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PTA > Skills 110 Finals Written Exam > Flashcards

Skills 110 Finals Written Exam Flashcards

1
Q

Signs

A

Objective and related to the
health condition. Observable
conditions

*Rashes
*Wheezing
*Red, scaly inflamed skin
*Edema
*Joint tenderness
*Cloudy lenses in eyes

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2
Q

Symptoms

A

Subjective feelings or
sensations experienced by the
patient.

  • Shortness of breath
  • Headache
    *Fatigue
    *Congested
    *Itching
    *Joint pain and stiffness
    *Blurry vision
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3
Q

Wave of blood in an artery created by the contraction
of the ventricles in the heart

A

pulse rate

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4
Q

normal pulse rate levels

A

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

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5
Q

points of assessment for pulse rate

A

Apical
Temporal
Brachial
Carotid
Radial
Femoral
Popliteal
Pedal

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6
Q

counting and documenting PR

A

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)

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7
Q

If a pulse is irregular, how long do you measure the pulse?

A

60 secs

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8
Q

how to find target heartrate

A

maximum HR = 220 - age
THR = 50-85% of Max. HR

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9
Q

pulse rate red flags

A

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

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10
Q

The measure of breathing, Each cycle has one inspiration and one expiration

A

respiratory rate

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11
Q

RR pain ratings

A

“0” = breathless with strenuous exercise  “4” = becomes breathless
with dressing

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12
Q

RR normal ranges

A

Neonates  40-60
Infants  25-60
Children  15-30
Adults  12-20

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13
Q

RR red flags

A

 Shortness of breath without much exertion
 Irregular breathing pattern
 Noisy breathing
 Pain with breathing

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14
Q

Measures arterial blood oxygenation

A

pulse oximetry

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15
Q

normal pulse oximeter readings

A

Normal = 96 – 100%

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16
Q

pulse oximeter red flags

A

Below 85 – severe hypoxia

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17
Q

Measures the force the blood exerts against a vessel wall.

Affected by:
◦ Blood volume
◦ Vessel size
◦ Vessel compliance

A

blood pressure

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18
Q

Korotkoff’s Sounds:
◦ Series of sounds as a result of:
◦ ___1__ – ventricular contraction
◦ ___2__ – ventricular relaxation

A
  1. systole
  2. diastole
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19
Q

blood pressure normal levels

A
  • 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+
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20
Q

BP red flags

A

◦ 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

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21
Q

How long does it take BP to return to normal after exercise?

A

3-5 mins

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22
Q

Which arm SHOULD BP be taken in?

A

left

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23
Q

pain descriptors

A

◦ 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:

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24
Q

“Alert and Oriented x____”

A

◦ 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

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25
Q

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

A

cardiopulmonary disease

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26
Q

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.

A

Pain is always abnormal and can be a valuable indicator of a serious problem.

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27
Q

All of the following are sites for measuring pulse rate except:

Radial

Ulnar

Brachial

Dorsal pedal

A

ulnar

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28
Q

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.

A

Arm position is not important when measuring blood pressure.

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29
Q

Pulse oximetry accuracy can be hampered by all of the following except:

Carbon monoxide inhalation

Poor circulation

Diameter of finger

Nail polish

A

poor circulation

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30
Q

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

A

Pulse 71, BP 117/70, RR 14

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31
Q

Cycle of Contamination and
Infection

A
  1. Infectious agent
  2. Reservoir for organism
  3. Method of exit
  4. Method of transmission
  5. Method of entry into a
    new host
  6. Susceptible host
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32
Q

Contact (Infection Transmission)

A

◦ Direct – body to body surface contact
◦ Indirect – contact with an intermediate
object

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33
Q

Droplet (Infection Transmission)

A

◦ Result of coughing, sneezing, suctioning,
etc
◦ Particles can travel about 3’

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34
Q

Airborne (Infection Transmission)

