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NPTAE Comprehensive Review > Ultimate Review Pt. 3 > Flashcards

Ultimate Review Pt. 3 Flashcards

1
Q

emphysema

A

develops from a long history of chronic bronchitis. alveolar walls present with significant pathology and air spaces are permanently over inflated. pink puffers. expiration is difficult. characterized as centrilobular, panlobular or paraseptal. symptoms include: dyspnea, chronic cough, orthopnea, barrel chest, increased use of accessory muscles, and increased RR.

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2
Q

restrictive pulmonary disease

A

lungs fail to fully expand due to a weakened diaphragm, structural inability of chest wall to expand, and a decrease in elasticity of lung tissue. symptoms include: shortness of breath, persistent non-productive cough, increased RR. results in a decrease in all lung volumes.

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3
Q

tuberculosis

A

bacterial infection that is transmitted by airborne fashion (coughing, sneezing, speaking). lungs are primarily involved, however TB can occur in kidneys, lymph nodes, and meninges. lesions in the lungs can be seen with x ray. symptoms: fatigue, weight loss, loss of appetite, low grade fever, productive cough, chest discomfort, and dyspnea. treatment includes anti-tb drug therapy. prevention of TB through immunization is recommended for children.

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4
Q

pharmacological intervention for pulmonary management

A

bronchodilator agents, inhaled corticosteriod agents, mucolytic agents, expectorant agents, antiasthmatic agents. examples: albuterol, serevent, epnephrine, vanceril, flovent, decadron, mucosil, plumozyne, guafenesin, terpin hydrate, intal, tilade

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5
Q

transfers: levels of phys assistance

A

…

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6
Q

independent

A

patient does not require any assistance to complete task

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7
Q

supervision

A

patient requires therapist to observe throughout completion of task

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8
Q

contact guard

A

patient requires therapist to maintain contact with patient to complete task. usually needed to assist of there is a loss of balance

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9
Q

min assist

A

patient requires 25% assist from therapist to complete task

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10
Q

mod assist

A

patient requires 50% assist from therapist to complete task

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11
Q

max assist

A

patient requires 75% assist from therapist to complete task

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12
Q

dependent

A

patient is unable to participate and therapist must provide all effort to perform task

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13
Q

3 person carry/lift

A

used to transfer patient from a stretcher to a bed or treatment plinth. 3 therapists carry patient in supine position. therapist at head usually gives commands.

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14
Q

2 person lift

A

used to transfer a patient btwn two surfaces of different heights or when transferring a patient to the floor.

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15
Q

dependent squat pivot transfer

A

used to transfer a patient who cannot stand independently, but can bear some weight thru the trunk and LEs. therapist should position patient at a 45 degree angle to the destination surface. patient places UEs on therapist’s shoulders, but should not pull on therapist’s neck. should position patient at edge of surface, hold patient around hips and under butt, block patients knees in order to avoid buckling. therapist should utilize momentum, straighten his or her legs and raise patient or allow patient to remain squatting, and pivot and slowly lower patient to destination surface.

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16
Q

sliding board transfer

A

used for a patient who has some sitting balance and some UE strength and can adequately follow directions. patient should be positioned at edge of w/c or bed and should lean to one side while placing one end of sliding board under proximal thigh. other end should be position on destination surface. use both arms to initiate a push up and scoot across board. therapist should guard in front of patient and assists as needed as patient performs a series of push ups across the board.

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17
Q

stand pivot transfer

A

used when a patient is able to stand and bear weight through one or both of LEs. must possess functional balance and ability to pivot.

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18
Q

wheelchair facts

A

…

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19
Q

adult w/c specs:

A

seat width: 18 inches, set depth: 16 inches, seat height: 20 inches

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20
Q

hemi-height w/c

A

decreased seat height (17.5 inches) to allow for propulsion using the unaffected foot

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21
Q

rear wheel axles

A

can be positioned 2 inches posteriorly from normal for patients with amputations to increase the BOS and to compensate for diminished weight in front of w/c

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22
Q

reclining w/c

A

allow intermittent or constant reclined positioning

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23
Q

tilt-in-space w/c

A

allow for reclined position without losing required 90 degrees of knee flexion. entire chair reclines without any anatomical changes in positioning.

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24
Q

standard w/c measurements for proper fit

A

seat height/leg length: 19.5 to 20.5 inches. measure from user’s heel to popliteal fold and add 2 inches to allow clearance of foot rest.

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25
Q

seat depth

A

measure from user’s bottom along lateral thigh to popliteal fold, then subtract approx 2 inches to avoid pressure from front edge of seat against popliteal space. 16 inches average.

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26
Q

seat width

A

measure the widest aspect of user’s bottom or hips and add aprx 2 inches. will provide space for clothing and clearance of trochanters from armrest side panel. approx 18 inches is average.

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27
Q

back height

A

measure from seat of chair to floor of axilla with user’s shoulder flexed to 90 and then subtract 4 inches. this will allow final back height to be below inferior angles of scapula. 16-16 1/2 inches average.

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28
Q

armrest height

A

measure from seat of chair to olecranon process with user’s elbow flexed to 90 and then add one inch. average usually 9 inches above chair seat.

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29
Q

assistive devices

A

parallel bars, walkers, axillary crutches, lofstrand crutches, canes

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30
Q

parallel bars

A

proper fit includes bar height that allows for 20-25 degrees of elbow flexion while grasping bars approx four to six inches in front of body.

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31
Q

walker

A

can be used with all levels of weight bearing. should allow for 20-25 degrees of elbow flexion. used with 3 point gait pattern

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32
Q

axillary crutches

A

all levels of weight bearing, but requires higher coordination for proper use. 6 inches in front, two inches out (lateral) to patient. crutch height should be adjusted no greater than 3 finger widths from axilla. handgrip height should be adjusted to ulnar styloid process and allow for 20-25 degrees of elbow flexion while grasping.

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33
Q

lofstrand (forearm) crutches

A

20-25 degrees of elbow flexion while holding handgrips with crutches 6 inches in front and 2 inches lateral. arm cuff should be positioned 1 to 1 1/2 inches below olecranon process so it does not interfere with elbow flexion

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34
Q

cane

A

provides minimal stability and support during ambulation, mainly for balance.

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35
Q

NWB

A

non weight bearing

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36
Q

TTWB

A

toe touch weight bearing

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37
Q

PWB

A

partial weight bearing

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38
Q

WBAT

A

weight bearing as tolerated

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39
Q

FWB

A

full weight bearing

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40
Q

2 point gait

A

when patient uses 2 crutches or canes. moves left crutch forward while simultaneously advancing rt lower extremity ad vice versa.

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41
Q

3 point gait

A

walker or crutches. injured lower extremity may have decreased weight bearing. AD is advanced followed by injured LE and then uninjured LE. AD and each LE are considered separate points

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42
Q

4 point gait

A

each advancement of crutch or cane as well as LEs indicates a single point, used one at a time.

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43
Q

swing to gait

A

patient with bilateral trunk and or LE weakness uses crutches or a walker and advances LEs at the same time only to point of AD.

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44
Q

swing through

A

advances LEs thru AD

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45
Q

arterial line

A

monitoring device consisting of a catheter that is inserted into an artery and attached to an electronic monitoring system. used to measure blood pressure or obtain blood samples. considered more accurate than traditional measures of blood pressure and does not require repeated needle punctures

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46
Q

external catheter

A

applied over shaft of penis and is held in place by a padded strap or adhesive tape

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47
Q

foley catheter

A

indwelling urinary tract catheter that has a balloon attachment at one end. balloon which is filled with air or sterile water must be deflated before catheter can be removed

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48
Q

suprapubic catheter

A

indwelling urinary catheter that is surgically inserted directly into patient’s bladder. insertion of a suprapubic catheter is performed under general anesthesia

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49
Q

swan-ganz catheter

A

soft, flexible catheter that is inserted through a vein into pulmonary artery. used to provide continuous measurements of pulm artery pressure. can exercise with device but patient should avoid activities that increase pressure on injection site

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50
Q

intravenous system

A

consists of a sterile fluid source, pump, clamp, and catheter to insert into a vein. can be used to infuse fluids, electrolytes, nutrients, and medication. IV lines are most commonly inserted into superficial veins such as basilic, cephalic, or antecubital.

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51
Q

nasal cannula

A

tubing extends into patient’s nostrils approx 1 cm. oxgyen therapy can deliver up to 6 L of oxygen per min

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52
Q

nasogastric tube

A

plastic tube inserted thru a nostril that extends into stomach. commonly used for liquid feeding, medication administration or to remove gas from the stomach

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53
Q

oximeter

A

photoelectric device used to determine the oxygen saturation of blood. device is most commonly applied to finger or ear. often used to assess activity tolerance

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54
Q

indications for therapeutic modalities

A

inflammation and repair, pain, restriction in motion, and abnormal tone.

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55
Q

phases of tissue healing

A

inflammation (1-6 days), proliferative phase (day 3-day 20), maturation phase (day 9 - ongoing)

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56
Q

inflammation phase of tissue healing

A

occurs secondary to trauma or disease. required for healing to occur. presents with calor, rubor, tumor, dolor. clot formation and phagocytosis occur

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57
Q

proliferative phase

A

involves connective tissue and epithelial cells. epithelialization, collagen production, wound contracture, and neurovascularization occur

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58
Q

maturation phase

A

longest in duration, progression towards restoration of the prior function of injured tissues, collagen synthesis and lysis balance, collagen fiber orientation

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59
Q

keloid scar

A

can occur during healing process when collagen production greatly exceeds collagen lysis. extends beyond original boundaries of an injury and damages healthy tissues.

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60
Q

hypertrophic scar

A

can occur during healing process when collagen production greatly exceeds collagen lysis. will be raised, but remain within borders of original injury

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61
Q

principles of heat transfer

A

conduction, conversion, convection, evaporation, radiation

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62
Q

heat conduction

A

direct contact btwn 2 materials at different temperatures. ex: hot pack, paraffin, ice massage, cold pack

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63
Q

heat convection

A

air or water moving in a constant motion across body. ex: whirlpool

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64
Q

heat conversion

A

transfer of heat when nonthermal energy is absorbed into tissue and transformed into heat. ex: diathermy and ultrasound

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65
Q

heat evaporation

A

transfer of heat as a liquid absorbs energy and changes from to a vapor. ex: vapocoolant spray

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66
Q

heat radiation

A

direct transfer of heat from a radiation energy source of higher temperature to one of cooler temperature. directly absorbed without the need for a medium. ex: infrared lamp

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67
Q

cryotherapy

A

ex: ice massage, cold pack, cold bath, vapocoolant spray

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68
Q

cryotherapy’s therapeutic effects

A

initial decrease of blood flow to treated area, decreased temp, increase pain threshold, decrease metabolism, decrease edema, initial vasoconstriction, decrease nerve conduction velocity, decrease nerve conduction velocity, reduce spasticity of muscle, produce analgesic effects

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69
Q

cryotherapy’s indications

A

acute or chronic pain, myofascial pain syndrome, muscle spasm, bursitis, acute or subacute inflammation, musculoskeletal trauma, reduction of spasticity, tendonitis

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70
Q

cryotherapy contraindications

A

compromised circulation, peripheral vascular disease, ischemic tissue, cold hypersensitivity, raynaud’s phenomenon, cold urticaria, hypertension, infection, cryoglobinemia

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71
Q

stages of perceived symptoms during cryotherapy

A

intense cold within 3 mins, aching/burning sensation from 4-7 mins, anesthesia to analgesia from 8-15 mins, numbness from 15-30 mins

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72
Q

ice massage

A

5-10 min treatment time

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73
Q

cold pack

A

requires a temp of 23 degrees. apply cold pack wrapped in moistened towel to area for 15 mins. application may extend to 30 mins but requires observation every 10 minutes (for spasticity) can be applied every one to two hours for reduction of inflammation and pain control.

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74
Q

cold bath

A

used for immersion of distal extremities. water temp ranges from 55 to 64 degrees. immersed for 5 to 15 mins to attain desired effects

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75
Q

vapocoolant sprays

A

often used in conjunction with passive stretching. fluori-methane is a commonly used vapocollant spray that is typically applied from prox to distal muscle attachments.

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76
Q

superficial heating agents

A

fluidotherapy, hot pack, infrared lamp, paraffin

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77
Q

deep heating agents

A

diathermy, ultrasound (and phonopheresis)

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78
Q

heating therapeutic effects

A

increase temp, increase blood flow to area, decrease nerve conduction latency, vasodilation, increase muscle elasticity, increase collagen extensibility, decreases tone

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79
Q

heating indications

A

pain control, chronic inflammatory conditions, trigger point, tissue healing, muscle spasm, decreased ROM, densensitization

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80
Q

heating contraindications

A

circulatory impairment, area of malignancy, acute musculoskeletal trauma, bleeding, sensory impairment, thrombophlebities, arterial disease

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81
Q

fluidotherapy

A

container that circulates warm air and small cellulose particles. extremity is placed into container and dry heat is generated thru energy transferred by forced convection. promotes tissue healing and prevention of edema. body part should be placed into unit prior to turning machine on. temp should be set between 111-125 degrees. treatment time usually 20 minutes.

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82
Q

hot pack

A

effects include soft tissue healing, promoting relaxation, decreasing pain and stiffness. must be stored in hot water between 158-167 degrees. requires 6-8 towels around hot pack. require approx 20 minutes to achieve desire effects

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83
Q

infrared lamp (IR)

A

produces superficial heating of tissue through radiant heat. form of heating is usually limited to penetration of less than one to three millimeters. use is declining due to risk of burns during treatment. patient should be positioned approx 20 inches from source. 20 inches in distance should equal 20 minutes of treatment. as distance decreases, intensity will increase and time of total treatment should decrease.

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84
Q

paraffin wax

A

most commonly used superficial heating agent of distal extremities. temp should be between 113-126 degrees. dip patient’s hand and wrap with plastic bag with a towel around it to insulate and maintain heating for approx 15-20 mins.

