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Adult Rehab > Week 3: Vitals, OTF, FIM > Flashcards

Week 3: Vitals, OTF, FIM Flashcards

1
Q

What type of clients were baseline vitals are needed?

A
  • Clients recovering from recent trauma/illness/hospitalization/secondary diagnoses
  • Clients with current or previous cardiovascular/cardiopulmonary conditions
  • Clients who are not very active or who have limited aerobic activities
  • Client’s with general fatigue or debility
    The very young and very old (older than 65)
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2
Q
  • Level or amount of activity
  • Emotional status of person
  • Physiological status of client
  • Environmental temperature
  • Client’s age
A

Factors influencing vital signs

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3
Q

What are some things contributing to physiological status of client?

A

Illness, disease, use of medication, trauma

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4
Q

What are some possible adverse and potentially dangerous responses to activity and exercise?

A
  • Confusion
  • Slow reactions of movement or response to directions
  • Lethargy
  • Fatigue
  • Decreased response to verbal or tactile stimulus
  • Fixed gaze or eyes rolling back in someone’s head
  • Complaints of nausea, vertigo, decrease in BP, pupil constriction/dilation
  • Loss of consciousness/fainting
  • Diaphoresis (profuse sweating)
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5
Q

Blood pressure is at which pressure?

A

brachial arterial pressure (major vessel which takes blood away from heart)

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6
Q

T/F: Pressure of circulating blood increases as it moves further away from heart

A

False. Pressure of circulating blood decreases as it moves further away from heart

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7
Q

is BP at the time of contraction of left ventricle heart

A

Systolic pressure

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8
Q

is the BP at the time of the rest period of the heart

A

Diastolic pressure

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9
Q

5 phases of Korotkoff’s Sound

A

Phase 1: first, faint, clear tapping sound which gradually increases (first indication of systolic pressure of an adult)
Phase 2: murmur or swishing quality present
Phase 3: sounds become crisp and louder than before
Phase 4: distinct and abrupt muffling of sounds until a soft, blowing sound is heard (initial indicator of the diastolic BP)
Phase 5: muted sound, disappearance of sound, also known as second diastolic pressure phase

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10
Q

distinct and abrupt muffling of sounds until a soft, blowing sound is heard (initial indicator of the diastolic BP)

A

Phase 4

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11
Q

Faint, clear tapping sound which gradually increases (first indication of systolic pressure of an adult)

A

Phase 1

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12
Q

sounds become crisp and louder than before

A

Phase 3

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13
Q

muted sound, disappearance of sound, also known as second diastolic pressure phase

A

Phase 5

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14
Q

murmur or swishing quality present

A

Phase 2

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15
Q

What are 2 specific Korotkoff sounds to record in BP?

A

Second sound and the first faint/muted sound… that is the BP to record
For more accurate reading, client can’t have coffee ,cigarette, or done strenuous exercise in last 30 mins

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16
Q

Normal BP?

A

120 mm of mercury/80 mmHg

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17
Q

Systolic 120-139

Diastolic 80-89

A

Pre-Hypertension

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18
Q

Systolic 140-159

Diastolic 90-99

A

Stage 1 Hypertension

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19
Q

Systolic 160+

Diastolic 100+

A

Stage 2 Hypertension

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20
Q

Age, obesity, physical inactivity, nicotine/salt/alcohol use, arteriosclerosis, DM, kidney disease, race, diet, dehydration, size & condition of arteries, arm position, cardiac output, etc…

A

Factors contributing to HTN

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21
Q

known as the “silent killer”

A

Hypertension

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22
Q

Abnormal when Diastolic pressure increases more than _____ mmHG during the activity

A

Diastolic pressure increases more than 10-15 mmHg during the activity

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23
Q

Systolic BP with vigorous exercise is normal to go up by _____ mmHG. Anything greater would be significant.

A

Systolic BP with vigorous exercise is normal to go up by 40-60 mmHG.

