” = breathless with strenuous exercise “4” = becomes breathless
with dressing
RR normal ranges
Neonates 40-60
Infants 25-60
Children 15-30
Adults 12-20
RR red flags
Shortness of breath without much exertion
Irregular breathing pattern
Noisy breathing
Pain with breathing
Measures arterial blood oxygenation
pulse oximetry
normal pulse oximeter readings
Normal = 96 – 100%
pulse oximeter red flags
Below 85 – severe hypoxia
Measures the force the blood exerts against a vessel wall.
Affected by:
◦ Blood volume
◦ Vessel size
◦ Vessel compliance
blood pressure
Korotkoff’s Sounds:
◦ Series of sounds as a result of:
◦ ___1__ – ventricular contraction
◦ ___2__ – ventricular relaxation
- systole
- diastole
blood pressure normal levels
- normal = 120/80
- elevated = 120-129/ less than 80
- high blood pressure stage 1 = 139-140/ 80-89
- high blood pressure stage 2 = 140+/90+
-hypertensive crisis = 180+/120+
BP red flags
◦ Systolic over 250
◦ Diastolic over 115
◦ Drop of systolic pressure more than 10 mmHg from baseline
◦ Failure of the systolic pressure to increase with increasing
workload
How long does it take BP to return to normal after exercise?
3-5 mins
Which arm SHOULD BP be taken in?
left
pain descriptors
◦ Muscle – cramping, dull,
aching
◦ Nerve – sharp, bright,
lighting-like
◦ Nerve root – sharp,
shooting
◦ Vasculature – throbbing,
diffuse, crushing
◦ Bone – Deep, nagging, dull
◦ Sympathetic n. – burning,
stinging, aching
Visceral pain – pain from internal organs
◦ Can refer to other body parts:
“Alert and Oriented x____”
◦ A & O x1 – person
◦ A & O x2 – person and place
◦ A & O x3 – person, place, and time= Normal
◦ A & O x4 – person, place, time, and event= Normal
All of the following are factors that affect body temperature except:
Drinking hot tea 15 minutes before having body temperature measured
Age
Time of day
Cardiopulmonary disease
cardiopulmonary disease
Which of the following is true regarding pain assessment in patient care?
Pain assessment is an objective measurement of the patient’s experience.
Responses to pain are similar across all social and cultural groups.
Pain assessment is rarely useful in determining the underlying source of pain.
Pain is always abnormal and can be a valuable indicator of a serious problem.
Pain is always abnormal and can be a valuable indicator of a serious problem.
All of the following are sites for measuring pulse rate except:
Radial
Ulnar
Brachial
Dorsal pedal
ulnar
Which of the following is NOT true about blood pressure?
High stress will increase blood pressure.
Younger patients have lower blood pressure.
Arm position is not important when measuring blood pressure.
Diastolic pressure may remain unchanged during exercise.
Arm position is not important when measuring blood pressure.
Pulse oximetry accuracy can be hampered by all of the following except:
Carbon monoxide inhalation
Poor circulation
Diameter of finger
Nail polish
poor circulation
Which of the following would be normal vital sign measurements for an adult?
Pulse 82, BP 148/80, RR 20
Pulse 71, BP 117/70, RR 14
Pulse 65, BP 154/82, RR 10
Pulse 112, BP 125/96, RR 22
Pulse 71, BP 117/70, RR 14
Cycle of Contamination and
Infection
- Infectious agent
- Reservoir for organism
- Method of exit
- Method of transmission
- Method of entry into a
new host - Susceptible host
Contact (Infection Transmission)
◦ Direct – body to body surface contact
◦ Indirect – contact with an intermediate
object
Droplet (Infection Transmission)
◦ Result of coughing, sneezing, suctioning,
etc
◦ Particles can travel about 3’
Airborne (Infection Transmission)
◦ Small particles can be widely dispersed
and suspended in air for long periods of
time
◦ About 6’ travel – hence “6 feet rule” for
social distancing
Contact-Based Precautions
- Gloves
- Gown maybe
- Private room preferred
- Dedicated equipment if possible
Droplet-Based Precautions
- Shield,
- Mask
- Gloves
- Gowns often needed
- private room prefered
Airborne-Based
Precautions
- mask (K2 or N95 mask)
- Private room with
negative air pressure - Particulate respirator
no visitors :(
Airborne + Contact
Precautions
-gown
-gloves
-mask and respirator (K2 or N95 mask)
no visitors :(
MRSA and C-diff should use what type of precautions?
contact
chickenpox is an example for which type of precaution?
airborne + contact
Hand washing should be performed…
after contact with secretions.
before and after patient contact.
after removing gloves.
