Test 2

Question 1

Mr Smith is admitted to the trauma Ward following a motor vehicle accident. He sustained chest wall trauma during his assessment you note the following: He breathes with an apical breathing pattern with an inspiration: Expiration (I:E) ratio of 1: 1
his vital Signs are heart rate 90 BPM respiratory rate 24 breaths per minute blood pressure 100 over 65
he complains of feeling short of breath and has an unproductive cough.

1.1 Analyse his vital signs and compare with the normal ranges for these parameters: (8)

Answer 1

RR: At 24 breaths/ min, therefore is presenting with tachyponea as normal rate is 12/16 breaths/min , and over 20b/m is considered tachyponea. The cause could be because of his chest wall trauma eg rib fractures

HR: At 90bpm; normal HR is 60-100bpm, however at rest it should be lower 60-80 bpm, therefore it is still in normal ranges even though elevated, therefore wont define it as tachycardia as that will only be over 100 bpm.

BP: His is at 100/65mmHg, ideal BP is to be 120/ 80 and systolic 95-140 and diastolic 60-90, therefore even though his BP is not in the ideal BP ranges it is still in normal systolic and diastolic ranges.

Question 2

1.2 Document the normal I:E ratio.

Answer 2

1:2

Question 3

1.3 Name the main respiratory muscle.

Answer 3

Diaphragm

Question 4

1.4 Mr Smith is admitted to the trauma Ward following a motor vehicle accident. He sustained chest wall trauma during his assessment you note the following: He breathes with an apical breathing pattern with an inspiration: Expiration (I:E) ratio of 1: 1
his vital Signs are heart rate 90 BPM respiratory rate 24 breaths per minute blood pressure 100 over 65
he complains of feeling short of breath and has an unproductive cough.
Explain three aims for the treatment of Mr Smith. (6)

Answer 4

1. To improve the distribution of ventilation thereby increasing his O2 levels in his body. This will help him breath more easily and promote healing. ( decrease his RR) won’t feel short of breath.
2. Enable the clearance of his airway secretions (sputum/ phlegm) to enable his lungs to heal and function effectively. ( his cough will be productive and secretions will be coughed out)
3. Improve the efficiency of the muscles needed for respiration (diaphragm, external intercostal muscles and accessory muscles) ( will improve his I:E)

Question 5

1.5 Name the components of ACBT and explain the function of each component.(9)

Answer 5

1.5 Name the components of ACBT and explain the function of each component.(9)

Breathing control: BC
- relaxation component of ACBT, during relaxed normal( tidal volume)
- By encouraging tidal volume breaths it allows for the patient to regain normal breathing patterns.
Thoracic expansion exercises (TEE)
3 types, during inspiratory phase of deep breathing.
-Basic TEE.
- TEE with 3 second inspiritory hold: patient holds inspiratory breath for 3 seconds before exhaling; the breath holds aims to improve airflow distribution through the collateral ventilation pathways at bronchiole-alveolar level to increase lung volume.
- TEE with inspiritory sniff: breath in deeply as possible then hold and sniff an additional breath through nose and then exhale.
Forced expiratory techniques FET:
- Two types
- Long FET(low volume FET)- two long huffs by patient, Aims to recruit secretions from the periphery of the lungs and move them more centrally for evacuations from the airways.
- short FET( high volume FET) - patient performs one or two short, sharp huffs at high lung v

Question 6

Short FET

Answer didn’t fit last card

Answer 6

short FET( high volume FET) - patient performs one or two short, sharp huffs at high lung volume, short FET assists with evacuating secretions from the central airways. ( usually followed by coughing)

Question 7

1.1 Document the factors influencing ventilation of the lungs. (5)

Answer 7

1. Respiratory muscle strength
2. Pressure- gradients
3. Resistance of air flow in airways and tissue movement
4. Compliance of lung tissue
5. Compliance of chest wall.

Question 8

1.2 list the segments of the right lower lobe. (5)

Answer 8

Apical basal, anterior basal, posterior basal, lateral basal and medial basal segments.

