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S3 - Clinical Practice 2 > Week 1- Hand Hygiene and Standard Precautions, Documentation: Eval/Diag and Assessment, Joint Mobs > Flashcards

Week 1- Hand Hygiene and Standard Precautions, Documentation: Eval/Diag and Assessment, Joint Mobs Flashcards

1
Q

HAND HYGIENE

A

HAND HYGIENE

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2
Q

What are HAIs?

A

Health care-associated infections

-Infections people get while recieving health care for another condition.

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3
Q

In American hospitals alone, the Centers for Disease Control (CDC) estimates that HAIs account for an estimated ____ million infections and ________ associated deaths each year.

A
  • 1.7 million

- 99,000 deaths

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4
Q

What is the most effective infection control measure in prevention of HAIs?

A

hand hygiene

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5
Q

What is the “patient zone”?

A
  • patient

- surfaces and items that are temporarily and exclusively dedicated to him/her

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6
Q

What is the “health care area”?

A

all surfaces in the health care setting outside the patient zone

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7
Q

What are the key 5 moments for hand hygiene?

A
  • BEFORE touching a patient
  • BEFORE clean/aseptic procedures
  • AFTER a body fluid exposure risk
  • AFTER touching a patient
  • AFTER touching a patients surroundings
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8
Q

What are the three things to avoid prolonged hand contamination?

A
  • use the appropriate technique
  • use an adequate quantity
  • use for recommended length of time
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9
Q

Do gloves take the place of hand hygiene?

A

NO

  • gloves neither alter nor replace the performance of hand hygiene
  • Gloves should be removed and hand hygiene performed when indicated by the 5 moments of hand hygiene and clean gloves put back on
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10
Q

If medical gloves don’t take the place of hand hygiene, then what are the 2 reasons we use them?

A
  • reduce risk of contamination of health-care workers hands

- reduce risk of germ dissemination to the environment and from worker to patient/ patient to worker/ patient to patient

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11
Q

What are the order of the 6 parts of the chain of infection?

A
  1. ) Harmful germ spread by contact (MRSA, Norovirus, C.diff)
  2. ) Hide/Grow/Multiply (GI tract, Nose, Wound)
  3. ) Way Out (Nose, Skin, Rectum, Urine)
  4. ) Going Mobile (HCW Hands, Surfaces, Equipment)
  5. ) Way In (Nose, Mouth, Wound, Devices)
  6. ) Next Person At Risk
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12
Q

What are standard precautions?

A

-Group of infection prevention practices applied during care of ALL individuals, regardless of suspected or confirmed infection status, in any health care setting.

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13
Q

Standard precuations assume that _____ blood, body fluids, secretions, excretions except sweat, non-intact skin, and mucous membranes may contain transmissible infectious microbes.

A

ALL

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14
Q

What are the 6 elements of standard precautions?

A
  • Hand Hygiene
  • PPE (Personal Protective Equipment)
  • Resident Placement (single resident rooms, cohorting)
  • Respiratory Hygiene/ Cough Etiquette
  • Safe Injection Practices
  • Textiles and Laundry Handling
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15
Q

What PPE to wear and when?

A
  • PPE usage is based on the type of task being performed.

- Also whether or not anticipating contact with blood, and/or body fluids, or pathogen exposure

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16
Q

We wear gloves when there is any anticipation of contact in what 5 instances?

A
  1. ) Blood or body substances
  2. ) Mucous membrane
  3. ) Non-intact skin
  4. ) Indwelling device insertion site
  5. ) Handling potentially contaminated items
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17
Q

We wear gowns when there is anticipation of contact in what 3 instances?

A
  1. ) Procedures likely to generate splashes, sprays, or droplets of blood and body fluids
  2. ) When in contact with non-intact skin
  3. ) Handling fluid containers likely to leak or spill when moved
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18
Q

Transmission-based Precautions are specific practices added to ________ precautions when the spread of infection or organisms is not completely stopped using _________ precautions alone.

A
  • standard

- standard

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19
Q

What are the 3 main kinds of Transmission-based Precautions?

A
  • Contact Precautions
  • Droplet Precautions
  • Airborne Precautions
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20
Q

What is the goal of contact precuations?