A

◦ 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

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35
Q

Contact-Based Precautions

A
  • Gloves
  • Gown maybe
  • Private room preferred
  • Dedicated equipment if possible
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36
Q

Droplet-Based Precautions

A
  • Shield,
  • Mask
  • Gloves
  • Gowns often needed
  • private room prefered
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37
Q

Airborne-Based
Precautions

A
  • mask (K2 or N95 mask)
  • Private room with
    negative air pressure
  • Particulate respirator

no visitors :(

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38
Q

Airborne + Contact
Precautions

A

-gown
-gloves
-mask and respirator (K2 or N95 mask)

no visitors :(

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39
Q

MRSA and C-diff should use what type of precautions?

A

contact

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40
Q

chickenpox is an example for which type of precaution?

A

airborne + contact

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41
Q

Hand washing should be performed…

after contact with secretions.

before and after patient contact.

after removing gloves.

All of the above

A

All of the abover

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42
Q

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

A

Infectious agent

Reservoir for organism

Method of exit

Method of transmission

Method of entry into a new host

Susceptible host

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43
Q

What are the two “contact” methods of infection transmission?

Specific and Nonspecific

General and Specific

Direct and Indirect

Contact and Airborne

A

direct and indirect

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44
Q

Universal design

A

concept of designing building that is usable by all
without the need for adaptation.
—–ADA enforced compliance with Standards for Accessible Design

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45
Q

Important Dimensions

A

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

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46
Q

public doorways

A

All controls, door handles, etc. operable with a fist

32-34”

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47
Q

ramps

A

◦ 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

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48
Q

What is the universal symbol that a building or space is accessible?

A

Blue square sign with a person in a wheelchair.

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49
Q

Why is accessibility important?

A

Ban discrimination based on disability

Remove employment and access barriers

Improve opportunities for employment

Designate transportation access

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50
Q

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

A

Designate transportation access to limited modes of transportation

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51
Q

“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

A

Creating a building accessible and free of barriers for people of all ages

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52
Q

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

A

Toilet grab bars placed horizontally at least 50
inches from the floor

—-requirement for grab rails is 33-36”

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53
Q

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

A

Availability to neighbor’s house

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54
Q

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.”

A

“She is wheelchair bound at this time.”

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55
Q

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

A

Inhale during exertion

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56
Q

Lumbar lordosis is caused by which of the following?

Anterior pelvic tilt

Posterior pelvic tilt

Lateral pelvic tilt

Flexion of the lumbar spine

A

Anterior pelvic tilt

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57
Q

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.

A

The CoM never changes position.

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58
Q

Pressure ulcers
(decubitus ulcers)

A

 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.

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59
Q

One week in bed can cause _____% loss in strength?

A

20%

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60
Q

When laying supine, name 5 places prone for pressure ulcers.

A

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

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61
Q

Death of tissue is called?

A

Necrosis or Necrotic

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62
Q

What stage of a wound or pressure ulcer is actual damage to the skin?

A

Stage III

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63
Q

preventing pressure ulcers

A
  • 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
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64
Q

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.”

A

“Her inability to move independently makes her more vulnerable to skin breakdown.”
-might be wrong idk

65
Q

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

A

Shortening or tightening of soft tissue that prevents normal movement

66
Q

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

A

Great trochanter

67
Q

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

A

All of the above.

68
Q

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

A

Circulation or respiratory impairments

69
Q
  1. T/F When able, always pull the load, rather than push the load.
  2. T/F Kneel versus bending over when working in lower positions.
  3. T/F Transfer patients to the weak side (normally).
  4. T/F It is ok to grab patients arms to transfer or move them.
  5. T/F Always use a gait belt unless a precaution prevents it.
  6. T/F If a patient is too big, it is not ok to connect 2 gait belts together.
A
  1. False
  2. True
  3. False
  4. False
  5. True
  6. False
70
Q

Dependency Levels

A

◦ Level 4 – Total dependence
◦ Level 3 – Extensive assistance
◦ Level 2 – Limited Assistance
◦ Level 1 – Supervision
◦ Level 0 - Independent

71
Q

Dependent Transfers

A

Hoyer, 2 person lift, squat-pivot, use of draw sheet

72
Q

One Person Lift (sit/squat pivot)

A

Used when patient is unable to stand or use
a sliding board

73
Q

assistance levels

A

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.)

