Week 3: ICF Model Flashcards
What does the ICF model stand for?
International Classification of Functioning, Disability, and Health
what types of tests and measures might be included in the examination?
-objective datda on impairments and functional limitations -Anthropometric characteristics -Arousal, attention, and cognition -Environmental, home, and work barriers -ROM -Muscle length/strength -Reflex integrity -Pain -Posture-Body mechanics
What are the four internationally recognized vital signs?
-HR -BP -RR -temp
What are some additional vital signs?
-Pain (often called the 5th vital sign) -pulse oximetry -perceived exertion rating
basal heart rate
-Pulse rate measured after an extended period of rest -An indication of cardiovascular function in the absence of physical stress
resting heart rate
HR without imposed stress
periactivity heart rate
-during intervention -Measurement of the cardiovascular system’s capacity to provide blood flow during imposed physiological or physical stress
recovery pulse rate
-1-3 min following intervention -Measurement of the cardiovascular system’s recovery capability following the imposition of physiological or physical stress
patency
-The openness of the peripheral portion of the cardiovascular system -Important measurement – presence or absence of pulse at a given site
what is a big red flag with patency
Patient with lack of patency without known pathology – immediate referral to MD
How is peripheral arterial disease assessed?
Intermittent claudication (limping) especially in lower extremities with activity (measure with Doppler / Ankle- Brachial Index)
what are some other signs of poor patency?
-Trophic changes: loss of hair, dry or flaky skin, muscle atrophy -Skin temp may be decreased in areas of decreased patency -Blanching
The ICF model components
Health condition (disorder or disease) Body functions or structures impairments Activity Participation Environmental Factors Personal Factors
What is the difference between an activity limitation vs a participation restriction?
Activity limitation is difficulty executing activities (ADLs, learning, functional mobility) Participation restrictions are problems experienced in involvement in life situations (work activities, leisure activities, or recreational)
Patient/Client model
Examination Evaluation Diagnosis Prognosis/Plan of Care Intervention Outcome
Examination
comprehensive and specific testing: history, systems review, tests and measures
Evaluation
clinical judgments based on data collected, creation of a problem list, determination of need for referral
Diagnosis
Identify impact of a condition on function; categorize impairments
Prognosis/Plan of Care
Predicted optimal level of function and time to achieve; planned interventions
Intervention
Procedures and techniques appropriate to diagnose to produce change; re-examin to make change
Outcome
Measure of intended results of patient/client management including interventions, function, risk, satisfaction
History component of the PT’s examination
Review of medical record Interviews (patient, family, caregiver)
Systems Review component of the PT’s examination
Determine areas of function and dysfunction in cardio/pulmonary, integ, MSK, and neuromuscular Info on cognition, communication, emotional status Determine next steps
Cardio/Pulmonary system
the assessment of HR, RR, BP, and Edema
Integumentary System
the assessment of pliability (texture), presence of scar formation, skin color, and skin integrity
Musculoskeletal system
the assessment of gross symmetry, gross ROM, gross strength, heigh, and weight
Neuromuscular system
a general assessment of gross coordinated movement (eg. balance, gait, transfers) and motor function (motor control and learning)
Communication ability, affect, cognition, language, and learning style
the assessment of the ability to make needs known; consciousness; orientation responses; learning preferences
Sign vs Symptom
Sign is observed or measurable and objective (ex: knee has edema, take measurement) Symptom is the person’s experience and subjective (my knee hurts)
How do you calculate a target HR?
Maximum HR x Desired Intensity (%)
How do you calculate max HR (in absence of pathology)?
220 - person’s age
Describe the scale for assessing pulse/heart rate.
What are the norms for heart rate?
What are the methods for assessing heart rate?
- Manual palpation
- Pads of index and middle finger placed over site
- Do not use thumb
- Auscultation: monitoring of the heart using a stethoscope
- Doppler Measurements: US based device that uses frequency of blood flow changes during blood flow to examine patency
- Pulse Oximeter
- ECG or Electronic Monitors
What is systole? Diastole?
what is the purpose of BP measurement?