All of the above
All of the abover
PUT THESE IN ORDER
The following are steps for the cycle of cross-contamination and infection. Put the steps in order by matching them to numbers 1 (the first step) to 6 (the last step).
Infectious Agent
Reservoir for Organism
Method of Exit for the Organism
Method of Transmission of the Organism
Method of Entry of the Organism into the New Host
Susceptible Host
Infectious agent
Reservoir for organism
Method of exit
Method of transmission
Method of entry into a new host
Susceptible host
What are the two “contact” methods of infection transmission?
Specific and Nonspecific
General and Specific
Direct and Indirect
Contact and Airborne
direct and indirect
Universal design
concept of designing building that is usable by all
without the need for adaptation.
—–ADA enforced compliance with Standards for Accessible Design
Important Dimensions
36” clear width for wheelchair
60” clear turning diameter for turning a wheelchair
15” to 48” forward reach
9” to 54” side reach
28” to 34” high table and counter tops
32” to 34” wide for doorways
34” to 38” for handrails
33” to 36” for grab bars
public doorways
All controls, door handles, etc. operable with a fist
32-34”
ramps
◦ 1:20 path of travel maximum slope for outside ramps
◦ For every inch of height, there are 20 inches of
ramp length
◦ 1:12 ramps for minimum ramp grade
◦ For every inch of height, there are 12 inches of
ramp length
◦ At least 36” wide
What is the universal symbol that a building or space is accessible?
Blue square sign with a person in a wheelchair.
Why is accessibility important?
Ban discrimination based on disability
Remove employment and access barriers
Improve opportunities for employment
Designate transportation access
The Americans with Disabilities Act is designed to do all of the following, except:
Remove employment and access barriers
Designate transportation access to limited modes of transportation
Improve opportunities for employment
Ban discrimination based on disability
Designate transportation access to limited modes of transportation
“Universal design” means…
All existing buildings should be barrier free
Using the same floor plans for all buildings with similar purposes
Creating environments without barriers for the elderly
Creating a building accessible and free of barriers for people of all ages
Creating a building accessible and free of barriers for people of all ages
When completing a home visit, considerations in the bathroom should include all of the following, except…
Toilet grab bars placed horizontally at least 50
inches from the floor
Non-skid surfaces in tub or shower
Height of toilet seat
Width of door frame
Toilet grab bars placed horizontally at least 50
inches from the floor
—-requirement for grab rails is 33-36”
To determine the most accessible exterior entrance, important factors to consider include all of the following, except…
Most level surface
Fewest number of stairs
Availability to neighbor’s house
Closest to where car will be parked
Availability to neighbor’s house
When presenting Mrs. Jones at a team meeting, it would NOT be acceptable to say…
“She requires mod assist with bed mobility activities.”
“She transfers from bed to wheelchair with max assist of 2.”
“She is wheelchair bound at this time.”
“She is 6 days post total hip replacement.”
“She is wheelchair bound at this time.”
Which of the following is NOT a general body mechanics guideline?
Position yourself close to the load.
When possible, push rather than pull.
Bend the hips and knees.
Inhale during exertion
Inhale during exertion
Lumbar lordosis is caused by which of the following?
Anterior pelvic tilt
Posterior pelvic tilt
Lateral pelvic tilt
Flexion of the lumbar spine
Anterior pelvic tilt
Which of the following statements is NOT true about the center of mass (CoM)?
The CoM is often referred to as the “center of gravity” (CoG).
The CoM never changes position.
The CoM is generally slightly higher in men than in women.
In the standing position, the CoM is located slightly anterior to S2.
The CoM never changes position.
Pressure ulcers
(decubitus ulcers)
Result of prolonged
pressure on tissue caught
between 2 firm surfaces
such as a bony prominence
and the seat of a chair
When pressure is applied
to an area, the circulation is
decreased and the tissues
do not receive the amount
of oxygen or nutrients that
they need.