Question 9

2.1 Document the aims of ACBT. (3)

Answer 9

1. Normalize the patients breathing pattern.
2. Normalize their lung volume
3. Clear excessive bronchial secretions from the patients tracheobronchial tree.

Question 10

2.2 List the components of ACBT(3).

Answer 10

1. Breathing control (BC)
2. Thoracic expansion exercises (TEE)
3. Forced expiratory technique (FET)

Question 11

2.3 Explain the infection control principles you would following when performing ACBT with patient. (4)

Answer 11

1. Important to instruct the patient to breath away from the physiotherapist face while performing ACBT for infection control purposes.
2. Make sure physiotherapist isnt wearing woolen clothing.
3. Make sure sleeves of physiotherapist are rolled up.
4. Make sure the physiotherapist have washed their hands before and after treatment.

Question 12

3.1 Describe the postural drainage position for the right middle lobe. (5)

Answer 12

The bed is elevated onto a platform to produce a chest-down tilt of 15°.
The patient lies in a supine and turns the body a quarter turn towards the left side. The right arm and upper torso are supported with a pillow and the head with another pillow

Question 13

3.2 list five precautions that your would check prior to using postural drainage as a treatment modality.

Answer 13

• congestive cardiac failure
• severe hypertension
• Cerbral oedema or raised intracranial pressure
• Aortic or Cerbral aneurysm
• Frank haemoptysis
• abnormal distention or obesity
• Gastro-eosphageal reflex
• Recent surgery or trauma to the head and neck

Question 14

Ms summer 24 year-old sustained an elbow injury during a friendly tennis match yesterday she presents with pain swelling and she’s unable to play tennis.

1. between hot and cold therapy which modality is appropriate for Ms summer?(1)

Answer 14

Cold therapy

Question 15

Ms summer 24 year-old sustained an elbow injury during a friendly tennis match yesterday she presents with pain swelling and she’s unable to play tennis.

2. Justify your treatment choice between hot and cold therapy for Miss summer(5)

Answer 15

The reason for my cold therapy over heat therapy is because she presents with pain and swelling as well as she is unable to play, therefore potentially having a poor muscle contraction, which are all indications to use cold therapy. Furthermore, it is in the first 48 hours of the injury and best use of cold therapy is within the first 48 hours of injury. Moreover, because she is presenting with pain and cold therapy will help reduce that by it decreasing the nerve conduction velocity and decreasing the nerve ending excitability. Furthermore cold therapy cools the damaged tissue as heat is withdrawn from the area and constricts the blood vessels as well as decreases the metabolism and consumption of oxygen in the area thus reducing cell damage. Also, ice therapy will reduce her swelling as vasoconstriction will occur and therefore will control the uncontrolled oedema fluid causing her swelling. Furthermore, it will promote healing and prevent futher damage by promoting the absorption of exudates and prevent further bleeding and exudate formation.

Question 16

3.Describe the normal stages of Sensation during Ms summer’s treatment. (4)

Answer 16

There will be 4 stages of sensation:

1) Intense cold- within 3 minutes of application.
2) Burning-4-7 minutes of application.
3) Aching pain -8-15 minutes.
4) Numbness- 15-30 minutes After application

Question 17

4. Name five general contraindications for the application of hot therapy.
   Heating must not be applied:(5)

Answer 17

1) Over acute injuries or hemorrhagic areas.
2) Immediately after the administration of analgesia.
3) Areas of gross oedema- thin skin
4) Over anesthetized areas/areas of impaired sensation.
5) area of inadequate blood supply

Question 18

1. List six factors that influence the magnitude of temperature change in the tissue when applying cryotherapy.

Answer 18

1) Type of cooling agent
2) Temperature difference between cold object and tissue.
3) Amount of subcutaneous insulation (fat)
4) Thermal conductivity of the area cooled.
5) limb circumference.
6) Duration of the application.