- To determine vascular resistance to blood flow
- To determine the effectiveness of cardiac muscle in pumping blood to overcome vascular resistance
What are some considerations for BP measurement?
- Size of cuff
- Placement of bladder
- Support of patient’s arm
-Patient Position
What are norms for blood pressure?
what are the BP categories?
A high blood pressure reading in addition to what symptoms warrant an immediate referral?
- Headache
- Dizziness
- Flushed face
- Spontaneous epistaxis
- Vision Changes
- Nocturnal urinary frequency
What criteria warrant termination of exercise and immediate referral?
- Blood pressure changes in the presence of unstable angina, dizziness, nausea, pallor or extreme diaphoresis at rest or during activity
- Patients with known hypertension who are taking an antihypertensive medication if their blood pressure is >140/90 mm Hg
What are some abnormal BP responses to activity?
- Diastolic increases more than 10 mm Hg with activity
- Systolic BP does not rise or it falls (falls > 10 mm Hg) with increasing workload
What is orthostatic hypotension?
- A sudden drop in blood pressure with changes in position
- Blood pressure and pulse are measured in supine, sitting, and standing
- Drop of > 20 mmHg systolic, drop of > 10 mmHg diastolic, or both
- Symptoms of faintness, light-headedness, dizziness, confusion, or blurred vision
What is the ankle brachial index? What are some significant values and what do they indicate?
- Systolic BP is measured in both posterior tibial and/or dorsalis pedis divided by the higher of the right or left arm brachial systolic BP.
- ABI = highest of PT and/or DT readings / highest brachial reading
- 0.90 or less = peripheral arterial disease, increased risk for cardiovascular events
- > 1.50 = abnormal finding (may be due to diabetes and calcified arteries
What is pulse pressure?
The difference between the systolic and diastolic pressure
How is respiration assessed? (subjectively and objectively)
- Objectively:
- Observation (Auditory, Visual, Palpation, Auscultation)
- Number of breathing cycles/minute
- Duration of inspiration and expiration
- Chest Excursion
- Subjectively:
- Depth of inspiration
- Regularity
- Ease (Labored, Difficult, Painful)
- Use of accessory muscles of respiration
What are some accessory muscles of inspiration?
- Sternocleidomastoid
- Pectoralis Major/Minor
- Serratus Anterior
- Latissimus Dorsi
- Trapezius
- Serratus Posterior
- Quadratus Lumborum
What are some accessory muscles of expiration?
-Transverse Abdominis
- Internal/External Abdominal Oblique
- Rectus Abdominis
- Intercostales
- Quadratus Lumborum
What is the Borg Scale for Breathlessness?
- 0 = not at all
- 5 = severe
- 10 = maximum
What is the ATS Dyspnea Scale?
- 0 – only with strenuous exercise
- 1 – Trouble when hurrying on level ground or up slight hill
- 2 – On level ground walks slower than those same age or has to stop to catch breath
- 3 – Stops for breath after 100 yd / few min on level ground
- 4 – Too breathless to leave house or becomes breathless while dressing
What is the purpose of temperature assessment?
- Basal metabolic states
- Infection, inflammation
- Response to exercise
What are some methods of temperature assessment?
- Thermometer
- Mercury glass
- Electronic
- Heat sensitive strips
- Palpation (using dorsal surface of hand)
What are some sites of temperature assessment?
Oral, rectal, auditory canal/tympanic, forehead, axillary
What are norms for temperature?
What factors may cause variations in temperature?
- Time of day (may vary by 2.7°F(1°C)) o Menstrual Cycle
- Pregnancy
- Aging
- Season (controversial)
- Physical Fitness
- Shift work
- Meals
- Alcohol
What is pulse oximetry?
Measures the oxygenation of the blood.
• Usually taken with a clip sensor on a fingertip (or earlobe or foot in a newborn).
• The degree to which red and infrared light is absorbed differs depending on the color of the blood it encounters. The ratio of red to infrared light absorption is presented on the display as a % of O2 saturation.
How is pain assessed? What is the purpose of pain assessment?
- with a visual or verbal analog scale
- purpose:
- Diagnosis
- Prognosis
- Appropriate interventions
- Response to interventions
Describe the use of the RPE scale.