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85
Q

diathermy

A

converts high frequency electromagnetic energy into therapeutic heat. produces vibration of molecules within a specific tissue, generates heat and elevates tissue temperature. main therapeutic effect is enhancement of soft tissue healing. can be delivered in continuous or pulsed mode. pulsed mode is usually used for thermal effects at 27.12 MHz.

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86
Q

contraindications for diathermy

A

low back, abdomen, pelvis of a pregnant woman, internal and external metal objects, eyes, malignant area, intrauterine device, cardiac pacemaker, pain and temp sensory deficits, moist wound dressing, testes, acute inflammation, ischemic tissue

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87
Q

diathermy parameters

A

inductive application: wrap coils around extremity that has been covered by a towel, place drum over treatment area. patient must remain in same position throughout treatment. treatment time varies from 15-30 mins.

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88
Q

ultrasound

A

common deep heating agent that transfers heat through conversion. elevates tissue temp to depths up to 5 cms, and uses inaudible acoustic mechanical vibrations of high frequency to produce thermal and nonthermal effects. crystal transducer converts electrical energy into sound.

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89
Q

ultrasound therapeutic effects

A

thermal: increase extensibility of collagen structure, decrease joint stiffness, pain relief, increase blood flow, decrease muscle spasm

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90
Q

ultrasound therapeutic effects (nonthermal)

A

nonthermal: stimulation of tissue regeneration, pain relief, soft tissue repair, increase blood flow,

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91
Q

indications for u/s

A

soft tissue repair, contracture, bone fracture, trigger point, dermal ulcer, scar tissue, pain, plantar wart, muscle spasm

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92
Q

contraindications for u/s

A

over eyes, over pregnant uterus, over cemented prosthetic joint, impaired circulation, impaired pain or temp sensory deficits, over heart, over testes, over epiphyseal areas in children, infection, over malignancy

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93
Q

u/s treatment parameters

A

place transducer over area before turning on machine (and gel already applied to head). move in small circular pattern over treatment area. maintain contact with skin and stay within treatment area. an area two to three times the size of the transducer typically requires a duration of five minutes of treatment. intensity for continuous u/s is normally set btwn .5 to 2 w/cm2 for thermal effects. pulsed u/s is normally set between .5 to .75 w/cm2 with a 20% duty cycle for nonthermal effects

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94
Q

BNR

A

beam nonuniformity ratio: ratio of intensity of highest peak to average intensity of all peaks. lower BNR, more favorable, since most patients will be less likely to experience hot spots and or discomfort during treatment. BNR values should range btwn 2:1 and 6:1, most devices often fall in 5:1 or 6:1 range.

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95
Q

ERA

A

effective radiating area. area of transducer that transmits u/s energy. always smaller than total size of transducer head.

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96
Q

acoustic cavitation

A

occurs as a result of acoustic energy generated by u/s that develops into microscopic bubbles causing cavities that surround soft tissues. the bubbles expand and contract.

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97
Q

2 types of cavitation that occur:

A

stable cavitation: microscopic bubbles increase and decrease in size but do not burst. triggers microsteaming. transient (unstable) cavitation: microscopic bubbles increase in size over multiple cycles and implode. this causes brief moments of local temperature ad pressure increases in area surrounding those bubbles. process should not occur during therapeutic u/s since intensities required are much higher than 3 w/cm2.

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98
Q

microsteaming

A

minute flow of fluid that takes place around vapor-filled bubbles that oscillate and pulsate

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99
Q

acoustic streaming

A

term for the consistent and circular flow of cellular fluids that results from u/s. responsible for altering cellular activity and the transport of fluids to different portions of the field.

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100
Q

phonophoresis

A

use of u/s for transdermal delivery of medication. u/s enhances the distribution of medication through the skin, provides a high concentration of the drug directly to the treatment site and avoids risks that may be involved with injection of medication. medications regularly used in phonophoresis include anti-inflammatory agents or analgesics. effective with both continuous and pulsed techniques.

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101
Q

hydrotherapy

A

the internal and external use of water in the treatment of disease. transfers heat thru conduction or convection and is administered in tanks of varying sizes. main therapeutic effects: wound care, unloading of weight, and reduction of edema.

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102
Q

buoyancy

A

(archmides): there is an upward force on body when immersed in water equal to amount of water that has been displaced by the body. ability to float in water results from the body possessing a specific gravity less than that of water.

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103
Q

hydrostatic pressure

A

water exerts pressure that is perpendicular to the body and increases in proportion with the depth of immersion

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104
Q

resistance

A

water molecules tend to attract to each other and provide resistance to movement of the body in the water. resistance by water increases in proportion to speed of motion.

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105
Q

specific gravity

A

computation for specific gravity of water is equal to 1. human body varies based on size and somatotype but typically has a specific gravity of less than 1 (average .974). therefore, a personal will generally float when fully submerged in water.

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106
Q

specific heat

A

measure of the ability of a fluid to store heat. calculated as amount of thermal energy required to increase fluid’s temp by one unit. water can store 4 times the heat as compared to air. water’s thermal conductivity is approx 25 times faster than air at the same temp.

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107
Q

total drag force

A

comprised of profile drag, wave drag and surface drag forces. is a hydromechanic force exerted on a person submerged in water that normally opposes the direction of the body’s motion.

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108
Q

therapeutic effects of hydrotherapy:

A

increase blood flow, increase core temp, relaxation, pain relief, vasodilation, decrease abnormal tone, wound/debridement

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109
Q

indications for hydrotherapy:

A

burn care, superficial heating or cooling, edema control, muscle strain, arthritis, desensitization of residual limb with contrast bath, pain management, wound care, decreased ROM, pool therapy/exercise, sprain, joint stiffness, muscle spasm/spasticity

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110
Q

contraindication for hydrotherapy:

A

peripheral vascular disease, gangrene, severe infection, urinary/fecal incontinence, advanced cardiov or pulm disease, buerger’s disease w/contrast bath, impaired circulation, renal infection, bleeding surface area, diminished sensation

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111
Q

types of hydrotherapy

A

extremity tank, lowboy tank, highboy tank, hubbard tank, therapeutic pool

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112
Q

treatment temps for water

A

32-79 degrees: acute inflammation of distal extremities, 79-92 degrees: exercise, 92-96: wound care, spasticity, 96-98: cardiopulmonary compromise, treatment of burns, 99-104: pain management, 104-110: chronic rheumatoid or osteoarthritis, increased ROM

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113
Q

treatment parameters for whirlpool

A

treatment time ranges from between 10 and 30 mins. select water temp based on diagnosis and goals and assist pt into comfortable position, monitor vital signs and level of comfort.

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114
Q

treatment parameters for pool therapy

A

general contraindications for superficial or deep heating, including incontinence, open areas, fear of water, confusion, and significant respiratory pathology. recommended populations for pool therapy include patients with arthritis, musculoskeletal injuries, neuro deficits, sci, cva, ms, and selected cardiopulmonary diagnoses. tank must be cleaned after each use with a disinfectant and antibacterial agent.

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115
Q

mechanical agent: traction

A

modality that applies mechanical forces to body to separate joint surfaces and decrease pressure. force can be applied manually by therapist or mechanically by a machine.

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116
Q

therapeutic effects of traction

A

joint distraction, soft tissue stretching, muscle relaxation, reduction of disk protrusion, joint mobility

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117
Q

indications for traction

A

nerve impingement, herniated or protruding disc, subacute joint inflammation, spondylolisthesis, joint hypomobility, paraspinal muscle spasm, degenerative joint disease, osteophyte formation

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118
Q

contraindications for traction

A

when motion is contraindicated, joint instability, tumor, pregnancy, acute inflammatory response, acute sprain, osteoporosis, fracture

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119
Q

treatment parameters for traction

A

treatment time is 5-20 mins. cervical: pt supine with approx 25-35 degrees of neck flexion, should start with a force btwn 10-15 lbs and progress to 7% of pt’s body weight as tolerated for separation of vertebrae. lumbar can be supine or prone, and should be set with a force of less than half body weight for initial treatment. traction force of 25-50 lbs is recommended when initiating mechanical lumbar traction. force of up to 50% of body weight is required for actual separation of the vertebrae.

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120
Q

compression

A

physical agent that applies a mechanical force to increase pressure on treated body part. works to keep venous and lymphatic flow from pooling into interstitial space. static compression utilizes bandaging and compression garments to shape residual limbs, control edema, prevent abnormal scar formation, and reduce risk of dvt. intermittent compression with a pneumatic device is used to reduce edema.

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121
Q

therapeutic effects of compression

A

control of peripheral edema, shaping of residual limb, management of scar formation, improve lymphatic and venous return, and prevention of DVT

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122
Q

indications for compression

A

lymphedema, new res limb, risk for DVT, edema, stasis ulcers, hypertrophic scarring

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123
Q

contraindications for compression

A

malignancy of treated area, DVT, unstable or acute fracture, heart failure, infection of treated area, pulm edema, circulatory obstruction

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124
Q

treatment parameters

A

therapist should measure girth and bp. therapist should set parameters based on desire effect. stockinette should be put over extremity and then compression sleeve. 3:1 ratio is generally used for on/off time with inflation btwn 40 to 100 seconds and deflation btwn 10-35 seconds. inflation pressure generally ranges from 30-80 mm Hg and should not exceed patient’s diastolic bp. treatment of upper extremities generally requires btwn 30 and 60 mm Hg of inflation pressure while treatment of LEs requires btwn 40 and 80 mm Hg of inflation pressure. treatment time varies for diagnosis, from 2-4 hours and is utilized from 3 x per week to 3 x per day. when treatment time is up, therapist should reassess extremity and remeasure girth and bp

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125
Q

UV: ultraviolet light

A

form of energy that is used therapeutically and absorbed one to two millimeters into the skin. divided into UV-A and UV-B, and UV-C. most effective use of UV is to treat skin disorders

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126
Q

therapeutic effects of UV

A

facilitate healing, exfoliation, Vit D production, increase pigmentation, tanning

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127
Q

indications for UV

A

acne, psoriasis, tetany, Vit D deficiency, chronic ulcer/wound, osteomalacia/rickets, sinusitis

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128
Q

contraindications for UV

A

photosensitive meds, lupus erythematosus, tb, herpes, renal or hepatic pathology, DM, pellagra

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129
Q

treatment parameters for UV

A

therapist must obtain a minimal erythemal dose before treatment (MED). this is the time of exposure needed to produce an area of mild redness btwn 8 and 24 hours after treatment. MED is tested by paper cutouts on forearm and therapist should wear goggles. squares on skin should be exposed in 15 sec increments for 15, 30, 45, 60 and 75 seconds and inspected after an 8 hr period to determine MED. treatment time should increase each consecutive treatment day since skin adapts to the UV exposure.

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130
Q

massage

A

manual therapeutic modality that produces physiologic effects through stroking, rubbing, and pressure.

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131
Q

effleurage

A

light in stroke and produces a reflexive response. performed at beginning and end of massage to allow patient to relax and should be directed towards the heart.

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132
Q

friction

A

incorporates small circular motion over a trigger point or muscle spasm. deep massage technique that penetrates into the depth of a muscle and attempts to reduce edema, loosen adhesions, and relieve muscle spasm. used with chronic inflammation or with overuse injuries

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133
Q

petrissage

A

kneading where muscle is squeezed and rolled under therapist’s hands. distal to proximal sequence of kneading over muscle. can be performed with 2 hands over larger muscle groups or with as few as two fingers over smaller muscles.

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134
Q

tapotement

A

provides stimulation through rapid and alternating movements such as tapping, hacking, cupping, and slapping. purpose is to enhance circulation and stimulate peripheral nerve endings

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135
Q

vibration

A

places hands or fingers firmly over area and uses a rapid shaking motion that causes vibration to treatment area. used primarily for relaxation.

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136
Q

therapeutic effects of massage

A

increases lymphatic circulation, removal of metabolic waste, decrease muscle atrophy, decrease anxiety and tension, facilitate healing, stimulate reflexive effects, reduction of edema, loosen adhesions, decrease muscle spasm

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137
Q

indications for massage

A

pain, decreased ROM, edema, adhesions, myositis, lactic acid excess, migraine, trigger point, muscle spasm and cramping, scar tissue, bursitis, tendonitis, intermittent claudication, raynaud’s syndrome

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138
Q

contraindications for massage

A

infection, arterioscelrosis, thrombus, cellulitis, acute injury, embolus, cancer.

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139
Q

electrotherapy

A

used for facilitation of skeletal muscle contraction, stimulation of denervated muscle, pain management, to retard muscle atrophy, osteogenesis, driving medications through the skin, and wound management

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140
Q

contraindications

A

cardiac pacemaker, patient with a bladder stimulator, over carotid sinus, seizure disorders, phlebitis, malignancy, over a pregnant uterus, cardiac arrhythmia, osteomyelitis

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141
Q

electrode configuration

A

techniques include: monopolar, bipolar, and quadripolar

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142
Q

monopolar

A

active (smaller) electrode is placed over target area. second dispersive electrode is placed at another site away from the target area. used for wounds, iontophoresis, and treatment of edema

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143
Q

bipolar

A

2 active electrodes are placed over target area. electrodes usually same size. used for muscle weakness, neuromuscular facilitation, spasms, and ROM

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144
Q

quadripolar

A

2 electrodes from 2 separate stimulating circuits are positioned so that the individual currents intersect with each other. utilized with interferential current.

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145
Q

electrode size

A

when using a smaller electrode it is particularly important to understand that since the current density is quite high compared to a larger electrode, the patient will be more susceptible to pain and potential tissue damage.

