Eval 1 - Integ, GU, Immune, Multi-System

Question 1

Most important functional mobility abilities for older adults (4)

Answer 1

1. Walk 1/4 mile without stopping.
2. Cross street on time.
3. Climb stairs.
4. Rise from floor.

Question 2

Integumentary: self report measures

Answer 2

Diabetes Impact Measurement Scale (DIMS)
Falls Efficacy Scale (FES)

Question 3

Integumentary: important meds to screen for (4) and why

Answer 3

1. Steroids - inhibits epidermis regeneration & collagen synthesis.
2. NSAIDs - decreases epithelialization & slows inflammatory healing process.
3. Immunosuppressants - higher risk of infections.
4. Aspirin/Anti-Coagulants - impedes blood clotting.

Question 4

Integumentary: nutrition requirements for older adult with wounds

Answer 4

Protein = 1-1.5 g/kgBW per day.
Total Caloric Intake = 35-40 kcal/kgBW per day.

Question 5

Integumentary: tests & measures

Answer 5

Sensation: sharp/dull best option; should be in dermotome pattern.
Gait: if foot wounds.
ABI
Ipswich Touch Test*

Question 6

Integumentary: what monofilmant size tests for protective sensation?

Answer 6

0.05

Question 7

Ipswich Touch Test

Answer 7

Purpose: protective sensation in diabetic foot, determines risk of ulcer.
Pt position: supine, eyes closed, feet off edge.
Procedure: gently touch tip of toes 1, 3, and 5 & dorsal aspect of hallux (both feet). Pt says “yes” when touch felt.
(+) = cannot feel 2 or more spots, indicates neuropathy.

Question 8

Genitourinary: incontinence red flags (5)

Answer 8

Sudden onset.
After surgery or after new meds.
Burning or blood in urine or stool.
Any large or unexpected amount.
LBP + difficulty initiating.

Question 9

Genitourinary: important meds to screen for (3) and why

Answer 9

1. Benzodiazepines - relaxes urethra.
2. Anti-HTNs (Anti-Cholinergic or Beta-Blockers) - may cause retention.
3. Opioids/Narcotics - puts stress on bladder.

Question 10

Genitourinary: tests & measures

Answer 10

Strength: glutes, abs, PFM.
Balance: esp eyes closed, bc getting up in night to pee.
Internal/External Pelvic Exam: palpation, sensation.
Sacral Reflex.

Question 11

Immune: what conditions are we mostly screening for? (2)

Answer 11

RA
Cancer

Question 12

Immune: important meds to screen for (2) and why

Answer 12

1. Chemo - neuropathy, inner ear dysfunction, vision changes, fatigue.
2. Steroids for RA flare - affects what we can/cant do with manual therapy.

Question 13

Immune: tests & measures

Answer 13

Sensation: neuropathy from chemo/cancer.
Balance: vestibular effects from chemo.
Endurance/Aerobic Capacity: fatigue.
Anthropometrics if lymphedema.
Balance/Falls: 40-50% higher risk w/in 1-2yrs of dx.

Question 14

Multi-System: important eval components for falls

Answer 14

Kyphosis: weight is more forward.
Fwd head: can mess with vestib.
DF ROM: need 8deg for ankle strategy.
Glut Max strength: predicts fallers vs non-fallers.

Question 15

Multi-System: Hopkins Falls Grading Scale

Answer 15

Grade 1 (near fall): did not fall to ground or lower surface.
Grade 2 (fall): fell to ground or lower surface, but no med attention needed.
Grade 3 (fall): received med attention, but no hospital admission.
Grade 4 (fall): admitted to hospital.