74
Q

Horizontal and Vertical
Transfers

A

Squat Pivot (less assistance)

Standing Pivot Transfers
◦ Dependent, assisted, standby, independent

Sitting
◦ Anteroposterior Transfers
◦ Sliding Board Transfers
◦ Dependent, assisted, standby, independent

75
Q

Anterior-Posterior Transfer

A

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

76
Q

Transfer patient to ________

A

strong side

77
Q

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.

A

Guard the patient using clothing or grasping an arm.

78
Q

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)

A

1
2
3
4
5

79
Q

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

A

The number of repetitions of the transfer being completed

80
Q

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

A

The sliding board is used to assist the patient in coming to stand

81
Q

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.

A

Place a stool in front of the wheelchair for him to move onto first.

82
Q

wheelchair fitting

A

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”)

83
Q

Confirming the fit of a wheelchair

A

◦ 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?

84
Q

wheelchair QUICK FIT

A

◦ 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

85
Q

On an amputee wheelchair the axle should be placed _____ posteriorly and why?

A

2” and for improved stability and prevent tipping.

86
Q

What angle should the patient be sitting at in a wheelchair? (hips, knees, ankles)

A

90-90-90

87
Q

When measuring seat width, one measures the widest points and adds/subtracts
what?

A

Add 2”

88
Q

When measuring armrest height, one measures what?

A

Olecranon to seat and add 1”

89
Q

Explain how you do a quick fit for seat width.

A

Use 2 fingers or vertical hands between patient and wheelchair.

90
Q

How long should it take to confirm the fit of a wheelchair?

1-2 minutes

5-10 minutes

15-20 minutes

45-50 minutes

A

1-2 mins

91
Q

he postural support system of the wheelchair includes: (check all that apply)

Seat surface

Back surface

Upper extremity supports

Lower extremity supports

Pelvic belt

A

all of the above

92
Q

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

A

Difficulty propelling the wheelchair

93
Q

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

A

Turn castor wheels forward

94
Q

Most wheelchair users benefit from a seating system that is…

Soft

Firm

A sling

Triangular

A

firm

95
Q

Gait cycle: phases, components

A

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

96
Q

gait cycle

A

(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.)

97
Q

important gait terms

A

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)

98
Q

The gait cycle can be divided
into two phases:

A

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.

99
Q
  1. Heel strike –
A

first moment of foot-floor
contact for the reference
limb

100
Q
  1. Foot flat –
A

the whole foot comes into contact
with the floor
–Shock absorption

101
Q
  1. Mid-stance –
A

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.

102
Q
  1. Heel off –
A

heel leaves
the supporting surface
this is followed by push
off

103
Q
  1. Toe off –
A

last contact
with the ground before
swing phase begins

104
Q

the swing phase accounts for ___ % of the gait cycle

A

40

105
Q
  1. Acceleration
A

◦ 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

106
Q
  1. Mid-swing
A

◦ The reference limb passes
directly beneath the body

107
Q
  1. Deceleration
A

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

108
Q

gait measuments

A

Width of walking base – 2-4”
Degree of toe out – 7°

109
Q

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.

A

The resulting gait is less efficient.

110
Q

Review of WB Terminology

A

◦ FWB- full weight bearing
◦ PWB- partial weight bearing
◦ NWB- non-weight bearing
◦ WBAT- Weight bearing as tolerated

111
Q

The more stable a
device is, the less
mobile it is and vice
versa.