One week in bed can cause _____% loss in strength?
20%
When laying supine, name 5 places prone for pressure ulcers.
Back of head, shoulder, elbow, buttocks, heel
areas prone to ulcers; prone or supine—–back of the head, shoulder, elbow, ribcage, hip, buttock, leg knees, heel, toe, scapula, sacrum
Death of tissue is called?
Necrosis or Necrotic
What stage of a wound or pressure ulcer is actual damage to the skin?
Stage III
preventing pressure ulcers
- Proper positioning
- Keep skin dry and clean
- Keep bed linens wrinkle free
- Frequent skin inspections
- Minimize friction/shearing when
moving patient - High protein diet
- Adequate hydration
*Use of pressure reducing devices
Your patient is a 14-year-old girl who was in a motor vehicle accident (MVA) and is now comatose in the ICU. You are working with the patient’s family regarding appropriate positioning for this patient. Which of the following would be most appropriate to tell them?
“She should have a pillow under her heels while she is in supine.”
“The patient needs to be repositioned every 3 hours when she is lying in bed.”
“Her inability to move independently makes her more vulnerable to skin breakdown.”
“You can add more pillows if you think she is uncomfortable.”
“Her inability to move independently makes her more vulnerable to skin breakdown.”
-might be wrong idk
Inattentiveness to proper positioning and position changes can lead to contracture. What is a contracture?
Softening of a solid region by soaking
Morphological changes indicative of cellular death
Shortening or tightening of soft tissue that prevents normal movement
A deficiency of blood in a body part due to functional constriction
Shortening or tightening of soft tissue that prevents normal movement
Pressure injuries are often caused by bony prominences. All of the following are bony prominences that need to be monitored while a patient is positioned in supine, except…
Sacrum
Great trochanter
Spine of scapula
Posterior calcaneous
Great trochanter
Draping is used to allow exposure of a body area to be treated. Which of the following is true about draping?
Drape material should not restrict movement or access to the area to be treated
A patient may help adjust drape material.
All of the above.
Draping protects a patient’s privacy during treatment
All of the above.
Some individuals require special care when positioning, and may not be able to remain in positions for more than a few minutes. Indicators that someone may be one of these patients include all of the following, except…
Difficulty complying with instructions to remain in a particular position
Inability to sense the need for a position change
Frequent phone calls from family and friends
Circulation or respiratory impairments
Circulation or respiratory impairments
- T/F When able, always pull the load, rather than push the load.
- T/F Kneel versus bending over when working in lower positions.
- T/F Transfer patients to the weak side (normally).
- T/F It is ok to grab patients arms to transfer or move them.
- T/F Always use a gait belt unless a precaution prevents it.
- T/F If a patient is too big, it is not ok to connect 2 gait belts together.
- False
- True
- False
- False
- True
- False
Dependency Levels
◦ Level 4 – Total dependence
◦ Level 3 – Extensive assistance
◦ Level 2 – Limited Assistance
◦ Level 1 – Supervision
◦ Level 0 - Independent
Dependent Transfers
Hoyer, 2 person lift, squat-pivot, use of draw sheet
One Person Lift (sit/squat pivot)
Used when patient is unable to stand or use
a sliding board
assistance levels
Dependent (100%)
Maximum assistance (max.) (>50%)
Moderate assistance (mod.)(25%-50%)
Minimum assistance (min.)(<25%)
Contact Guard assistance (CGA)
Stand By assistance (SBA)
Independent (I, Ind.)
Horizontal and Vertical
Transfers
Squat Pivot (less assistance)
Standing Pivot Transfers
◦ Dependent, assisted, standby, independent
Sitting
◦ Anteroposterior Transfers
◦ Sliding Board Transfers
◦ Dependent, assisted, standby, independent
Anterior-Posterior Transfer
Straight on
◦ Chair is facing toward the surface they are
transferring to
◦ Often used by patient’s with bilateral
amputations or SCI
◦ Must have good UE strength and hamstring
length
Transfer patient to ________
strong side
Which of the following statements is NOT a general precaution during transfers?
Guard the patient using clothing or grasping an arm.
The patient’s footwear should be suitable for the transfer.
Predetermine the patient’s physical and mental capabilities.
Be alert for any unexpected events that may occur during the transfer.