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24
Q

T/F: It is normal with exercise for systolic BP to go up by 50-60 mmHG

A

False. 40-60

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25
Q

Diastolic pressure increase by how many mmHG during exercise?

A

10-15

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26
Q

Can assess by observation or touch: rate, rhythm, depth, character

A

Respiration Rate

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27
Q

What is normal RR for adults?

A

12-18 respirations per minute

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28
Q

What is normal RR for kids?

A

30-50 respirations per minute

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29
Q

Can assess by observation or touch:
Rate = number of breaths per minute
Rhythm = regularity of the pattern
Depth = amount of air exchanged with each respiration
Character = deviations from normal, resting, or quiet respiration

A

Respiration Rate

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30
Q

RR, what is number of breaths per minute?

A

Rate

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31
Q

RR, what is Depth?

A

Amount of air exchanged with each respiration

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32
Q

RR, what is rhythm?

A

regularity of pattern

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33
Q

RR, what is character?

A

deviations from normal, resting, quiet respiration

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34
Q

2 ways people breathe?

A

Upper thoracic or abdominal breather

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35
Q

T/F: With respiratory distress, a person can demonstrate both thoracic and abdominal breathing

A

True

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36
Q 
Age
Emotional status
Physical activity
Air quality
Altitude 
disease/illness
A

Factors Affecting respiration

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37
Q

indirect measure of the contraction of the left ventricle of the heart

A

Heart Rate

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38
Q

Normal Adult HR

A

60-100

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39
Q

Normal newborn HR

A

100-130

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40
Q

Normal kid HR

A

80-120

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41
Q 
Medications
Emotional status
Age and gender
Temperature of environment 
Infection (recall dysphagia signs and symptoms)
Physical activity/condition
Cardiopulmonary disease
A

Factors affecting HR

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42
Q

Pulse rate should return to normal pulse rate approximately ___ minutes after activity.

A

3-5 mins

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43
Q

What arteries used for HR?

A

Carotid and Radial

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44
Q

even beats w/good force to each beat

A

strong and regular

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45
Q

even beats w/weak force to each beat

A

weak and regular

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46
Q

both strong and weak beat/force but regular beat

A

irregular

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47
Q

weak force to each beat, and irregular heart beats

A

thready

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48
Q

HR under 60

A

bradycardia

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49
Q

HW over 100

A

tachycardia

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50
Q

—For adults, acceptable normal range for temperature

A

96.8 to 99.3

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51
Q

——Time of day
—Age
—Emotional status
—Environmental temperature
—Infection (remember dysphagia signs & symptoms)
—Site of assessment (oral cavity can fluctuate depending on hot/cold food or beverage)
—Physical activity

A

Factors affecting Temperature

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52
Q

What is oxygen saturation?

A

Measures the client’s oxygen saturation level in the blood

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53
Q

T/F: Should be maintained above 90% at rest & during activity

A

True

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54
Q

Pain Analog Scale

A

1-10 (10 being most pain)

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55
Q

Biomechanical FOR Concerned with:

A

Musculoskeletal capacity
Peripheral nerve involvement/dysfunction
Cardiopulmonary system dysfunction (related to endurance)

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56
Q

Best suited for clients with isolated/selective motor control

A

Biomechanical FOR

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57
Q

T/F: Biomechnical best suited for clients with an intact central nervous system (Pedreti & Pasquinelli, 1990) because clients must be able to perform smooth, isolated movements.

A

True

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58
Q

˜˜True or False: After ROM, strength, and endurance are regained, the client will automatically regain function

A

False. Research shows that improvement of biomechanical components alone does not necessarily improve engagement in occupation.

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59
Q

What assumptions of biomechanical FOR?