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146
Q

small electrodes

A

increased current density, increased impedance, decreased current flow

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147
Q

large electrodes

A

decreased current density, decreased impedance, increased current flow

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148
Q

estim indications

A

pain management, urinary incontinence, edema management, osteoarthritic pain, migraines

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149
Q

estim contraindication

A

malignancy, with all types of electrical implants, during first trimester of pregnancy, over lower abdomen/uterus during pregnancy, over anterior transcervical area

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150
Q

direct current

A

also known as galvanic, constant flow of electrons from anode to cathode without interruption. iontophoresis uses direct current

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151
Q

alternating current

A

polarity that changes from positive to negative with change in direction of current flow. biphasic, symmetrical or asymmetrical, and is a waveform that is sinusoidal in shape. used in muscle retraining, spasticity and stimulation of denervated muscle

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152
Q

interferential current

A

combines two high frequency alternating waveforms that are biphasic. used for deep muscle stimulation. attempts to reach deeper tissues using higher frequencies of each waveform along with overall shorter pulse widths. uses a frequency of 50-1250 pps and a pulse width of 50-150 microseconds for pain management; and a frequency of 20-50 pps and pulse width of 100-200 microseconds for muscle contractions

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153
Q

russian current

A

medium frequency polyphasic waveform. alternating current is produced in a 50 burst per second interval with a pulse width range of 50-200 microseconds, and an interburst interval of 10 milliseconds. type of NMES or FES and is believed to augment muscle strengthening by depolarizing both sensory and motor nerve fibers resulting in tetanic contractions that are painless and stronger than those made voluntarily by the patient. electrode should be placed parallel to muscle fibers along line of pull of muscle group.

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154
Q

russian stim parameters

A

average peak current amplitude of 100 mA, 50 bursts per second, with on/off time ration of 10/50. usually is done 10 evoked contractions with a 10 second contraction and a 50 second rest period between each of the 10 contractions.

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155
Q

NMES

A

neuromuscular electrical stimulation: used to facilitate skeletal muscle activity. stim of an innervated muscle occurs when an electrical stimulus of appropriate intensity and duration is administered to the corresponding peripheral nerve. commonly used to facilitate return of controlled functional muscular activity or to maintain postural alignment until recovery occurs.

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156
Q

NMES parameters

A

bipolar electrode placement over muscle. interrupted current is used with a range of 20-40 pulses per second an on time of 6-10 secs followed by off time of approx 50-60 secs. 15-20 mins for several times a day

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157
Q

TENS: transcutaneous electrical nerve stimulation

A

widely used for acute and chronic inflammation. main effects of TENS include pain relief through gate control theory. used for home use and is portable.

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158
Q

TENS contraindications

A

cardiac pacemakers, epilepsy, during 1st trimester

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159
Q

TENS Parameters

A

conventional, acupuncture like, pulse burst, and brief intense (high-intensity)

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160
Q

conventional TENS

A

frequency: 50-100 Hz, duration: 20-100 microseconds, amplitude: 10-30 mA

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161
Q

acupuncture like TENS

A

frequency: 1-4 Hz, 100-200 microseconds, amplitude: 30-80 mA

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162
Q

pulse burst

A

frequency: 70-100 Hz/burst, duration: 40-75 microseconds, amplitude: 30-60 mA

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163
Q

brief intense (high intensity)

A

frequency: 70-100 Hz/burst, duration: 150-200 microseconds, amplitude: 30-60 mA

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164
Q

TENS guidelines

A

electrodes may be placed on sites of nerve roots, trigger points, acupuncture sites or key points of pain and sensitivity. net polarity is normally equal to zero. if waveform is unbalanced, there will be an accumulation of charges that will lead to skin irritation under the electrodes. includes a pulse duration that can vary from 20-400 microseconds; pulse frequency that varies in range from 1-200 Hz, and current amplitude from .1-120 mA.

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165
Q

iontophoresis

A

process by which medications are induced through the skin into the body by means of continuous direct current electrical stimulation. medication is separated into ions based on the polarity of the current.

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166
Q

acidic/alkaline reaction

A

acidic reaction can cause hardening of skin. alkaline reaction can cause skin to soften over time.

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167
Q

buffering

A

technique used to stabilize the pH of skin during ionto by placing buffering agents into electrode pads that cover drug reservoir area within the electrode

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168
Q

electrolysis

A

decomposition of a compound that results from passing an electrical current through it

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169
Q

electron exchange

A

occurs during ionto where there is an exchange btwn ions within solutions and electrodes

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170
Q

redox reaction

A

decomposition of water when electrical current is passed through it. water will be reduced to a net accumulation of hydrogen ions (H+) under anode and hydroxyl ions (OH-) under the cathode.

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171
Q

iontophoresis parameters

A

pt should never lie on top of electrodes. unit should be set to continuous direct current. polarity must be set to same polarity as ion solution. ion solution should be massaged into treatment site or space within electrode. conductive surface area of the negative electrode (cathode) is twice the size of the conductive surface area of the positive electrode (anode) regardless of which on is the active electrode. active electrode must be placed over target area the the dispersive electrode should be placed as far as possible from active electrode. slowly increase intensity towards a max of five milliamperes. treatment should last 15-20 mins. additional time is required for treatment at an intensity of less than five milliamperes.

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172
Q

therapeutic ions and charge

A

positive charge: lidocaine, hydrocortisone, histamine, lithium, magnesium, zinc. negative charge: acetate, dexamethasone, salicylate, iodine, chlorine, tap water (+ and -)

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173
Q

hvpc

A

high voltage pulsed current: twin peak monophasic, pulsed current. produces high electromotive forces. has a phase duration of 5-20 microsecs (fixed in most machines), a short pulse duration that ranges btwn 100-200 microsecs, and voltage greater than 150V to a max of 500V. one large dispersive pad along with one, two or four active electrodes. active electrodes can be positive or negative in polarity based on treatment goals.

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174
Q

indications for hvpc

A

wound management, pain management, soft tissue edema, levator ani syndrome, muscle spasm, muscle weakness, bell’s palsy

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175
Q

contraindications for hvpc

A

cardiac pacemakers, over heavy scarring tissues, malignancy, pregnancy

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176
Q

hvpc parameters

A

secure one electrode over wound (using warm sterile gauze and sponge) and other over healthy skin a min of 5 cm from wound itself. polarity should be in reversal mode so that it allows for 50% of treatment with positive polarity. frequency is generally 30-200 pps, amplitude 1-500V, and duration of treatment from 10-60 mins per session. dermal wounds should be treated 5-7 days per week for best results

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177
Q

electromyography

A

science of evaluating motor units (anterior horn cell, axon, neuromuscular junctions and muscle fibers innervated by unit) through use of intramuscular needle electrodes or surface electrodes. potentials include abnormal: spontaneous and voluntary.

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178
Q

biofeedback

A

modality that uses an electromechanical device to provide visual and or auditory feedback. can be utilized to receive information related to motor performance, kinesthetic performance or physiological response. can measure peripheral skin temp, changes in blood volume thru vasodilation and vasoconstriction using finger phototransmission, sweat gland activity, and electrical activity during muscle contraction. electromyographic feedback is the most commonly used biofeedback modality in clinical setting.

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179
Q

biofeedback measures:

A

muscle activity, heart rate, balance, skin temp, bp, posture, abnormal mvmt, normal mvmt

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180
Q

types of feedback

A

myoelectric/electromyographic biofeedback, EMG-BF, position biofeedback, bp biofeedback, respiratory bioFB, sphincter control biofb, temp and blood flow bioFB, electroencephalographic bioFB

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181
Q

biofeedback therapeutic effects

A

muscle relaxation, improve muscle strength, decrease muscle spasm, neuromuscular control, decrease accessory muscle use, decrease pain

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182
Q

biofeedback indications

A

muscle spasm, pain, sci, urinary incontinence, improve neuromuscular control, muscle weakness, hemiplegia, cp, bowel incontinence, promote relaxation

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183
Q

biofeedback contraindications

A

any condition where muscle contraction is detrimental, skin irritation at electrode site

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184
Q

biofeedback treatment guidelines

A

2 active electrodes and 1 ground electrode in a bipolar arrangement best deletes “noise” (noise is any extraneous electrical activity not produced by the contraction of the muscle). surface electrodes with some form of conduction gel are required to adhere to prepared, clean skin. electrodes should be placed parallel to direction of the muscle fibers, set level of sensitivity on device relative to treatment goals: low level sensitivity settings for muscle re-education, high level sensitivity setting for relaxation

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185
Q

biofeedback treatment parameters

A

2 active electrodes should be placed parallel to muscle fibers and close to each other. reference or ground electrode can be placed anywhere on the body, but is often secured between 2 active electrodes. signals are transmitted to a differential amplifier and info is conveyed thru visual and audio feedback. for muscle re-education, should begin with pt performing a max muscle contraction. sensitivity of bfb unit should be set at a low sensitivity setting and adjusted so that the pt can perform reps at a ratio of 2/3rds of max muscle contraction. isometric contractions should continue for 6-10 secs with relaxation in btwn each contraction. treatment duration for a single muscle group is 5-10 mins. treatment for muscle relaxation requires a high sensitivity setting and a similar electrode placement with active electrodes initially positioned close to each other. as patient improves with relaxation, electrodes should be placed further apart and sensitivity setting increased. during this treatment, patient may also benefit from adjunct relaxation techniques such as imagery. treatment duration of 10-15 mins is usually adequate to attain relaxation.

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186
Q

gfci:

A

ground fault circuit interrupter: designed to cut off electrical supply to a piece of equipment if it detects any form of leakage or ground fault.

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187
Q

electrotherapy terms

A

…

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188
Q

accommodation

A

an occurrence where a nerve and muscle membrane’s threshold for excitability increases secondary to a stimulation by a pulse that has a slow phase rise time. the quicker the rise time, the less the nerve can accommodate to the impulse.

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189
Q

alternating current (biphasic)

A

alternating current allows for the constant change in flow of ions

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190
Q

ampere

A

unit of measure used to describe rate of current

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191
Q

amplitude

A

magnitude of current. often labeled intensity or voltage.

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192
Q

anode

A

positively charged electrode that attracts negative ions

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193
Q

cathode

A

negatively charged electrode that attracts positive ions

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194
Q

biphasic

A

pulse that moves in one direction, returns to baseline, then in other direction and back to baseline again within a predetermined amount of time.

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195
Q

types of biphasic pulse

A

symmetrical: positive phase is identical to negative phase, asymmetrical: positive phase and negative phase are not identical in shape, balanced: positive phase’s electrical charge is equal to negative phase’s electrical charge, unbalanced: positive phase and negative phase do not have identical electrical charges

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196
Q

burst

A

interrupted group of pulses that are delivered in a finite series and a predetermined frequency

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197
Q

capacitance

A

property of an insulator that allows for the storage of energy when opposing surfaces of the insulator have an electrical potential difference

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198
Q

chronaxie

A

testing procedure used to measure amount of time required to produce a small muscle contraction at a particular intensity

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199
Q

conductance

A

ease at which a particular material will allow current flow (mho)

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200
Q

current

A

flow electrons from one place to another

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201
Q

direct current (monophasic)

A

constant unidirectional flow of ions. dependent on polarity

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202
Q

duration of stimulus/duration of rest

A

time period of stimulation and time period of rest btwn periods of stimulation.

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203
Q

duty cycle

A

percentage of time that electrical current is on in relation to entire treatment time.

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204
Q

electrical impedance

A

resistance of a tissue to electrical current

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205
Q

frequency

A

determines number of pulses delivered through each channel per second. often labeled “rate”

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206
Q

high volt current

A

characterized by a waveform greater than 150 volts with a short pulse duration. is intermittent and is used for deeper tissue penetration

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207
Q

impedance

A

property of a substance that provides resistance to flow of current by offering an alternate current

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208
Q

inductance

A

how easily a certain material will induce an electromotive force (emf) within a circuit

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209
Q

interpulse interval

A

period of time of electrical inactivity btwn each pulse, usually expressed in microsecs or millisecs

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210
Q

ion

A

positively or negatively charged atome

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211
Q

low volt current

A

waveform of less than 150 volts and is used for neuromuscular stimulation

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212
Q

monophasic

A

pulse that has either a positive or negative polarity and moves in only one direction from a zero baseline and returns to baseline within a predetermined amount of time

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213
Q

negative ion

A

gained one or more electrons and possesses a negative charge

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214
Q

ohm’s law

A

current of an electrical current. there is a direct proportional relationship btwn current and voltage and an indirect proportional relationship btwn current and resistance

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215
Q

positive ion

A

lost one or more electrons and possesses a positive charge

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216
Q

pulse

A

pulse is one individual waveform

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217
Q

pulse duration

A

amount of time that it takes to complete all phases of a single pulse. often labeled “pulse width”

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218
Q

pulsed current (interrupted)

A

allows for a non-continuous flow of either alternating or direct current with periods of no electrical activity

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219
Q

ramp

A

refers to number of seconds it takes for amplitude to gradually increase or decrease to the max value set by amplitude control

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220
Q

resistance

A

ability of a material to oppose the flow of ions through it

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221
Q

rheobase

A

minimal intensity used with a long current duration that produces a small muscle contraction

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222
Q

volt

A

unit of measure of electrical power or electromotive force

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223
Q

waveform

A

consistent pattern of a current measured on an oscilloscope

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224
Q

clinical application templates executive summaries

A

…

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225
Q

achilles tendon rupture

A

usually one to two inches above tendinous insertion on calcaneous, greatest btwn 30-50 yrs of age, typically be unable to stand on their toes and tend to exhibit a positive Thompson test

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226
Q

adhesive capsulitis

A

occurs more in middle-aged population, greater incidence in women, arthrogram can assist with dx by detecting decreased volume of fluid within the joint capsule, ROM restriction typically in a capsular pattern (lateral rotation, abduction, medial rotation)

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227
Q

amyotrophic lateral sclerosis

A

risk is higher in males, usually occurs between 40-70, clinical presentation may include both upper and lower motorneuron involvement with weakness occurring in a distal to prox progression, average course of dx is 2-5 yrs with only 20-30% of patients surviving longer than five years

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228
Q

ankylosing spondylitis

A

systemic condition, inflammation of spine and larger peripheral joints, males greater risk btwn 20-40, presentation initially includes recurrent and insidious onset of back pain, morning stiffness, and impaired spinal extension

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229
Q

anterior cruciate ligament sprain

A

most commonly occurs during hyperflexion, rapid deceleration, hyperextension or landing in an unbalanced position, females involved in selected sports have higher ligament injury rates, approx 2/3 of time acl is completely torn, there is an associated meniscal tear

230
Q

bicipital tendonitis

A

increased incidence of injury is associated with selected sports such as baseball pitching, swimming, rowing, gymnastics, and tennis; characterized by subjective reports of a deep ache directly in front and on top of the shoulder made worse with overhead activities or lifting, examination may reveal a positive speed’s test or yergason’s test

231
Q

carpel tunnel syndrome

A

incidence is higher in females with most common age being from 35-55, muscle atrophy is often noted in abductor pollicis brevis muscle and later in the thenar muscles; electromyography studies, tinel’s sign, and phalen’s test can be used to assist with confirming diagnosis

232
Q

cerebral palsy

A

spastic cp involves upper motor neuron damage; athetoid cp involves damage to cerebellum, cerebellar pathways or both; clinical presentation includes motor delays, abnormal muscle tone and motor control, reflex abnormalities, poor postural control, and balance impairments; mental retardation and epilepsy are present in 50-60% of children diagnosed with cp.

