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FND III > FND III - EXAM 1 > Flashcards

FND III - EXAM 1 Flashcards

1
Q

What is the ICF schematic?

A

International classification of functioning, disability, and health

Impairment
Activity - extent of functioning
Participation - involvement in life
Context - social/attitudinal environment

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2
Q

What is the difference between a primary and a rehab treatment diagnosis?

A

Primary - medical diagnosis resulting in therapy disorder

Rehab treatment - conditions and functional deficits manifested as a result of the primary diagnosis and for which services are rendered.

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3
Q

Plan of Care

A 
Safe, effective, patient-centered
Meet goals/outcomes with avail. resources
Specified length of time
Predicted level of improvement
Specific interventions
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4
Q

What are 3 important performance-based functional tests?

A

Six-Minute Walk Test
Timed Up and Go Test
Functional Reach Test

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5
Q

What is supervision?

A

Another individual is needed within arm’s reach as a precaution but low probability of a problem

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6
Q

What is close guarding?

A

Person assisting is ready to assist in “ready mode”

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7
Q

What is contact guarding?

A

Physical contact is maintained but not giving patient assistance

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8
Q

What is minimal assistance?

A

Patient performs 75% of activity (majority)

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9
Q

What is moderate assistance?

A

Patient performs 50% of activity

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10
Q

What is maximal assistance?

A

Patient performs 25% of activity

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11
Q

What is dependent?

A

Patient unable to perform any of the activity

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12
Q

What is a normal balance grade?

A

Static - pt able to maintain steady balance without hand-held support

Dynamic - accepts max challenge and can weight-shift within full ranges

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13
Q

What is “good” balance grade?

A

Static - able to maintain balance without hand-held support; limited sway

Dynamic - accepts moderate challenges and can maintain balance while picking up object from floor

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14
Q

What is “fair” balance grade?

A

Static - requires hand-held assist, may require occasional assistance

Dynamic - accepts minimal challenge and maintains balance while turning head

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15
Q

What is “poor” balance grade?

A

Static - requires hand-held support and mod/max assist to maintain balance

Dynamic - unable to accept challenges or move without loss of balance

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16
Q

What is the Lawton-Brody IADL Scale?

A

Identifies specific actions of a skill such as ability to use telephone, shopping, food prep, housekeeping, laundry, mode of transpo, medication management, and ability to handle finances.

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17
Q

What is the Barthel Index?

A

Specifically measures degree of assistance on 10 items: complete independence or needs help

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18
Q

What is the Katz Index of Independence in ADLs?

A

Examines BADLs but doesn’t mention ambulation. Evaluation of independence in bathing, dressing, toileting, transferring, and feeding

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19
Q

What is the Sickness Impact Profile?

A

136 items in 12 distinct domains of QOL

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20
Q

What is the SF-36?

A

Global measure of function and well-being used in outpatient settings.

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21
Q

What is the Functional Independence Measure (FIM)?

A

13 motor and 5 social-cognitive items assessing self care, sphincter control, transfer, locomotion, communication, social interaction, and cognition

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22
Q

What is the Outcome and Assessment Information Set (OASIS)?

A

Adult home care scoring system for home health agencies to predict outcomes and measure quality of care.

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23
Q

What is test reliability?

A

How well the test is able to be repeated giving the same results

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24
Q

What is inter-rater vs. intra-rater reliability?

A

Inter - multiple testers

Intra - same tester

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25
Q

What is test validity

A

Does the test measure what it is supposed to measure?

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26
Q

What is NWB?

A

Non-weight bearing

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27
Q

What is TTWB?

A

Toe touch weight bearing

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28
Q

What is PWB?

A

Partial weight bearing

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29
Q

What is WBAT?

A

Weight bearing as tolerated?

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30
Q

What is FWB?

A

Full weight bearing

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31
Q

What side do you transfer toward: strong or limited?

A

Strong side

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32
Q

What are the hip precautions for a THA posterolateral approach?