A
  • Occupational performance requires the ability to move the limbs and the endurance to sustain activity/movement until a goal is accomplished.
  • Purposeful activities can be used to treat loss of ROM, strength, and endurance
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60
Q

Assessing endurance…

A

Part of the Biomechanical FOR, but mainly done during occupational performance evaluation & linked to the Rehabilitation FOR “Activity tolerance”

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61
Q

What is definition of endurance?

A

Sustain effort and resist fatigue

62
Q
  • Related to cardiopulmonary and muscular function

- Related to intensity, duration, and frequency of activity

A

Endurance

63
Q

3 things related to endurance?

A

intensity, duration, frequency

64
Q

______ endurance is the ability of the whole body to sustain prolonged rhythmical activity”

A

“Cardiopulmonary endurance is the ability of the whole body to sustain prolonged rhythmical activity” Relates to the demand for oxygen created by muscular work: Muscular work à need for oxygen

65
Q

_____ Ability (of a muscle or muscle group) to sustain intensive activity”

A

muscular

66
Q

of repetitions per unit of time

A

dynamic assessment

67
Q

Amount of time a contraction can be held

A

static assessment

68
Q

Intensity: rated as light, moderate, or heavy work or based on WHAT LEVELS?

A

MET

metabolic equivalent levels

69
Q

MET light house keeping?

A

1.5-4

70
Q

MET heavy home maintenance?

A

4.5-6

71
Q

APHRO

A 
activity
position of activity
heart rate
rest break needed?
other signs of fatigue
72
Q

“Patient tolerated 60 mins. of seated activity for OT assessment without rest breaks. No c/o fatigue.”

A

Sample documentation

73
Q

How to increase endurance?

A

To increase muscle endurance, the OT must increase the # of repetitions of a specific motion, or add to the resistance of the activity…cardiopulmonary precautions must be considered!

74
Q

FIM - 4

A

Minimal Assistance - performs 75%

75
Q

FIM - 6

A

Modified independence

76
Q

FIM - 1

A

Total assistance - less than 25%

77
Q

FIM - 7

A

Complete independence

78
Q

FIM - 2

A

Maximum assistance - patient performs 25%-49%

79
Q

FIM - 3

A

Moderate Assistance - patient performs 50-74%

80
Q

What does grooming consist of?

A

oral care (brushing only), hair grooming (brushing only), washing face, washing hands (drying too) - also shaving and make up

81
Q

What does bathing consist of?

A

washing, rinsing, drying body from neck down (exclude neck and back) in tub, shower, or sponge bath

82
Q

Dressing PJ/hospital gown does not count!

A

Only clothes they wear in public

83
Q

What does toiling consist of?

A

Maintaining perineal hygiene, adjusting clothes before and after using toilet

84
Q

What consists of toilet transfer?

A

getting on and off toilet

85
Q

What consists of social interaction?

A

getting along and participating with others, represents how one deals with one’s needs and with others

86
Q

Social Interaction FIM: patient interacts appropriately in most situations, only occasionally loses control. May require more time to adjust

A

6 - modified independence

87
Q

Social Interaction FIM: may require encouragement to initiate participation

A

5 - supervision

88
Q

Problem Solving: solves routine problems 75% time

A

4 - minimal assistance

89
Q

Problem solving: recognizes problems when present, make appropriate decisions, carries out steps to solve complex problems until task completed

A

7 - complete independence

90
Q

Activities such as managing checking account, participating in discharge plans are called…

A

complex problem solving

91
Q

Includes asking for assistance during transfer, asking for new milk when milk is missing, asking for utensils when missing

A

routine problem solving

92
Q

Memory: patient appears to have mild difficulty recognizing faces, remembering daily routines. May use self initiated or environmental cues, aids.

