Exam 1 Flashcards
(139 cards)
1
Q
Indication of mechanical ventilation
A
acute respiratory failure, protection of airway, relief of upper airway obstruction, and Improvement of pulmonary toilet in patients with excessive secretions or inability to clear secretions by coughing
2
Q
Lines of an EKG monitor in order from top down
A
HR BP arterial line blood pressure central venous catheter O2 sat
3
Q
Types of artificial airways
A
tracheostomy, endotracheal tube (both oral and nasal)
4
Q
Types of ventilatory support
A
hand controlled ventilation (bag) and mechanical ventilators (ICU ventilator and PAP ventilators)
5
Q
Type of artificial airway used for someone who needs help breathing for a longer period of time (longer than a week)
A
tracheostomy
6
Q
What are 3 things you need to do with a trach tube
A
Make sure to secure straps around the neck.
Make sure inner cannula is locked in place.
Make sure the cuff is fully deflated before placing a passy muir valve.
7
Q
Airway pressure at the end of expiration that forces alveoli open and maintains greater lung volume.
A
PEEP (Positive End-Expiratory Pressure)
8
Q
If PEEP is greater than ___ then typically you won’t see the pt
A
10
9
Q
Each spontaneous respiratory effort generated by patient, machine delivers pre-set tidal volume
A
CMV (controlled mechanical ventilation)
10
Q
Pressure support is to be added to augment patients tidal volume
A
CPAP (continuous positive airway pressure)
11
Q
Patient is able to breath spontaneously between ventilator breaths
On each spontaneous breath, patient will receive as much volume as he can generate
A
SIMV – Synchronized Intermittent Mandatory Ventilation
12
Q
Applies to spontaneous breaths only
Once pt triggers vent, pre-set positive pressure is delivered
A
PSV – Pressure Support Ventilation
13
Q
What activity restrictions are there for a patient with an arterial sheath
A
strict bedrest (while catheter is in place and for several hours after sheath is removed). No ROM!
14
Q
what should you do if an arterial line becomes dislodged
A
apply pressure with sterile gauze immediately and alert the RN.
15
Q
catheter that runs directly to the heart to measure cardiac output
A
Pulmonary Artery Catheter aka Swan-Ganz
16
Q
What activity restrictions are there for a patient with a Swan Ganz catheter
A
Patients with a PA catheter are usually not candidates for mobilization because of the risks
Avoid full ROM and therapeutic exercise to the ipsilateral shoulder
You CAN manually move the scapula or passively move them
17
Q
feeding tube that is interested through a surgical opening through the skin into the stomach through abdominal wall
A
G Tube
18
Q
type of G tube where tube is placed endoscopically under local anesthesia using the PEG method
A
PEG Tube
19
Q
feeding tube that goes directly into the jejunum
A
J Tube
20
Q
catheter tube inserted through mouth down esophagus to stomach, usually positioned just past stomach with weighted tip in duodenum
A
Dobhoff Feeding Tube
21
Q
temporary small thin tube inserted through nose, throat and down into stomach – held in place with tape. Don’t push it back down if it becomes dislodged
A
NG Tube
22
Q
tube inserted through the mouth into stomach usually used for patients with poor gastrointestinal function
A
OG Tube
23
Q
tube inserted via patients nasopharynx and esophagus with distal tip in stomach or duodenum
A
Nasoenteric Feeding Tube
24
Q
Are you allowed to see a patient receiving dialysis on the same day
A
NO!
25
long term. Tunneled catheter that goes into the arteries
dialysis catheter
26
Restrictions for pacemakers that are placed via the jugular or subclavian vein
No ROM assessment or therapeutic exercise to the involved shoulder
If cleared for mobilization, use caution avoid dislodging the wires
Have the RN reinforce the dressing over the wires
Keep the temporary pacing box in a safe location close to the patient
27
Restrictions for pacemakers that are placed via the femoral vein
Strict bedrest while the pacemaker is in place.
| No ROM assessment or therapeutic exercise to the involved hip.