A 
No hip flexion > 90 deg.
No adduction/IR beyond neutral
Do not cross legs
Knees lower than hip when sitting
No bending over in sit-to-stand
Raised seats
Pivot on strong side
Sleep in supine with abduction pillow
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33
Q

What are the hip precautions for a THA anterolateral and lateral approach?

A

No hip extension, adduction, ER past neutral
No tailor sitting (combined flexion, abduction, ER)
No hip hyperextension when ambulating

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34
Q

What are radiographic findings in a patient with osteoarthritis?

A

Decreased joint space
Sclerosis of bone
Bone spurs
Articular cartilage breakdown

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35
Q

What is the most common place to get DJD?

A

Weight bearing joints: hip/knee

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36
Q

What are intracapsular hip fractures vulnerable to?

A

Post-traumatic vascular complications (blood vessels in close proximity)

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37
Q

What kind of arthritis causes symmetrical, multi-joint pain and deformity?

A

Rheumatoid

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38
Q

Rheumatoid affects the UE and LE how?

A

UE - impedes ADLs

LE - impedes locomotion, transfers

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39
Q

What kind of pain medication is used for RA?

A

NSAIDs, DMARDs, steroids

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40
Q

What is your concern with a transfermoral amputee?

A

Preserve hip extension, reduce pain

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41
Q

What is your concern with a transtibial amputee?

A

Preserve hip and knee extension, reduce pain

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42
Q

How is a spinal cord injury level defined?

A

By the last cord segment in which there is remaining function

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43
Q

What is tetraplegia?

A

Injury occurs in cervical spine or T1 with resultant bilateral paralysis/paresis of UEs, trunk, LEs

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44
Q

A complete lesion of the cord between C1 and C3 is…?

A

Incompatible with life

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45
Q

What is paraplegia?

A

SCI that occurs below T1 which results in bilateral partial/complete paralysis of LEs and trunk musculature.

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46
Q

What is damaged/preserved in Anterior Cord Syndrome?

A

Damaged: motor function (CST) and pain/temperature (STT)

Preserved: proprioception, kinesthesia, vibratory sense (dorsal columns)

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47
Q

What is damaged/preserved in Posterior Cord Syndrome?

A

Damaged: proprioception (wide BOS)

Preserved: motor, pain, light touch

48
Q

What is damaged/preserved in Central Cord Syndrome?

A

UEs more involved than LEs (distal wasting, trouble with ADLs)

Varying sensory involvement, potential for ambulation.

49
Q

Anterior Cord Syndrome is caused by what kind of injury?

A

Flexion

50
Q

Central cord syndrome is caused by?

A

Hyperextension injury or congenital narrowing of the canal

51
Q

What usually causes Brown-Sequard Syndrome?

A

Trauma such as knife-wound through laminae

52
Q

What is Brown-Sequard Syndrome?

A

Transection of 1/2 the spinal cord

Ipsilateral loss of sensation, proprioception, vibratory sense

Contralateral loss of pain and temperature

53
Q

Where does cauda equina syndome occur? What is CEI?

A

Below L1

Peripheral nerve injuries with potential for regeneration.

54
Q

What is a CVA?

A

Cerebrovascular Accident: ischemic or hemorrhagic lesions resulting in neurological dysfunction.

55
Q

What is hemiplegia and hemiparesis in a CVA?

A

Paralysis/paresis on side contralateral to infarct

56
Q

What is reversible ischemic neurologic deficit?

A

CVA that resolves within 3 weeks with spontaneous recovery

57
Q

What are the direct impairments of a CVA patient?

A 
Proprioception deficit
Pain (if PCA)
Homonymous hemianopsia, visual neglect
Motor deficits
Aphasia (speech)
Dysphagia (aspiration)
Cognitive dysfunction
Affective disorders
Seizures
Bowl/bladder dysfunction
58
Q

What is the most common reason for loss of functional ability in the elderly?

A

Immobility

59
Q

What are the effects of immobility related to?