Guard the patient using clothing or grasping an arm.
A variety of terms are used to document the amount of assistance that a patient requires. Match the term to the number indicating the level of assistance from 1 (least assist) to 5 (most assist).
Stand by Assist (SBA)
Contact Guard Assist (CGA)
Minimal Assist (min A)
Moderate Assist (mod A)
Maximal Assist (max A)
1
2
3
4
5
Which of the following is most strongly related to injuries sustained when guarding or transferring patients?
The age and/or weight of the person completing the transfer
The diagnosis of the patient being transferred
The number of repetitions of the transfer being completed
The occurrence of unexpected position changes during the transfer
The number of repetitions of the transfer being completed
All of the following are true about sliding board transfers, except:
The wheelchair armrest should be removed prior to the transfer
Caster wheels should be turned forward prior to the transfer
The sliding board is used to assist the patient in coming to stand
The sliding board is used to assist patients who are unable to stand
The sliding board is used to assist the patient in coming to stand
Your patient has been working on transferring from the floor into his wheelchair using his upper body. He is having great difficulty with the task, primarily because his arms are not very strong. You are going to call the PT and suggest a change to the transfer training. What would make the transfer easier for the patient?
Place a pillow on the floor for him to climb onto first.
Place a stool beside the wheelchair to give him an additional support surface.
Place a stool in front of the wheelchair for him to move onto first.
Tip the wheelchair forward to make it easier for him to reach.
Place a stool in front of the wheelchair for him to move onto first.
wheelchair fitting
Seat Width
1. Widest point
2. Hip width
3. Chest width
Measure widest point
and add 2 inches
4. Seat height – heel to popliteal
fold (+ 2”)
5. Seat depth (most accurate in
supine) – posterior buttock to
popliteal fold (– 2”)
6. Armrest height – seat to
olecranon process (+1”)
7. Back height – seat to floor of
axilla (-4”)
Confirming the fit of a wheelchair
◦ Does the patient’s posture appear
symmetrical?
◦ Is the patient’s position
approximately 90-90-90?
◦ Are the patient’s hips fully back in
the wheelchair with the knees at or
slightly above the level of the hips?
◦ Are the patient’s normal spinal
curves being maintained?
wheelchair QUICK FIT
◦ Seat width – (or an open hand) with palm toward hips, between hips and sides of wheelchair
◦ Seat depth – horizontal fingers between popliteal fold and front edge of chair
◦ Seat height – horizontal (vertical) fingers between the underside of the patient’s distal thigh and the surface of the front of the seat
◦ Armrest height – sweep vertical fingers between the underside of the patient’s forearm and the top of the drive wheel
◦ Leg rest length – sweep vertical fingers between the floor and the footrest
◦ Seat back height – vertical fingers between the top of the wheelchair back and the patient’s axilla
◦ Slide fingers between positioning straps and the patient’s body
On an amputee wheelchair the axle should be placed _____ posteriorly and why?
2” and for improved stability and prevent tipping.
What angle should the patient be sitting at in a wheelchair? (hips, knees, ankles)
90-90-90
When measuring seat width, one measures the widest points and adds/subtracts
what?
Add 2”
When measuring armrest height, one measures what?
Olecranon to seat and add 1”
Explain how you do a quick fit for seat width.
Use 2 fingers or vertical hands between patient and wheelchair.
How long should it take to confirm the fit of a wheelchair?
1-2 minutes
5-10 minutes
15-20 minutes
45-50 minutes
1-2 mins
he postural support system of the wheelchair includes: (check all that apply)
Seat surface
Back surface
Upper extremity supports
Lower extremity supports
Pelvic belt
all of the above
If the seat of the wheelchair is too wide, the user may experience…
Difficulty propelling the wheelchair
Excessive pressure on the greater trochanters
Excessive forward trunk inclination
All of the above
Difficulty propelling the wheelchair
When educating a patient about reaching forward towards the floor while sitting in a wheelchair, you should instruct them to…
Unlock their wheels
Make sure their anti-tip extensions are in place
Turn castor wheels forward
Not lean forward when in a wheelchair
Turn castor wheels forward
Most wheelchair users benefit from a seating system that is…
Soft
Firm
A sling
Triangular
firm
Gait cycle: phases, components
Stance phase - the period of time when the limb under consideration is in contact with the floor
Swing phase - the period of time when the limb under consideration is not in contact with the floor
Double support - when both feet are in contact with the ground at the same time (occurs twice in the cycle)
Single support - the period of time when only one foot is in contact with the ground
gait cycle
(stride duration)- the activity that occurs between the time the heel of one extremity touches the floor and the time the same foot touches the floor again (1 sec.)