Question 19

2. Explain the hunting response phenomenon (6)

Answer 19

It is the process of alternating vasoconstriction and vasodilation in extremities exposed to cold. The application of intense cold to the body causes vasoconstriction with the liberation of histamine like ‘H’ substances produced by the intense cold and noxious stimuli. Histamine is an organic nitrogen compound involved in a local immune responses as well as regulating physiological function in the gut and acting as a neurotransmitter. Initial vasoconstriction last about the 9 to 16 minutes. When there are sufficient H substances vasodilation occurs for a BRIEF period of time for 4-6 minutes and vasodilation removes all the histamine substances. Vasoconstriction again happens followed by vasodilation occurring at further intervals of 15 to 16 minutes. After removing prolonged cold there is vasodilation which increases greatly for 20 minutes and it subsides slowly. The sudden vasodilation due to intense cold application is termed the hunting response.

Question 20

Sibusiso presents with pain (2/5 VAS) and stiffness of his hand due to arthritis.
Prescribe the most appropriate heat modality for Sibusisos condition. (1)

Answer 20

Wax therapy

Question 21

3.2 List five advantages of the heat modality for Sibusisos conditions. (5)

Answer 21

1) Wax has low thermal conductivity which means it gives off heat slowly and useful in patients with low heat intolerance.
2) More than one patient can be treated at the same time.
3) It moulds easily around the hands and feet.
4) It improves skin condition after removal of POP.
5) It does not require a coupling medium.
6) The wax can be used after implementation of exercises.

Question 22

4. Briefly discuss the pain gate theory.(5)

Answer 22

If there is a noxious stimulus to the body it will be transported via the A and C small nerve fibres which opens the ‘pain gate’ to transmit info to the CNS, therefore pain will be sensed. If however there is a distractive stimulus such as the application of heat, the stimulus will cause the a stimulation of the mechanoreseptors which causes the large peripheral A- Alpha and A- beta fibers to send transmissions to travel which passes through the ‘pain gate’ which causes the release of inhibitory neurotransmitters to switch off the transmission of pain. Therefore because of the distractive stimulus the pain is not felt.

Question 23

State and give two reasons why you would prescribe a particular walking aid for each patient (2)

2.1 Tom a 15 year old boy who fell down a tree and fractured his right ankle he is non weight-bearing on the right leg

Answer 23

Gutter crutches

He can use the three point gait pattern as it will be effective mode to walk for his injured leg as well as he will have an increase range of mobility with the crutches as this will be needed since he is young and therefore extremely mobile

Question 24

State and give two reasons why you would prescribe a particular walking aid for each patient

2.2 Mr Dunphy a 5 year old male who had a left total hip replacement and has Parkinson’s(2)

Answer 24

A walking frame as it enhances the base of support for better balance, because of the Parkinson’s the bars will provide suitable support for the shaking; he is older and more fragile and a wider base of support will help him move balanced without the fear of falling.

Question 25

State and give two reasons why you would prescribe a particular walking aid for each patient
2.3 MR PORTER a 50 year old female who is on a waiting list for a knee replacement due to osteoporosis.(2)

Answer 25

Walking cane,
It will help relieve pressure off her affected knee, as well as will provide her with a broad base of support as she will be have balance difficulties with he problematic knee.

Question 26

1. List and explain five factors that influence the selection of a walking aid (9)

Answer 26

Age- elderly need more stability 
Strength- of upper limbs needed for crutches 
Balance- more for crutches than frame 
Complications-upper limb fractures 
Patients needs- stairs, space

Question 27

What safety precautions would you take before mobilising a patient out of bed?(10)

Answer 27

Need to make sure that the patient is medically stable, socks off proper shoes, drips catheters taking care of, circulatory preparation, check balance check for dizziness, have a chair ready, know weight-bearing status, check strength of weight bearing limbs, explain/demonstrate,walking aid is safe/ intact, general condition metal/ plastic, Ferrules rubber tips are not worn to the point where no trade is showing, correct perscription/type, correct use and instruction, crutches are a matching pair. Do not issue a mismatched pair, spring clips tips are located into both holes, (for axillary crutches make sure the nuts and bolts are tight), adjustment mechanism adjusts freely (elbow crutches)