Exam 1 Flashcards
(219 cards)
1
Q
What is an iterative process?
A
a process for calculating a desired result by means of a repeated cycle of operations
2
Q
As the number of “iterations” increases, what should you be doing?
A
you should become closer to the desired result (convergent)
3
Q
What are the six elements of the patient/client management model?
A
examination
evaluation
diagnoses
prognosis
intervention
outcomes
4
Q
What are the three portions of a physical therapy examination?
A
history
systems review
tests and measures
5
Q
What kinds of things will you be examining while conducting a patient history?
A
(coming from graphic on slide 6)
activities/participation
current condition
family history
general demographics
general health status
growth and development
living environment
medical/surgical history
medications
review of systems
social/health habits
social history
6
Q
What systems are being covered during the Systems Review of a PT Examination?
A
musculoskeletal
neuromuscular
cardiovascular/pulmonary
integumentary
communication
7
Q
What is the difference between conducting a Systems Review and the Review of Systems during Patient History?
A
Review of Systems covers any and all medical or health conditions (endocrine, ear/nose/throat, gastro, hematologic/lymphatic, etc.) while the Systems Review is a limited set of hands-on tests to determine further instruction and test for conditions treatable with physical therapy.
8
Q
What is tested during the Systems Review to assess the Cardiovascular/Pulmonary system?
A
heart rate
respiratory rate
blood pressure
edema
9
Q
What is tested during the Systems Review to assess the Integumentary System?
A
pliability (texture)
presence of scar formation
skin color
skin integrity
10
Q
What is tested during the Systems Review to assess the Musculoskeletal System?
A
gross symmetry
gross ROM
gross strength
height/weight
11
Q
What is tested during the Systems Review to assess the Neuromuscular System?
A
gross coordinated movement (balance, gait, locomotion, transfer, transitions)
motor function (motor control and motor learning)
12
Q
What is tested during the Systems Review to assess Communication?
A
ability to make needs known
consciousness
orientation (person, place, time)
expected emotional/behavioral responses
learning preference (barriers, education needs)
13
Q
What occurs during the tests and measures portion of the PT Examination?
A
gathering of data
ruling in and out
14
Q
In the tests and measures portion of the PT examination, you should perform what is necessary to:
A
confirm or reject your hypothesis
support PT clinical judgements about diagnosis, prognosis, and plan of care
15
Q
What are the four branches of the “Physical Therapist Decision Making” graphic?
A
retain
consult
refer
co-manage
16
Q
In the PT decision-making process, what should a physical therapist do if they plan to retain the patient?
A
develop POC
retain accountability for POC
define boundaries within which others assisting with service delivery operate
always have the option to perform all elements or direct and supervise
17
Q
Who does a PT direct and supervise if they plan to retain the patient?
A
physical therapy assistants
physical therapy aides/technicians
18
Q
In the PT decision-making process, who should a PT consult with in regard to a patient?
A
others PTs
other disciplines
MD/DO/DDS (etc)
NPs/PAs
psychology
social work
nursing
19
Q
In the PT decision-making process, who could a PT refer a patient to?
A
other PTs
other disciplines
MD/DO/DDS (etc)
NPs/PAs
psychology
social work
nursing
20
Q
In the PT decision-making process, who could a PT co-manage a patient with?
A
other disciplines
MD/DO/DDS (etc)
NPs/PAs
psychology
social work
nursing
21
Q
What are the four portions of a SOAP note?
A
subjective
objective
assessment
plan
22
Q
What all is involved in the subjective content portion of an evaluation? (SOAP)
A
general demographics (age, gender, race)
chief complaint
history of present illness
pain rating/description
past medical history
past surgical history
23
Q
how can the subjective content portion of an evaluation be obtained?