28
Restrictions for epicardial pacer
No UE ROM restrictions as the wires are transthoracic
When epicardial pacing wires are removed through skin: Typically on bedrest for 1-2 hours before being able to do OT(check post procedure orders or check with MD/RN)
29
catheter that measures the pressure inside the head
ventriculostomy catheter
30
What types of activities would you want to avoid with a patient who has a ventriculostomy catheter
Laying flat supine and trendelenburg (head down, feet up)
Valsalva maneuver (forcing exhalation against closed airway i.e. plugging nose)
Isometric exercises (due to holding breath)
Coughing (stop movement)
Pain
Agitation
31
what is the usual positioning of someone with a ventriculostomy catheter
bed rest with head of bed locked at ~30 degrees
32
Device that increases cardiac output and coronary blood flow
IABP: intra-aortic balloon pump
33
With an IABP inserted via femoral artery, what are the restrictions
Strict bedrest
| Do not flex the involved hip
34
With an IABP inserted via subclavian artery
Able to mobilize with caution
Requires a perfusionist (the person who runs the heart/lung machine during cardiothoracic surgery) with you at all times.
No ROM/exercises of ipsilateral shoulder
35
Therapeutic Intensity in the ICU
Therapeutic Intensity
15 to 30 minute sessions
1-2 X day
3-5 X a week
36
What are the goals of OT in an acute setting
Prevent secondary complications
Improve functional mobility
Prevent falls & improve balance
Improve sensorimotor function & facilitate return of movement
Promote cognitive & perceptual performance needed for basic functional activities
Improve or relearn BADL skills through remedial or compensatory techniques
Recognize affective issues (depression) institute coping strategies; make referrals
Promote participation in valued occupation & leisure
Recognize client & family as integral components of intervention process
Promote interdisciplinary collaboration & d/c planning
37
Therapeutic intensity in a rehabilitation and skilled care environment
```
Therapeutic Intensity
30 to 90 minute sessions
1-2 X day
5-7 X a week
Average LOS ~ 10 to 35 days
```
38
Goals of OT in Rehab Environments
Promote independence in areas of occupation
Prevent secondary complications
Improve functional mobility
Prevent falls & improve balance
Improve sensorimotor function & facilitate return of movement
Promote cognitive & perceptual performance needed for basic functional activities
Dysphagia management
Recognize affective issues & institute coping strategies; make referrals
Recognize client & family as integral components of intervention process
Patient/support system education
Interdisciplinary collaboration & d/c planning
Facilitate patient directing their own care
Prepare for next stage of recovery
39
Therapeutic Intensity in the Community Setting
30 to 90 minute sessions
| 1-2 X a week
40
Potential barriers to engaging in occupation and social participation
```
Falls
Lack of access to community mobility
Environmental distractions
Socio-economic limitations
Personal biases (
Home accessibility issues
```
41
Goals of OT in community environments
Explore more fully independence in areas of occupational performance
Prevent secondary complications & manage the effects of secondary complications
Improve functional mobility
Prevent falls & improve balance
Improve sensorimotor function & facilitate return of movement
Promote cognitive & perceptual performance needed for basic functional activities
Dysphagia management
Recognize affective issues & institute coping strategies; make referrals
Patient/support system/community education
Facilitate patient directing their own care
Environmental modifications
Address barriers
42
Symptoms of low Hgb and/or low HCT include
weakness, fatigue, tachycardia, dyspnea on exertion, decreased activity tolerance
43
Therapy considerations for low platelet count
Use soft bristle toothbrush only
Avoid flossing
Use an electric razor for shaving
Don’t allow pt. to blow their nose, only wipe
44
Useful screening tool for renal disease and diabetes
| Measures electrolyte levels, acid-base balance, renal function and blood sugar levels
BMP: Basic Metabolic Panel
45
If you mobilize a patient whose vital signs fall outside of the “normal” parameters, treatment should be terminated if any of the following symptoms are observed:
Numbness or tingling in any body part.
