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PHTH 507: Foundations of Patient Assessment > Final Exam Prep > Flashcards

Final Exam Prep Flashcards

1
Q

Arousal levels

A

-Coma
-Stupor
-Obtunded
-Lethargic
-Alert
-Hyperalert

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2
Q

What is alert?

A

Patient is awake and attentive to normal levels of stimulation

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3
Q

What is lethargic?

A

Patient is drowsy and may fall asleep without stimulation and has difficulty concentrating and focusing

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4
Q

What is obtunded?

A

Patient is difficult to arouse from a sleeping state and is confused when awake. Interactions with providers are largely unproductive

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5
Q

What is coma?

A

Patient is unable to arouse by any type of stimulation

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6
Q

What is hyperalert?

A

Patient is anxious, sympathetic nervous system in overdrive

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7
Q

Alert and oriented

A
  1. Name
  2. Where they are
  3. The date/day
  4. The “event” a.k.a. why they are there
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8
Q

What are two common formal cognitive screens?

A

-Mini mental state exam (MMSE)
-Montreal Cognitive Assessment (MoCA)

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9
Q

Which formal cognitive assessment takes education level into account?

A

MoCA

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10
Q

What is considered “good” posture?

A

A state of muscular and skeletal balance which protects the supporting structures of the body against injury

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11
Q

What is the plumb line of Kendall?

A

All of these points should be in one line for posture
-Tragus of ear
-Head of humerus
-Lumbar vertebrae
-Greater trochanter of femur
-Anterior to the middle of the knee
-Anterior to lateral malleolus
-Calcaneocuboid joint

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12
Q

What should the joints be during optimal posture?

A

-Not at end range
-Loose pack
-Neutral

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13
Q

What should the muscles be during optimal posture?

A

Balanced!

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14
Q

What muscles are tight and which are weak in upper crossed syndrome?

A

-Tight muscles are upper traps, levator scapula, and pectorals
-Weak muscles are deep neck flexors, rhomboids, and serratus anterior

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15
Q

What muscles are tight and which are weak in lower crossed syndrome?

A

-Tight muscles are erector spinae and iliiopsoas
-Weak muscles are abdominals and gluteus maximus

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16
Q

What defines and influences posture?

A

-Bony structure
-Habits
-Strength
-Mood
-Ranges and limits of muscles, fascia, joints, and neural tissue
-Pain

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17
Q

What is forward head?

A

Increased cervical lordosis

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18
Q

What is rounding of thoracic spine?

A

Increased thoracic kyphosis

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19
Q

What is flat thoracic spine?

A

Decreased thoracic kyphosis

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20
Q

What is sway back?

A

Increased lumbar lordosis

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21
Q

What is knee hyperextension called?

A

Genu recurvatum

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22
Q

What causes flat foot/dropping arches?

A

Over pronation

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23
Q

What causes high arches?

A

Over supination

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24
Q

When someone has scoliosis, which muscles are lengthened and which are shortened?

A

-Muscles on the concave side of the curve are shortened
-Muscles on the convex side are lengthened

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25
Q

What different pain scales are there?

A

-Verbal intensity scale
-Visual analogue scale (meter stick or ruler)
-Numeric pain scale (0-10)
-Wong Baker Faces scale

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26
Q

What is edema? What is it caused by?

A

-Swelling
-Caused by excess fluid that is trapped in body tissues
-One of the 5 cardinal signs of the inflammatory response

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27
Q

Where is edema most commonly seen?

A

-In the lower extremities, in the feet and ankles
-Hands

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28
Q

What is pitting edema?

A

-When a “pit” or indentation is seen from poking the area of swelling

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29
Q

What are the ratings of pitting edema?

A

-1: indentation is barely detectable
-2: slight indentation visible when skin is depressed, returns to normal in 15 seconds
-3: deeper indentation occurs and returns to normal within 30 seconds
-4: indentation last for more than 30 seconds

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30
Q

What are common causes of edema?

A

-Heart disease
-Chronic venous insufficiency
-Liver or renal disease
-Lymphedema

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31
Q

How can edema be measured?

A

-Tape measure (circumferential or figure 8)
-Volumetric measurement (water displacement)

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32
Q

What are the rules for circumferential edema measurement?

A

You must pick a bony landmark to start from and then measure in intervals of 3-4 cm apart

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33
Q

What are the landmarks for hand figure 8 edema measurement?

A

Radial styloid process, to fifth metacarpal head, to second metacarpal head, to ulnar styloid process, and back to radial styloid process

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34
Q

What are the landmarks for ankle and foot figure 8 edema measurement?