233
Q

cva: cerebrovascular accident

A

types include ischemic (thrombus, embolus, lacunar) and hemorrhagic stroke (intracerebral, subdural, subarachnoid), left CVA may present with weakness or paralysis to rt side, impaired processing, heightened frustration, aphasia, dysphagia, and motor apraxia. right cva may present with weakness or paralysis to left side, poor attention span, impaired awareness and judgment, spatial deficits, memory deficits, emotional lability, and impulsive behavior

234
Q

chf: congestive heart failure

A

etiologies include arrhythmia, pulm embolism, hypertension, valvular heart disease, myocarditis, unstable angina, renal failure, severe anemia;

235
Q

cystic fibrosis

A

causes exocrine glands to overproduce thick mucus which causes subsequent obstruction, autosomal recessive genetic disorder located on long arm of chromosome seven, terminal disease but death age has increased to 32 yrs due to early detection and management

236
Q

degenerative spondylolisthesis

A

caused by weakening of joints that allows for forward slippage of one vertebral segment on one below due to degenerative changes, most common site is L4/L5, william’s flexion exercises may be indicated to strengthen abs and reduce lumbar lordosis

237
Q

diabetes mellitus (type 1)

A

insulin is functionally absent due to destruction of beta cells of pancreas; where insulin would normally be produced. starts in children ages 4 or older, adolescense. symptoms include polyuria, polydipsia, polyphagia, nausea, weight loss, fatigue, blurred vision, and dehydration

238
Q

down syndrome

A

clinical presentation: hypotonia, flattened nasal bridge, simian line (palmar crease), epicanthal folds, enlargement of tongue and dd.

239
Q

duchenne muscular dystrophy

A

x linked recessive trait manifesting in only male offspring while female offspring become carriers. waddling gait, prox muscle weakness, toe walking, pseudohypertrophy of calf and difficulty climbing stairs. rapid progression of this disease with inability to ambulate by ten to 12 yrs of age with death occurring as teenager or less frequently in the 20’s.

240
Q

fibromyalgia

A

nonarticular rheumatic condition with pain caused by tender points within muscles, tendons, and ligaments. pain exists in all 4 quadrants of body and there is pain in at least 11 of 18 standardized tender point sites

241
Q

full thickness burns

A

burn causes immediate cellular and tissue death and subsequent vascular destruction, eschar forms from necrotic cells and creates a dry and hard layer that requires debridement. absent sensation and pain due to destruction of free nerve endings

242
Q

guillain barre syndrome

A

motor weakness in a distal to prox progression, sensory impairment, and possible respiratory paralysis. may be an autoimmune response to a previous respiratory infection, flu, immunization or surgery. patients usually have full recovery

243
Q

huntingtons disease

A

chronic progressive genetic disorder that is fatal within 15 to 20 yrs after clinical manifestation. degeneration and atrophy of basal ganglia (stiatum) and cerebral cortex w/in brain. clinically presents with enlarged ventricles secondary to atrophy of basal ganglia, mental deterioration, speech disturbances and ataxic gait

244
Q

juvenile rheumatoid arthritis

A

autoimmune disorder found in children less than 16 that occurs when immune cells mistakenly begin to attack the joints and organs causing local and systemic effects. girls more likely than boys. symptoms include joint swelling, pain, stiffness

245
Q

lateral epicondylitis (tennis elbow)

A

inflammation or degenerative changes at common extensor tendon that attaches to lateral epicondyle of elbow. repeated overuse of wrist extensors. clinical symptoms include difficulty holding or gripping objects and insufficient forearm functional strength

246
Q

integumentary system

A

consists of dermal and epidermal layers, air follicles, nails, sebaceous glands, sweat glands

247
Q

dermis

A

true skin: well vascularized, elastic, flexible and tough.

248
Q

epidermis

A

avascular, consists of outermost layer of skin

249
Q

arterial insufficiency ulcers

A

occur secondary to ischemia from inadequate circulation of oxygenated blood often due to complicating factors such as atherosclerosis

250
Q

venous insufficiency ulcers

A

occur secondary to inadequate functioning of the venous system resulting in inadequate circulation and eventual tissue damage and ulceration

251
Q

pressure ulcer

A

decubitus ulcer: results from sustained or prolonged pressure at levels greater than the level of capillary pressure on the tissue

252
Q

neuropathic ulcer

A

secondary complication usually associated with a combination of ischemia and neuropathy. most often associated with diabetes. frequently found on plantar surface of foot, often beneath the metatarsal heads. wound has good granulation tissue and little or no drainage. often do not report pain due to altered sensation

253
Q

arterial ulcers

A

lower one third of leg, toes, web spaces. smooth edges, well defined, lack of granulation tissue, tend to be deep. severe pain, diminished or absent pedal pulses, normal edema, decreased skin temperature, thin and shiny tissue, hair loss, yellow nails. leg elevation increases pain.

254
Q

venous ulcers

A

proximal to the medial malleolus, irregular shape, shallow, mild to moderate pain, normal pedal pulses, increased edema, normal skin temp, flaky, dry skin, leg elevation lessens pain

255
Q

intervention for arterial insufficiency ulcer

A

cleansing the ulcer, rest, reducing risk factors, limb protection

256
Q

intervention for venous insufficiency ulcer

A

cleansing the ulcer, compression to control edema

257
Q

hydrocolloid dressing

A

gel forming polymer such as gelatin, pectin, and carboxymethylcellulose with a strong film or foam adhesive backing. absorb exudate by swelling into a gel like mass and vary from being occlusive to semi permeable. does not attach to actual wound itself and is instead anchored to intact skin surrounding the wound.

258
Q

when to use hydrocolloids

A

useful for partial and full thickness wounds. can be effective with granular or necrotic wounds

259
Q

advantages to hydrocolloids

A

moist environment for wound healing, enables autolytic debridement, offers protection from microbial contamination, provides moderate absorption, does not require a secondary dressing, provides a waterproof surface

260
Q

disadvantages to hydrocolloids

A

may traumatize surrounding intact skin upon removal, may tend to roll in areas of excessive friction, cannot be used on infected wounds

261
Q

hydrogels

A

consist of varying amounts of water and varying amounts of gel-forming materials such as glycerin, dressings are available in sheet form or amorphous form

262
Q

when to use hydrogels

A

commonly used on superficial and partial thickness wounds (abrasions, blisters, pressure ulcers) that have minimal drainage. rather than absorb drainage, hydrogels are moisture retentive

263
Q

advantages to hydrogels

A

provides a moist environment for wound healing, enables autolytic debridement, may reduce pressure and diminish pain, can be used as a coupling agent for ultrasound, minimally adheres to wound

264
Q

disadvantages to hydrogels

A

potential for dressings to dehydrate, cannot be used on wounds with significant drainage, typically requires a secondary dressing

265
Q

foam dressings

A

composed from a hydrophilic polyurethane base. hydrophilic at wound contact surface and are hydrophobic on the outer surface. allows exudates to be absorbed into the foam through the hydrophilic layer. most commonly available in sheets or pads with varying degrees of thickness.

266
Q

when to use foam dressings

A

used to provide protection over partial and full thickness wounds with varying levels of exudate. can be used as secondary dressings over amorphous hydrogels

267
Q

advantages to foam dressings

A

provides a moist environment for wound healing, available in adhesive and nonadhesive forms, provides prophylactic protection and cushioning, encourages autolytic debridement, provides moderate absorption

268
Q

disadvantages to foam dressings

A

may tend to roll in areas of excessive friction, adhesive form may traumatize periwound area upon removal, lack of transparency makes inspection of wound difficult

269
Q

transparent film

A

film dressings are thin membranes made from transparent polyurethane with water resistant adhesives. permeable to vapor and oxygen, but are mostly impermeable to bacteria and water. highly elastic, conform to a variety of body contours, and allow easy visual inspection of the wound since they are transparent.

270
Q

when to use transparent films

A

useful for superficial wounds (scalds, abrasions, lacerations) or partial-thickness wounds with minimal drainage.

271
Q

advantages to transparent films

A

provides a moist environment for wound healing, enables autolytic debridement, allows visualization of the wound, resistant to shearing and frictional forces, cost effective over time

272
Q

disadvantages to transparent films

A

excessive accumulation of exudates can result in periwound maceration, adhesive may traumatize periwound area upon removal, cannot be used on infected wounds

273
Q

gauze dressings

A

most readily available used in inpatient environment. commonly used on infected or non-infected wounds of any size. can be used for wet to wet, wet to moist, or wet to dry debridement. readily available and cost effective but has a tendency to adhere to wound bed. requires frequent dressing changes. increased infection rate compared to occlusive dressings

274
Q

alginates

A

consist of calcium salt of alganic acid that is extracted from seaweed. highly permeable and non-occlusive. requires a secondary dressing. based on the interaction of calcium ions in the dressing and the sodium ions in the wound exudate.

275
Q

when to use alginates

A

typically used on partial and full thickness draining wounds such as pressure wounds or venous insufficiency ulcers, often used on infected wounds due to likelihood excessive drainage.

276
Q

advantages to alginates

A

high absorptive capacity, enables autolytic debridement, offers protection from microbial contamination, can be used on infected or uninfected wounds, non-adhering to wound

277
Q

disadvantages to alginates

A

may require frequent dressing changes based on level of exudate, requires a secondary dressing, cannot be used on wound with an exposed tendon, joint capsule or bone

278
Q

occlusion

A

refers to ability of a dressing to transmit moisture, vapor or gases from wound bed to atmosphere. truly occlusive substance would be completely impermeable, while a truly non-occlusive substance would be completely permeable.

279
Q

most occlusive to non-occlusive

A

hydrocolloids, hydrogels, semi-permeable foam, semi-permeable film, impregnated gauze, alginates, and traditional gauze

280
Q

most moisture retentive to least moisture retentive

A

alginates, semi-permeable foam, hydrocolloids, hydrogels, semi-permeable film

281
Q

primary versus secondary dressing

A

primary - direct contact with wound. secondary - directly over primary dressing to provide protection, absorption, and/or occlusion

282
Q

selective debridement

A

remove only nonviable tissue from a wound. selective debridement is most often performed by sharp debridement, enzymatic debridement, and autolytic debridement

283
Q

red-yellow-black tissue

A

red: protect wound, maintain moist environment, yellow: moist yellow slough. debride necrotic tissue and absorb drainage. black: debride necrotic tissue.

284
Q

sharp debridement

A

requires use of scalpel, scissors, and/or forceps to selectively remove devitalized tissues, foreign materials or debris from a wound. most often used for wounds with large amounts of thick, adherent, necrotic tissue, also for cellulitis or sepsis. most expedient form of removing necrotic tissue. PTs are permitted to perform sharp debridement in the majority of states.

285
Q

enzymatic debridement

A

topical application of enzymes to surface of necrotic tissue. can be used on infected and non-infected wounds with necrotic tissue. may be used in wounds that have not responded to autolytic debridement or in conjunction with other debridement techniques. can be slow to establish a clean wound bed and should be discontinued after removal of devitalized tissues in order to avoid damage

286
Q

autolytic debridement

A

using body’s own mechanisms to remove nonviable tissue. methods include transparent films, hydrocolloids, hydrogels and alginates. results in a moist wound environment that permits rehydration of the necrotic tissue and eschar and allows enzymes to digest the nonviable tissue. can be used with any amount of necrotic tissue and is non-invasive and pain free; however takes longer for wound healing to occur. should not be performed on infected wounds.

287
Q

Revered

develops from a long history of chronic bronchitis. alveolar walls present with significant pathology and air spaces are permanently over inflated. pink puffers. expiration is difficult. characterized as centrilobular, panlobular or paraseptal. symptoms include: dyspnea, chronic cough, orthopnea, barrel chest, increased use of accessory muscles, and increased RR.

A

emphysema

288
Q

Revered

lungs fail to fully expand due to a weakened diaphragm, structural inability of chest wall to expand, and a decrease in elasticity of lung tissue. symptoms include: shortness of breath, persistent non-productive cough, increased RR. results in a decrease in all lung volumes.

A

restrictive pulmonary disease

289
Q

Revered

bacterial infection that is transmitted by airborne fashion (coughing, sneezing, speaking). lungs are primarily involved, however TB can occur in kidneys, lymph nodes, and meninges. lesions in the lungs can be seen with x ray. symptoms: fatigue, weight loss, loss of appetite, low grade fever, productive cough, chest discomfort, and dyspnea. treatment includes anti-tb drug therapy. prevention of TB through immunization is recommended for children.