A
via patient interview and/or information gathered from questionnaires or surveys
24
Q
What all is involved in the objective content portion of an evaluation? (SOAP)
A
observation (posture, gait)
range of motion (PROM, AROM)
strength (MMT, resisted)
joint mobility
palpation
special tests
neurological testing
muscle length testing
systems review (neuromuscular, cardiopulm, integ, MSK)
25
What all is involved in the assessment portion of an evaluation? (SOAP)
clinical decision making based on subjective and objective content
problem list/areas of deficit
establish a clinical diagnosis
is this patient appropriate for PT?
are additional referrals needed?
establish patient goals (SMART goals)
26
What are some components to developing an appropriate plan of care?
therapist recommendations
agreement and consent from the patient
specific correlation to diagnosis, prognosis, and established goals
anticipated number of visits
clear plan of progression
flexible but specific
27
What is the definition of goniometry?
the measurement of angles
28
what are goniometers used for in physical therapy?
measure the joint angles created by the bones in the body
29
What is inclinometry?
measuring angles of slope, elevation, or depression of an object with respect to gravity's direction
30
Is goniometry objective or subjective?
objective
31
What two things does goniometry help us get a comprehensive exam of?
joints and surrounding tissues
32
What are some common applications of goniometry to physical therapy?
describing specific positions used for splinting/immobilization or exercises
fabrication or fitting orthosis or adaptive devices
documenting changes and progression in the patient's condition in response to treatment
determining impairment present
research tool
33
What are some skills necessary to adequately perform goniometric measurements?
knowledge of normal joint structure and function
skill in palpation of body and soft tissue landmarks
skill in positioning and stabilizing body parts
information about best positions for instrument alignment
skill in accuracy of reading and recording measurements
34
what are the three parts of a goniometer?
body
stationary arm
moving arm
35
where should the body of the goniometer be in regard to the body?
placed directly in the center of the landmark (joint axis/joint line) that is used to measure that specific joint angle
creates a fulcrum
36
where should the stationary arm of the goniometer be placed in regard to the body?
attached to the body, cannot be moved independently of the body
aligned parallel to long bones of proximal segment
37
where should the moving arm of the goniometer be in regard to the position of the body?
attached to the center of the body and freely moves on the body to record measurement
aligned parallel to long bones of distal segment
38
What are some keys to reading the scale on a goniometer?
be sure to read the correct increments/scale for measurement
be at eye level with the goniometer when reading the scale
39
what is inclinometry primarily used to assess?
spinal ROM
40
what does the display of the inclinometer indicate?
the angle at which the inclinometer is situated relative to the line of gravity
41
how does using two inclinometers benefit?
improve accuracy of measurement by assisting in identifying extraneous joint movements
42
what are kinematics?
study of motion without regard to forces (motion of body segments, type/direction/magnitude)
43
What are the three types of movement that bony segments can undergo?
translation (linear displacement)
rotation (angular displacement)
combination of both
44
what does arthrokinematics refer to?
the movement of the joint surfaces in relation to one another
45
what are arthrokinematics measured with?
joint play
46
what does osteokinematics refer to?
the gross movement of the shaft of the bones (rather than the joint surfaces)
usually described in angular/rotatory motion produced around fixed axis
47
what are osteokinematics measured with?
goniometer
48
osteokinematics occur in one of three ____________ and around three corresponding ______________.
cardinal planes, axes
49
where does the sagittal plane go through the body?
anterior to posterior aspect of the body
50
what are the motions occurring in the sagittal plane?
flex/extend
51
all motions in the sagittal plane take place around what kind of axis?
medial-lateral axis
52
where does the frontal plane go through the body?
from one side of to the other (split into front and back halves)
53
what motions are occurring in the frontal plane?
ab/adduction
54
all motions of the frontal plane take place around what kind of axis?
anterior/posterior axis
55
where does the transverse plane go through the body?
goes through the body horizontally (same way cross-sections are made)
56
what kind of motion occurs in the transverse plane?
rotation
57
all motions in the transverse plane take place around what kind of axis?
vertical or longitudinal axis
58
what does one degree of freedom of motion refer to?
joints that allow motion in only one plane around a single axis
59
what does three degrees of freedom of motion refer to?
joints that allow motion in all three planes
60
what is used to measure motions occurring in a single plane?
goniometer
61
what is the definition of range of motion?
the arc of motion (in degrees) between the beginning and the end of a motion in a specific plane
62
what is the starting position for measuring all ROM (except rotation in transverse plane)?
anatomical position
63
where is the starting position of ROM for measuring rotations in the transverse plane?
half way between full medial rotation and full lateral rotation (neutral positon)
64
what is the definition of active range of motion?
voluntary unassisted muscle contraction resulting in joint motion
65
which should be assessed first in the exam process, active or passive ROM?
active ROM
66
what does active range of motion provide information about?
willingness to move
coordination
muscle strength
joint ROM
67
what is the definition of passive range of motion?
motion attained by the examiner, without assistance from the subject
68
which is usually greater, AROM or PROM?