A

-Ankle: medial malleolus, to base of fifth metatarsal, to base of first metatarsal, to lateral malleolus, and back to medial malleolus
-Foot: same but instead of using the bases of the metatarsals, you will go to the head

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35
Q

What are ways to decrease the amount of edema present?

A

-Elevation
-Muscular activity
-Wrapping/taping
-Compression stockings
-Ice massage
-Manual drainage techniques

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36
Q

What is lymphedema? What is it caused by?

A

-A chronic disorder characterized by an abnormal accumulation of lymph fluid in the body tissues (not relieved by elevation)
-Caused by a mechanical insufficiency in the lymphatic drainage system

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37
Q

Who should get a skin inspection?

A

Everyone!!!

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38
Q

What should you observe during a skin assessment?

A

-Dryness
-Color
-Plumpness
-Amount of hair
-Bruising

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39
Q

What should you palpate during a skin assessment?

A

-Temperature
-Edema
-Pain/tenderness (subjective response)
-Skin over bony prominences or surgical site

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40
Q

What type of wounds are there?

A

-Pressure ulcers
-Vascular ulcers
-Neuropathic ulcers
-Surgical incisions
-Traumatic abrasions
-Skin tears

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41
Q

Where do pressure ulcers usually occur?

A

-Over bony prominences where someone is placing all of their body weight for long periods of time, which leads to ischemia and tissue necrosis

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42
Q

What are the two different types of skin tears?

A

-Shear: when the underlying tissue moves parallel to the support surface (sliding down in bed, transfers)
-Friction: when two surfaces rub together

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43
Q

What can cause pressure ulcers?

A

-Too much pressure over a long period of time that causes the capillaries to close and leads to necrosis
-Moisture which can lead to maceration and a weak epidermis

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44
Q

What are extrinsic causes of pressure ulcers?

A

-Cognition
-Equipment, seating, bed, etc.
-Family support and care
-Moisture

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45
Q

What are intrinsic causes of pressure ulcers?

A

-Body mass and atrophy
-Immobility, paralysis, joint contractures
-Impaired sensation and circulation
-Incontinence
-Meds
-Age

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46
Q

What are the two main screening risk assessment tools for pressure ulcers? What do each of them test?

A

-Norton scale tests physical amd mental activity, mobility, and incontinence
-Braden scale tests sensation, moisture, activity levels, mobility, nutrition, shear/friction
-For both tests, the lower the score, the more increased risk of pressure ulcers

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47
Q

What is a stage I pressure ulcer?

A

-Changes in color, appearance, and temperature
-Skin feels boggy, over a pressure point
-Skin still intact

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48
Q

What is a stage II pressure ulcer?

A

-Skin broken through the first few layers

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49
Q

What is a stage III pressure ulcer?

A

-Full thickness, subcutaenous structure damaged or necrotic
-Can be as deep as fascia

50
Q

What is a stage IV pressure ulcer?

A

-Extensive damage
-Bone, tendon, muscle, or joint capsule exposed

51
Q

What are the stages of normal healing?

A

-Stage I: Inflammatory phase
-Stage II: Proliferation phase
-Stage III: Remodeling or maturation phase

52
Q

What is stage I of normal healing?

A

-Inflammatory phase
-24-72 hours after initial trauma through day 10
-Protects the body and promotes repair
-Central role in healing
-Increased blood flow
-WBC’s and enzymes released

53
Q

What is stage II of normal healing?

A

-Proliferation phase
-New tissue fills in the wound
-WBC’s are decreasing
-Granulation and angiogenesis (weak, soft, red scar)
-Day 3 to 3 weeks

54
Q

What is stage III of normal healing?

A

-Remodeling or maturation phase
-Begins when granulation tissue is forming
-3 weeks onward
-New skin has 15% tensile strength compared to normal
-Collagen stronger and more organized

55
Q

What is the purpose of a sensory screen?

A

-Determine areas that are intact/not intact
-Assists with diagnosis and prognosis
-Guides POC and treatment

56
Q

What senses are part of the superficial sensory system?

A

-Pain, temperature, light touch

57
Q

What senses are part of the deep sensory system?

A

-Position sense (proprioception), kinesthesia, vibration

58
Q

What senses are part of the combined sensory system?

A

-Sterognosis, two-point discrimination, barognosis, graphesthesia, tactile localization, recognition of tecture

59
Q

What does a sensory screen include?

A

-One test from each of the three categories (superficial, deep, combined)
-Random, over large surfaces (both upper and lower extremities)
-Bilateral

60
Q

What happens if impairments are identified in a sensory screen?

A

A full sensory exam must be conducted

61
Q

When would you skip a sensory screen and go straight to a sensory exam?