A

tuberculosis

290
Q

Revered

bronchodilator agents, inhaled corticosteriod agents, mucolytic agents, expectorant agents, antiasthmatic agents. examples: albuterol, serevent, epnephrine, vanceril, flovent, decadron, mucosil, plumozyne, guafenesin, terpin hydrate, intal, tilade

A

pharmacological intervention for pulmonary management

291
Q

Revered

…

A

transfers: levels of phys assistance

292
Q

Revered

patient does not require any assistance to complete task

A

independent

293
Q

Revered

patient requires therapist to observe throughout completion of task

A

supervision

294
Q

Revered

patient requires therapist to maintain contact with patient to complete task. usually needed to assist of there is a loss of balance

A

contact guard

295
Q

Revered

patient requires 25% assist from therapist to complete task

A

min assist

296
Q

Revered

patient requires 50% assist from therapist to complete task

A

mod assist

297
Q

Revered

patient requires 75% assist from therapist to complete task

A

max assist

298
Q

Revered

patient is unable to participate and therapist must provide all effort to perform task

A

dependent

299
Q

Revered

used to transfer patient from a stretcher to a bed or treatment plinth. 3 therapists carry patient in supine position. therapist at head usually gives commands.

A

3 person carry/lift

300
Q

Revered

used to transfer a patient btwn two surfaces of different heights or when transferring a patient to the floor.

A

2 person lift

301
Q

Revered

used to transfer a patient who cannot stand independently, but can bear some weight thru the trunk and LEs. therapist should position patient at a 45 degree angle to the destination surface. patient places UEs on therapist’s shoulders, but should not pull on therapist’s neck. should position patient at edge of surface, hold patient around hips and under butt, block patients knees in order to avoid buckling. therapist should utilize momentum, straighten his or her legs and raise patient or allow patient to remain squatting, and pivot and slowly lower patient to destination surface.

A

dependent squat pivot transfer

302
Q

Revered

used for a patient who has some sitting balance and some UE strength and can adequately follow directions. patient should be positioned at edge of w/c or bed and should lean to one side while placing one end of sliding board under proximal thigh. other end should be position on destination surface. use both arms to initiate a push up and scoot across board. therapist should guard in front of patient and assists as needed as patient performs a series of push ups across the board.

A

sliding board transfer

303
Q

Revered

used when a patient is able to stand and bear weight through one or both of LEs. must possess functional balance and ability to pivot.

A

stand pivot transfer

304
Q

Revered

…

A

wheelchair facts

305
Q

Revered

seat width: 18 inches, set depth: 16 inches, seat height: 20 inches

A

adult w/c specs:

306
Q

Revered

decreased seat height (17.5 inches) to allow for propulsion using the unaffected foot

A

hemi-height w/c

307
Q

Revered

can be positioned 2 inches posteriorly from normal for patients with amputations to increase the BOS and to compensate for diminished weight in front of w/c

A

rear wheel axles

308
Q

Revered

allow intermittent or constant reclined positioning

A

reclining w/c

309
Q

Revered

allow for reclined position without losing required 90 degrees of knee flexion. entire chair reclines without any anatomical changes in positioning.

A

tilt-in-space w/c

310
Q

Revered

seat height/leg length: 19.5 to 20.5 inches. measure from user’s heel to popliteal fold and add 2 inches to allow clearance of foot rest.

A

standard w/c measurements for proper fit

311
Q

Revered

measure from user’s bottom along lateral thigh to popliteal fold, then subtract approx 2 inches to avoid pressure from front edge of seat against popliteal space. 16 inches average.

A

seat depth

312
Q

Revered

measure the widest aspect of user’s bottom or hips and add aprx 2 inches. will provide space for clothing and clearance of trochanters from armrest side panel. approx 18 inches is average.

A

seat width

313
Q

Revered

measure from seat of chair to floor of axilla with user’s shoulder flexed to 90 and then subtract 4 inches. this will allow final back height to be below inferior angles of scapula. 16-16 1/2 inches average.

A

back height

314
Q

Revered

measure from seat of chair to olecranon process with user’s elbow flexed to 90 and then add one inch. average usually 9 inches above chair seat.

A

armrest height

315
Q

Revered

parallel bars, walkers, axillary crutches, lofstrand crutches, canes

A

assistive devices

316
Q

Revered

proper fit includes bar height that allows for 20-25 degrees of elbow flexion while grasping bars approx four to six inches in front of body.

A

parallel bars

317
Q

Revered

can be used with all levels of weight bearing. should allow for 20-25 degrees of elbow flexion. used with 3 point gait pattern

A

walker

318
Q

Revered

all levels of weight bearing, but requires higher coordination for proper use. 6 inches in front, two inches out (lateral) to patient. crutch height should be adjusted no greater than 3 finger widths from axilla. handgrip height should be adjusted to ulnar styloid process and allow for 20-25 degrees of elbow flexion while grasping.

A

axillary crutches

319
Q

Revered

20-25 degrees of elbow flexion while holding handgrips with crutches 6 inches in front and 2 inches lateral. arm cuff should be positioned 1 to 1 1/2 inches below olecranon process so it does not interfere with elbow flexion

A

lofstrand (forearm) crutches

320
Q

Revered

provides minimal stability and support during ambulation, mainly for balance.

A

cane

321
Q

Revered

non weight bearing

A

NWB

322
Q

Revered

toe touch weight bearing

A

TTWB

323
Q

Revered

partial weight bearing

A

PWB

324
Q

Revered

weight bearing as tolerated

A

WBAT

325
Q

Revered

full weight bearing

A

FWB

326
Q

Revered

when patient uses 2 crutches or canes. moves left crutch forward while simultaneously advancing rt lower extremity ad vice versa.

A

2 point gait

327
Q

Revered

walker or crutches. injured lower extremity may have decreased weight bearing. AD is advanced followed by injured LE and then uninjured LE. AD and each LE are considered separate points

A

3 point gait

328
Q

Revered

each advancement of crutch or cane as well as LEs indicates a single point, used one at a time.

A

4 point gait

329
Q

Revered

patient with bilateral trunk and or LE weakness uses crutches or a walker and advances LEs at the same time only to point of AD.

A

swing to gait

330
Q

Revered

advances LEs thru AD

A

swing through

331
Q

Revered

monitoring device consisting of a catheter that is inserted into an artery and attached to an electronic monitoring system. used to measure blood pressure or obtain blood samples. considered more accurate than traditional measures of blood pressure and does not require repeated needle punctures

A

arterial line

332
Q

Revered

applied over shaft of penis and is held in place by a padded strap or adhesive tape

A

external catheter

333
Q

Revered

indwelling urinary tract catheter that has a balloon attachment at one end. balloon which is filled with air or sterile water must be deflated before catheter can be removed

A

foley catheter

334
Q

Revered

indwelling urinary catheter that is surgically inserted directly into patient’s bladder. insertion of a suprapubic catheter is performed under general anesthesia

A

suprapubic catheter

335
Q

Revered

soft, flexible catheter that is inserted through a vein into pulmonary artery. used to provide continuous measurements of pulm artery pressure. can exercise with device but patient should avoid activities that increase pressure on injection site

A

swan-ganz catheter

336
Q

Revered

consists of a sterile fluid source, pump, clamp, and catheter to insert into a vein. can be used to infuse fluids, electrolytes, nutrients, and medication. IV lines are most commonly inserted into superficial veins such as basilic, cephalic, or antecubital.

A

intravenous system

337
Q

Revered

tubing extends into patient’s nostrils approx 1 cm. oxgyen therapy can deliver up to 6 L of oxygen per min

A

nasal cannula

338
Q

Revered

plastic tube inserted thru a nostril that extends into stomach. commonly used for liquid feeding, medication administration or to remove gas from the stomach

A

nasogastric tube

339
Q

Revered

photoelectric device used to determine the oxygen saturation of blood. device is most commonly applied to finger or ear. often used to assess activity tolerance

A

oximeter

340
Q

Revered

inflammation and repair, pain, restriction in motion, and abnormal tone.

A

indications for therapeutic modalities

341
Q

Revered

inflammation (1-6 days), proliferative phase (day 3-day 20), maturation phase (day 9 - ongoing)

A

phases of tissue healing

342
Q

Revered

occurs secondary to trauma or disease. required for healing to occur. presents with calor, rubor, tumor, dolor. clot formation and phagocytosis occur

A

inflammation phase of tissue healing

343
Q

Revered

involves connective tissue and epithelial cells. epithelialization, collagen production, wound contracture, and neurovascularization occur

A

proliferative phase

344
Q

Revered

longest in duration, progression towards restoration of the prior function of injured tissues, collagen synthesis and lysis balance, collagen fiber orientation

A

maturation phase

345
Q

Revered

can occur during healing process when collagen production greatly exceeds collagen lysis. extends beyond original boundaries of an injury and damages healthy tissues.

A

keloid scar

346
Q

Revered

can occur during healing process when collagen production greatly exceeds collagen lysis. will be raised, but remain within borders of original injury

A

hypertrophic scar

347
Q

Revered

conduction, conversion, convection, evaporation, radiation

A

principles of heat transfer

348
Q

Revered

direct contact btwn 2 materials at different temperatures. ex: hot pack, paraffin, ice massage, cold pack

A

heat conduction

349
Q

Revered

air or water moving in a constant motion across body. ex: whirlpool

A

heat convection

350
Q

Revered

transfer of heat when nonthermal energy is absorbed into tissue and transformed into heat. ex: diathermy and ultrasound

A

heat conversion

351
Q

Revered

transfer of heat as a liquid absorbs energy and changes from to a vapor. ex: vapocoolant spray

A

heat evaporation

352
Q

Revered

direct transfer of heat from a radiation energy source of higher temperature to one of cooler temperature. directly absorbed without the need for a medium. ex: infrared lamp

A

heat radiation

353
Q

Revered

ex: ice massage, cold pack, cold bath, vapocoolant spray

A

cryotherapy

354
Q

Revered

initial decrease of blood flow to treated area, decreased temp, increase pain threshold, decrease metabolism, decrease edema, initial vasoconstriction, decrease nerve conduction velocity, decrease nerve conduction velocity, reduce spasticity of muscle, produce analgesic effects

A

cryotherapy’s therapeutic effects

355
Q

Revered

acute or chronic pain, myofascial pain syndrome, muscle spasm, bursitis, acute or subacute inflammation, musculoskeletal trauma, reduction of spasticity, tendonitis

A

cryotherapy’s indications

356
Q

Revered

compromised circulation, peripheral vascular disease, ischemic tissue, cold hypersensitivity, raynaud’s phenomenon, cold urticaria, hypertension, infection, cryoglobinemia

A

cryotherapy contraindications

357
Q

Revered

intense cold within 3 mins, aching/burning sensation from 4-7 mins, anesthesia to analgesia from 8-15 mins, numbness from 15-30 mins

A

stages of perceived symptoms during cryotherapy

358
Q

Revered

5-10 min treatment time

A

ice massage

359
Q

Revered

requires a temp of 23 degrees. apply cold pack wrapped in moistened towel to area for 15 mins. application may extend to 30 mins but requires observation every 10 minutes (for spasticity) can be applied every one to two hours for reduction of inflammation and pain control.

A

cold pack

360
Q

Revered

used for immersion of distal extremities. water temp ranges from 55 to 64 degrees. immersed for 5 to 15 mins to attain desired effects

A

cold bath

361
Q

Revered

often used in conjunction with passive stretching. fluori-methane is a commonly used vapocollant spray that is typically applied from prox to distal muscle attachments.

A

vapocoolant sprays

362
Q

Revered

fluidotherapy, hot pack, infrared lamp, paraffin

A

superficial heating agents

363
Q

Revered

diathermy, ultrasound (and phonopheresis)

A

deep heating agents

364
Q

Revered

increase temp, increase blood flow to area, decrease nerve conduction latency, vasodilation, increase muscle elasticity, increase collagen extensibility, decreases tone

A

heating therapeutic effects

365
Q

Revered

pain control, chronic inflammatory conditions, trigger point, tissue healing, muscle spasm, decreased ROM, densensitization

A

heating indications

366
Q

Revered

circulatory impairment, area of malignancy, acute musculoskeletal trauma, bleeding, sensory impairment, thrombophlebities, arterial disease

A

heating contraindications

367
Q

Revered

container that circulates warm air and small cellulose particles. extremity is placed into container and dry heat is generated thru energy transferred by forced convection. promotes tissue healing and prevention of edema. body part should be placed into unit prior to turning machine on. temp should be set between 111-125 degrees. treatment time usually 20 minutes.

A

fluidotherapy

368
Q

Revered

effects include soft tissue healing, promoting relaxation, decreasing pain and stiffness. must be stored in hot water between 158-167 degrees. requires 6-8 towels around hot pack. require approx 20 minutes to achieve desire effects

A

hot pack

369
Q

Revered

produces superficial heating of tissue through radiant heat. form of heating is usually limited to penetration of less than one to three millimeters. use is declining due to risk of burns during treatment. patient should be positioned approx 20 inches from source. 20 inches in distance should equal 20 minutes of treatment. as distance decreases, intensity will increase and time of total treatment should decrease.

A

infrared lamp (IR)

370
Q

Revered

most commonly used superficial heating agent of distal extremities. temp should be between 113-126 degrees. dip patient’s hand and wrap with plastic bag with a towel around it to insulate and maintain heating for approx 15-20 mins.

A

paraffin wax

371
Q

Revered

converts high frequency electromagnetic energy into therapeutic heat. produces vibration of molecules within a specific tissue, generates heat and elevates tissue temperature. main therapeutic effect is enhancement of soft tissue healing. can be delivered in continuous or pulsed mode. pulsed mode is usually used for thermal effects at 27.12 MHz.