A

:)

112
Q

Types of Assistive Devices
Listed in order from most to least stable

A
  1. Body Weight Support (BWS)
  2. Parallel bars
  3. Walkers
    • Standard walker, Front-wheel walker (FWW),
      Walkane or hemicane
    • Rollator
      ◦ Modifications, such as a platform attachment
  4. Axillary crutches
  5. Forearm crutches
  6. Canes
     Large-base quad cane
     Small-based quad cane
     Single point cane
113
Q

BWS – Body Weight Support

A

◦↓ 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

114
Q

Parallel Bars

A

◦ 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?

115
Q

Walkers

A

◦ 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

116
Q

Axillary Crutches

A

◦ 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

117
Q

Methods to Fit Axillary Crutches

A

◦ 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.

118
Q

When check fitting crutches, there should be a _____ degree angle at the elbows?

A

20-30

119
Q

Who makes the initial decision on which assistive device to use?

A

PT

120
Q

Forearm (Lofstrand) Crutches

A

◦ 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

121
Q

Canes

A

◦ 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?

122
Q

Four Point

A

◦ requires bilateral ambulation devices
◦ slow, but safe pattern
◦ hand, opposite foot, other hand, other foot
◦ R cane, L foot, L cane, R foot

123
Q

Two point

A

◦ 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

124
Q

Modified four point or two point

A

◦ 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

125
Q

Three point pattern

A

◦ 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

126
Q

other gait stuff

A

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

127
Q

precautions four gait patterns

A

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

128
Q

Match the device with the number indicating it as “least stable” (1) to “most stable”(4).

Walker

Single Point Cane

Parallel Bars

Bilateral Crutches

A
  1. (least stable) Single Point Cane
  2. Bilateral Crutches
  3. Walker
  4. (most stable) Parallel Bars
129
Q

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

A

Loss of stability

130
Q

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.

A

Assistive devices must always be fit while the patient is supine.

131
Q

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

A

Standing behind and slightly to the right of the patient

132
Q

SOAP

A

subjective
objective
assessment
plan

133
Q

Subjective

A

◦ 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

134
Q

Objective

A

◦ 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.

135
Q

Handwritten documentation errors

A

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.

136
Q

Assesment

A

◦ 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)

137
Q

Plan

A

◦ 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

138
Q

Maintenance Therapy

A

◦ 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.

139
Q

When goals need to be changed what does the PTA do?

A

Notify the PT

140
Q

Maintenance therapy a covered service?

A

Yes

141
Q

what ICF disablement model does

A

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

142
Q

Nagi includes

A

◦ Pathology
◦ Impairment
◦ Functional
Limitation
◦ Disability

143
Q

ICF includes

A

◦ Body structures and
function
◦ Activities
◦ Participation
◦ Environmental
◦ Personal

144
Q

PTA’s Progress Notes during POC (treatment plan):

A

◦ 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

145
Q

PT’s Initial Evaluation Note:

A

◦ 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

146
Q

PT’s Re-evaluation Note

A

◦ Completed by PT
◦ What services have been provided
◦ Patient status
◦ Results of re-examination

147
Q

IV Lines

A

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.

148
Q

Arterial line

A

◦ Inserted into an artery. Used to draw arterial blood,
measure arterial blood pressure, deliver medication

149
Q

Swan Ganz Catheter

A

◦ 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.

150
Q

Hickman

A

◦ 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.

151
Q

External Urinary Catheter

A

Non- Invasive catheter that draws urine away from body
Male external catheter
Female external catheter

152
Q

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.

A

Contact the patient’s nurse and ask them to help reposition the IV

153
Q

This device is inserted into an artery to measure blood pressure and/or obtain blood samples.

Arterial Line

Swan-Ganz Catheter

Oximeter

Sphygnomanometer

A

Arterial Line

154
Q

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

A

Sequential Compression Device

155
Q

Types of ROM

A

◦ 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

156
Q

PROM indications

A

◦ 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

157
Q

T/F PROM can increase strength.

A

False

158
Q

PROM precautions

A

◦ 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

159
Q

Abnormal end feels

A

◦ 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

PTA (5 decks)

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