Dizziness not resolved within 60 seconds of obtaining upright.
Nausea
Blurred vision
Dilated pupils
change in patient’s heart rate of 30 bpm over baseline.
A change in the patient’s systolic blood pressure of 30 mmHg or a change in the diastolic blood pressure of 10 mmHg.
Anginal pain
Shortness of breath
46
Complaints specific to neurology
pain, headaches, vertigo, and nausea/vomiting
47
Types of questions you ask about pain
location, quality, severity, duration, precipitating factors, associated symptoms, exasperation/diminished pain, onset
48
Sensation of moving around in space or objects moving around them
vertigo
49
associated symptoms of vertigo
nausea, light-headed, off-balance
50
What do you asses for cerebral function
```
Mental status
Intellectual function
Thought content
Emotional status
Perception
Motor ability
Language ability
```
51
Level of consciousness
| Rostral-caudal Progression
mental status
52
Open eyes spontaneously
Responds appropriately, briskly
Oriented
alert
53
Opens eyes to verbal stimuli
Slow to respond, but appropriate
Short attention span
Obtunded (sleepy, mentally dulled from some sort of head trauma)
lethargic
54
Responds to stimuli (usually physical) with moans and groans
Never fully awake
Confused
Conversation unclear
stupor
55
Responds to painful stimuli
No conversation
Protective reflexes present
semi-comatose
56
Unresponsive EXCEPT to severe pain
Protective reflexes absent
Pupils fixed
No voluntary movement
Coma
57
No cognitive brain function
Wake sleep cycles
Very poor prognosis (if in state > 3-6 months)
persistent vegetative state
58
Types of stimulus for coma
```
Voice
Touch
Shaking
Voice + Shaking
Noxious/painful stimuli
(Rubbing on sternum w/knuckles
Pen on nailbed )
```
59
No brain function
| Only reflexive movements
brain dead
60
Types of nature of response
Eye opens
Remove stimuli
Abnormal posturing
No response
61
Glasgow Coma Scale GCS
```
Eye Opening
Spontaneous – 4
To speech – 3
To pain – 2
Nil – 1
```
```
Best Motor Response
Obeys -6
Localizes – 5
Withdraws – 4
Abnormal flexion – 3
Extension response – 2
Nil - 1
```
```
Verbal response
Oriented – 5
Confused conversation – 4
Inappropriate words – 3
Incomprehensible sounds – 2
Nil - 1
```
A strong predictor of outcome
13: mild brain injury
9-12: Moderate brain injury
< 8: Severe brain injury (coma)
62
General Appearance Evaluation
```
How do they look?
Grooming
Dress
Aids
Eye deviation
Skin integrity
```
63
Bruising over the Mastoid, behind ear.