A

-When it makes clinical sense such as when someone has diabetes, Peripheral Vascular Disease, or neurological diseases
-Make sure to follow a dermatome pattern
-Systematic and thorough

62
Q

What are signs of a cardiac patient?

A

-Dyspnea
-Fatigue
-Chest pain or palpitations
-Cyanosis or clubbing
-Intermittent claudication
-Edema
-Overweight and out of shape

63
Q

What is normal pulse for adults? What is tachycardia? What is bradycardia?

A

-60-90 bpm
- > 100 bpm
- < 60 bpm

64
Q

What is normal pulse for newborns?

A

70-190 bpm

65
Q

What is normal pulse for children?

A

70-120 bpm

66
Q

What are the different qualities of pulse? What do they mean?

A

-Absent (0): no perceptible pulse
-Thready (1): easily obliterated, barely perceptible
-Weak (2): difficult to palpate, stronger than thready, obliterated with light pressure
-Normal (3): easy to palpate, requires moderate pressure to obliterate
-Bounding (4): very strong. not obliterated with moderate pressure

67
Q

What factors effect pulse rate?

A

-Age
-Gender m<f
-Emotions and stress
-Body temperature
-Exercise

68
Q

What are the pulse sites in the upper extremity?

A

-Radial artery at cubital fossa
-Radial artery at wrist
-Ulnar artery at wrist

69
Q

What are the pulse sites in the lower extremity?

A

-Popliteal artery behind the knee
-Dorsalis pedis artery near the big toe

70
Q

What is normal respiratory rate for adults? What is tachypnea? What is bradypnea?

A

-Females: 16-20
-Males: 14-18
- > 20
- < 10

71
Q

What are the qualitative measures of respiratory rate?

A

-Depth (shallow or deep)
-Rhythm (regularity of breaths)

72
Q

What are different sounds of respiration?

A

-Abnormal
-Wheezing
-Stridor (harsh, high pitched sound)
-Crackles/rales (rattling or bubbling sounds)
-Sigh
-Stertor (snoring sound)
-Absent

73
Q

What is blood pressure?

A

The pressure exerted on arterial walls due to the contractile force of blood ejected by the ventricles each beat

74
Q

What is systolic blood pressure?

A

Peak ventricular contractile force pushing through the arteries

75
Q

What is diastolic blood pressure?

A

Ventricular filling

76
Q

What is normal blood pressure?

A

Less than 120 and less than 80

77
Q

What is elevated blood pressure?

A

120-129 and less than 80

78
Q

What is hypertension stage 1?

A

130-139 or 80-89

79
Q

What is hypertension stage 2?

A

140 or higher or 90 or higher

80
Q

What is hypertensive crisis?

A

Higher than 180 and/or higher than 120

81
Q

What are factors that affect blood pressure?

A

-Age (increases with age)
-Gender (women<men)
-Exercise, stress, anxiety, etc.
-Circadian rhythm
-Medications
-“White coat syndrome”

82
Q

What is hypotension? What are signs of hypotension?

A

-Systolic < 90mmHg
-Tachycardia, dizziness, confusion, restlessness, clammy & pale

83
Q

What is orthostatic hypotension?

A

-Positional changes in BP (laying down to sitting to standing)
-Characterized by changes in systolic greater than 20 mmHg or changes in diastolic greater than 10mmHg

84
Q

What are possible causes of hypotension?

A

-Prolonged bed rest
-Pregnancy
-Decrease in blood volume
-Medications
-Bradycardia
-Heart attack
-Septic shock
-Hormonal issues
-Nutritional deficiencies

85
Q

What are Karotkoff’s sounds? Which ones indicate systolic and diastolic bp?

A

-Phase I: first faint clear sound, first 2 successive sounds are systolic
-Phase II: swishing sound
-Phase III: crisp, more intense
-Phase IV: muffling, soft blowing quality
-Phase V: silence, disappearance of sound is diastolic

86
Q

What are normal oxygen saturation levels? What is abnormal?

A

-92-99%
-100% indicates carbon monoxide poisoning
-88% or less indicates “desat”

87
Q

What can affect oxygen saturation reading?

A

-Excessive ambient light
-Nail polish
-Poor circulation
-Movement

88
Q

What are factors effecting muscle performance?

A

-Muscle fiber type and size
-Force-velocity relationships
-Length-tension relationships
-Muscle architecture
-Neural control
-Age
-Fatigue
-Cognitive training
-Corticosteroids
-Muscle pathology
-Disease
-Disuse atrophy

89
Q

What are the different muscle fiber types?

