Exam 1 Flashcards
1
Q
Interview Questions
A
- open ended
- neutral questions
- therapist responses (follow up, eye contact)
2
Q
Content of Initial Exam
A
- demographics
- employment and work history
- social history
- growth and development
- living environment
- family history
- medical history
- surgical history
- general health status
3
Q
Objectives of Interviewing Patient
A
- assists in formulating a working hypothesis
- gives clinical signs/symptoms
- assists with making examination plan
- helps with setting goals
- *clinical decision on KEEP, REFER, CONSULT
4
Q
Patient Specific Functional Scale
A
- patient names 5 activities that they have trouble with and rate their functional limit from 0 (unable to do at all) to 10 (able to do same as injury/issue)
- minimal detectable change = 2 points
5
Q
Sudden vs. Gradual onset
A
- sudden = 24-48 hours after traumatic event (often musculoskeletal injury)
- gradual = don’t know much mechanism of injury
6
Q
Musculoskeletal vs. Systemic pain
A
- musculoskeletal = generally gets better over time, pain intensity lessens
- systemic = stays same or increases over time
7
Q
Nerve Pain descriptors
A
- sharp, burning, shooting pain, pins & needles, numbness
8
Q
Bone Pain descriptors
A
- aching, deep, boring, stiffness
9
Q
Vascular Pain descriptors
A
- throbbing, pulsating
10
Q
Muscle Pain descriptors
A
- soreness, stiffness, twinges with active movement or passive stretch
- ligament painful when something put across it, giving it tension, not when in movement/stretch
11
Q
Musculoskeletal Pain
A
- lessens at night generally
- sharp or superficial ache
- decreases when activity stopped
- can be continuous or intermittent
- aggravated by mechanical stress
- no associated constitutional signs/symptoms
12
Q
Systemic Pain
A
- usually disturbs sleep
- deep aching/throbbing
- reduced by pressure
- constant or waves of pain/spasm
- not aggravated by mechanical stress
- associated constitutional signs/symptoms
13
Q
Review of Systems
A
- QUESTIONS asked in the history interview to determine if the cause of the patients pain is within scope of PT practice
14
Q
4 systems
A
- integument
- musculoskeletal
- neuromuscular
- cardiorespiratory
15
Q
Systems Review
A
- PHYSICAL test of measures taken
- taking vitals, resp, pulse, etc
16
Q
Red Flags with patient symptoms
A
- fevers, chills, night sweats
- nausea, vomitting
- shortness of breath, malaise, fatigue
- weight changes
- bowel/bladder dysfunction
- paresis or parasenthia
- insidious onset of pain
- multiple levels of neurological symptoms
- pain at night
- increase in pain intensity over time
17
Q
Advantages vs. Disadvantages of Electronic Documentation
A
- Advantages = don’t have to write out or dictate so much info, & uniform data base
- Disadvantages = someone else may have computer, may not have all the boxes exactly as you want
18
Q
Writing Tips for Documentation
A
- SOAP = subjective, objective, assessment, plan
- be specific
- use objective statements
- write complete sentences
- write eligibly
- only use standardized abbreviations
- no empty or open lines between entries or within entry
19
Q
Advantages vs. Disadvantages of Written documentation
A
- Advantages = can be done right with patient
- Disadvantages = time consuming, and send the info out to be typed…takes time to come back and must be reviewed
20
Q
Clinical Reasoning
A
- cognitive process/thinking process used in the eval and management of a patient
- involves interaction of individuals in collaborative exchange to achieve mutual understanding of problem
- involves inductive, deductive, and abductive reasoning
- is complex, non-linear, and cyclical in nature
21
Q
Inductive reasoning
A
- broad generalization from specific observation
- pattern recognition
- allows for false conclusion
- used to form hypothesis or therory
- *SPECIFIC TO BROAD
22
Q
Deductive reasoning
A
- general statement or hypothesis
- examines possibilities to reach specific/logical conclusion
- testing of hypothesis and thesis
- to be sound, hypothesis must be correct
- *BROAD TO SPECIFIC
23
Q
Abductive reasoning
A
- incomplete set of observations and proceeds to the likeliest possible explanation for the group of observation
- making and testing hypotheses using the best info available
- educated guess after observing something for which there is no clear explanation
- used by medical personnels (PT, physicians)
- diagnosis based on test results