A

Prevent transmission of infectious pathogens that are spread by direct or indirect contact with a resident or their environment

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21
Q

Illnesses requiring contact precaution include, but are not limited to:

  • uncontained excessive wound ________
  • uncontained fecal or urine __________ or other body fluids
  • infection or colonization with MDROs (multi-drug resistant organisms) or other epidemiologically significant organisms
A
  • drainage

- incontinence

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22
Q

For contact precaution strategies, in addition to standard precautions care providers should wear _______ and _______.

A

gloves and gowns

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23
Q

In addition to wearing gloves and gowns for contact precaution strategies, you should ensure proper _________ and _________ care.

A

environment and equipment

  • use disposable equipment or equipment dedicated to that patient when possible
  • clean and disinfect resident room (at least daily) with a focus on high-touch surfaces
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24
Q

Contact precaution strategies also include assessing _______ placement (single room, cohort, existing roommates) and establishing policies for movement of resident outside of the room.

A

resident

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25
Q

What is the goal of droplet precautions?

A

Prevention of transmission of infectious pathogens that are spread to others by speaking, sneezing, or coughing

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26
Q

Should care providers be wearing masks and gloves when interacting with patients on droplet precautions?

A

Yes

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27
Q

What is the goal of airborne precautions?

A

Prevention against transmission of airborne pathogens

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28
Q

Airborne transmission occurs through the dissemination of either _________________ or _______________ that contain an infectious agent.

A
  • airborne droplet nuclei

- dust particles

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29
Q

What should care providers wear when interacting with patients on airborne precautions in addition to standard precautions?

A

Masks and respirators (N95)

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30
Q

Patients on airborne precautions should be placed in an ____________________ (AIIR) which is a negative pressure room.

A

Airborne Infection Isolation Room

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31
Q

EVALUATION/DIAGNOSIS AND ASSESSMENT

A

EVALUATION/DIAGNOSIS AND ASSESSMENT

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32
Q

Why do we document?

A
  • To serve as a record of patient care
  • To convey our unique body of knowledge and our practice
  • To communicate among different providers
  • To be used for policy or research purposes
  • To reflect appropriate provision of care in accordance with local, state, and federal regulations
  • To record the episode of care of the patient/client
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33
Q

Insurance reports consistently indicate error rate for PT services primarily due to _________ problems.

A

documentation

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34
Q

Of the top 20 list of services with insufficient documentation, 3 were from PT, what are they?

A
  • Therapeutic Exercise (97110) - $33 million
  • Manual Therapy (97140) - $12 million
  • Therapeutic Activities (97530) - $10 million
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35
Q

Reasons for denial include:

  • No documentation for date of service
  • ___________ documentation
  • Documentation not understood due to ___________
  • Goals are not written as _________ outcomes
  • Medical necessity is not identified clearly
  • Does not support the billing (coding)
  • Does not demonstrate __________
  • Does not demonstrate ________ care
A
  • incomplete
  • abbreviations
  • functional
  • progress
  • skilled
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36
Q
  • The _________ _________ list developed by the PT may include several conditions.
  • Is it always possible to come to an immediate decision about a medical diagnosis? If not, what would the PT consider?
A
  • differential diagnosis

- No, consider the problems that might explain the signs and symptoms

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37
Q

What is the physical therapist’s diagnosis guided by?

A

Patient/client response to intervention

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38
Q

What is a medical diagnosis?

A

The anatomical, biochemical, physiological, or psychological derangement

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39
Q

A medical diagnosis is a _______ or _________ based diagnostic label that can be useful in identifying necessary health care services or prevention methods.

A

disease or pathology

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40
Q

What is a physical therapy diagnosis?

A

The primary dysfunction toward which the physical therapist directs treatment

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41
Q

What may be a physical therapy diagnosis for these 2 medical diagnosis:

  • Lumbar herniated disc
  • CVA
A

Lumbar Herniated Disc
-Right-sided lower extremity radiculopathy centralizing with repeated extension
CVA
-Left-sided hemiplegia – 3 on the Modified Ashworth Scale, moving with a flexion synergy in UE

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42
Q

What is primary diagnosis?