A

Absence of gravity and hydrostatic pressures

60
Q

Immobility and/or bedrest can lead to:

A

Generalized weakness (atrophy), orthostatic intolerance, pneumonia, DVT, PE, osteoporosis, urinary retention, constipation, and impaired sensory perception.

61
Q

What are the effects of Orthostatic Hypertension?

A

Tachycardia with transfers, nausea, diaphoresis (sweating), syncope, risk of falls, postural instability, diminished exercise intolerance

62
Q

What are the stages of postural hypotension?

A

Lie supine –> blood diverted to thorax –> increased cardiac output triggers baroreceptors –> decreased diuretic hormone –> increased urine output creates negative fluid balance –> decreased plasma volume –> increased blood viscosity and decreased electrolytes –> decreased venous return and BP –> postural intolerance

63
Q

What is cardiac deconditioning?

A

Decreased cardiac size leading to decreased cardiac output and capacity to respond to any level of physical activity.

Increased resting HR, decreased SV

64
Q

What is venous stasis?

A

Supine/sidelying causes lack of skeletal muscle pump and the compression of the LEs against the bed can damage blood vessels

65
Q

How does venous stasis cause thrombosis?

A

Ca is released from bones which converts to prothrombin –> thrombin –> fibrinogen –> fibrin –> clotting.

66
Q

What is atelectasis?

A

Lung collapse

67
Q

Why does immobility affect the pulmonary system?

A

Lying in supine decreases chest expansion and the mechanics of breathing (fewer deep breaths, increased WOB). Vital capacity decreases, secretions build up, bacteria grows, oxygen desaturation.

Leads to aspiration pneumonia and PE

68
Q

How much muscle strength is lost in the 1st week of bed rest?

A

1/8 of strength

69
Q

What happens to connective tissue during bedrest?

A

Shortening, especially in hips, knees, ankles

Collagen denser (shortened tendons), ligament atrophy, joint stiffening (water loss).

70
Q

How early does osteoporosis begin during bedrest?

A

Within 3 days

71
Q

If increased blood Ca does not go to the bones, what does it do?

A

Forms kidney stones

72
Q

What causes pressure ulcers?

A

Prolonged compression –> skin circulation and perfusion decrease over bony prominences causing infarction of skin

73
Q

What are the early signs of pressure wounds?

A

Redness
Dusky
Cyanotic

74
Q

Skin is vulnerable to…?

A

Shearing
Pressure
Moisture

75
Q

How often should patient be repositioned in bed?

A

Every 2 hours

76
Q

How often should patient be repositioned in seat?

A

Every 15 minutes

77
Q

How do you minimize risks for pressure wounds?

A 
Positioning/turning
Bedding
HOB lower than 30 deg
Relief materials
Protective clothing
78
Q

Who is at risk for integumentary changes?

A 
Patients with sensory deficits
Dependent patients
Incontinent patients
Obese patients
Patients with poor nutrition
Older adults
Patients who are unable to move
79
Q

How does bedrest affect urinary function?

A

Stagnation of urine, changes in urine calcium levels, decreased pH, increased risk of kidney stones, crystalloids, UTIs

80
Q

How does bedrest affect gastrointestinal function?

A

Decreased appetite, alterations in GI process, constipation

81
Q

How does bedrest affect metabolic functions?

A

Glucose intolerance due to decreased metabolism and increased protein lysis

Hypercalcemia and negative nitrogen balance –> cramping, constipation, muscle weakness, lethargy, nausea

82
Q

How does bedrest afect neurological function?

A

Compression neuropathies, sensory deprivation (hallucinations, mood changes, vivid dreams), altered sleep, decreased body temp, balance/coordination decline, prolonged reaction times

83
Q

How does bedrest affect the mental status?

A

Depression, lack of motivation, distortion of time, mood swings, learned helplessness.

84
Q

What are strategies to minimize negative effects of bedrest?

A 
Minimize duration of bedrest
Bathroom privileges
Stand 30-60 sec during transfers
Encourage street clothes
Meals sitting up or at table
Encourage walking and movement
Use protective orthotics
85
Q

What are commonly seen contractures?