24
Q
Expert Learners
A
- know great deal about a domain and understand how discipline is organized
- ability to comprehend and contribute to methodology
- performance is intuitive and automatice
- understands critical aspects of given situations
- uses abilities to build broad base/organized system
- recognize patterns of info
25
Novice Learners
- limited or no experience in their domain
- understanding based largely on rules
- rely on faces and features of domain to guide behavior
- inflexible and limited performance
- don't organize growing knowledge / don't categorize info acquired into meaningful units
- biomedical knowledge
- hypothetico-deductive reasoning
26
Theories on reflection
- knowing in action: knowledge and skills a professional has and uses within given context
- surprise: unexpected or novel problem encountered
- reflection in action: ongoing meta-cognition about what's occurring
- experimentation: arises when solution to a problem is attempted
- reaction on action: look back at what occurred allowing to broaden/change decision-making
27
Clinical Reasoning Strategies
- algorithms
- forward reasoning
- backward reasoning
- interactive reasoning
- conditional reasoning
28
Algorithms
- logical sequence of activities, focused on process - not outcomes
- move from generalized to specifics
- independent of treatment philosophies
29
Forward Reasoning
- tendency to look for, notice, and remember info that fits with pre-existing expectations
- specifics observations and data lead to generalization
- "if, then" pattern recognition
30
Backward Reasoning
- relies on detailed, biomedical concepts for hypothesis development
- inefficient due to demand on clinicians working memory
- used by novice and experts outside their own domain
31
Interactive Reasoning
- interactions between clinicians and their patients
| - working to better understand patient, collaboration, teaching, ethical practice
32
Conditional Reasoning
- "thinking about thinking"
- reflection on own thinking process
- reflection on overall encounter with patient
- critique own reasoning process
33
Errors in Clinical Reasoning
- framing errors
- confirmation bias
- outcome bias
34
Framing Errors
- forming wrong initial concept to problem
- failure to generate plausible hypothesis & inadequate testing of hypothesis
- premature acceptance of hypothesis
- failure to attend to features that are missing
35
Confirmation Bias
- over-emphasis on features which support the "favorite" hypothesis
- tendency to look for, notice, and remember info that fits with pre-existing expectations
36
Outcome Bias
- over-reliance on outcome information to indicate the accuracy or quality of the clinical reasoning that occurred when the interventions were chosen
- good outcome = good clinical reasoning (don't think it is due to anything other than what you've done)
37
Ways to overcome errors
- develop an awareness of cognitive processes or reasoning used to come to clinical decisions
- understand common clinical reasoning errors
- always include in exam Qs, physical screening and tests and measures that would disprove your hypothesis
- try to understand why your reasoning might be wrong
- don't jump to pattern recognition too soon
38
Body Mechanics
- using all body parts efficiently to safely lift and move
39
Body Alignments
- correct positioning of head, back, limbs
40
Base of Support
- area on which an object rests, and provides support for the object
41
Center of Gravity
- mass of a body or object is centered
42
8 Rules for good body mechanics
```
1- have broad base of support
2- bend from hips and knees to get close
3- use strongest muscles to do job
4- use weight of body to help push/pull object
5- carry heavy objects close to body
6- avoid twisting of body as work
7- avoid bending for long periods of time
8- get help with mechanical lifts
```
43
Ergonomics
- adapting environment and using techniques to avoid injury
- correct placement of furniture/equipment
- training in required muscle movements
- efforts to avoid repetitive motions
- awareness of environment to prevent injuries
44
Short term positioning
- supine, prone, sidelying, sitting, long-sitting
45
Long term positioning
- SAFETY
- prevent negative effects of mobility
- supine, prone, sidelying, sitting, 3/4 prone, 1/4 supine
46
Checklist before leave patient alone
- is patient safe?
- can they call for help?
- comfort? as long as safe...
