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Foundations of Patient Care > Continuation Of Timeline > Flashcards

Continuation Of Timeline Flashcards

1
Q

In what year was the APTA formed?

A

In 1941

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2
Q

World War II was important in the development of what?

A

Prosthetics

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3
Q

When was the competency exam developed? How many members in APTA were there?

A

1951 Over 4,000 members

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4
Q

When was the increased movement toward private practice and other settings?

A

In the 1960’s and 1970’s

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5
Q

When were the APTA sections developed?

A

1975

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6
Q

When did PT become mainstream in public schools?

A

1977

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7
Q

When did joint replacements become more common, increasing the need for PT?

A

1980’s

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8
Q

When was the American Disability Act?

A

1990

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9
Q

“Guide to Physical Therapy Practice” developed?

A

2001

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10
Q

Today’s focus in PT?

A

Evidence based and direct access

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11
Q

How many practicing PT’s? How many APTA members?

A

215,000 practicing PT’s 95,000 APTA members

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12
Q

How many PT programs were there in 1950’s? How many programs today?

A

-39 programs in 1950’s -Today 250

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13
Q

When first baccalaureate programs?

A

1980

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14
Q

Transitional DPT when and where start?

A

1992 at USC

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15
Q

Entry level DPT when and where start?

A

1993 at Creighton

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16
Q

4 Elements in PT Practice

A
  1. Evaluation/Examination
  2. Formulation of Clinical Judgements and Treatment Plan
  3. Provide interventions
  4. Re-evaluation and outcome measures (FIM= Functional Independent Measure)
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17
Q

Evaluation/Examination

A
  • -Chart review
  • -PT interview
  • -Recent Medical course
  • -Medications
  • -Cognitive status
  • -Function prior to admission
  • -home situation/environment
  • -PT’s goals
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18
Q

Evaluation/Examination cont

A
  • -Vital signs
  • -Pain assessment
  • -Skin inspection
  • -Sensation
  • -Posture
  • -ROM (AROM & PROM)
  • -Strength/motor control
  • -Tone
  • -Balance
  • -Functional Tests
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19
Q

Evaluation of Pain (PQRSTQ)

A
  • -Provoke (triggers vs. relief)
  • -Quality (dull, sharp, shock-like, burning)
  • -Radiates -Severity (pain scale)
  • -Time (history, periods of exacerbation, constant)
  • -Questionnaire (Oswestry scale etc.)
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20
Q

Functional Evaluation (one of the most important part of evaluation)

A

ADLs - activities of daily living

  • Bed mobility
  • Transfers
  • Sit to stand
  • Ambulation
  • WC mobility
  • Standard functional tests
21
Q

Functional Tests

A
  • • TUG (The Up and Go)- time that a person takes to rise from a chair, walk three meters, turn around, walk back to the chair, and sit down. should be less than 10 secs
  • • 10 meter walk test- looks at elapsed time it takes to walk 10 meters
  • • Functional ambulation profile (GAITRite®)- mat looks at step length, velocity, symmetry…
  • • 6 minute walk test- walk for 6 min. look at distance & calculate velocity
  • • 3 minute walk test- abbreviated one
  • • Functional reach test- standing & reaching out
  • • Berg balance test- test for balance to see if risk for falls
22
Q

Cinical Implications Related to Gait Velocity

A
  • Correlational to general health status, functional capabilities
  • Individual confidence in balance
  • Need for rehabilitation / “red flag”
  • Provide criteria for discharge
  • Contribute to outcome measures
  • Relation to quality of gait
23
Q

Fomulation of Treatment Plan

A
  • -Results of evaluation (based on)
  • -Problem lists (patients major problems)
  • -Goals writing (short term & long term)
  • -Modifications / progressions
  • -Priorities
  • -Referrals (if you feel patient needs a specialist)
24
Q

Provide Interventions

A
  • -Functional Training
    • Therapeutic Exercise
  • -Stretching
  • -Positioning (in bed, wheelchair)
  • -Manual Therapy
  • -Orthotic/prosthetic training
  • -Balance activities
  • -Patient education
  • -Specialized interventions (kinesio tape, dry needling, manual lymph. draining)
25
Q