A

Condition established to be chiefly responsible for patient to seek medical care

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43
Q

What are some examples of primary diagnosis?

A
  • Total knee replacement
  • Patellofemoral pain syndrome
  • CVA
44
Q

What is secondary diagnosis?

A

Any additional conditions that affect patient care

45
Q

What are some examples of secondary diagnosis?

A
  • Patient being treated s/p TKA with hypertension
  • Patient with patellofemoral pain syndrome with history of MS
  • Patient being treated s/p CVA with history of heart disease and cancer
46
Q

The assessment is based on the information gathered from the ________ and _____________.

A
  • history

- tests and measures

47
Q

For an assessment, a PT must determine what 3 things?

A
  1. ) Is PT appropriate
  2. ) Do they need consultation with another health care provider in conjunction with PT
  3. ) Is intervention by a PT indicated or do they need to be referred to another health care professional
48
Q
  • An assessment interprets data from ________ and _________ sections using sound clinical judgement.
  • Should we introduce new subjective or objective data?
A
  • subjective and objective

- NO

49
Q

Use the ____ model to link medical and physical therapy dx with impairements, activity limitations, and participation restrictions.

TIE THE PIECES TOGETHER

A

ICF

50
Q

Where do a majority of users of your notes go to find out why the patient requires physical therapy services?

A

Assessment

51
Q

What are the 6 parts of the ICF model?

A
  • Health Condition
  • Body Functions and Structure
  • Activity
  • Participation
  • Environmental Factors
  • Personal Factors
52
Q

Examples of Body Functions and Structure?

A
  • ROM
  • Strength
  • Balance
  • Cognition
53
Q

Examples of Activity Limitations?

A
  • ADLs
  • Functional Mobility
  • Learning
54
Q

Examples of Participation Restrictions?

A
  • Work Activities
  • Community Activities
  • Leisure Activities
  • Relational Activities
55
Q

Examples of Personal Factors?

A
  • Age/Gender
  • Coping Styles
  • Education/Profession
  • Past Experiences
56
Q

Examples of Environmental Factors?

A
  • Social Attitudes
  • Stress
  • Physical Space
  • Legal/Social Structures
57
Q

Assessment:

  • Should clearly outline the _____ for physical therapy services.
  • Simply reporting patient has experienced a “decline in function” or “patient improving” is ___ enough.
  • Include details you want highlighted to your patient’s referral source or anyone using the note to make a decisions.
  • Include recommendations and actions taken to address concerns.
  • Conveys professional judgment for predicted ________ outcome and the required duration of services to obtain this __________ outcome.
A
  • NEED
  • NOT
  • functional, functional
58
Q

Can an assessment change?

A

Yes, based on new or changing information

59
Q

Therapy services are considered reasonable and necessary when what conditions are met?

A
  • The services are consistent with the nature and severity of the illness, injury, and medical needs.
  • The services are specific, safe, and effective treatment for the condition according to accepted medical practice.
  • There should be a reasonable expectation that observable improvement in functional ability will occur.
  • The services do not just promote the general welfare of the beneficiary.
60
Q

Document complications and safety issues as a result of the patient current status. What are some examples?

A
  • Fall Risk
  • Reduced Mobility - increased risk for further complications
  • Inability to complete tasks ie. ADLs
61
Q

Services must be at a level of complexity that it requires physical therapy services to safely and effectively perform and progress interventions. A therapist’s skill may also be required for _______ reasons.

A

safety

62
Q

Justifying physical therapy services also requires demonstrating __________.

A

progression

63
Q

When demonstrating progression, we document _______ as compared to current function. We also use percentages, levels of assistance or function but make sure that they are _______ understood. Finally, we use __________ outcome measures.

A
  • previous
  • easily
  • standardized
64
Q

JOINT MOBILIZATIONS

A

JOINT MOBILIZATIONS

65
Q

Injury to a joint or structures surrounding a joint will often lead to what 3 things?

A
  • Pain
  • Loss of Motion
  • Excessive Motion
66
Q

Joint loss of motion could be due to what reasons?