| Suggests skull fracture
Battle sign
64
Periorbital edema and bruising
Suggests frontal- basal fracture
Can affect vision
Raccoon's eyes
65
Drainage of CSF from the nose
| Suggests Fracture of the cribiform with torn meninges
Rhinorrhea
66
Drainage of CSF from the ear
Suggests:
Fracture of the temporal bone with torn meninges
Otorrhea
67
```
Flexed Posturing
Flexed arm/elbow
Flexed wrists/fingers
Adducted arms
Legs with internal rotation
Foot: Plantar flexed
Suggests
Damage to the cortico-spinal tract
```
decorticate posture
68
```
Extension posturing
Extended arm/elbow
Flexed wrist/fingers
Adducted arm
Pronation of arm
Foot: Plantar flexed
Suggests
severe injury to the brain at the level of the brainstem
```
Decerebrate posture
69
severe muscle spasm of the neck and back
| More ominous posture: extension posturing back with arched back and extended neck
opisthotonos
70
when we look at someone bottom up we measure ____
component skills
71
when we look at someone top down we look at _____
performance in task
72
Where should you gather data for an evaluation
Medical Record / Chart Review
Observation of client including with family, staff, other clients
Interviews with client and family
Quantitative Assessment
73
occupation based evaluations
Doing performance tasks
| FIM
74
Critical Evaluations
```
Sensation
Head and neck ROM
Upper Extremity ROM
Head and UE motor control
Wrist and hand function
Trunk Control
Deformity control
Activities of daily living (FIM scoring)
```
75
Assess ability to tolerate activity in following positions:
Bed
Sitting edge of bed
Sitting in chair
Standing
76
Evaluate disturbances in what 3 areas
Thinking
Memory
Personality
77
Evaluation of psychosocial elements
```
Client’s understanding of the situation
Coping skills available
Problem solving skills
Ability to direct others
Family involvement
Discharge plans/options
Motivation/Participation in goal setting
```
78
ability to regulate and direct the mechanisms essential to movement
motor control
79
Damage to any of these areas will impact motor movement
Cerebral cortex: motor, visual, auditory, cognition, intellect
Basal ganglia: coordination, tone, equilibrium
Cerebellum: coordinated movements
Brain stem (midbrain, pons, medulla): righting reactions
80
what do we look at in persons with CNS insults when trying to evaluate how well movement is regulated and directed
selective movements
tone
postural control and mechanisms (balance, reflexes)
coordination
81
resistance of a muscle to passive elongation or stretching
tone
82
characteristics of normal tone
Effective co activation of axial and proximal joints
Ability to move against gravity and resistance
Can maintain position of limb passively placed and released
Balanced agonist and antagonist muscle tone
Ease of shifting from stability to mobility & vice-versa
Ability to use muscles in groups or separately
Resilience or slight resistance in response to passive movement
83
Muscle Tone Continuum
```
(high tone to low tone)
Rigidity
Spasticity
Normal
Hypotonia
Flaccidity
```
84
Complete loss of muscle tone
flaccidity
85
Reduction in muscles stiffness
| Characterized by low tone, weak neck & trunk control, poor muscular co-contraction, limited stability
hypotonia
86
Hypertonicity
spasticity
87
Hypertonicity with heightened resistance to passive movement
rigidity
88
what type of activity can stop clonus
weight bearing
89
uncontrolled oscillations in spastic muscle groups
| repetitive contractions in the antagonistic muscles in response to rapid stretch
clonus
90
jerky resistance
cogwheel rigidity
91
severe rigidity – sustained stretch will relax muscle group & give way (like when you’re returning the blade on a pocket knife)
clasp knife syndrome
92
What is tone like following an insult
Typically, flaccid first 48 hours
Followed by increasing resistance to PROM
Spasticity pronounced in UE flexor muscles and LE extensors
Treatment: encourage voluntary movement, ROM, meds, splinting (elbow, resting hand)
Normalize tone
93
Ability to maintain a steady position in weight bearing, antigravity posture
postural control
94
What is postural control influenced by
Neuromuscular mechanisms—postural alignment, muscle tone & postural tone
Musculoskeletal mechanisms e.g. ROM, strength
Sensory mechanisms-vision, vestibular, somatosensory
Perceptual mechanisms e.g. body image, laterality
Cognitive mechanism e.g. attention, judgement
95
Automatic movements: provide an appropriate level of stability & mobility
normal postural control
96
Controlling the center of mass (COM) in relation to the base of support (BOS). Maintaining an appropriate relationship between body segments and between the body, the environment and task—orientation
balance
97
first response against falling or first line of defense
equilibrium reactions
98
ability to produce accurate, controlled movement
coordination
99
Coordination problems
```
Synergy
(Abnormal or disordered motor control)
