Test I Flashcards
What is a particular tool, systematic observation or instrument that is used to collect data about the patient during the evaluation process?
Assessment
What is the process of reviewing data, observing a client and using screening tools to identify the individual’s potential to benefit from further assessment?
Screening
What encompasses obtaining, interpreting and synthesizing data to understand the patient, the situation or system factors that may or may not influence the therapeutic intervention?
Evaluation
when does discharge planning begin in acute care?
At the time of the initial evaluation.
Chart review, interview and occupational profile, specific evaluation measures, interpretations and findings and recommendations for treatment are all part of the ______ process.
Evaluation
What type of performance is the OT’s primary focus on in acute care?
Cognitive and physiological performance
What is the ultimate goal of acute care?
To move the patient home or to another setting as soon as the patient becomes stable.
What is the typical expected time frame for OT evaluations after they are ordered by a physician?
Same day or within 24 hours of referral.
How long is a typical acute care eval?
30 minutes
What are the benefits of co-evals and co-treats?
They reduce the need to compete for time and reduce the client fatigue since they don’t have to perform the same tasks multiple times or answer questions twice.
During what process do OTs typically gain most of their information about their acute care patient?
During the patient interview and task oriented assessment
What is the most limiting factor in the acute care setting?
time
What is a POC?
the medical plan of care
What are the two key measures of homeostasis?
lab results and vital signs
List some of the most common lab tests conducted for patients in acute care.
Blood cell counts, arterial blood gasses, pH, basic metabolic panel, coagulation panels, d-dimer, urinalysis
At what O2 sat can the OT typically remove a patient’s oxygen during treatment?
95% or above
What’s an important test for determining the need for at home O2?
6 minute walk test
What is unique about the way cardiopulmonary patients often breathe?
Using accessory muscles, such as the scalene muscles over the diaphragm.
For emphysema patients, what’s the most difficult position for breathing?
Supine
What should an OT do if their client’s cognition seems impaired?
Follow up with a subtest from a standardized assessment.
What kind of body structure/function is a patient’s temperament?
Global function (specific mental functions include memory, hearing, vision etc.)
What is a simple way to check a patient’s proprioception?
Flex or extend a patient’s finger and while it is out of their view, ask them to identify if the digit is bent or straight.
What’s the best way to check a new patient’s vestibular function?
Offer a balance challenge to a patient sitting on the edge of the bed.
If a patient has a dysfunctional body structure, what is the OT’s role in helping the patient with that structure?
Teaching the patient to compensate for difficulties with that body structure.
List the common classes of performance patterns
roles, habits, rituals, patterns
What is the difference between hypoxemia and hypoxia?
Hypoxemia is insufficient oxygenation in the arterial blood (not getting enough into circulation) while hypoxia is the inadequate oxygen in the body tissues (not absorbing enough from blood)
WHAT IS NORMAL HEART RATE?
60-100
WHAT IS NORMAL SYSTOLIC PRESSURE?
DIASTOLIC?
systolic 90-120
diastolic 60-80
What is hypotension?
< 90 systolic
WHAT IS WNL FOR O2 SAT?
96-100%
WHAT IS WNL FOR RESP?
12-20
What is the function of a bipap?
Provides positive inspiratory pressure to decrease the work of breathing.
What is the major purpose of endotracheal tubes?
Used to provide an airway
In what case would nasal-tracheal intubation be used?
In the case if jaw, neck, mouth or facial trauma.
Where is a tracheostomy inserted?
Into the anterior trachea below the vocal cords.
What is the most common reason for tracheostomy placement?
For extended vent weaning.
WHAT IS THE FUNCTION OF A CENTRAL LINE?
Provides long term vascular access for administering drugs or fluids or taking blood samples. (Placed in the subclavian, jugular, basilic or femoral vein)
Where does a Peripherally Inserted Central Venous Catheter typically terminate?
Terminates in the superior vena cava via basilic or cephalon veins.
What are special precautions for patients with temporary pacemakers?
Avoid raising arms and anything that could pull on pacemaker leads.
WHAT IS A TYPICAL REQUIREMENT FOR ALL FOUR RAILS TO BE RAISED?
