04-01: Patient Management, Body Mechanics, Vital Signs

Question 1

Definition and purpose of HIPAA

Answer 1

Health Insurance Portability and Accountability Act - Protects confidentiality of pt medical info, protects pt record when stored, protects pt records between healthcare providers and insurers

Question 2

Patient Identifiers

Answer 2

• 18 identifiers
• Name, address, date of birth, last four digits of SS#, Contact info, All ages over 89, Vehicle identifiers, Device identifiers, biometrics, photo images

Question 3

5 steps of Patient Management

Answer 3

Examination, Evaluation, Diagnosis, Prognosis, Plan of Care: Intervention

Question 4

Open-ended questions

Answer 4

Questions that require patient to elaborate and give details

Question 5

Closed-ended questions

Answer 5

Yes or no questions

Question 6

Four parts to an intervention

Answer 6

• Type: What activity is being done
• Amount: Number of sets/reps
• Duration: How long exercise /activity done
• Frequency: How many times/day was activity done

Question 7

Preparation for Patient Care

Answer 7

• Be aware of environment at all times
• Prepare treatment area
• Handling of patients

Question 8

Preparing treatment area

Answer 8

• Sufficient room to work with pt
• Safe environment
• Gather necessary equipment
• Clean any equipment prior to and after treatment

Question 9

Patient preparation

Answer 9

• Prepare treatment area
• Gait belt
• Keep patient informed (Limit waiting time)
• Appropriate pt dress: modest. safe
• Appropriate footwear: shoes, non-skid socks
• Draping for modesty, treatment
• Observe location of lines and equipment attached to pt

Question 10

Types of CDC Handwashing

Answer 10

• Handwashing: Plain soap and water
• Antiseptic: Washing hands with antiseptic agent
• Alcohol-based rub: Rubbing with alcohol-containing preparation
• Surgical hand hygiene/antiseptis: Washing or using alcohol-based hand rub before surgery

Question 11

Hand Hygiene - Visibly soiled

Answer 11

Wash with non-antimicrobial or antimicrobial soap and water

Question 12

Hand Hygiene - Not visibly soiled

Answer 12

Alcohol-based hand rub for routinely decontaminating hands

Question 13

When to wash hands

Answer 13

• Hands are visibly soiled with blood or infectious matter
• Touching contaminated items
• Before and after treating patients
• Removal of PPE

Question 14

Principle of proper body mechanics

Answer 14

• Center of gravity over base of support (BOS should be shoulder width apart)
• Reduces stress on musculoskeletal system during lifting, lowering, pushing and carrying

Question 15

5 Cardinal Rules of Body Mechanics

Answer 15

• Keep load close to you
• Widen the BOS
• Isometric contraction of trunk (Stabilizes back)
• LIft with legs
• Do not twist

Question 16

Gait Belt

Answer 16

• Safety device that provides level of control for PTA/PT with pt during transfers and gait training
• Used in case patient starts to fall, loses balance
• Can pull patient close or control lowering to ground

Question 17

Gait training

Answer 17

Skilled teaching mechanics of normal vs. abnormal movement

Question 18

Ambulation

Answer 18

No skills required for gait, just movement

Question 19

Position guarding during gait

Answer 19

• Posterior and slightly lateral to pt (about 45˚)

- On the involved side, feet in stride with pt

Question 20

If patient has LOB…

Answer 20

• PTA pulls pt towards him creating COG ot PTA/pt over BOS and lowers pt to ground

Question 21

Verbal Cues

Answer 21

Providing auditory commands for specific action

Question 22

Ergonomics

Answer 22

Area of physical therapy that includes workstation modification - moving things around to avoid repetitive motions

Question 23

Vital Signs

Answer 23

• Heart Rate (HR)
• Pulse Rate (PR)
• Respiratory Rate (RR)
• Blood Pressure (BP)
• Temperature (T)
• Pain

Question 24

Heart Rate

Answer 24

Measure taken over heart (auscultation)

Question 25

Pulse Rate

Answer 25

- Beats per minute palpated and measured distally | - Most common areas: Radial and Carotid

Question 26

Resting Heart Rate

Answer 26

HR at rest

Question 27

Basal Heart Rate

Answer 27

HR after extended rest (ex: nap)