PROM
69
what does passive range of motion provide information about?
integrity of articular surfaces
extensibility of the joint capsule and associated ligaments, muscles, fascia, and skin surround the joint
70
what are some common causes of pain with active range of motion?
contracting/stretching of "contractile" tissues and attachments to bone (muscles/tendons)
stretching or pinching of non-contractile tissues (ligaments, joint capsules, bursa, fascia, skin, nerve)
71
what are some common causes of pain with passive range of motion?
non-contractile tissue (pain due to moving, stretching, pinching)
pain at end range PROM (could be result of stretching either contractile or non-contractile)
72
What does comparing motion with pain (PROM and/or AROM) and location do?
helps to begin your guide to examination and treatment
73
what are the four main range of motion reasonings?
mobility deficit (non-contractile)
movement coordination (control)
muscle power deficit (contractile)
radiating pain (neurological)
74
what is the definition of an end feel?
the barrier to further motion at the end of PROM
75
how are you able to characterize the type of end feel you assess in terms of pressure application?
slight overpressure to joint (ex: joint capsule vs soft tissue)
76
what is a normal soft end feel?
typically due to soft tissue approximation
yielding compression that stops further movement
(ex: knee flexion)
77
what is a normal firm end feel?
due to tissue stretch (muscle, capsule, ligament)
has a firm, springy type of movement with slight give
(ex: hip flex w/ knee straight, shoulder external rotation, forearm supination)
78
what is a normal hard end feel?
due to bone contacting bone
a hard, unyielding sensation that is painless
(ex: elbow extension)
79
what are some examples of abnormal end feels?
any normal end feels that are found in an unexpected point in ROM or in a joint that should display a different end feel
muscle spasms (rebound, stop, may have pain)
empty (no mech restriction, pain)
boggy (soft, mushy with effusion)
springy block (firm, elastic resistance at unexpected point - usually indicates internal derangement)
80
what are some precautions to consider when measuring joint ROM?
joint dislocation
joint subluxation
unstable bone fracture
tendon/ligament rupture
infectious or acute inflammatory response
severe osteoporosis
81
how do you document ROM?
1. joint
2. movement
3. side of body
4. degrees of motion
5. AROM/PROM
6. position (if different than standard)
7. abnormalities (if found)
82
what is the best way to document hypermobility?
best if you further clarify that the patient has ____ degrees of hyperextension and ____ amount of flexion to limit confusion, rather than some of the other ways you may see it.
BE CLEAR
83
what is hypermobility?
denotes ROM that is beyond normal values for the tested joint
84
what is hypomobility?
refers to a decrease in the PROM that is substantially less than normal values for age matches norms
85
what are some key points to ROM education and set up for the patient?
providing description of procedure
having necessary tools ready (towel, goni, etc) PREP/PLAN ENVIRONMENT
discuss what patient should expect
provide a rationale for why you need to perform the procedure
always finish with obtaining patient consent
86
what is the common procedure methodology and administration steps to performing ROM on your patient?
1. place the subject in proper testing position
2. stabilize the proximal joint
3. position distal joint segment so that the patient is in a zero starting position
4. slowly take the joint through PROM (assess end feels, quality, visual estimate)
5. return to starting position
6. palpate bony anatomical landmarks
7. align the goniometer
8. read/record starting position
9. remove goniometer
10. stabilize the proximal segment
11. move distal segment through available ROM
12. realign/reread goniometer as needed
87
what is the definition of reliability?
amount of consistency between successive measurements of the same variable, same individual, same conditions
extent to which the measurements are repeatable
88
what is poor reliability indicative of?
the measurement is not dependable
89
should you use a measurement with poor reliability in a clinical decision-making process?
no
90
does goniometry have good/excellent relability?
yes
91
which kind of reliability is greater, intratester or intertester?
intratester
92
when can intertester reliability be higher?
when using the same positions/landmarks/procedures
93
what is a normal variation of ROM difference between testers?