important gait terms
Nonsupport - A period of time when neither foot is in contact with the ground
Cadence - steps per minute (113 steps/min)
Velocity - time taken to walk a set distance (82 m/min)– consider “speed” of gait
Stride length - the distance of the gait cycle
Step length - distance between heel strike of one limb and heel strike of the other limb
Stride or step width - the distance between the two feet, measured from the mid-points of the heels (2-4 inches)
COG – Center of gravity – point in body from which weight is equally distributed. Sacral vertebrae 2 (S2)
The gait cycle can be divided
into two phases:
Stance phase is
approximately 60% of
the Gait cycle.
–1. Heel Strike
2. Foot Flat
3. Mid-stance
4. Heel off
5. Toe Off
Swing phase is
appropriately 40% of
the gait cycle.
–Has 3 parts: acceleration, mid-swing, deceleration
——One “gait cycle” refers
to the movement of
one lower limb moving
through both stance
and swing phase. The
limb we are talking
about is called the
reference limb.
- Heel strike –
first moment of foot-floor
contact for the reference
limb
- Foot flat –
the whole foot comes into contact
with the floor
–Shock absorption
- Mid-stance –
the body
is carried forward over
the stance limb and the
opposite is in the swing
phase.
The body’s COG passes
from behind to in front of
the stance foot and it
rises to its highest point.
- Heel off –
heel leaves
the supporting surface
this is followed by push
off
- Toe off –
last contact
with the ground before
swing phase begins
the swing phase accounts for ___ % of the gait cycle
40
- Acceleration
◦ Begins once the toe leaves the
ground
◦ Continues until mid-swing or the
point at which the swinging is
directly under the body
◦ Movements include
◦ Active hip flexion
◦ Active knee flexion
- Mid-swing
◦ The reference limb passes
directly beneath the body
- Deceleration
Occurs after mid-swing when
the tibia passes beyond the
perpendicular and the knee is
extending in preparation for
heel strike
◦ Movements include
◦ Knee extends
◦ Ankle moves into dorsiflexion
gait measuments
Width of walking base – 2-4”
Degree of toe out – 7°
Your patient is beginning to walk after a severe brain injury. You observe that he hikes his right hip when he advances the right leg. The PT has asked you to work on that gait deviation. Which of the following is the most appropriate reason to address this gait deviation?
It draws attention to his gait.
The resulting gait is less efficient.
It makes assistive device selection more challenging.
All of the above.
The resulting gait is less efficient.
Review of WB Terminology
◦ FWB- full weight bearing
◦ PWB- partial weight bearing
◦ NWB- non-weight bearing
◦ WBAT- Weight bearing as tolerated
The more stable a
device is, the less
mobile it is and vice
versa.
:)
Types of Assistive Devices
Listed in order from most to least stable
- Body Weight Support (BWS)
- Parallel bars
- Walkers
- Standard walker, Front-wheel walker (FWW),
Walkane or hemicane - Rollator
◦ Modifications, such as a platform attachment
- Standard walker, Front-wheel walker (FWW),
- Axillary crutches
- Forearm crutches
- Canes
Large-base quad cane
Small-based quad cane
Single point cane
BWS – Body Weight Support
◦↓ risk of falls
◦ ↓’s demands on patient
and therapist
◦ Allows easier facilitation of
reciprocal movement
◦ Treadmill and over ground
◦ Can reduce arm swing
◦ Can’t determine exact
amount of body weight
that is supported
Parallel Bars
◦ Often site of initiation of gait training
◦ Maximum support and stability
◦ Severely limits mobility
◦ Bars should be adjusted to patient’s
height
◦ When patient is grasping bars, angle of
elbow flexion should be 20° to 30°
when patient grasps bars 6 inches
anterior to hips.
◦ Bars should be at level of greater
trochanter or wrist crease, ulnar
styloid, with arm straight along side
◦ Look at these two pictures. Are bars at
correct height?