Coactivation
(Agonist & antagonist muscles both fire, preventing functional movement (extremity will lock out))
Timing problems
```
100
accuracy without making corrective movements
precisision
101
quality of movement
smoothness
102
what is incoordination caused by
trauma to muscles or peripheral nerve diseases
103
lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye
dysmetria
104
inability to perform rapid alternating movements
ataxia
105
involuntary quick movements of the feet or hands are comparable to dancing
chorea
106
slow, involuntary, convoluted, writhing movements of the fingers, hands, toes, and feet and in some cases, arms, legs, neck and tongue
athetoid movements
107
uncontrolled sustained muscle contraction
dystonia
108
violent flinging of extremities
ballism
109
Secondary effect factors that may impair purposeful coordinated movement
```
Contractures
Pain
Edema
Subluxation
Decreased endurance—muscular and cardiovascular
```
110
The study of the acquisition and/or modification of movement
A set of processes associated with practice and experience that leads to permanent change in behavior or capacity to respond
motor learning
111
therapeutic intervention structure
instruction, feedback, opportunities for practice, encouragement/ feedback
112
temporary change that occurs when performer is provided with solutions to problems
training
113
relatively permanent change in capability for responding that occurs as a result of practice or experience
learning
114
most potent factors that influence motor learning
feedback and practice
115
stages of motor learning
cognitive, associate, autonomous
116
stage of motor learning where Info gathered about task demands (learn elements)
Movement slow with lots of errors
Explanations & demonstrations valuable
cognitive
117
stage of motor learning where Distinguish between correct performance and error
Attention to finer details
associative
118
stage of motor learning where Skill automatic, does not require attention
Performance is stable
autonomous
119
feedback offered during movement
concurrent
120
feedback offered offered at the end of movement
terminal
121
feedback from individual’s sensory systems as a result of movement
intrinsic
122
feedback from the environment (e.g. therapist or a device)
extrinsic
123
knowledge of what the movement produces (outcome) in terms of achieving goal or result
knowledge of results
124
knowledge about the movement pattern or process used during task performance
knowledge of performance
125
effort to become proficient
practice
126
types of practice
Physical: direct experience of them doing it
Mental: motor imagery
127
practice condition where practice time is greater than amount of time between trails (fatigue)
massed
128
two practice conditions that focus on building endurance
massed and distributed
129
practice condition where rest time between trials equals or is greater than time in trial
distributed
130
practice condition where performance of task in same way (may improve performance but fatiguing, less effect)
constant
131
practice condition where perform task in different way by varying characteristics of the task (improves ability to generalize to various situations)
variable
132
practice condition where practicing each task in a block before progressing to a new task (better for cog. impair)
blocked
133
practice condition where you're practicing a series of tasks in a random order
random
134
practicing a subset of task component (maybe they don’t have endurance or get frustrated)
part practice
135
what type of feedback and practice should you give for acquisition (learning new skill)
Feedback: frequent extrinsic, concurrent
Practice: physical & mental, repetition, consistency
Provide manual & verbal cueing
136
what type of feedback and practice should you give for retention and transfer (such as getting ready to go home)
Feedback: less frequent, terminal
Practice: promote entire pattern, encourage problem solving, variable
Allow for error & refinement; don’t over cue
137
Therapeutic considerations for motor learning
```
Therapeutic Environment
(TV’s, family members, lighting, yourself)
Arousal and Attention
(Inquire about their day, sleep schedule, etc.)
Motivation and Meaning
Instruction
(Prepping them ahead of time. Game plan)
Feedback
Practice
```
138
process therapists use to facilitate learning
```
Therapeutic intervention:
Select tasks/activities to use during session
Provide instruction
Provided feedback about performance
Always leave on a positive note
Structure opportunities for practice
Provide encouragement
```
139
treatment assumptions
Return is cephalo-caudal & proximal-distal & medial-lateral
Mobility established 1st, then proximal stability, then controlled mobility, & finally distal skilled movement
Mass patterns replaced by selective voluntary movement
Gross to fine
Large mass movements before discrete
Undifferentiated to specific