A

-Type I: slow twitch
-Type II: fast twitch

90
Q

What types of muscle assessments can you do?

A

-Functional strength tests (5 times sit to stand, glute bridge, push ups, etc.)
-MMT
-Dynamometry
-Isokinetic testing

91
Q

What are indications for passive range of motion? When is it contraindicated?

A

When a patient is unable to perform any form of active contractions
-Paralysis
-Comatose
-Recovery from surgery or trauma
-Healing fractures

When passive movement significantly increases the patient’s symptoms

92
Q

What are the benefits of passive exercise?

A

-Preserves and maintains range of motion
-Minimizes contracture formation
-Minimizes adhesion formation
-Maintains mechanical elasticity of muscles
-Promotes and maintains local circulation
-Promotes awareness of joint motion
-Evaluates integrity of joint
-Enhances cartilage nutrition
-Inhibits or reduces pain

93
Q

What does PROM not do?

A

-Prevent muscular atrophy
-Increase muscle strength or endurance
-Assist in circulation as well as AROM

94
Q

What are the goals of AROM?

A

-Maintain physiologic elasticity and contractility
-Provides sensory feedback from the contracting muscle
-Provides a stimulus for bone and joint tissue integrity
-Increases circulation and prevents thrombus formation
-Develop coordination and motor skills

95
Q

What is the purpose of assisted AROM (AAROM)

A

To protect healing tissue

96
Q

What modes of stretching are there?

A

-Static
-Dynamic
-Ballistic

97
Q

What is an appropriate intensity of stretching that will induce changes in the tissue?

A

Slow, low load, prolonged stretch

98
Q

What is an appropriate duration and frequency of stretching that will induce changes in the tissue?

A

-15-60 seconds for 2-5 reps
-3-5 times per week

99
Q

How should two joint muscles be stretched?

A

-They should be stretched one joint at a time
-Progression would be stretching it at both joints

100
Q

When is the most appropriate time to stretch? Why?

A

After exercise to reduce DOMS

101
Q

What are the two types of isotonic contractions?

A

-Eccentric: lengthening contraction
-Concentric: shortening contraction

102
Q

What are the benefits of isotonic contractions?

A

-Maintains or increases strength, power, and endurance
-Promotes local circulation
-Enhance cardiovascular efficiency
-Creates hypertrophy of muscles
-Maintains elasticity of muscles
-Maintains joint motion
-Maintains or enhances coordination

103
Q

What is open vs closed chain?

A

-Open is unrestricted movement in space of the distal segment during the exercise (glute kick backs)
-Closed chain is when the distal segment is fixed during the activity (squat or step up)

104
Q

What is an isometric contraction?

A

When a muscle contracts, but there is no joint motion

105
Q

What is isokinetic exercise?

A

When the speed stays the same throughout the motion but the resistance is variable

106
Q

What are contraindications to exercise?

A

-Pain with resistance
-Inflammation
-Severe cardiopulmonary disease

107
Q

What are precautions for resistance exercise for patients?

A

-Avoid valsalva maneuver because it can cause an abrupt increase in blood pressure
-Avoid substitute motions/improper form

108
Q

What are the components of exercise prescription?

A

-Mode
-Intensity
-Frequency
-Duration
-Progression/modification

109
Q

What are motor skills?

A

Activities or tasks that require voluntary control over movements of the joints and body segments to achieve a goal

110
Q

What is motor learning?

A

The acquisition of motor skills, the performance enhancement learned or highly experienced motor skills

111
Q

What are the motor learning stages?

A

-Cognitive phase
-Associative phase
-Autonomous phase

112
Q

What is the cognitive phase of motor learning?

A

-Movements are slow, inconsistent, and inefficient
-Large parts of the movement are consciously controlled
-Thinking

113
Q

What is the associative phase of motor learning?

A

-Movements become more fluid, reliable, and efficient
-Some parts of the movement are controlled automatically

114
Q

What is the autonomous phase of motor learning?

A

-Movements are accurate, consistent, and efficient
-Movement is largely controlled automatically

115
Q

What is motor control?

A

How our neuromuscular system functions to activate and coordinate the muscles and limbs in the performance of a motor skill

116
Q

What is motor development?

A

The combination of motor learning and motor control and the development from infancy to old age

117
Q

What is a motor program?

A

A series of mini routines organized into the correct sequence to perform a movement

118
Q

What is motor memory?

A

The recall of motor programs

119
Q

What is the stages of motor function training?

A

-Stability (always comes first)
-Mobility on stability
-Mobility
-Motor skill

120
Q
A

PHTH 507: Foundations of Patient Assessment (5 decks)

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