Re-evaluation/ outcome measures

A
  • FIM scores (Functional Independent Measure)-
    • assess all functional stuff, walking with what amount of supervision
    • numerical scale
      • at admission & at discharge
  • Functional re-evaluation
    • Ex. needed max assistance, now need minimal, instead of numerical
  • Changes in pain
      • Changes in ROM
    • Passive and active
  • Changes in muscle strength / motor control
  • Changes in balance
  • Standardized tests
    • Ex. TUG before and after
26
Q

Vital Signs

A
  • Establish baseline
  • Medical stability
    • will determine how to monitor their treatment
  • Response to treatment
  • HR, BP, Pulse oximetry (SpO2 (saturation of peripheral oxygen)), RR
27
Q

Heart Rate

A
  • -60-100 bpm (bradycardia less, tachycardia more)
  • -Rhythm
  • -Amplitude (strong or weak)
  • -Resting (3-5 min) after coming in
  • -During or immediately after activity
  • -Max HR (220-age)
  • -Target HR (50 to 85% of max HR)
    • Ex. patient is 80 & is ordered to not exceed 75% of max HR
      • 220-80= 140
      • 140 • 0.75= 105
      • so wouldn’t want to have Pt exceed 105 HR
28
Q

Places to Take Heart Rate

A
  • Radial
  • Carotid
  • Brachial
  • Dorsalis Pedis
29
Q

Normative Values of HR in diff. ages

A
  • 120 - 160 bpm for neonates (1 to 28 days) *
  • 100 - 120 bpm for infants (1 to 12 months) *
  • 80 - 120 bpm for 3 to 4 yr. old
  • 75 - 115 bpm for 5 to 6 yr. old
  • 70 - 110 bpm for 7 to 9 yr. old
  • 60 - 100 bpm for adults (>10 yr. old)

** Brachial pulses used in neonates and infants

30
Q

Factors influencing HR

A
  • -Medications
  • -Environment
  • -Activity
  • Anxiety/ SNS
  • -Fitness Level
  • Age
31
Q

Blood Pressure in Adults

A

Systole / Diastole

  • Normal = 100-119/ 70-79
  • Prehypertension = 120-139/ 80-89
  • Stage 1 HTN = 140-159/ 90-99
  • Stage 2 HTN = _>_160/ _>_100
32
Q

Avg. Pediatric BP

A
  • Neonate (1- 28 days) = 60/ 35
  • Toddler = 100/ 55
  • 5 yo = 105/ 70
  • 10 yo = 115/ 75
33
Q

Red Flags with Exercise

A
  • Systolic > 200
  • Diastolic > 100
  • Drop in diastolic of >10
34
Q

Signs and Symptoms of hypertension

A
  • Severe headache
  • Chest pain / difficulty breathing
  • Pounding chest, neck and ears
  • Confusion / Fatigue
  • Blood in urine
35
Q

Signs and Symptoms of Hypotension

A
  • Light headedness
  • Blurry vision
  • Fatigue / weakness
  • Sleepiness
  • Syncope (fainting)
36
Q

Factors to Consider with BP

A
  • Anxiety / pain
  • Tobacco use
  • Position change / activity
  • Alcohol consumption
  • Exposure to heat/cold
  • Valsalva (holding breath)
37
Q

Taking BP

A
  • -Left arm desirable
  • -Sphygmomanometer
  • -Arm diameter = 80-100% cuff length
  • -Approx 1 inch above cubital fossa
  • -Palpate brachial artery and align bladder
  • -Arm at heart level
  • -Don’t round off
  • know BP before assessment ?
38
Q

Additional Considerations for Taking BP

A
  • -Slow deflation
  • -Test stethoscope
  • -Angle ear pieces forward
  • -At least 1 min before retrying
  • -“White coat” HTN (nervousness about Dr. office)
39
Q