A

diathermy

372
Q

Revered

low back, abdomen, pelvis of a pregnant woman, internal and external metal objects, eyes, malignant area, intrauterine device, cardiac pacemaker, pain and temp sensory deficits, moist wound dressing, testes, acute inflammation, ischemic tissue

A

contraindications for diathermy

373
Q

Revered

inductive application: wrap coils around extremity that has been covered by a towel, place drum over treatment area. patient must remain in same position throughout treatment. treatment time varies from 15-30 mins.

A

diathermy parameters

374
Q

Revered

common deep heating agent that transfers heat through conversion. elevates tissue temp to depths up to 5 cms, and uses inaudible acoustic mechanical vibrations of high frequency to produce thermal and nonthermal effects. crystal transducer converts electrical energy into sound.

A

ultrasound

375
Q

Revered

thermal: increase extensibility of collagen structure, decrease joint stiffness, pain relief, increase blood flow, decrease muscle spasm

A

ultrasound therapeutic effects

376
Q

Revered

nonthermal: stimulation of tissue regeneration, pain relief, soft tissue repair, increase blood flow,

A

ultrasound therapeutic effects (nonthermal)

377
Q

Revered

soft tissue repair, contracture, bone fracture, trigger point, dermal ulcer, scar tissue, pain, plantar wart, muscle spasm

A

indications for u/s

378
Q

Revered

over eyes, over pregnant uterus, over cemented prosthetic joint, impaired circulation, impaired pain or temp sensory deficits, over heart, over testes, over epiphyseal areas in children, infection, over malignancy

A

contraindications for u/s

379
Q

Revered

place transducer over area before turning on machine (and gel already applied to head). move in small circular pattern over treatment area. maintain contact with skin and stay within treatment area. an area two to three times the size of the transducer typically requires a duration of five minutes of treatment. intensity for continuous u/s is normally set btwn .5 to 2 w/cm2 for thermal effects. pulsed u/s is normally set between .5 to .75 w/cm2 with a 20% duty cycle for nonthermal effects

A

u/s treatment parameters

380
Q

Revered

beam nonuniformity ratio: ratio of intensity of highest peak to average intensity of all peaks. lower BNR, more favorable, since most patients will be less likely to experience hot spots and or discomfort during treatment. BNR values should range btwn 2:1 and 6:1, most devices often fall in 5:1 or 6:1 range.

A

BNR

381
Q

Revered

effective radiating area. area of transducer that transmits u/s energy. always smaller than total size of transducer head.

A

ERA

382
Q

Revered

occurs as a result of acoustic energy generated by u/s that develops into microscopic bubbles causing cavities that surround soft tissues. the bubbles expand and contract.

A

acoustic cavitation

383
Q

Revered

stable cavitation: microscopic bubbles increase and decrease in size but do not burst. triggers microsteaming. transient (unstable) cavitation: microscopic bubbles increase in size over multiple cycles and implode. this causes brief moments of local temperature ad pressure increases in area surrounding those bubbles. process should not occur during therapeutic u/s since intensities required are much higher than 3 w/cm2.

A

2 types of cavitation that occur:

384
Q

Revered

minute flow of fluid that takes place around vapor-filled bubbles that oscillate and pulsate

A

microsteaming

385
Q

Revered

term for the consistent and circular flow of cellular fluids that results from u/s. responsible for altering cellular activity and the transport of fluids to different portions of the field.

A

acoustic streaming

386
Q

Revered

use of u/s for transdermal delivery of medication. u/s enhances the distribution of medication through the skin, provides a high concentration of the drug directly to the treatment site and avoids risks that may be involved with injection of medication. medications regularly used in phonophoresis include anti-inflammatory agents or analgesics. effective with both continuous and pulsed techniques.

A

phonophoresis

387
Q

Revered

the internal and external use of water in the treatment of disease. transfers heat thru conduction or convection and is administered in tanks of varying sizes. main therapeutic effects: wound care, unloading of weight, and reduction of edema.

A

hydrotherapy

388
Q

Revered

(archmides): there is an upward force on body when immersed in water equal to amount of water that has been displaced by the body. ability to float in water results from the body possessing a specific gravity less than that of water.

A

buoyancy

389
Q

Revered

water exerts pressure that is perpendicular to the body and increases in proportion with the depth of immersion

A

hydrostatic pressure

390
Q

Revered

water molecules tend to attract to each other and provide resistance to movement of the body in the water. resistance by water increases in proportion to speed of motion.

A

resistance

391
Q

Revered

computation for specific gravity of water is equal to 1. human body varies based on size and somatotype but typically has a specific gravity of less than 1 (average .974). therefore, a personal will generally float when fully submerged in water.

A

specific gravity

392
Q

Revered

measure of the ability of a fluid to store heat. calculated as amount of thermal energy required to increase fluid’s temp by one unit. water can store 4 times the heat as compared to air. water’s thermal conductivity is approx 25 times faster than air at the same temp.

A

specific heat

393
Q

Revered

comprised of profile drag, wave drag and surface drag forces. is a hydromechanic force exerted on a person submerged in water that normally opposes the direction of the body’s motion.

A

total drag force

394
Q

Revered

increase blood flow, increase core temp, relaxation, pain relief, vasodilation, decrease abnormal tone, wound/debridement

A

therapeutic effects of hydrotherapy:

395
Q

Revered

burn care, superficial heating or cooling, edema control, muscle strain, arthritis, desensitization of residual limb with contrast bath, pain management, wound care, decreased ROM, pool therapy/exercise, sprain, joint stiffness, muscle spasm/spasticity

A

indications for hydrotherapy:

396
Q

Revered

peripheral vascular disease, gangrene, severe infection, urinary/fecal incontinence, advanced cardiov or pulm disease, buerger’s disease w/contrast bath, impaired circulation, renal infection, bleeding surface area, diminished sensation

A

contraindication for hydrotherapy:

397
Q

Revered

extremity tank, lowboy tank, highboy tank, hubbard tank, therapeutic pool

A

types of hydrotherapy

398
Q

Revered

32-79 degrees: acute inflammation of distal extremities, 79-92 degrees: exercise, 92-96: wound care, spasticity, 96-98: cardiopulmonary compromise, treatment of burns, 99-104: pain management, 104-110: chronic rheumatoid or osteoarthritis, increased ROM

A

treatment temps for water

399
Q

Revered

treatment time ranges from between 10 and 30 mins. select water temp based on diagnosis and goals and assist pt into comfortable position, monitor vital signs and level of comfort.

A

treatment parameters for whirlpool

400
Q

Revered

general contraindications for superficial or deep heating, including incontinence, open areas, fear of water, confusion, and significant respiratory pathology. recommended populations for pool therapy include patients with arthritis, musculoskeletal injuries, neuro deficits, sci, cva, ms, and selected cardiopulmonary diagnoses. tank must be cleaned after each use with a disinfectant and antibacterial agent.

A

treatment parameters for pool therapy

401
Q

Revered

modality that applies mechanical forces to body to separate joint surfaces and decrease pressure. force can be applied manually by therapist or mechanically by a machine.

A

mechanical agent: traction

402
Q

Revered

joint distraction, soft tissue stretching, muscle relaxation, reduction of disk protrusion, joint mobility

A

therapeutic effects of traction

403
Q

Revered

nerve impingement, herniated or protruding disc, subacute joint inflammation, spondylolisthesis, joint hypomobility, paraspinal muscle spasm, degenerative joint disease, osteophyte formation

A

indications for traction

404
Q

Revered

when motion is contraindicated, joint instability, tumor, pregnancy, acute inflammatory response, acute sprain, osteoporosis, fracture

A

contraindications for traction

405
Q

Revered

treatment time is 5-20 mins. cervical: pt supine with approx 25-35 degrees of neck flexion, should start with a force btwn 10-15 lbs and progress to 7% of pt’s body weight as tolerated for separation of vertebrae. lumbar can be supine or prone, and should be set with a force of less than half body weight for initial treatment. traction force of 25-50 lbs is recommended when initiating mechanical lumbar traction. force of up to 50% of body weight is required for actual separation of the vertebrae.

A

treatment parameters for traction

406
Q

Revered

physical agent that applies a mechanical force to increase pressure on treated body part. works to keep venous and lymphatic flow from pooling into interstitial space. static compression utilizes bandaging and compression garments to shape residual limbs, control edema, prevent abnormal scar formation, and reduce risk of dvt. intermittent compression with a pneumatic device is used to reduce edema.

A

compression

407
Q

Revered

control of peripheral edema, shaping of residual limb, management of scar formation, improve lymphatic and venous return, and prevention of DVT

A

therapeutic effects of compression

408
Q

Revered

lymphedema, new res limb, risk for DVT, edema, stasis ulcers, hypertrophic scarring

A

indications for compression

409
Q

Revered

malignancy of treated area, DVT, unstable or acute fracture, heart failure, infection of treated area, pulm edema, circulatory obstruction

A

contraindications for compression

410
Q

Revered

therapist should measure girth and bp. therapist should set parameters based on desire effect. stockinette should be put over extremity and then compression sleeve. 3:1 ratio is generally used for on/off time with inflation btwn 40 to 100 seconds and deflation btwn 10-35 seconds. inflation pressure generally ranges from 30-80 mm Hg and should not exceed patient’s diastolic bp. treatment of upper extremities generally requires btwn 30 and 60 mm Hg of inflation pressure while treatment of LEs requires btwn 40 and 80 mm Hg of inflation pressure. treatment time varies for diagnosis, from 2-4 hours and is utilized from 3 x per week to 3 x per day. when treatment time is up, therapist should reassess extremity and remeasure girth and bp

A

treatment parameters

411
Q

Revered

form of energy that is used therapeutically and absorbed one to two millimeters into the skin. divided into UV-A and UV-B, and UV-C. most effective use of UV is to treat skin disorders

A

UV: ultraviolet light

412
Q

Revered

facilitate healing, exfoliation, Vit D production, increase pigmentation, tanning

A

therapeutic effects of UV

413
Q

Revered

acne, psoriasis, tetany, Vit D deficiency, chronic ulcer/wound, osteomalacia/rickets, sinusitis

A

indications for UV

414
Q

Revered

photosensitive meds, lupus erythematosus, tb, herpes, renal or hepatic pathology, DM, pellagra

A

contraindications for UV

415
Q

Revered

therapist must obtain a minimal erythemal dose before treatment (MED). this is the time of exposure needed to produce an area of mild redness btwn 8 and 24 hours after treatment. MED is tested by paper cutouts on forearm and therapist should wear goggles. squares on skin should be exposed in 15 sec increments for 15, 30, 45, 60 and 75 seconds and inspected after an 8 hr period to determine MED. treatment time should increase each consecutive treatment day since skin adapts to the UV exposure.

A

treatment parameters for UV

416
Q

Revered

manual therapeutic modality that produces physiologic effects through stroking, rubbing, and pressure.

A

massage

417
Q

Revered

light in stroke and produces a reflexive response. performed at beginning and end of massage to allow patient to relax and should be directed towards the heart.

A

effleurage

418
Q

Revered

incorporates small circular motion over a trigger point or muscle spasm. deep massage technique that penetrates into the depth of a muscle and attempts to reduce edema, loosen adhesions, and relieve muscle spasm. used with chronic inflammation or with overuse injuries

A

friction

419
Q

Revered

kneading where muscle is squeezed and rolled under therapist’s hands. distal to proximal sequence of kneading over muscle. can be performed with 2 hands over larger muscle groups or with as few as two fingers over smaller muscles.

A

petrissage

420
Q

Revered

provides stimulation through rapid and alternating movements such as tapping, hacking, cupping, and slapping. purpose is to enhance circulation and stimulate peripheral nerve endings

A

tapotement

421
Q

Revered

places hands or fingers firmly over area and uses a rapid shaking motion that causes vibration to treatment area. used primarily for relaxation.

A

vibration

422
Q

Revered

increases lymphatic circulation, removal of metabolic waste, decrease muscle atrophy, decrease anxiety and tension, facilitate healing, stimulate reflexive effects, reduction of edema, loosen adhesions, decrease muscle spasm

A

therapeutic effects of massage

423
Q

Revered

pain, decreased ROM, edema, adhesions, myositis, lactic acid excess, migraine, trigger point, muscle spasm and cramping, scar tissue, bursitis, tendonitis, intermittent claudication, raynaud’s syndrome

A

indications for massage

424
Q

Revered

infection, arterioscelrosis, thrombus, cellulitis, acute injury, embolus, cancer.

A

contraindications for massage

425
Q

Revered

used for facilitation of skeletal muscle contraction, stimulation of denervated muscle, pain management, to retard muscle atrophy, osteogenesis, driving medications through the skin, and wound management

A

electrotherapy

426
Q

Revered

cardiac pacemaker, patient with a bladder stimulator, over carotid sinus, seizure disorders, phlebitis, malignancy, over a pregnant uterus, cardiac arrhythmia, osteomyelitis

A

contraindications

427
Q

Revered

techniques include: monopolar, bipolar, and quadripolar

A

electrode configuration

428
Q

Revered

active (smaller) electrode is placed over target area. second dispersive electrode is placed at another site away from the target area. used for wounds, iontophoresis, and treatment of edema

A

monopolar

429
Q

Revered

2 active electrodes are placed over target area. electrodes usually same size. used for muscle weakness, neuromuscular facilitation, spasms, and ROM

A

bipolar

430
Q

Revered

2 electrodes from 2 separate stimulating circuits are positioned so that the individual currents intersect with each other. utilized with interferential current.

A

quadripolar

431
Q

Revered

when using a smaller electrode it is particularly important to understand that since the current density is quite high compared to a larger electrode, the patient will be more susceptible to pain and potential tissue damage.