A

6 - modified independence

93
Q

Memory; require prompting only under stressful conditions but no more than 10% of time

A

5 - supervision

94
Q

List Client Factors

A

Values, beliefs, spiritual, body functions, body structures

95
Q

List occupations

A

work, play, leisure, rest and sleep, social participation, education, ADL, IADL

96
Q

List performance skills

A

motor skills, process skills, social interaction

97
Q

List performance patterns

A

habit, routine, ritual, roles

98
Q

Lis context and environment

A

cultural, personal, temporal, virtual, social, physical

99
Q

Dressing, feeding, functional mobility, bladder, sex, eating

A

ADLs

100
Q

care of others, child rearing, driving, computers, cooking

A

IADLs

101
Q

What is goal of ADL/IADL training?

A

client and family learn to adapt to the life changes or situations and to participate as fully as possible in those occupations that are meaningful.

102
Q

What 5 things to consider when analyzing ADL?

A 
O Assessing client factors
O Performance skills
O Performance patterns
O Physical and social environment
O Clients contextual framework
103
Q

describes client’s occupational history, patterns of living, interests, values, and needs

A

occupational profile

104
Q

T/F: Feasibility of ADL assessment or ADL training should be determined by the OT in concert w/ client, supervising physician, and others rehab team members

A

True

105
Q

T/F: Partial/complete performance analysis important to assess ADL performance; interview not enough

A

true. Ideally OT assess performance of activities in the context/environment where they usually take place or under simulated conditions
Should start with relatively simple/safe tasks from ADL/IADL list and progress to more difficult/complex

106
Q

requires 25% physical or verbal assistance of one person to complete safely (performs 75% or more of task)

A

minimal assistance

107
Q

requires 50% physical or verbal assistance of one person to complete safely (performs 50-74% task)

A

moderate assistance

108
Q

client requires physical or verbal assistance for 51-75% of an activity by one person (performs 25-49% of task)

A

maximal assistance

109
Q

client requires more than 75% physical or verbal assistance (performs less than 25% of task); Ex. Performs 1 or 2 steps of the activity or very few steps)

A

dependent/total assistance

110
Q

standard assessment to evaluate executive skills required to perform IADLs; can be used to determine is person safe to remain at home and how much assistance is required

A

Executive Function Performance Test

111
Q

Most basic IADLs required to stay home alone?

A

prepare/retrieve a simple meal, employ safety precautions and exhibit good judgment, take medication, get emergency aid if necessary, system for managing toileting , method to allow for rest periods

112
Q

the most common type of heart disease in which there is a narrowing of the blood vessels that supply the heart due to the buildup of plaque, which can eventually lead to myocardial infarction (MI), angina (chest pain, discomfort, or tightness), or other complications.

A

Coronary heart disease (CHD

113
Q

The average age at first MI for men?

A

64.5

114
Q

The average age at first MI for women?

A

70.3

115
Q

is the leading cause of death for both genders in the United States?

A

heart disease

116
Q

high cholesterol, hypertension, diabetes, cigarette smoking, overweight & obesity, poor diet, physical inactivity, and alcohol use main factors for…

A

coronary heart disease

117
Q

___ can be caused by heart disease, myocardial infarction, or any other condition in which the cells responsible for the electrical conduction of the heart are affected.

A

Arrhythmia

118
Q

____ can cause MI, cardiac arrest, or stroke.

A

Arrhythmia

119
Q

Change in pattern of angina or shortness of breath
Heart palpitations or “fluttering” feeling in chest
Feeling lightheaded, dizzy, or confused; fainting or near-fainting spells
Experiencing more fatigue than expected
Unusual pain or discomfort in muscles or joints after exercise
Sweating
Blood pressure falls 20 mm Hg or more, or heart rate is 20 beats per minute or more over resting heart rate

A

Signs of cardiac event

120
Q

What is first sign of CHD?

A

MI (heart attack)

121
Q

shortness of breath, persistent coughing or wheezing, edema, fatigue, lack of appetite, nausea, confusion, impaired thinking, and increased heart rate

A

Sign of CHF (heart failure)

122
Q

blue skin, low blood pressure, difficulty breathing, feeding problems, and inability to gain weight. (Minor heart defects often do not produce noticeable symptoms.)