Physician’s order
What are the SAFE guidelines for optimal care?
Sharpen observation skills, Acquire necessary handling skills, Follow medical guidelines, Enhance the environment.
What are the six elements of the continuum of acute care?
Review medical information, observe the patient and environment, initiate patient contact, assess body functions and structures, assess functional activities, intervention.
What are possible benefits of bedrest?
Reducing O2 needs, decreasing pain levels, providing needed rest
What is the rate of decreased muscle strength for a person on bedrest?
1-3% per day!
What are the common effects of bedrest on the cardiovascular system?
Heart rate increases, stroke volume decreases, increased risk of DVTs, and orthostatic hypotension.
What are common effects of bedrest on the pulmonary system?
Restricted movement of the chest & diaphragm, shallower breathing, increased respiratory rate, impaired cough, hypostatic pneumonia, and atelectasis.
What are two disorders that can result from urinary stagnation during bedrest?
kidney stones and UTIs
What is the term for nearsightedness / objects far away appear blurry?
Myopia
Where is the focus of light in myopia?
In front if the retina.
What is the term for farsightedness / seeing distant objects more clearly than close ones?
Hyperopia
What is a condition in which the eye does not focus light evenly into the retina, making the image look blurry or stretched out.
Astigmatism
What is the most common symptom of refractive errors?
Blurry vision
What is defined as the clarity or sharpness of vision?
Visual acuity
What part of the eye is the white, outermost layer?
Sclera
What layer covers the iris and allows light into the eye?
Cornea
What is the clear structure that sits behind the iris and helps to focus images into the retina?
Lens
What is the name for the layers of blood vessels between the sclera and retina that supply blood for nutrients to the eye and removal of waste?
Choroid
What part of the eye allows vision of great detail?
Macula
What spot in the retina contains mostly cones and allows for the greatest acuity?
Fovea
What are the functions of the central visual field?
Analytical vision, denotes form, pattern, color, accuracy, needs light and high concentration.
What are the functions of peripheral vision?
Awareness, feedback about body in space, denotes movement and obstacles, does not require bright light, important for balance
What is ARMD and what are the two common types?
Macular degeneration causes loss of central vision; can be wet- blood vessels rupturing in the macula, or dry- causing the macula to atrophy
What is the major eye disease that causes cloudiness and yellowing of the lens and blurry vision?
Cataracts
What is the eye disease characterized by fluid pressure on the optic nerve?
Glaucoma
What part of the visual field is first to go for patients with glaucoma?
Peripheral field
What eye disease is called the “silent theif” because it usually goes undetected until it’s too late?
Glaucoma
What eye problems are caused by leaky blood vessels in the retina?
Diabetic retinopathy
What form of diabetic retinopathy is caused by micro aneurysms?
Mild nonproliferative retinopathy
What diabetic retinopathy involves the blockage of some blood vessels as the disease progresses?
Moderate nonproliferative retinopathy
What diabetic retinopathy involves many blocked blood vessels and a retina that is significantly deprived of blood supply?
Severe Nonproliferative Retinopathy
What form of diabetic retinopathy consists of the growth of abnormal and fragile new blood vessels?
Proliferative Retinopathy
Which forms of diabetic retinopathy do not have associated vision changes with changes in glucose levels?
Nonproliferative forms of D.R.
What is a visual deficit that cannot be corrected with lens, surgery or medication and interferes with daily activities?
Low Vision
What are 5 areas that can be improved to help clients with low vision?
• Maximizing usable vision, • increasing identifiability of objects, • environmental modifications for safety and tasks, • adapting tasks and routines and • maximizing wellness.
What is a disease in which visual deficits are accompanied by obscure visual hallucinations?
Charles Bonnet syndrome
What type of neck injury (commonly associated with car accidents) causes a tear of the posterior longitudinal ligament?
Hyper-flexion injury
What is the common cause of hyper-extension injuries of the neck, and what is the most vulnerable ligament when those injuries occur?
Falls causing a torn anterior longitudinal ligament
What is the term for a closed collection of blood which can compress the spinal cord?