A

electrode size

432
Q

Revered

increased current density, increased impedance, decreased current flow

A

small electrodes

433
Q

Revered

decreased current density, decreased impedance, increased current flow

A

large electrodes

434
Q

Revered

pain management, urinary incontinence, edema management, osteoarthritic pain, migraines

A

estim indications

435
Q

Revered

malignancy, with all types of electrical implants, during first trimester of pregnancy, over lower abdomen/uterus during pregnancy, over anterior transcervical area

A

estim contraindication

436
Q

Revered

also known as galvanic, constant flow of electrons from anode to cathode without interruption. iontophoresis uses direct current

A

direct current

437
Q

Revered

polarity that changes from positive to negative with change in direction of current flow. biphasic, symmetrical or asymmetrical, and is a waveform that is sinusoidal in shape. used in muscle retraining, spasticity and stimulation of denervated muscle

A

alternating current

438
Q

Revered

combines two high frequency alternating waveforms that are biphasic. used for deep muscle stimulation. attempts to reach deeper tissues using higher frequencies of each waveform along with overall shorter pulse widths. uses a frequency of 50-1250 pps and a pulse width of 50-150 microseconds for pain management; and a frequency of 20-50 pps and pulse width of 100-200 microseconds for muscle contractions

A

interferential current

439
Q

Revered

medium frequency polyphasic waveform. alternating current is produced in a 50 burst per second interval with a pulse width range of 50-200 microseconds, and an interburst interval of 10 milliseconds. type of NMES or FES and is believed to augment muscle strengthening by depolarizing both sensory and motor nerve fibers resulting in tetanic contractions that are painless and stronger than those made voluntarily by the patient. electrode should be placed parallel to muscle fibers along line of pull of muscle group.

A

russian current

440
Q

Revered

average peak current amplitude of 100 mA, 50 bursts per second, with on/off time ration of 10/50. usually is done 10 evoked contractions with a 10 second contraction and a 50 second rest period between each of the 10 contractions.

A

russian stim parameters

441
Q

Revered

neuromuscular electrical stimulation: used to facilitate skeletal muscle activity. stim of an innervated muscle occurs when an electrical stimulus of appropriate intensity and duration is administered to the corresponding peripheral nerve. commonly used to facilitate return of controlled functional muscular activity or to maintain postural alignment until recovery occurs.

A

NMES

442
Q

Revered

bipolar electrode placement over muscle. interrupted current is used with a range of 20-40 pulses per second an on time of 6-10 secs followed by off time of approx 50-60 secs. 15-20 mins for several times a day

A

NMES parameters

443
Q

Revered

widely used for acute and chronic inflammation. main effects of TENS include pain relief through gate control theory. used for home use and is portable.

A

TENS: transcutaneous electrical nerve stimulation

444
Q

Revered

cardiac pacemakers, epilepsy, during 1st trimester

A

TENS contraindications

445
Q

Revered

conventional, acupuncture like, pulse burst, and brief intense (high-intensity)

A

TENS Parameters

446
Q

Revered

frequency: 50-100 Hz, duration: 20-100 microseconds, amplitude: 10-30 mA

A

conventional TENS

447
Q

Revered

frequency: 1-4 Hz, 100-200 microseconds, amplitude: 30-80 mA

A

acupuncture like TENS

448
Q

Revered

frequency: 70-100 Hz/burst, duration: 40-75 microseconds, amplitude: 30-60 mA

A

pulse burst

449
Q

Revered

frequency: 70-100 Hz/burst, duration: 150-200 microseconds, amplitude: 30-60 mA

A

brief intense (high intensity)

450
Q

Revered

electrodes may be placed on sites of nerve roots, trigger points, acupuncture sites or key points of pain and sensitivity. net polarity is normally equal to zero. if waveform is unbalanced, there will be an accumulation of charges that will lead to skin irritation under the electrodes. includes a pulse duration that can vary from 20-400 microseconds; pulse frequency that varies in range from 1-200 Hz, and current amplitude from .1-120 mA.

A

TENS guidelines

451
Q

Revered

process by which medications are induced through the skin into the body by means of continuous direct current electrical stimulation. medication is separated into ions based on the polarity of the current.

A

iontophoresis

452
Q

Revered

acidic reaction can cause hardening of skin. alkaline reaction can cause skin to soften over time.

A

acidic/alkaline reaction

453
Q

Revered

technique used to stabilize the pH of skin during ionto by placing buffering agents into electrode pads that cover drug reservoir area within the electrode

A

buffering

454
Q

Revered

decomposition of a compound that results from passing an electrical current through it

A

electrolysis

455
Q

Revered

occurs during ionto where there is an exchange btwn ions within solutions and electrodes

A

electron exchange

456
Q

Revered

decomposition of water when electrical current is passed through it. water will be reduced to a net accumulation of hydrogen ions (H+) under anode and hydroxyl ions (OH-) under the cathode.

A

redox reaction

457
Q

Revered

pt should never lie on top of electrodes. unit should be set to continuous direct current. polarity must be set to same polarity as ion solution. ion solution should be massaged into treatment site or space within electrode. conductive surface area of the negative electrode (cathode) is twice the size of the conductive surface area of the positive electrode (anode) regardless of which on is the active electrode. active electrode must be placed over target area the the dispersive electrode should be placed as far as possible from active electrode. slowly increase intensity towards a max of five milliamperes. treatment should last 15-20 mins. additional time is required for treatment at an intensity of less than five milliamperes.

A

iontophoresis parameters

458
Q

Revered

positive charge: lidocaine, hydrocortisone, histamine, lithium, magnesium, zinc. negative charge: acetate, dexamethasone, salicylate, iodine, chlorine, tap water (+ and -)

A

therapeutic ions and charge

459
Q

Revered

high voltage pulsed current: twin peak monophasic, pulsed current. produces high electromotive forces. has a phase duration of 5-20 microsecs (fixed in most machines), a short pulse duration that ranges btwn 100-200 microsecs, and voltage greater than 150V to a max of 500V. one large dispersive pad along with one, two or four active electrodes. active electrodes can be positive or negative in polarity based on treatment goals.

A

hvpc

460
Q

Revered

wound management, pain management, soft tissue edema, levator ani syndrome, muscle spasm, muscle weakness, bell’s palsy

A

indications for hvpc

461
Q

Revered

cardiac pacemakers, over heavy scarring tissues, malignancy, pregnancy

A

contraindications for hvpc

462
Q

Revered

secure one electrode over wound (using warm sterile gauze and sponge) and other over healthy skin a min of 5 cm from wound itself. polarity should be in reversal mode so that it allows for 50% of treatment with positive polarity. frequency is generally 30-200 pps, amplitude 1-500V, and duration of treatment from 10-60 mins per session. dermal wounds should be treated 5-7 days per week for best results

A

hvpc parameters

463
Q

Revered

science of evaluating motor units (anterior horn cell, axon, neuromuscular junctions and muscle fibers innervated by unit) through use of intramuscular needle electrodes or surface electrodes. potentials include abnormal: spontaneous and voluntary.

A

electromyography

464
Q

Revered

modality that uses an electromechanical device to provide visual and or auditory feedback. can be utilized to receive information related to motor performance, kinesthetic performance or physiological response. can measure peripheral skin temp, changes in blood volume thru vasodilation and vasoconstriction using finger phototransmission, sweat gland activity, and electrical activity during muscle contraction. electromyographic feedback is the most commonly used biofeedback modality in clinical setting.

A

biofeedback

465
Q

Revered

muscle activity, heart rate, balance, skin temp, bp, posture, abnormal mvmt, normal mvmt

A

biofeedback measures:

466
Q

Revered

myoelectric/electromyographic biofeedback, EMG-BF, position biofeedback, bp biofeedback, respiratory bioFB, sphincter control biofb, temp and blood flow bioFB, electroencephalographic bioFB

A

types of feedback

467
Q

Revered

muscle relaxation, improve muscle strength, decrease muscle spasm, neuromuscular control, decrease accessory muscle use, decrease pain

A

biofeedback therapeutic effects

468
Q

Revered

muscle spasm, pain, sci, urinary incontinence, improve neuromuscular control, muscle weakness, hemiplegia, cp, bowel incontinence, promote relaxation

A

biofeedback indications

469
Q

Revered

any condition where muscle contraction is detrimental, skin irritation at electrode site

A

biofeedback contraindications

470
Q

Revered

2 active electrodes and 1 ground electrode in a bipolar arrangement best deletes “noise” (noise is any extraneous electrical activity not produced by the contraction of the muscle). surface electrodes with some form of conduction gel are required to adhere to prepared, clean skin. electrodes should be placed parallel to direction of the muscle fibers, set level of sensitivity on device relative to treatment goals: low level sensitivity settings for muscle re-education, high level sensitivity setting for relaxation

A

biofeedback treatment guidelines

471
Q

Revered

2 active electrodes should be placed parallel to muscle fibers and close to each other. reference or ground electrode can be placed anywhere on the body, but is often secured between 2 active electrodes. signals are transmitted to a differential amplifier and info is conveyed thru visual and audio feedback. for muscle re-education, should begin with pt performing a max muscle contraction. sensitivity of bfb unit should be set at a low sensitivity setting and adjusted so that the pt can perform reps at a ratio of 2/3rds of max muscle contraction. isometric contractions should continue for 6-10 secs with relaxation in btwn each contraction. treatment duration for a single muscle group is 5-10 mins. treatment for muscle relaxation requires a high sensitivity setting and a similar electrode placement with active electrodes initially positioned close to each other. as patient improves with relaxation, electrodes should be placed further apart and sensitivity setting increased. during this treatment, patient may also benefit from adjunct relaxation techniques such as imagery. treatment duration of 10-15 mins is usually adequate to attain relaxation.

A

biofeedback treatment parameters

472
Q

Revered

ground fault circuit interrupter: designed to cut off electrical supply to a piece of equipment if it detects any form of leakage or ground fault.

A

gfci:

473
Q

Revered

…

A

electrotherapy terms

474
Q

Revered

an occurrence where a nerve and muscle membrane’s threshold for excitability increases secondary to a stimulation by a pulse that has a slow phase rise time. the quicker the rise time, the less the nerve can accommodate to the impulse.

A

accommodation

475
Q

Revered

alternating current allows for the constant change in flow of ions

A

alternating current (biphasic)

476
Q

Revered

unit of measure used to describe rate of current

A

ampere

477
Q

Revered

magnitude of current. often labeled intensity or voltage.

A

amplitude

478
Q

Revered

positively charged electrode that attracts negative ions

A

anode

479
Q

Revered

negatively charged electrode that attracts positive ions

A

cathode

480
Q

Revered

pulse that moves in one direction, returns to baseline, then in other direction and back to baseline again within a predetermined amount of time.

A

biphasic

481
Q

Revered

symmetrical: positive phase is identical to negative phase, asymmetrical: positive phase and negative phase are not identical in shape, balanced: positive phase’s electrical charge is equal to negative phase’s electrical charge, unbalanced: positive phase and negative phase do not have identical electrical charges

A

types of biphasic pulse

482
Q

Revered

interrupted group of pulses that are delivered in a finite series and a predetermined frequency

A

burst

483
Q

Revered

property of an insulator that allows for the storage of energy when opposing surfaces of the insulator have an electrical potential difference

A

capacitance

484
Q

Revered

testing procedure used to measure amount of time required to produce a small muscle contraction at a particular intensity

A

chronaxie

485
Q

Revered

ease at which a particular material will allow current flow (mho)

A

conductance

486
Q

Revered

flow electrons from one place to another

A

current

487
Q

Revered

constant unidirectional flow of ions. dependent on polarity

A

direct current (monophasic)

488
Q

Revered

time period of stimulation and time period of rest btwn periods of stimulation.

A

duration of stimulus/duration of rest

489
Q

Revered

percentage of time that electrical current is on in relation to entire treatment time.

A

duty cycle

490
Q

Revered

resistance of a tissue to electrical current

A

electrical impedance

491
Q

Revered

determines number of pulses delivered through each channel per second. often labeled “rate”

A

frequency

492
Q

Revered

characterized by a waveform greater than 150 volts with a short pulse duration. is intermittent and is used for deeper tissue penetration

A

high volt current

493
Q

Revered

property of a substance that provides resistance to flow of current by offering an alternate current

A

impedance

494
Q

Revered

how easily a certain material will induce an electromotive force (emf) within a circuit

A

inductance

495
Q

Revered

period of time of electrical inactivity btwn each pulse, usually expressed in microsecs or millisecs

A

interpulse interval

496
Q

Revered

positively or negatively charged atome

A

ion

497
Q

Revered

waveform of less than 150 volts and is used for neuromuscular stimulation

A

low volt current

498
Q

Revered

pulse that has either a positive or negative polarity and moves in only one direction from a zero baseline and returns to baseline within a predetermined amount of time

A

monophasic

499
Q

Revered

gained one or more electrons and possesses a negative charge

A

negative ion

500
Q

Revered

current of an electrical current. there is a direct proportional relationship btwn current and voltage and an indirect proportional relationship btwn current and resistance

A

ohm’s law

501
Q

Revered

lost one or more electrons and possesses a positive charge

A

positive ion

502
Q

Revered

pulse is one individual waveform

A

pulse

503
Q

Revered

amount of time that it takes to complete all phases of a single pulse. often labeled “pulse width”

A

pulse duration

504
Q

Revered

allows for a non-continuous flow of either alternating or direct current with periods of no electrical activity

A

pulsed current (interrupted)

505
Q

Revered

refers to number of seconds it takes for amplitude to gradually increase or decrease to the max value set by amplitude control

A

ramp

506
Q

Revered

ability of a material to oppose the flow of ions through it

A

resistance

507
Q

Revered

minimal intensity used with a long current duration that produces a small muscle contraction

A

rheobase

508
Q

Revered

unit of measure of electrical power or electromotive force

A

volt

509
Q

Revered

consistent pattern of a current measured on an oscilloscope

A

waveform

510
Q

Revered

…

A

clinical application templates executive summaries

511
Q

Revered

usually one to two inches above tendinous insertion on calcaneous, greatest btwn 30-50 yrs of age, typically be unable to stand on their toes and tend to exhibit a positive Thompson test

A

achilles tendon rupture

512
Q

Revered

occurs more in middle-aged population, greater incidence in women, arthrogram can assist with dx by detecting decreased volume of fluid within the joint capsule, ROM restriction typically in a capsular pattern (lateral rotation, abduction, medial rotation)

A

adhesive capsulitis

513
Q

Revered

risk is higher in males, usually occurs between 40-70, clinical presentation may include both upper and lower motorneuron involvement with weakness occurring in a distal to prox progression, average course of dx is 2-5 yrs with only 20-30% of patients surviving longer than five years

A

amyotrophic lateral sclerosis

514
Q

Revered

systemic condition, inflammation of spine and larger peripheral joints, males greater risk btwn 20-40, presentation initially includes recurrent and insidious onset of back pain, morning stiffness, and impaired spinal extension

A

ankylosing spondylitis

515
Q

Revered

most commonly occurs during hyperflexion, rapid deceleration, hyperextension or landing in an unbalanced position, females involved in selected sports have higher ligament injury rates, approx 2/3 of time acl is completely torn, there is an associated meniscal tear

A

anterior cruciate ligament sprain

516
Q

Revered

increased incidence of injury is associated with selected sports such as baseball pitching, swimming, rowing, gymnastics, and tennis; characterized by subjective reports of a deep ache directly in front and on top of the shoulder made worse with overhead activities or lifting, examination may reveal a positive speed’s test or yergason’s test

A

bicipital tendonitis

517
Q

Revered

incidence is higher in females with most common age being from 35-55, muscle atrophy is often noted in abductor pollicis brevis muscle and later in the thenar muscles; electromyography studies, tinel’s sign, and phalen’s test can be used to assist with confirming diagnosis

A

carpel tunnel syndrome

518
Q

Revered

spastic cp involves upper motor neuron damage; athetoid cp involves damage to cerebellum, cerebellar pathways or both; clinical presentation includes motor delays, abnormal muscle tone and motor control, reflex abnormalities, poor postural control, and balance impairments; mental retardation and epilepsy are present in 50-60% of children diagnosed with cp.