A
  • Pain and muscle guarding
  • Joint hypomobility
  • Joint effusion
  • Contractures or adhesion in joint capsule or supporting structures
  • Combination
67
Q

What are the objectives of manual therapy?

A
  • Pain modulation
  • Address tissue extensibility
  • Address muscle guarding
  • Peripheral effects (improve circulation, fluid/waste uptake, improve healing)
  • Improve tolerance for other interventions
68
Q

There are many different frameworks (Maitland, Kaltenborn, Mulligan, etc.) and the effectiveness should be assessed via _____ _______.

A

test re-test

-have patient do 5 squats, do joint mobs, have them do 5 squats, ask if better/worse/same

69
Q

Should we assess/re-assess every time?

A

Yes, to make sure the joint mobilizations we are doing are still needed (maybe their pain was gone after visit 2 joint mobilizations and were on visit 6).

70
Q

We perform the assessment in the _______ position of the joint and assess both ________ and _______ of movement.

A
  • resting

- quality and quantity

71
Q

When assessing joint mobility, what 3 things are we assessing?

A 
Gross Quantity of Movement 
-hypomobile, normal, hypermobile
Quality of Movement (End-Feel)
-firm, hard, empty
Provocation
-painful, painless
72
Q

Joint Mobilizations are manual therapy techniques involving movement of articulating surfaces with the intention of doing what?

A
  • Regaining ROM
  • Improving joint capsule extensibility
  • Regaining normal distribution of forces on a joint
  • Reducing pain
  • Lubricating joint surfaces
  • Providing nutrition to joint structures
73
Q

Should we do anything after performing joint mobilizations?

A

Yes, do something active to use the “new” ROM

74
Q

What are the absolute contraindications to performing joint mobilizations?

A
  • Malignancy
  • Infectious arthritis
  • Joint fusion
  • Joint fracture
  • Practitioner lack of ability
  • Neurological deterioration
  • Upper cervical spine instability
  • Cervical arterial dysfunction
75
Q

What are the relative contraindication to performing joint mobilizations?

A
  • Excessive pain or swelling
  • Arthroplasty
  • Hypermobility
  • Osteoporosis
  • Spondylolisthesis
76
Q

Joint mobilization biomechanical effects?

A
  • Motion improvement
  • Positional improvement
  • Increase joint capsule extensibility
77
Q

Joint mobilization nutritional effects?

A
  • Synovial fluid movement

- Improve nutrient exchange

78
Q

Joint mobilization neurophysiological effects?

A
  • Stimulates mechanoreceptors to inhibit pain impulses
  • Gate control theory
  • Descending pathway inhibition theory
  • Peripheral inflammatory modulation
79
Q

3 regions of the stress strain curve?

A
  • Toe region
  • Elastic region
  • Plastic region
80
Q

Compression is the ___________ of joint surfaces; force is ___________ to joint plane.

A
  • approximation

- perpendicular

81
Q

Traction/Distraction is the _________ of joint surfaces; force is ___________ to joint plane.

A
  • seperation

- perpendicular

82
Q

Gliding is a force direction __________ to the joint surface.

A

parallel

83
Q

How many distraction joint mobilization Grades are there?

A
  • Grade I = piccilo
  • Grade II = slack
  • Grade III = stretch
84
Q

How many joint glide mobilization Grades are there?

A
  • Grade I = first 25%
  • Grade II = 25%-75%
  • Grade III = 50%-100%
  • Grade IV = 75%-100%
  • Grade V = joint manip
85
Q

What joint glide mobilization grades are used for pain and muscle guarding?

A

Grade I and II

86
Q

What joint glide mobilization grades are used for stretching joint capsule and associated structures?

A

Grade III and IV

87
Q

Grade V joint glide mobilizations are often referred to as what?

A

Joint manipulation (high velocity thrust technique)

88
Q

What are the 2 other joint mobilizations other than distractions and oscillation mobilizations?

A
  • Sustained hold mobilizations

- Mobilization with movement

89
Q

Sustained hold mobilizations can target both ___________ and ______.

A

joint mobility and pain

90
Q

If performing sustained hold mobilizations for pain, we will be holding from _______ range to _____ range.