Walkers
◦ Maximal support and stability with mobility
◦ Most have 4 legs
◦ Some have wheels
◦ Disadvantages:
◦ Difficult to store and transport
◦ Difficult to use on stairs
◦ Reduces speed of ambulation
◦ Difficult to perform normal gait pattern
◦ Difficult to use in crowded or narrow area
Axillary Crutches
◦ Allow greater selection of gait patterns, amb. speed and
good stability
◦ Disadvantages
◦ Less stable
◦ can cause injury to vessels under arm
◦ require good standing balance
◦ functional muscle strength of UE and trunk
muscles is required
◦ elderly may feel insecure
Methods to Fit Axillary Crutches
◦ Use height markings on crutch 77% of patient’s height
◦ Subtract 16 in. from pt’s height
◦ Measure from floor of axilla to 6-8” lateral from heel
◦ In standing:
◦ Position tips of crutches 2 inches out and at least 4-6 inches forward
from toes.
◦ Adjust the length of the crutch so that you can get two finger widths
between the axilla and the top of the crutch
* Adjust hand grip after height using same technique as walker
* To check fit:
* With crutch positioned ready to walk, there should be 20° to 30° and you should
be able to get 2-3 fingers between floor of axilla and top of crutch.
When check fitting crutches, there should be a _____ degree angle at the elbows?
20-30
Who makes the initial decision on which assistive device to use?
PT
Forearm (Lofstrand) Crutches
◦ Easy to store
◦ Stays on forearm when arm is moved
◦ Disadvantages:
◦ Provide less stability
◦ Require good standing balance and good upper
body and UE strength
◦ Cuff makes it difficult to remove crutch
◦ Elderly may feel insecure
◦ Fitting
◦ Height of hand piece is measured using same
method as for the walker
◦ Forearm cuff should be located 1 to 1½ inches
distal to olecranon process when
patient grasps hand piece with the cuff on and
wrist in in neutral
Canes
◦ More functional on stairs, in narrow
areas
◦ Can be stored and transported easily
◦ Disadvantages
◦ Provides limited stability
◦ Fitting
◦ Place cane parallel to femur and tibia with tip
resting on floor
◦ Patient’s wrist, greater trochanter, ulnar styloid
should be even with hand grip
◦ Wrist should be in neutral position
◦ How much elbow flexion should there be with
cane in position to walk?
Four Point
◦ requires bilateral ambulation devices
◦ slow, but safe pattern
◦ hand, opposite foot, other hand, other foot
◦ R cane, L foot, L cane, R foot
Two point
◦ Use one or two ambulation devices
◦ Simultaneous and reciprocal forward placement of device and patient’s opposite
LE
◦ Requires coordination
◦ Faster than 4 point, not as stable
◦ R crutch and L foot, L crutch and R foot
◦ R crutch and L foot, L arm and R foot
Modified four point or two point
◦ Not “task force” language, but used in other textbooks
◦ Use one ambulation device
◦ Aid is held in the hand opposite to LE requiring assistance
◦ Same sequence as 2 or 4 point
Three point pattern
◦ bilateral aids (not canes) or walker
◦ used when patient is PWB or NWB on one extremity
◦ less stable, but very fast
◦ energy expenditure is high
◦ patient needs good UE and trunk strength
◦ Device and involved extremity are advanced at same time then uninvolved
extremity
other gait stuff
Step-to – LE advanced only as far as the assistive device
Step-through – LE is advanced beyond assistive device
Swing-to – Crutches are advanced simultaneously, then legs are simultaneously advance to device
Swing-through – Same as above, but feet are advanced beyond device
precautions four gait patterns
Educate patient about
◦ Remove small rugs or mats that might slide
◦ Avoid waxing floors or use a “nonskid” wax
◦ Immediately wipe fluids from floors
◦ Check ambulation aids weekly for loose nuts, cracks, worn tips, and clean tips
◦ Remove clutter
◦ Keep devices clean with damp cloth
◦ Teach safety specific to device
◦ Wearing house slippers, socks with non-skid soles, or shoes
Match the device with the number indicating it as “least stable” (1) to “most stable”(4).