Hematoma
What is a rupture of a blood vessel which can cause ischemia or can cause pressure to build up on the cord?
Hemmorhage
What is the difference between a thrombosis and an embolus?
A thrombosis is an occlusion of circulation while an embolus is the occluding factor (usually a blood clot)
What is typically collecting in the spinal column if a patient has tuberculosis of the spine?
Pus
What is the condition in which long “wormy looking” cavities form in the spinal column that cause patchy deficits?
Syringomyelia
What term refers to any paralysis of upper and lower extremities due to a cervical injury?
Tetraplegia
What refers to partial or complete paralysis of the lower extremities and trunk due to thoracic, lumbar or sacral injury?
Paraplegia
What type of spinal cord lesions can leave “sacral sparing” which may involve client retaining perianal sensation or toe flexion?
Incomplete lesions
How is the neurological level determined?
The level is named after the most caudal segment of the spinal cord with normal sensory and motor function in both sides of the body.
What are areas of the skin that are innervated by the sensory axons within each segmental nerve root?
Dermatomes
What are collections of muscle fibers innervated by the motor axons within each segmental nerve root?
Myotomes
What would the ASIA score be for a paraplegic with a loss of the lower 5 key segments?
50 (out of 100)
The ASIA impairment scale includes classifications from A meaning _____ to E meaning ______.
A is a complete injury
E is a healthy person with normal motor and sensory function
What is a common scale of functional independence that ranges from 1-7?
FIM score
What syndrome could cause motor impairments of the upper extremities but not the lower extremities?
Central cord syndrome(which is commonly caused by osteoarthritis)
Cervical traction and a halo brace are both ____ methods of spine stabilization.
Closed
What are some open methods of spine stabilization?
Fusions using bone grafts or wiring
What are Gardner Wells Tongs?
A cervical traction device which is no longer commonly used.
What is the typical duration of spinal shock when it occurs?
1-6 weeks
What are the major symptoms accompanying spinal shock?
Areflexia (flaccid paralysis and DTRs decreased)
Sympathetic disturbances (low blood pressure and heart rate, vasodilated, no sweating below the lesion)
Why are “raises” and “proning” useful techniques for SCI patients?
They prevent pressure sores from developing by allowing blood to circulate through frequent repositioning.
What are the major stages of decubitus ulcer formation?
(1) redness and skin won’t blanch
(2) penetrates epidermis
(3) penetrates dermis
(4) extends into muscle tissue
What are three major types of urinary catheters SCI patients may use?
Intermittent catheterization, Foley catheters and external catheters
What is the best immediate treatment for a patient with orthostatic hypotension?
Tilt patient back and elevate the legs
What might you do if your SCI patient complains of a pounding headache, sweats above the level of their lesion and has sudden chills or flushing?
Autonomic dysreflexia - try to identify and remove noxious stimulus
What’s the best (although painful) treatment for heterotopic ossification?
Aggressive passive range of motion
What does Ditropan do for the urinary bladder?
helps prevent spasms
Why do SCI patients need drugs like Benzodiazepines, Dandtrium and Lioresal?
To relax muscle spacticity
What are the key muscles still available with C1-C3 injuries?
Sternocleidomastoid and neck accessory muscles allowing for some head and neck movement
What key muscles are spared at C4 injuries and what is the significance of health care protocol for injuries at this level?
Upper trapezius and DIAPHRAGM so these patients can be weaned from the ventilator, and also have scapular elevation
What key muscles are spared in a C5 SCI and why are they important?
Deltoids and biceps - so the patient can flex, extend and abduct at the shoulders, as well as flexing the elbow and supinating the forearm (motions key for feeding, grooming and hygiene)
At what level do SCI patients retain the mucle function for a tenodesis grasp?
C6
What are the key muscles spared at C6?
ECRL & ECRB, and clavicular pec major - allowing independence in most self care
What muscles are spared at C7 level SCIs?
Triceps, flexor carpi radialis, lats, pec major, extensor digitorum - now the patients can actively extend the elbow, and extend the fingers, but cannot flex the fingers
What is important about C8, T1 SCIs?
Finger flexors and hand intrinsics are intact, patient still lacks trunk control.