A

cerebral palsy

519
Q

Revered

types include ischemic (thrombus, embolus, lacunar) and hemorrhagic stroke (intracerebral, subdural, subarachnoid), left CVA may present with weakness or paralysis to rt side, impaired processing, heightened frustration, aphasia, dysphagia, and motor apraxia. right cva may present with weakness or paralysis to left side, poor attention span, impaired awareness and judgment, spatial deficits, memory deficits, emotional lability, and impulsive behavior

A

cva: cerebrovascular accident

520
Q

Revered

etiologies include arrhythmia, pulm embolism, hypertension, valvular heart disease, myocarditis, unstable angina, renal failure, severe anemia;

A

chf: congestive heart failure

521
Q

Revered

causes exocrine glands to overproduce thick mucus which causes subsequent obstruction, autosomal recessive genetic disorder located on long arm of chromosome seven, terminal disease but death age has increased to 32 yrs due to early detection and management

A

cystic fibrosis

522
Q

Revered

caused by weakening of joints that allows for forward slippage of one vertebral segment on one below due to degenerative changes, most common site is L4/L5, william’s flexion exercises may be indicated to strengthen abs and reduce lumbar lordosis

A

degenerative spondylolisthesis

523
Q

Revered

insulin is functionally absent due to destruction of beta cells of pancreas; where insulin would normally be produced. starts in children ages 4 or older, adolescense. symptoms include polyuria, polydipsia, polyphagia, nausea, weight loss, fatigue, blurred vision, and dehydration

A

diabetes mellitus (type 1)

524
Q

Revered

clinical presentation: hypotonia, flattened nasal bridge, simian line (palmar crease), epicanthal folds, enlargement of tongue and dd.

A

down syndrome

525
Q

Revered

x linked recessive trait manifesting in only male offspring while female offspring become carriers. waddling gait, prox muscle weakness, toe walking, pseudohypertrophy of calf and difficulty climbing stairs. rapid progression of this disease with inability to ambulate by ten to 12 yrs of age with death occurring as teenager or less frequently in the 20’s.

A

duchenne muscular dystrophy

526
Q

Revered

nonarticular rheumatic condition with pain caused by tender points within muscles, tendons, and ligaments. pain exists in all 4 quadrants of body and there is pain in at least 11 of 18 standardized tender point sites

A

fibromyalgia

527
Q

Revered

burn causes immediate cellular and tissue death and subsequent vascular destruction, eschar forms from necrotic cells and creates a dry and hard layer that requires debridement. absent sensation and pain due to destruction of free nerve endings

A

full thickness burns

528
Q

Revered

motor weakness in a distal to prox progression, sensory impairment, and possible respiratory paralysis. may be an autoimmune response to a previous respiratory infection, flu, immunization or surgery. patients usually have full recovery

A

guillain barre syndrome

529
Q

Revered

chronic progressive genetic disorder that is fatal within 15 to 20 yrs after clinical manifestation. degeneration and atrophy of basal ganglia (stiatum) and cerebral cortex w/in brain. clinically presents with enlarged ventricles secondary to atrophy of basal ganglia, mental deterioration, speech disturbances and ataxic gait

A

huntingtons disease

530
Q

Revered

autoimmune disorder found in children less than 16 that occurs when immune cells mistakenly begin to attack the joints and organs causing local and systemic effects. girls more likely than boys. symptoms include joint swelling, pain, stiffness

A

juvenile rheumatoid arthritis

531
Q

Revered

inflammation or degenerative changes at common extensor tendon that attaches to lateral epicondyle of elbow. repeated overuse of wrist extensors. clinical symptoms include difficulty holding or gripping objects and insufficient forearm functional strength

A

lateral epicondylitis (tennis elbow)

532
Q

Revered

consists of dermal and epidermal layers, air follicles, nails, sebaceous glands, sweat glands

A

integumentary system

533
Q

Revered

true skin: well vascularized, elastic, flexible and tough.

A

dermis

534
Q

Revered

avascular, consists of outermost layer of skin

A

epidermis

535
Q

Revered

occur secondary to ischemia from inadequate circulation of oxygenated blood often due to complicating factors such as atherosclerosis

A

arterial insufficiency ulcers

536
Q

Revered

occur secondary to inadequate functioning of the venous system resulting in inadequate circulation and eventual tissue damage and ulceration

A

venous insufficiency ulcers

537
Q

Revered

decubitus ulcer: results from sustained or prolonged pressure at levels greater than the level of capillary pressure on the tissue

A

pressure ulcer

538
Q

Revered

secondary complication usually associated with a combination of ischemia and neuropathy. most often associated with diabetes. frequently found on plantar surface of foot, often beneath the metatarsal heads. wound has good granulation tissue and little or no drainage. often do not report pain due to altered sensation

A

neuropathic ulcer

539
Q

Revered

lower one third of leg, toes, web spaces. smooth edges, well defined, lack of granulation tissue, tend to be deep. severe pain, diminished or absent pedal pulses, normal edema, decreased skin temperature, thin and shiny tissue, hair loss, yellow nails. leg elevation increases pain.

A

arterial ulcers

540
Q

Revered

proximal to the medial malleolus, irregular shape, shallow, mild to moderate pain, normal pedal pulses, increased edema, normal skin temp, flaky, dry skin, leg elevation lessens pain

A

venous ulcers

541
Q

Revered

cleansing the ulcer, rest, reducing risk factors, limb protection

A

intervention for arterial insufficiency ulcer

542
Q

Revered

cleansing the ulcer, compression to control edema

A

intervention for venous insufficiency ulcer

543
Q

Revered

gel forming polymer such as gelatin, pectin, and carboxymethylcellulose with a strong film or foam adhesive backing. absorb exudate by swelling into a gel like mass and vary from being occlusive to semi permeable. does not attach to actual wound itself and is instead anchored to intact skin surrounding the wound.

A

hydrocolloid dressing

544
Q

Revered

useful for partial and full thickness wounds. can be effective with granular or necrotic wounds

A

when to use hydrocolloids

545
Q

Revered

moist environment for wound healing, enables autolytic debridement, offers protection from microbial contamination, provides moderate absorption, does not require a secondary dressing, provides a waterproof surface

A

advantages to hydrocolloids

546
Q

Revered

may traumatize surrounding intact skin upon removal, may tend to roll in areas of excessive friction, cannot be used on infected wounds

A

disadvantages to hydrocolloids

547
Q

Revered

consist of varying amounts of water and varying amounts of gel-forming materials such as glycerin, dressings are available in sheet form or amorphous form

A

hydrogels

548
Q

Revered

commonly used on superficial and partial thickness wounds (abrasions, blisters, pressure ulcers) that have minimal drainage. rather than absorb drainage, hydrogels are moisture retentive

A

when to use hydrogels

549
Q

Revered

provides a moist environment for wound healing, enables autolytic debridement, may reduce pressure and diminish pain, can be used as a coupling agent for ultrasound, minimally adheres to wound

A

advantages to hydrogels

550
Q

Revered

potential for dressings to dehydrate, cannot be used on wounds with significant drainage, typically requires a secondary dressing

A

disadvantages to hydrogels

551
Q

Revered

composed from a hydrophilic polyurethane base. hydrophilic at wound contact surface and are hydrophobic on the outer surface. allows exudates to be absorbed into the foam through the hydrophilic layer. most commonly available in sheets or pads with varying degrees of thickness.

A

foam dressings

552
Q

Revered

used to provide protection over partial and full thickness wounds with varying levels of exudate. can be used as secondary dressings over amorphous hydrogels

A

when to use foam dressings

553
Q

Revered

provides a moist environment for wound healing, available in adhesive and nonadhesive forms, provides prophylactic protection and cushioning, encourages autolytic debridement, provides moderate absorption

A

advantages to foam dressings

554
Q

Revered

may tend to roll in areas of excessive friction, adhesive form may traumatize periwound area upon removal, lack of transparency makes inspection of wound difficult

A

disadvantages to foam dressings

555
Q

Revered

film dressings are thin membranes made from transparent polyurethane with water resistant adhesives. permeable to vapor and oxygen, but are mostly impermeable to bacteria and water. highly elastic, conform to a variety of body contours, and allow easy visual inspection of the wound since they are transparent.

A

transparent film

556
Q

Revered

useful for superficial wounds (scalds, abrasions, lacerations) or partial-thickness wounds with minimal drainage.

A

when to use transparent films

557
Q

Revered

provides a moist environment for wound healing, enables autolytic debridement, allows visualization of the wound, resistant to shearing and frictional forces, cost effective over time

A

advantages to transparent films

558
Q

Revered

excessive accumulation of exudates can result in periwound maceration, adhesive may traumatize periwound area upon removal, cannot be used on infected wounds

A

disadvantages to transparent films

559
Q

Revered

most readily available used in inpatient environment. commonly used on infected or non-infected wounds of any size. can be used for wet to wet, wet to moist, or wet to dry debridement. readily available and cost effective but has a tendency to adhere to wound bed. requires frequent dressing changes. increased infection rate compared to occlusive dressings

A

gauze dressings

560
Q

Revered

consist of calcium salt of alganic acid that is extracted from seaweed. highly permeable and non-occlusive. requires a secondary dressing. based on the interaction of calcium ions in the dressing and the sodium ions in the wound exudate.

A

alginates

561
Q

Revered

typically used on partial and full thickness draining wounds such as pressure wounds or venous insufficiency ulcers, often used on infected wounds due to likelihood excessive drainage.

A

when to use alginates

562
Q

Revered

high absorptive capacity, enables autolytic debridement, offers protection from microbial contamination, can be used on infected or uninfected wounds, non-adhering to wound

A

advantages to alginates

563
Q

Revered

may require frequent dressing changes based on level of exudate, requires a secondary dressing, cannot be used on wound with an exposed tendon, joint capsule or bone

A

disadvantages to alginates

564
Q

Revered

refers to ability of a dressing to transmit moisture, vapor or gases from wound bed to atmosphere. truly occlusive substance would be completely impermeable, while a truly non-occlusive substance would be completely permeable.

A

occlusion

565
Q

Revered

hydrocolloids, hydrogels, semi-permeable foam, semi-permeable film, impregnated gauze, alginates, and traditional gauze

A

most occlusive to non-occlusive

566
Q

Revered

alginates, semi-permeable foam, hydrocolloids, hydrogels, semi-permeable film

A

most moisture retentive to least moisture retentive

567
Q

Revered

primary - direct contact with wound. secondary - directly over primary dressing to provide protection, absorption, and/or occlusion

A

primary versus secondary dressing

568
Q

Revered

remove only nonviable tissue from a wound. selective debridement is most often performed by sharp debridement, enzymatic debridement, and autolytic debridement

A

selective debridement

569
Q

Revered

red: protect wound, maintain moist environment, yellow: moist yellow slough. debride necrotic tissue and absorb drainage. black: debride necrotic tissue.

A

red-yellow-black tissue

570
Q

Revered

requires use of scalpel, scissors, and/or forceps to selectively remove devitalized tissues, foreign materials or debris from a wound. most often used for wounds with large amounts of thick, adherent, necrotic tissue, also for cellulitis or sepsis. most expedient form of removing necrotic tissue. PTs are permitted to perform sharp debridement in the majority of states.

A

sharp debridement

571
Q

Revered

topical application of enzymes to surface of necrotic tissue. can be used on infected and non-infected wounds with necrotic tissue. may be used in wounds that have not responded to autolytic debridement or in conjunction with other debridement techniques. can be slow to establish a clean wound bed and should be discontinued after removal of devitalized tissues in order to avoid damage

A

enzymatic debridement

572
Q

Revered

using body’s own mechanisms to remove nonviable tissue. methods include transparent films, hydrocolloids, hydrogels and alginates. results in a moist wound environment that permits rehydration of the necrotic tissue and eschar and allows enzymes to digest the nonviable tissue. can be used with any amount of necrotic tissue and is non-invasive and pain free; however takes longer for wound healing to occur. should not be performed on infected wounds.

A

autolytic debridement

NPTAE Comprehensive Review (15 decks)

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