Respiration Rates

A

Breaths/min

  • 12- 20 = adult
  • 15- 30 = 1- 8 yo
  • 25- 50 = 1- 12 months
  • 40- 60 = 1- 28 days
  • OTHER FACTORS -
    • Rhythm
    • Ease
    • Talk (can they talk comfortably during activity)
    • Accessory muscle activity
40
Q

Pulse Oximetry

A
  • Saturation of oxygen to hemoglobin
  • NORMAL: 94-100% SpO2
  • < 92% considered hypoxemia = RED FLAG
41
Q

Pulse Oximetry Limitations

A
  • Weak or irregular pulse
    • may not get true value
  • Hypotension
  • Cold fingers
    • lots of vasoconstriction in vessels, may not get reliable SPO2 reading
  • With inflated blood pressure cuff
    • affects blow flow to finger
  • Hand movement / tremors (ear lobe option)
  • Excessive environmental light
  • Dark nail polish
  • Always Relate to patient presentation (look for other signs)
    • Accessory muscle use
    • Rapid shallow breaths / rapid HR
    • Inability to talk
  • Carbon monoxide / smoking
  • PAOD (Periphery Arterial Occlusive Disease a type of PVD)
  • Correlate with other indicators
42
Q

Causes for Low SpO2

A
  • -COPD (Chronic Obstructive Pulmonary Disease)
  • -Asthma
  • -Pneumonia
  • -Pulmonary fibrosis or edema
    • pressure impeades lungs ability to expand
  • -Heart failure
  • -Sleep apnea
  • -Pneumothorax
  • -Narcotics / anesthetics
43
Q

Scale that Relies of Pt feedback rating level of exertion used in addition to vital signs

A

•Borg’s Rate of Perceived Exertion (RPE) Scale

44
Q

Body Mechanics

A
  • -Keep neutral spine
  • -Use large muscle groups
  • -Keeps objects close to COG (center of gravity) and BOS (base of support)
  • -Pivot on feet instead of twisting at trunk
  • -Use assistive devices
45
Q

Functional Training Terminology (Stages of Help)

A
  • -Independent (I)
    • Pt can do activity w/o compensation (no need walker, cane…)
  • -Mod I - independent with adaptive device
  • -DS - distant supervision
    • Pt can do activity PT can be in same space
  • -CS - Close supervision
    • need be in ready position w/o hands on
  • -CG - contact guard
    • Hands on Pt, usually on involved side
  • -Min A - Patient >75%
    • Pt does 75% or greater of activity
  • -Mod A - Patient between 50-75%
    • Pt does 50- 75 of work
  • -Max A - Patient <50%
    • Pt less than 50%
    • if Pt can give some sort of assistance
  • -Dependent - 0%
    • not able to do anything
46
Q

Weight Bearing Terminology

A
  • -NWB - non-weight bearing
  • -TTWB - Toe touch weight bearing - no appreciate weight through foot, like having sponge under foot
  • -PWB - partial weight bearing= 50%
    • 50% legs, 50% arms
    • should have bilateral support cause when walking transfer of weight
  • -WBAT - weight bearing as tolerated
  • -FWB - Full weight bearing
47
Q

Assistive Ambulatory Devices

A
  • -SW - Standard Walker
  • -RW - Rolling Walker
  • -PRW - Platform rolling walker
    • For when can’t weight-bear through hands
      • RA, wrist fx, multiple fx
  • -Axillary Crutches (AC)
  • -Loftstrand Crutches - forearm cuff
  • -HW - Hemiwalker - one side with major support
    • used for stroke Pts
  • -WBQC - Wide-based quad cane
    • More acute angle faces out
  • -NBQC - Narrow-based quad cane, can be used for stairs
  • -SC - Straight cane
  • Knee walker
  • Pediatric Walker
  • Rollator walker
48
Q

Assistive Device Height

A
  • Walker/Cane = Greater trochanter
  • Walker/Axillary crutches = Styloid process (elbow flexed 20 degrees)
  • Axillary crutches = 2-3 fingers below axilla

Foundations of Patient Care (3 decks)

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