A

beginning to mid

91
Q

If performing sustained hold mobilizations for joint mobility, we will be holding at _____ range.

A

end

92
Q

How do you know what direction to push for joint glides?

A

Convex/Concave Rule

93
Q

Joint positions:

  • Resting position used for assessment, acute stage, during grade __ and __ oscillations.
  • When attempting to improve ____ (grades III and IV) should place joint at end ROM if tolerable
  • One half of joint should be _______, while the other half is _______.
A
  • I and II
  • ROM
  • stabilized, mobilized
94
Q

Therapist position:

  • Both stabilizing and mobilizing hands should be as close as possible to the _________
  • Clinician’s hands should make ________ contact with patient’s body
  • Arm should be in-line with direction you want to mobilize
A
  • joint line

- maximum

95
Q

Oscillation mobilizations are - seconds and typically have - sets for __-__ seconds each.

A
  • 1-3 seconds
  • 1-5 sets
  • 15-60 seconds
96
Q

Sustained hald mobilizations are typically - sets for - seconds each. They are also more commonly used to treat ____.

A
  • 1-5 sets
  • 5-30 seconds
  • ROM
97
Q

Techniques to joint mobilizations:

  • Allow _______ to assist when possible
  • Your body and the mobilizing part should act as one unit as much as possible
  • Body ________!!!
  • When possible your forearm should align with the intended direction of your force
  • ________ afterwards
  • Stop for the day when a large improvement has been obtained or when improvement ceases
A
  • gravity
  • mechanics
  • reassess
98
Q

Grade I and II mobilizations direction _____ important as not stretching the joint capsule. Perform grade I and II in direction which initially caused their pain. Often done in ___________ position.

A
  • less

- open pack (resting)

99
Q

Deciding Which Direction To Perform A Joint Glide:

  1. ) Determine what motion you want to improve and the direction of the roll (ie hip extension)
  2. ) Determine what joint you are going to mobilize (ie ___ joint)
  3. ) Determine which part of the joint you are going to mobilize which part is going to be stationary (ie femur=________, acetabulum=__________)
  4. ) Determine if bone mobilizing is convex or concave (femur=______)
  5. ) Convex on concave=mobilize opposite direction as roll; if concave on convex=mobilize in same direction as roll
  6. ) If tolerated should mobilize at the ___ range (where restriction likely is)
A
  • coxofemoral (hip) joint
  • femur=mobilizing, acetabulum=stationary
  • convex
  • end
100
Q

Mobilization with Movement (MWMs) are typically combined ______ and ______ joint mobilization

A

active and passive

101
Q

What is the golden rule of MWMs?

A

Should be painless, if pain occurs either need to change direction of force, correct pressure, or not use MWMs

102
Q

What is the theory behind MWMs?

A

Bony positional faults contribute to painful joint restrictions and MWMs help to correct the bony positional faults.

103
Q

What are the 3 guidelines to follow for MWMs?

A
  • should be pain free
  • apply 10 times before reassessing joint motion
  • overpressure should be applied at end range of AROM
104
Q

What direction of joint glide would you perform in non-weight bearing to improve ROM in the following areas:

  • Ankle dorsiflexion
  • Tibiofemoral flexion
  • Radiocarpal extension
A
  • Ankle DF = Posterior Glide
  • Tibiofemoral Flexion = Posterior Glide
  • Radiocarpal Extension = Anterior Glide
105
Q

What grade(s) of joint mobilization glides would you want to perform for the following:

  • GH hypomobility without pain = ____________
  • GH pain without hypomobility = _____________
  • GH hypomobility with pain = ______________
A
  • Grade III or IV
  • Grade I or II
  • Grade I or II before and after Grade III and IV
106
Q

What are working to improve if the following is performed:

  • Grade III GH joint distraction?
  • Grade II inferior patellofemoral mobilization?
  • Grade III anterior hip mobilization?
  • Grade III posterior radiohumeral mobilization?
A
  • Improve general mobility of GH joint
  • Reducing pain or muscle spasms
  • Improve hip extension and ER
  • Improve radiohumeral extension

S3 - Clinical Practice 2 (13 decks)

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