A

Congenital heart disease

123
Q

pain/discomfort in the jaw, neck, or back; feeling weak, lightheaded, or faint; chest pain/discomfort; pain or discomfort in arms or shoulder; shortness of breath

A

myocardial infarction

124
Q

Role Checklist, Occupational Performance History Interview II (OPHI-II), Performance Assessment of Self-Care Skills (PASS), COPM

A

Occupation Focused assessments for CHD

125
Q

Beck Depression Inventory-II (BDI-II), measures of pain, measures of muscle strength, monitoring vital signs (e.g. blood pressure, heart rate)

A

Client factor assessment for CHD

126
Q

Teaching energy conservation techniques to minimize stress placed on heart
Retrain in ADLs
Environmental adaptations
Educating client and family member about risk factors of cardiac conditions
Lifestyle modifications - ex. Identify new occupations that allow client to participate satisfactorily without inducing cardiac stress
Medication management
Recommendations of support group and resources within community

A

Common OT interventions for CHD

127
Q

muscles are stiff and weak (most common)

A

Spastic CP

128
Q

slow, writhing, involuntary movement

A

Athetoid CP

129
Q

muscle weakness, poor coordination, tremors

A

Ataxic CP

130
Q

combines spastic and athetoid

A

Mixed

131
Q

premature birth, low weight, inadequate nutrients in utero, blood type incompatibility, bacterial infections, oxygen deprivation, severe jaundice

A

Risk factors for CP

132
Q

motor disorders characterized by impaired voluntary movement and muscle control. Can result from prenatal, perinatal, or postnatal brain injury occurring before age 5

A

CP

133
Q

combines spastic and athetoid

A

Mixed CP

134
Q

Difficulties with CP?

A 
cognitive delays
speech difficulty
seizure disorders
feeding problems
impaired vision & hearing
abnormal sensation and perception
difficulty with bowel control
breathing problems secondary to poor posture
skin conditions
135
Q

Secondary conditions in adults?

A 
musculoskeletal changes (increased spasticity and decreased strength, endurance, flexibility) 
Pain
Fatigue
Arthritis
Fractures
Osteoporosis
136
Q

CP precautions?

A

Seizure disorders
Difficulty breathing
Impaired vision/hearing
Abnormal sensation/perception

137
Q

What decrease muscle stiffness and allow for more controlled movement & increased function when used with OT?

A

Botox

138
Q

Anticonvulsant drugs do what to CP?

A

treat seizures

139
Q

Baclofen pumps for CP?

A

relax muscles and control tremors & spasticity

140
Q

Benzodiazepines?

A

manage spasticity

141
Q

Selective dorsal rhizotomy surgery?

A

reduce muscle tone

142
Q

any condition or disease that affects or is located in the lungs

A

Pulmonary conditions

emphysema, asthma, cystic fibrosis, pneumonia, tuberculosis

143
Q

COPD?

A

chronic obstructive pulmonary disease, includes emphysema and chronic
bronchitis.

144
Q

more than 4% of adults aged 18 and older were living with a diagnosis of _____

A

chronic bronchitis

145
Q

_____ diseases are the fourth leading cause of death in the US

A

chronic lower respiratory

146
Q

T/F: Almost all causes of COPD are due to long term exposure to lung irritants, most commonly cigarette smoke.

A

true

147
Q

Comorbidity with depression, hypertension, high cholesterol, and osteoporosis

A

Pulmonary disease

148
Q

Medication therapy for pulmonary disease?

A

inhaler

149
Q

Interdisciplinary Interventions for PD?

A

pulmonary rehab, medication therapy, oxygen therapy

150
Q

Interventions for PD?

A

energy conservation teaching, i.e. breathing techniques, retraining in
ADLs (grading to reduce excessive strain), upper extremity strength and ROM training,
education, lifestyle modification, medication management, recommendation of support
groups

Adult Rehab (16 decks)

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