Walker
Single Point Cane
Parallel Bars
Bilateral Crutches
- (least stable) Single Point Cane
- Bilateral Crutches
- Walker
- (most stable) Parallel Bars
Patients with hemiparesis who use a cane on the uninvolved side demonstrate all of the following EXCEPT:
Reduced mediolateral and anteroposterior sway
Increased walking speed
Loss of stability
Increased stance time on the affected leg
Loss of stability
Which statement is NOT true about assistive devices?
Assistive devices must always be fit while the patient is supine.
An incorrect fit will adversely affect a patient’s gait pattern.
When using a device that is held by just one hand (such as a crutch or cane), generally it should go on the side opposite the affected lower extremity.
Platform attachments are used when a person can’t bear weight through their wrists and/or hands.
Assistive devices must always be fit while the patient is supine.
Your patient is a 79 year-old woman who has just had a right total hip arthroplasy (THA). You are going to gait train her with a walker. What is the best position for guarding this patient as she walks?
Standing directly behind the patient
Standing directly in front of the patient
Standing behind and slightly to the left of the patient
Standing behind and slightly to the right of the patient
Standing behind and slightly to the right of the patient
SOAP
subjective
objective
assessment
plan
Subjective
◦ Includes relevant information reported by the patient
◦ Can be left blank
◦ Information from caregivers/family members goes here.
◦ Ask questions to get more information, ie when did it start, rate it, why?
◦ If pain changes during treatment, can be put in “O”
◦ Provide location and scale
——5/10 in the right hip
◦ Tips for Documenting:
◦ Don’t repeat “patient” after first used in section.
◦ Use quotes if the patient’s actual words make the
relevance clearer.
◦ Common verbs used to document information:
states, reports, complains of, expresses, describes,
denies.
◦ Record relevant information provided by
someone else
Objective
◦ Results of measurements and tests
◦ Description of function
◦ Description of interventions
◦ PTA’s objective observations of patient
◦ Patient education done that day
◦ Should reflect data collected by PT. Can provide comparison to initial
evaluation if appropriate.
◦ Tips for Documenting
◦ Documentation should be consistent with initial
evaluation in procedure, technique,
and how recorded (eg. cm vs inches)
◦ Should paint a picture of the treatment session,
so someone else can duplicate the
session
◦ Group like information together – intervention
descriptions, results of tests and
measurements, descriptions of patient functioning
◦ Can use charts or graphs to give a quick picture.
Handwritten documentation errors
draw a single line through the error,
write the correction and initial and date the correction.
◦ Don’t erase, white or black out the error.
Assesment
◦ Reports on progress toward goals
◦ “What does it mean?”
◦ Significance of data (interpretation)
◦ Recommended changes to POC or discharge
◦ Often the primary section read by physician or third party payer
Provides:
◦ Area to note that goals may need to be modified
and why
◦ Note response to treatment
◦ Connect changes in pt. functional level to goals
◦ Discrepancies between subjective and objective
or other
inconsistencies (refer to your data)
Plan
◦ What will be done in next session
◦ When next session is going to be
◦ If PT consult is needed or anyone else
◦ Info or equipment that is needed
◦ Progress toward discharge
◦ # of visits left
◦ It goals met, or changes needed, etc.
◦ Things patient is to do before next visit
◦ Verbs are in the future tense!
◦ Serves as a reminder to the therapist
Maintenance Therapy
◦ Patient is no longer making progress
◦ Not skilled service
◦ Did not used to be reimbursable as physical therapy
◦ Medicare does cover services to maintain or manage
a beneficiary’s current condition when no functional
improvement is possible if the services are medically
necessary and meet the skilled care requirements.
When goals need to be changed what does the PTA do?
Notify the PT
Maintenance therapy a covered service?
Yes
what ICF disablement model does
Provides standard language world wide
Describes what the individual CAN do in relation to function and positive aspects of health
Describes what the individual CANNOT do in relation to disability and negative aspects of health
Provides standardized coding for disease
Nagi includes
◦ Pathology
◦ Impairment
◦ Functional
Limitation
◦ Disability
ICF includes
◦ Body structures and
function
◦ Activities
◦ Participation
◦ Environmental
◦ Personal
PTA’s Progress Notes during POC (treatment plan):
◦ Document patient’s progress (or
lack thereof) and report to the PT
◦ Report if patient needs a change
in the POC based on how well
they are achieving the goals set by
the PT
◦ Assist with the evaluation by
gathering subjective data and
taking measurements, performing
tests and recording
measurements.