4-5 degrees
94
what is the definition of validity?
the degree to which an instrument measures what it is purported to measurement
"how well does a measurement represent the true value?"
95
what is face validity?
"does the test appear to measure what it is supposed to measure?"
96
what is criterion validity?
comparing to a well-established gold standard
97
what is true biological variation?
differences noted between individuals caused by factors of age, gender, race, medical history, etc.
98
what is temporal variation?
variation in measurement on the same individual at different times, caused by activity level, health status, emotional status, etc.
99
what is measurement error?
variation (difference in measurement) due to testers, measurement instruments, procedural methods, etc.
100
what is the definition of muscle strength? (multiple)
the ability of muscle to develop tension or torque
force generated over a single, unlimited episode against an immovable resistance
the maximal force a muscle or muscle group can generate at a specified or determined velocity
101
why is muscle strength tested?
to determine the capability of muscles to function in movement and their ability to provide stability and support
102
what is the purpose of performing muscle strength assessment in someone with a spinal cord injury?
it can be used to determine the level of the lesion and degree of damage to the cord
103
what can help differentiate between two possible diagnoses in muscle strength assessment?
the pattern of the muscle strength loss
104
what is the testing of strength with use of a constant external resistance?
isotonic muscle strength testing
105
what is isotonic muscle strength testing
the testing of strength with use of a constant external resistance
106
what is the subject's ability to provide resistance through the range of motion at a constant velocity referred to as?
isokinetic
107
why is isokinetic muscle strength testing rarely used?
necessary equipment is very costly
108
what is generating force against an immovable resistance with muscle length remaining at the same throughout the test referred to as?
isometric muscle strength testing
109
what are some common ways/equipment used to assess isometric muscle strength?
MMT
hand-held dynamometer
110
what are the advantages of isometric muscle strength testing?
structure, reproducibility
111
what are the disadvantages of isometric muscle strength testing?
provides information about strength at only one point in ROM
112
what phase in the lifespan do you see a gradual increase in muscle strength?
during childhood and into young adulthood
113
what phase in the lifespan do you see a gradual decline in muscle strength?
from young adulthood (age 20-30) throughout the remainder of the patient's life
114
what happens within the muscle as you begin to see a decline in muscle strength?
decrease in total muscle mass
loss of motor neurons
reduction in the number and size of muscle fibers
115
at what age do you begin to see greater muscle strength in males over females?
9-10 years old
116
do males or females see an earlier decline in muscle strength in the lifespan?
males
117
how did manual muscle testing begin (what condition did the patients have)?
Wilhelmine Wright in 1912 assessed patients with polio, built classifications to distinguish the extent of the condition
118
who introduced the concept of percentages in grading MMT?
henry and florence kendall
119
who published the first comprehensive text on MMT in regard to gravity and gravity-eliminated positions?
lucille daniels and catherine worthingham
120
what are some important things to explain/tell the patient during the education/consent portion of muscle testing?
describe what is being done, tell why it is important
discuss what the patient should expect
show them the tools being used and explain them
explain the importance of exerting maximum effort
use layman/understandable terminiology
ALWAYS FINISH BY ASKING CONSENT
121
what kinds of things should you consider during the preparation and set-up portion of muscle testing?
non-distracting environment
understand that the testing may cause patient discomfort/pain
firm mat/table, small amount of friction of the surface material
ensure table height gives you proper leverage/body mechanics
organize testing to limit patient position changes throughout the assessment
ensure all needed materials are at hand
122
what is the common administration/procedure for manual muscle testing (after prep/consent/etc)?