A 
FHP
Rounded shoulders
Elbow flexion
Wrist/hand flexion
Hips/knees flexion
Hip abduction or adduction + ER
Ankle plantar flexion
86
Q

When is short-term positioning used?

A

For therapeutic interventions of when pt able to make minor positional adjustments during/after treatment

87
Q

When is long-term positioning used?

A

When patient must remain in one position for extended period of time.

88
Q

What test should you perform before repositioning patient?

A

Blanching test - nonblanching tissue indicates development of pressure sore.

89
Q

How does repositioning prevent pulmonary issues?

A

Facilitate drainage of moisture from smaller passageways

90
Q

What are the pressure areas of supine?

A 
Sacrum
Calcaneous
Lateral malleoli
Occiput
Scapula
Greater trochanter
Lateral humeral epicondyle
Olecranon process
Spinous process
91
Q

What are the pressure areas of side-lying

A 
Ear
Acromion
Spine of scapula
Greater trochanter
Medial femoral condyle
Lateral femoral dondyle
Lateral malleoli
5th MT head
92
Q

What are the pressure areas of prone?

A 
Ear/face
Acromion
Costal margins
ASIS
Patella
93
Q

What is sacral sitting? Why is it bad?

A

Pt slumped down in chair when muscles fatigue

Increased risk of skin breakdown

94
Q

What are the pressure areas in sitting?

A 
Scapula
Malleoli
Plantar surface
5th MT head
Ischial tuberosity
Popliteal area
Sacrum
95
Q

What are the 3 stages of motor learning?

A

Cognitive - patient needs a lot of assistance

Associative - some assistance, less cues

Autonomous - less cognition needed to accomplish task; little assistance needed

96
Q

How do you measure permanent effects of practice?

A

Evaluate performance at beginning of therapy session

97
Q

Increasing speed of an activity decreases…?

A

Spatial accuracy

98
Q

What are the 3 learning styles?

A

Visual
Auditory
Kinesthetic

(VAK)

99
Q

How do visual learners learn?

A

Prefer seeing what they are learning - pictures and images help them understand ideas and information.

100
Q

How do auditory learners learn?

A

“Talkers” need to hear their own voice

“Listeners” remember what is said to them

101
Q

How do kinesthetic learners learn?

A

By sensing the position and movement of what they are working on.

102
Q

What factors influence patient education?

A 
Memory
Willingness to learn
Motivation
Fatigue
Stress
Understanding their situation
Self-perception
103
Q

What are the ABC’s of documentation?

A

Accuracy
Brevity
Clarity

104
Q

What does SOAP note stand for?

A

Subjective
Objective
Assessment
Plan

105
Q

What is the subjective component of SOAP?

A

Information received by patient or significant other - current condition, goals, social history, etc.

106
Q

What is the objective component of SOAP?

A

Measureable and reproduced information - history, systems review, tests/measures, intervention of the day

107
Q

What is the assessment component of SOAP?

A

Evaluation, diagnosis, prognosis

108
Q

What is the plan component of SOAP?

A

Plan of care - anticipated goals, expected outcomes, interventions

109
Q

When is an encounter note written?

A

Each session

110
Q

When is a progress note written?

A

Every 30 days (summary of encounter notes)

111
Q

What are the top 10 complaints about documentation?

A 
Poor legibility
Incomplete
No document for DOS
Too many abbreviations
Incorrect coding
Does not demonstrate skilled care
Does not support medical necessity
Does not demonstrate progress
Notes show no change in status
Interventions with no time, freq, duration
112
Q

What kinds of tires are used for indoor/outdoor?

A

Pneumatic (air-filled) - outdoors

Rubber - indoors

113
Q

What is the inward position of the drive wheel of a wheelchair?

A

Camber

114
Q

What are the small wheels that allow for directional changes?

A

Casters

115
Q

What are the wheelchair measurements?

A 
Seat depth
Seat width
Seat height
Seat back height
Armrest height
Seat height to leg rest length
Footplate size
Standard measurements
Two finger confirmation

FND III (5 decks)

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