47
Supine positioning
- treat cervical, shoulders, anterior thigh or knee, medial knee, anterior ankle
- pillows at head, behind humerus, under knees and ankles
48
Prone Positioning
- treat posterior cervical, upper traps, posterior shoulder, back, buttock region, posterior thigh/knee/ankle/foot
- pillows at head, under stomach/ankles/shoulder
- want head to be straight down - no twisting neck
49
Sidelying Positioning
- treat shoulder, upper traps, back, SI joint, hip, lateral thigh, knee, ankle
- pillows under superior arm, between knees/ankles
- make sure head, trunk, hips aligned
50
Sitting Positioning
- treat neck, upper back, anterior and posterior shoulder, UE
- supported sitting-forward with head supported = arms supported, head straight, pillows in lap at chest...use stool if short legs
- supported sitting-head upright = pillow in lap, behind back, UE supported
51
Fowler's Position
- semi-reclined, patient supine, head of bed 45-60 deg
- common after abdominal surgery
- position of comfort
52
Trendelenburg
- patient supine, head of bed lower than feet
- used during abdominal and gynecolic surgery, hypotensive patients
- used for short-term repositioning and postural drainage of lungs
53
Patient attire for acute setting
- usually only a gown
54
Patient attire for rehab, OP, home
- primarily clothing, may use gowns as needed
55
Vital Signs
- provide critical info regarding patients physiological status
- they measure body's core ability to stay alive
- APTA guidelines = heart rate, BP, respiration temp
- gait speed often an extra one to take into account
56
Sign vs. symptom
- sign = observable, objective measure that can often be quantified by using valid and reliable measures
- symptom = how a person experiences a condition
57
Observable signs of change in physiological status
- changes in mental health, mood, appearance
- slow to respond/react
- fatigue/lethargy/exhaustion
- decrease response to verbal or tactile stimuli
- pupil constriction/loss
58
Pulse Rate
- heart beats per minute
- each time left ventricle heart contracts, pushes blood through aorta and increases blood volume
- helps determine the patients physiological response to activity, especially energy expended
59
Neonates (1-28 days) Normal pulse rate
120-160 beats/min
60
Infants (1-12 month) normal pulse rate
100-120 beats/min
61
children (1-8 yr) normal pulse rate
80-100 beats/min
62
adults normal pulse rate
60-100 beats/min
63
tachycardia
over 100 beats/min
64
bradycardia
less than 60 beats/min
65
Bounding HR
- high pressure on artery walls
- easy to find HR
- (+3)
66
Regular HR
- beats occur repeatedly at fixed intervals
| - (+2)
67
Weak (thready) HR
- low pressure on arteriole walls
- hard to find/keep pulse
- (+1)
68
Pulse amplitude
- pressure being put on arteriole walls
- decreases in pulse amplitude can be indicative of pathological conditions like peripheral vascular disease or thoracic outlet syndrome
69
Pulse Location
- must lie close to surface to palpate
- most common = radial and carotid
- pedal pulse used to screen for intermittent claudication
- others = temporal, carotid, brachial, radial, tibialis posterior
- femoral, popliteal, and dorsal pedal help check flow
- begin counting with first beat
70
Infants pulse location
- children under 1 yr
- use brachial artery at middle of upper arm
- placing ear over infants chest can be quicker
71
Electronic HR monitoring methods
- ECG or EKG
- portable electronic monitors
- doppler sonography
- auscultation = stethoscope or direct listening
- pulse oximeter
- BP monitor
72
Blood Pressure
- force exerted by blood against any unit area of vessel wall
- systolic = ventricular contraction / pushing blood into aorta
- diastolic = ventricular relaxation / filling
- if blood vol decreases, BP decreases
- if vessel size decreases, BP increases
- if elasticity decreases, BP increases
73
Pulse Pressure
- difference between systolic and diastolic
74
Direct measurement of BP
- measured through catheter placed in artery
- arterial line, A-line, Art-line
- used for severely ill patients
75
Indirect measurement of BP
- sphygmomanometer and stethascope
| - electronic device
76
Differences between direct and indirect BP measures