1. place patient in gravity-resisted position
2. take patient through PROM and return to starting position
3. ask patient to move through their available AROM while proximal joint is stabilized
4. identify correct muscles and palpate appropriately
5. if patient is able to complete ROM against gravity, resistance is applied at designated location
5a if patient is not able to complete ROM against gravity, the patient is repositioned in a gravity-eliminated/gravity-limited position, patient is asked to move through AROM in this position (no resistance applied)
6. appropriate muscle grade is given
123
which segment of the joint should be fixed and which should be moveable during MMT?
proximal segment is fixed, distal is moveable
124
what are some ways to stabilize the proximal segment of the joint during MMT?
patient position
use of firm testing surface
muscle activity by patient
manual fixation by examiner
125
what is resistance in MMT?
the force acting in opposition to a contradicting muscle
126
where is resistance typically applied/strongest in a one-joint muscle?
applied at end of ROM
127
where is resistance typically applied in a two-joint muscle?
applied at mid-range
128
resistance must be applied in MMT/strongest in order to give what MMT grade?
>3
129
what is the break test?
increasing force is applied until the patient's muscle contraction is overcome by the examiner
130
what kind of force should you apply during resisted MMT and how long should you hold?
maximal force, 4-5 seconds
131
in what direction should you apply resistance in MMT?
perpendicular to the primary axis of the body part being tested
132
what does a 0 (zero) represent on the MMT grading scale?
no evidence of visible or palpable contraction
muscle is not connected, no attachment/contraction
133
what does a 1 (trace) represent on the MMT grading scale?
slight contraction, but no motion
can palpate muscle activation
134
what does a 2 (poor) represent on the MMT grading scale?
movement through complete test range in a gravity-eliminated position
can move through ROM
135
what does a 3 (fair) represent on the MMT grading scale?
movement through complete test range against gravity
can move through ROM, gravity applied
136
what does a 4 (good) represent on the MMT grading scale?
movement through complete test range against gravity and able to hold against moderate resistance
can move through ROM, can withstand some resistance
137
what does a 5 (normal) represent on the MMT grading scale?
movement through complete test range against gravity and able to hold against maximum resistance
138
what does a 2- represent on the MMT grading scale?
movement through partial test range in a gravity eliminated position
139
what does a 2+ represent on the MMT grading scale?
movement through complete test range in a gravity eliminated position, through up to 1/2 of test range against gravity
140
what does a 3- represent on the MMT grading scale?
movement through complete test range in gravity eliminated position and through >1/2 test range against gravity
141
what does a 3+ represent on the MMT grading scale?
movement through complete test range against gravity and able to hold minimal resistance
142
can you give someone with a hard block 160 degrees of shoulder flexion a grade above a 3?
clinically, yes. you just need to be sure that you document that they fulfilled their full capable ROM to 160 degrees
143
in diagnosing, what is the most important MMT grading difference?
between 0 to 1, because 0 means there is no muscle activation at all, and 1 means it is at least present and can be strengthened
144
what is the definition of a substitution in MMT?
results from one or more muscles attempting to compensate for the lack of strength in another muscle of group of muscles
145
what is the presence of a substitution a good indicator of?
muscle weakness in target muscle
may indicate inadequate stabilization
may even occur as a result of poor instruction given to patient
146
how are fusiform muscle fibers arranged?
parallel to the line from origin to insertion
147
why is tendonitis so common in full muscle groups of fusiform muscles?
during overuse, it affects the entire muscle since fibers extend from origin to insertion
148
how are pennate muscle fibers arranged?
obliquely into the tendon/tendons that extend the length of the muscle on one side (unipennate) of through the belly of the muscle (bipennate)
149
how are fan-shaped muscle fibers arranged?
side by side to form a fan-shaped unit
150
what is active muscle insufficiency?
when a prime mover (agonist) becomes shortened to the point it cannot generate or maintain active tension
occurs in two joint muscles
151
what is passive muscle insufficiency?
not enough length from the opposing side for the muscle to go through the full ROM
152
muscles with fewer fasciculi have greater _______ but less ______
ROM, power
153
muscles with a larger number of fasciculi have less _______ but greater _________
ROM, power
154
what questions do you ask to determine the selection of appropriate testing tools?
is it appropriate for the patient's strength? (MMT/functional best if weakness is present, HHD/isokinetic best is strength is good or above)
is it age appropriate? (assess functional ability/strength in patients younger than 3-4 years)
what is available?
when more than one option is available, which provides the most quantifiable data?