Question 28

Trophic changes due to impaired circulation

Answer 28

- Loss of hair - Dry or flaky skin - Muscle atrophy - Cool temperature - Blanching

Question 29

Pulse Regularity Scale

Answer 29

``` 0 = absent 1 = thready, weak 2 = normal 3 = strong 4 = full bounding ```

Question 30

Methods of measuring HR/PR

Answer 30

- Manual palpation - Auscultation (Stethoscope) - Doppler (Ultrasound) - Oximeter (Blood O2 concentrations)

Question 31

Normal pulse rates

Answer 31

Adults 60-100 bpm | Children 80-100 bpm

Question 32

Abnormal pulse rates

Answer 32

Bradycardia - slow resting PR 100 bpm

Question 33

Maximal HR (PR) or Age-predicted Max HR

Answer 33

- Highest HR person should achieve during exercise | - Formula: 220-age

Question 34

Target HR

Answer 34

- HR attempt to achieve during exercise, between 60-80% of max HR - Formula: (220-age) x (.60) to (220-age) x (.80)

Question 35

Locations of palpating PR

Answer 35

Carotid, Brachial, Radial, Femoral, Popliteal, Dorsal Pedal

Question 36

Systolic Pressure

Answer 36

Pressure exerted by blood against arterial walls when the heart CONTRACTS

Question 37

Diastolic Pressure

Answer 37

Pressire exerted by blood against arterial walls when the heart IS NOT CONTRACTING (relaxes)

Question 38

Kortokoff Sounds

Answer 38

Sounds heard through stethoscope when taking BP (5 sounds)

Question 39

Kortokoff #1

Answer 39

Snapping sound first heard at systolic pressure (Clear tapping, repetitive sounds for at least two consecutive beats is systolic pressure)

Question 40

Kortokoff #2

Answer 40

Murmurs heard between systolic and diastolic pressures

Question 41

Kortokoff #3

Answer 41

Loud, crisp tapping sound

Question 42

Kortokoff #4

Answer 42

Thumping and muting sounds at pressures within 10 mmHg above the diastolic pressure

Question 43

Kortokoff #5

Answer 43

Silence when cuff pressure drops below diastolic pressure

Question 44

Parts of stethoscope

Answer 44

- Earpiece - Binourel piece - Flexible Tubing - Stem - Chestpiece - Headset: Eartip, Eartube - Chestpiece: Tunable Diaphragm

Question 45

BP Ranges

Answer 45

Normal: 120/80 Pre-Hyp: 120-39/80-89 Stage 1 Hyp: 140-159/90-99 Stage 2 Hyp: Greater than 160/Greater than 100

Question 46

Orthostatic Hypotension

Answer 46

- Drop in BP with changes in position - Decrease in systolic BP of 20 mmHg or more - Often occurs after prolonged bedrest

Question 47

Normal respiratory rate

Answer 47

- 1 cycle = one inspiration + one expiration - Adult: 12-18 bpm - Children: 20 bpm

Question 48

Normal temperature

Answer 48

Afebrile: No fever = normal temp (98.6˚ F) Febrile: temp above 100˚ F

Question 49

O2 Saturation

Answer 49

Normal = 100% Medicare payment = below 90% Terminate exercise = 88%

Question 50

Contraindications for Exercise - VS

Answer 50

Resting HR = >100 bpm or 200 mmHg or 110 mmHG | O2 Sat = <90%

Question 51

Pain

Answer 51

- "new" vital sign | - Subjective, but can be objectified using VAS (numeric scale or facial pics)

Question 52

Characteristics of pain

Answer 52

- Type - Location - Intensity - Duration - Frequency

Question 53

Common Lab Values - Hemoglobin

Answer 53

``` Male = 14-18 gm/dL Female = 12-16 gm/dL Newborn = 16.5-19.5 gm/dL Children = 11.2-16.5 gm/dL ```

Question 54

Common Lab Values - Glucose

Answer 54

100-250 mg/dL

Question 55

Common Lab Values - BUN

Answer 55

10-20 mg/dL

Question 56

Common Lab Values - Platelets

Answer 56

150,000-400,000 mm3