- SBP only has little differences
| - DBP has greater differences between the two measures
77
Korotkoff Sounds
- BP sounds
1) clear, tapping sound, can start faint = SYSTOLIC
2) softer sound & swishing
3) louder and more crisp sound
4) sound changes from distinct to muffled/softens
5) sound stops = DIASTOLIC
78
Neonates (1-28 days) normal resting BP
>60 SBP / highly variable DBP
79
Infants (1-12 month) normal resting BP
70-95 SBP / highly variable DBP
80
Children (1-8 yr) normal resting BP
80-110 SBP / highly variable DBP
81
Adults normal resting BP
90-140 SBP / 60-90 DBP
| --> 120/80 is the # everyone uses
82
Red Flags with BP
- STOP IF
- SBP > 250 (generally stop if over 200)
- DBP > 115 (generally stop if over 100)
- a drop in SBP >10 from baseline
- failure of systolic pressure to increase with an increasing workload
83
BP for those with Diabetes or chronic kidney disease
- keep at 130/80 or LESS
84
Prehypertensive BP
120-139 /or/ 80-89
85
Hypertension Stage 1
140-159 /or/ 90-99
86
Hypertension Stage 2
160+ /or/ 100+
87
Hypertensive crisis = EMERGENCY CARE NEEDED
higher than 180 SBP or higher than 110 DBP
88
Sign/Symptoms of low BP
- dizziness, lightheadedness, fainting
- dehydration or unusual thirst
- lack of concentration
- blurred vision
- nausea
- cold/clammy/pale skin
- rapid/shallow breaths
- fatigue
- depression
89
How high (mmHg) to inflate BP cuff
- 30 above where radial pulse disappears
OR
- 20 above when 1st korotkoff sound disappears
90
How slowly to let air out of BP cuff
- 2-3 mmHg/sec
91
Which arm to use for BP
- left because nearer to aorta
| - but don't use if IV or insertion, abnormally high or low tone, lymphedema
92
BP Cuff Size Generalizations
- 80% arm's circumference (length)
- 40% arm circumference (width)
- smaller cuffs cause greatest error
- length to width ratio = 2:1
93
BP Cuff Sizes for small adult, adult, large adult and adult thigh
- small adult (12X22)
- adult (16X30)
- large adult (16X36)
- adult thigh (16X42)
94
Breathing
- inhale O2 from outside air into body cells
- activation of muscles attached to thorax = inspiration
- relaxation = expiration
95
Ventilation
- moving oxygenated air into smallest tubes of lungs (alveoli)
96
Pulm. gas exchange
- moving O2 from alveoli into pulmonary capillaries
97
Gas transport
- moving gas into blood from capillaries of lungs throughout the body to extremities and organs
98
Peripheral gas exchange
- O2 entering mitochondria and cells of body
99
Assess Respiration
- count for 30 and multiply by 2
100
Neonates (1-28 day) normal respiration rate
40-60 breaths/min
101
Infants (1-12 month) normal respiration rate
25-50 breaths/min
102
Children (1-8 yr) normal respiration rate
15-30 breaths/min
103
Adult normal respiration rate
12-20 breaths/min
104
Dyspnea
difficulty breathing
105
Oxygen Saturation (SpO2)
- % of Hemoglobin saturated with O2
- oxygenated status doesnt reflect patients ability to ventilate or arterial partial pressure of O2
- norm = 97-99% ...95% acceptable with normal Hemoglobin
106
hypoxia
- under 90% SpO2 = hypoxia
- under 85% SpO2 = severe hypoxia
- don't ever push someone under 90%
107
Factors affecting SpO2
- Physical amount
- amount of Hemoglobin
- % of inspired O2
- arterial blood flow
- lung disorders
- temp of finger/digit being measured
- dark nail polish
108
SpO2 equipment
- pulse oximeter: determines O2 saturation level of blood using infrared light
- clip sensor: fingers (minus thumb), earlobe
- "wrap" disposable sensor: fingers (all), great toe, nose
109
Common SpO2 problems
- external light interference
- movement artifacts
- sensory application
- inadequate blood flow
- nail polish
110
Normal Body Temperature
- core temp = 37 deg C (98.6 deg F) as measured rectally
| - varies with individuals (everyone has their specific norm)
111
Places of Temperature measurement
- oral, rectal, tympanic, axillary, skin
112
Oral temp measurement
- smoking has ZERO impact
- R or L post. sublingual pocket for 4 min w/mercenary thermometer
- drink or eat hot or cold 15-20 min before will change outcome
113
Rectal temp measurement
* *tend to be highest and closest to real
- hold for 3 min if using mercenary thermometer