155
when would you want to use a functional muscle testing (isotonic)?
good strength or above
inability to follow commands
tests multiple muscles and joints at once
156
when would you want to use manual muscle testing (isometric)?
when able to provide a pain free contraction
gravity eliminated - lack of full ROM against gravity
gravity dependent - full ROM against gravity
157
when would you want to use resisted muscle testing (isometric)?
done when muscle is painful to contract (not graded)
strong/weak
pain free/painful
muscle screening vs manual muscle testing
158
what is the main difference between strength screening and testing?
no grade is assigned for screening due to lack of positioning and adherence of grading criteria, positioning is much more specific in test (gravity eliminated/gravity dependent)
159
what kinds of patient influences can be presented during testing?
patient effort
pain threshold, reaction to discomfort
comprehension of instruction
available motor skills
attitude and depression
cultural, social, gender influences
160
what is the definition of palpation per the medical encyclopedia?
method of feeling with the hands during a physical examination
161
what are the goals of palpation?
identify target structure
assess target structure
162
how would a therapist educate their patient prior to palpation?
staying professional
providing a description of the procedure
discussing what the patient should expect
providing a rationale behind the procedure
asking permission from the patient
163
how do therapists set up palpation procedures? what are the benefits of this?
draping patient appropriately
- preserves patient modesty that allows for proper evaluation while maintaining client-clinician boundaries
164
what surface or fingers of the hands have the greatest discriminatory ability?
palmar surface
fingertips of index and middle finger
165
what is important for the clinician to understand when palpating a specific landmark?
muscle attachments
actions of the muscles
bony landmarks in the region
166
how does a clinician approach palpation administration?
they will go from bony to soft tissue and go superficial to deep
167
what is the grasping technique?
either using the entire hand to "cup" an object or using the thumb and index finger to "pinch" an object
168
if one is assessing a gross region or landmark, it would be best to use a ___________ contact surface
large contact surface
ie - entire palm
169
what is "rate" in concern to palpation application?
the quick assessment of a large area by scanning / stroking of the hands
170
when is a static rate used in palpation?
when palpating a moving phenomenon like pulse or respiration
171
how does a clinician balance the duration of necessary palpation?
he/she does not want to be hurried or abrupt with contact, while also not prolonging at a location for more than a few seconds
172
if a clinician palpates for a prolonged duration, they run the risk of _________
altering client's tissue
173
in regards to pressure of palpation, how do superficial and deep structures differ?
superficial structures require less pressure whereas deep structures require more pressure
174
what is a general rule of thumb when regarding pressure of palpation?
use the minimum amount of pressure required
175
what is the benefit of applying firm pressure?
expresses knowledge and confidence to the patient
176
if palpation pressure is too hard, the clinician runs the risk of
causing patient discomfort and not accurately assessing the condition
177
in what instances would perpendicular application of pressure be necessary
pitting edema
palpating pulse
measuring the sensitivity of a trigger point
178
in what instances would parallel application of pressure be necessary
to create a drag / shear force
assessment of difference in tissues
179
when documenting palpation, a clinician would want to document the
Location/Tissue
texture (abnormal vs normal)
temperature
patient's response
180
when documenting the patient's response, the clinician would want to make note of the
skin discoloration
any pain
change of muscle tension (twitching, spasm, relaxation)
181
what are the steps of clinical reasoning for palpation?
selection
administration
interpretation
182
how does selection and administration of palpation techniques coincide?
knowing the structure and appropriate technique for palpation allows for a better understanding of the rate, duration and direction that one should palpate with
183
what body systems is the clinician interpreting during palpation?
musculoskeletal
cardiovascular
integumentary
neuromuscular
184
how is/what parts of the musculoskeletal system are assessed in palpation?
pain
muscle tension changes
tendon insertions
ligaments
185
how is the cardiovascular system assessed during palpation
pulses
edema
capillary refil
186
how does assessment of pulse and edema differ?