◦ The interpretation of the data
collected is done by the PT.
◦ Use Initial Evaluation as a
guideline for documenting
changes in patient status in
progress notes
PT’s Initial Evaluation Note:
◦ History, observations, risk factor identification
◦ Subjective data
◦ Information about: Strength, ROM, Functional abilities, Pain, Muscle tone,
Communication status, adaptive equipment needs, automatic reactions,
abnormal reflexes, level of independence in daily care, alignment, quality of
movement, cognitive function
◦ Results of tests and measures
◦ Interpretation of results
◦ PT Diagnosis
◦ PT Goals
◦ Treatment plan (POC)
◦ Name and title of PT
PT’s Re-evaluation Note
◦ Completed by PT
◦ What services have been provided
◦ Patient status
◦ Results of re-examination
IV Lines
The purpose is to either hydrate the person, administer IV
antibiotics, or provide electrolytes for the patient.
If the pump is not flowing then the nurse should be called.
Be aware of the IV line when getting the pt. up to the chair or when taking them down to PT. If the tubing is not long enough let the nurse know for an extension.
Arterial line
◦ Inserted into an artery. Used to draw arterial blood,
measure arterial blood pressure, deliver medication
Swan Ganz Catheter
◦ Pulmonary artery catheterization. Inserted into a large vein (subclavian v., femoral v., internal jugular v.) and moved into the pulmonary artery. Use to monitor
cardiac output.
◦ Precautions Do not get anyone up with femoral line.
70 degree limit in flexion for femoral, Life threatening
if pulled out, apply pressure and call for help!. Limit
shoulder flexion to under 90 degrees for subcl. Limit
cervical motion with jug placement.
Hickman
◦ Implanted into a vein for long-term placement. Used
to administer meds (chemotherapy), blood collection,
dialysis
◦ Precautions – limit ipsilateral shoulder movements, BP measurements, no aquatic therapy until healed.
External Urinary Catheter
Non- Invasive catheter that draws urine away from body
Male external catheter
Female external catheter
When you enter your patient’s ICU room, you notice immediately that the patient has several machines running with various lines and tubes attached to the patient. You are planning to assist the patient to the bedside chair and note that one of the machines (which is connected to an IV line) is on the side of the bed opposite the chair and other monitoring equipment. What should you do?
Change your plan and only perform in-bed activities
Contact the patient’s nurse and ask them to help reposition the IV
Defer treatment until the IV is removed
Disconnect the line and move the machine to the opposite side of the bed.
Contact the patient’s nurse and ask them to help reposition the IV
This device is inserted into an artery to measure blood pressure and/or obtain blood samples.
Arterial Line
Swan-Ganz Catheter
Oximeter
Sphygnomanometer
Arterial Line
This sleeve is placed over a patient’s leg(s) and applies compression to improve venous return.
Nasogastric Tube
Foley Catheter
Venous Compression Tube
Sequential Compression Device
Sequential Compression Device
Types of ROM
◦ PROM - passive - the therapist or another external force moves the body part through the ROM
◦ AAROM - active assisted - the therapist assists the movement
◦ AROM - active - the patient moves the body part without assistance
◦ RROM - resisted - the movement is resisted
PROM indications
◦ Pain occurs with active contraction
◦ Paralysis or marked weakness
◦ Active contraction is prohibited
◦ Assess joint movement
◦ Counteract negative effects of immobilization
◦ Provide sensory stimulation and awareness
◦ Reduce stress on cardiopulmonary system
◦ To teach movement
T/F PROM can increase strength.
False
PROM precautions
◦ If it temporarily increases pain
◦ In patients taking medication
for pain or muscle relaxants,
because the patient may not be
able to respond appropriately
and movement may be
performed too vigorously
◦ In the region of marked
osteoporosis or in conditions
where bone fragility is a factor.
◦ When it elicits undesired
muscle tone
Abnormal end feels
◦ Hard – OA
◦ Soft – synovitis, edema
◦ Firm – capsule, muscle, or ligament shortening/tightness
◦ Empty - patient requests movement be stopped, usually secondary to pain, so
there is no end feel; bursitis, inflammation