- risk of rectal perforation with nerborns and kids
- about 0.5-0.7 deg F higher than orally
114
Tympanic temp measurement
- ear tug should be done to straighten external auditory canal
- infants, toddlers, geriatrics
115
Axillary temp measurement
* *tend to be lowest and furthest from real
- adduct arm and hold thermometer for 6 min with mercenary
- great variations --> less accurate
- IVs have no impact
- about 0.3-0.4 deg F lower than orally
116
Skin temp measurement
skin on forehead
117
Equipment for temperature measures
- infrared measurements = most cost effective and rapid reading
- glass thermometers should be taken out of use b/c risk breaking and contain mercury
118
Pain
- unpleasant sensory and emotional experience
- is a perception
- primary and secondary somatosensory cortex, posterior multimodal assoc area, and limbic system
119
Pain norms
- normal = no pain present
- usually assessed with 0-10 scale
- very subjective --> don't judge
120
Pain assessment tools
- verbal numeric rating scale (VNRS)
- visual analogue scale (VAS)
- descriptive scale
- thermometer scale
- McGill Pain Questionnaire
121
Verbal Numeric Rating Scale (VNRS)
- pain scale
- ask what number from 0-10
- 0 = no pain
- 10 = severe pain/disabling
- preferred by patients and shows better results than others
* *not interchangeable with VAS
122
Visual Analogue Scale (VAS)
- pain scale
- 10 cm line with one end representing no pain and other end is as bad as pain can get
* *not interchangeable with VNRS
123
McGill Pain Questionnaire
- 20 categories of word descriptors in 3 domains (sensory, affective, evaluative)
- patient asked to select word in any of 20 categories that best describes their pain experience
124
Universal Pain Assessment Tool
- uses the faces (Wong-Baker Facial Grimace Scale)
- behavioral observations
- for adults and kids over 3 yrs
125
Rate of Perceived Exertion (RPE)
- measure of energy expenditure
- tend to correlate with heart rate
- scale goes from 6-20 (6=at rest, 20=working so hard may collapse)
- 6-20 represents 60-200 for heart rate measure
126
Gait Speed
- used more often in elder assessment
- sensitive, specific, reliable, valid
- correlated with functional ability and balance confidence
- predictive of falls, mortality, hospitalization, and location of residence after discharge
- discriminative regarding the potential for rehabilitation
127
Infection Control
the set of methods used to control and prevent the spread of disease
128
Infections
caused by pathogens/germs
129
Communicable disease
disease spread from one person to another
130
Infectious disease
disease caused by a pathogen/germ or bacteria
131
Contaminated
dirty, soiled, unclean
132
Disinfection
cleaning so that pathogens are destroyed
133
Mode of transmission
way germs are passed from one person to another
134
Mucous Membranes
membranes that line the body cavities that open up to outside the body
135
How infection Happens
- requires source of infectious agents, susceptible host, and means of pathogen travel
- bacteria and viruses most frequently encountered by health care workers
- people and objects are most common sources of pathogens
- hand hygiene is single most effective means of interrupting transmission of infection
136
Multidrug-resistant organisms (MDROs)
organisms/bacteria that have developed resistance to 1+ antibiotics
137
Portal of exit for disease
- secretions
- excretions
- openings in skin
138
Direct contact vs. Indirect contact
- Direct contact = person-to-person
| - Indirect contact = person-to-object-to-person
139
Droplet
- large pathogenic particle coming in contact with host's conjunctive mucous membrane (often when coughing, talking, sneezing by medical procedures)
- most droplets travel max of 3 feet
140
Airborne
- small pathogenic particles that remain suspended in the air for longer periods of time
- are inhaled by, or deposited on the host
141
Most common entry portals of disease/pathogens
- mucous membranes and skin openings
142
Susceptible host
- several factors increase susceptibility like existing disease process, weakened immune system, medical interventions, being at either end of life span
143
Sanitizer/Hand rub
- preferred in most clinics