in pulse assessment never use thumb
in edema assessment always use thumb
187
how is the integumentary system assessed during palpation?
temperature (dorsal aspect of hand)
skin turgor (lift/pinch test)
188
how is the neuromuscular system assessed during palpation?
sympathetic changes such as sweating, cold or clammy skin
muscle tone (hyper vs hypotonia)
189
what bony landmarks are in the face?
temporomandibular joint
angle of jaw
189
what bony landmarks are in the anterior portion of the shoulder/thorax?
clavicle
glenohumeral joint
manubrium / sternum
coracoid process
190
what bony landmarks are in the anterior portion of the arm?
lateral / medial epicondyle of humerus
head of radius
191
what are the bony landmarks of the anterior portion of the wrist?
scaphoid bone
pisiform bone
192
what are the bony landmarks of the posterior head and neck?
occiput
vertebra prominens (CV7)
193
what are the bony landmarks of the back?
scapula - spine, lateral and vertebral border, inferior angle
spinous processes / transverse processes of thoracic vertebra
194
what are the bony landmarks of the posterior arm
styloid process of ulna / radius
metacarpal heads
195
what are the bony landmarks of the anterior portion of lower extremities?
illiac crest
asis
greater trochanter of femur
medial / lateral femoral epicondyle
patella
tibial tuberosity
medial / lateral malleolus
196
what are the bony landmarks of the posterior lower extremities?
PSIS
Sacrum
Ischial tuberosity
fibular head
calcaneus
197
what is the common term for edema?
swelling
198
what is vascular permeability?
ability of blood vessels to move fluid in and out
199
what is hydrostatic pressure? if it is higher than osmotic pressure what happens?
pressure within a blood vessel
higher - fluid travels out into tissue
200
why would having high hydrostatic pressure be good in certain instances?
during injury, an increased hydrostatic pressure allows for fluid / cells to cycle in and out for repair
201
what is osmotic pressure? what happens if osmotic pressure is higher than hydrostatic?
pressure of fluid in the tissue
fluid travels from tissue into the blood vessel
202
what is a characteristic of normal tissue?
osmotic and hydrostatic pressure are equal
203
when there is tissue injury and swelling, there is __________, ___________, and _______________
damage to capillary wall
arterial vasodilaton
increased vascular permeability
204
if capillaries are damaged, is there a(n) increase or decrease in permeability factor?
a decrease
205
can permeability return to normal levels if the capillaries are damaged?
no, capillary wall must heal before permeability can return to normal
206
what is a "pitting" assessment?
test to assess the time it takes for an indention in the skin to rebound to original position?
207
what are the grades to the pitting assessment? what depth and time is associated with each?
1 - 2 mm - immediate rebound
2 - 3 to 4 mm - <15 seconds
3 - 5 to 6 mm - 10 to 30 seconds
4 - 8 mm - > 20 seconds
(grade - depth - rebound time)
208
if it takes longer to rebound what does that generally mean about the fluid in the interstitial space? what about if you have to press deeper?
Longer – thicker fluid
Deeper – more fluid
209
what options are there for measuring edema?
circumferential measurement
figure 8 measurement
volumetric displacement
210
what do you want to avoid when doing circumferential / figure 8 measurements?
tightening tape measure on the skin, can cause fluid to move from area of measurement resulting in a less accurate measurement
211
what is a pro associated with figure 8 measurements?
better for global swelling in larger regions
212
what areas are figure 8 measurements most common in?
wrist / hand
foot / ankle
213
what are the landmarks typically used for figure 8 measurements in the foot/ankle?
lateral and medial malleolus
navicular bone and 5th metatarsal
214
what are the landmarks typically used for figure 8 measurements in the wrist/hand?
ulnar and radial styloid process
2nd and 5th metacarpals
215
what is the average difference between dominant and nondominant sides during volumetric displacement?
10 mL
216
what milliliter difference is indicative of swelling?
30-50 mL
217
how is edema documented?
side of the body
subjective rating (temp,color, size)
objective rating (pitting grade)
measurements (fig 8, circumferential, vol displacement)
218