- remove jewelery, cover all surfaces of hands
- rub dry ~15 sec
- don't rinse after
144
Antimicrobial soap and water
- must use if hands visibly dirty or if pathogen known to be C. defficile
- after multiple applications of hand rub/sanitizer
- wash 15-60 sec (60 sec after known contact) using soap and warm water
145
PPE (personal protective equipment)
- gloves, gowns, face masks, goggles, face shield
146
transmission based precautions
- mode of transmission determines PPE and order or donning/doffing
- 3 types: airborne, droplet, contact
147
Contact transmission precautions
- gloves don upon entering room and change as frequently as needed
- gown don upon entering and doff before leaving
- leave patient care equipment in patient's room
148
Droplet transmission precautions
- mask worn when working within 3 feet of patient
- gloves and gown
- patient must wear mask if leaves room
149
Airborne transmission precautions
- mask and maybe N95 respirator
- patient must be placed in negative air flow room and door remain closed
- patient must wear mask if leaves room
150
Isolation and PPE summary
- contact isolation = private room, gown, gloves, no mask needed, minimal transport
- droplet isolation = private room, mask, no gown or gloves needed, mask patient when leave
- Airborne isolation = private and neg airflow room, mask, N95, gloves, no gown needed, mask patient when leave
- Airborne AND contact isolation = private and neg airflow room, mask, N95, gown, gloves and mask patient when leave
151
When to wash hands?
- never enough!
- before and after patient contact, contact with possible contaminants, wounds, dressings, specimens, bed linen and clothing
- before/after bathroom
- after sneezing, coughing, nose blowing or nasal contact
- before donning and after doffing gloves
- before and after eating
152
Soap efficiency (in order good to best)
- good = plain soap
- better = antimicrobial soap
- best = alcohol-based handrub
153
Common hand hygiene errors
- failing to hygiene at appropriate times
- overlooking areas (thumbs, back of hand, etc)
- not taking enough time
- turning faucet off with clean hands
- not allowing hands to completely dry
154
Sequence of Donning
1) gown
2) mask/respirator
3) goggles/face shield
4) gloves
155
Sequence of Duffing
1) gloves
2) face shield/goggles
3) gown
4) mask/respirator
156
Donning Gown
- unfold carefully, holding gown from inside
- one arm goes into gown sleeve
- use other arm to put through sleeve
- verify coverage and then tie straps and waist/neck
157
Doffing Gloves
- using one hand, pinch outside of other glove at wrist and pull off that glove inside out
- carefully keep glove in palm of gloved hand and use fingers of bare hand to slide under cuff of right glove
- pull glove towards fingers, over the already removed glove and pull inside out
- dispose of gloves
158
Asepsis
- absence of microorganisms that produce disease
| - prevention of infection by using a sterile technique
159
Medical (clean) Asepsis
- practices that help reduce the number of microorganisms and reduce the spread
160
Surgical (sterile) type
- practices that render and keep objects and areas free of all microorganisms
161
Decontamination
to remove, inactivate, or destroy blood-borne pathogens on a surface or item to point where they're no longer capable of transmitting infectious particles, and surface is rendered safe for handling, use or disposal
162
Sterilization
used to destroy all forms of microbial life including bacterial spores
- methods: steam under pressure (autoclaved), gas (ethylene oxide), dry heat source, chemical sterilant for 6-10 hrs
163
High level disinfection
destroys all forms of microbial life except high numbers of spores
164
Intermediate level disinfection
destroys most viruses, most fungus, vegetative bacteria and Tb bacterium but not bacterial spores
165
Low level disinfection
destroys most bacteria, some viruses and some fungi but Not Tb and NOT bacterial spores
166
HOAC
hypothesis oriented algorithm for clinicians
| - a logical sequence of activities for patient assessment/diagnostic formulation
167
The BIG FIVE Questions
- cancer
- heart disease
- diabetes
- falls within a year
- hypertension
