Geri Midterm Flashcards
1
Q
Alzheimer’s Disease
A
- most prevalent type of progressive dementia
- lifespan = 4-8 years after receiving dx
- probs with remembering names of individuals and recent events
- lack of interest/depression
- decline in communication ability
- decline in judgement
- disorientation/confusion (*especially in new environment)
- off-set circadian rhythm (sleep/wake cycle)
- change in behaviors
- end stage: probs with gait, speech, swallowing
- most die from secondary cause of aspirating pneumonia
2
Q
Vascular Dementia
A
- insufficient O2 blood getting to the brain
- common causes are: stroke, TIA, untreated high BP
- disease tends to plateau to huge decline
- impairments in executive functions
- confusion/disorientation
- loss of vision
- lang probs
- impaired decision making and judgement
- decrease in ability to plan and organize
- daily fluctuations in cognition
- sx can be similar to AD (Alzheimer’s) or be more localized
3
Q
Dementia with Lewy Bodies
A
- probs with attention
- impairments in memory
- sleep disturbances (violent)
- visual hallucinations (often small children and animals)
- thinking and reasoning probs
- confusion and varied alertness
- memory loss
- Parkinsonian type mvmnts
- Probable dx, has to be definitive by autopsy
4
Q
Dementia with Lewy Bodies: Parkinson’s dementia
A
-starts with motor component then cognitive issues (pt has Parkinson’s)
5
Q
Dementia with Lewy Bodies (parkinsonian onset)
A
-starts with cognition probs then motor component
6
Q
Frontotemporal Dementia
A
- common with 45-65 years old
- frontal and temporal lobe affected
- changes in personality and behavior
- lang probs
- alterations in muscle and/or motor functions
- changes in behavior
- “drunk like” behavior (slurring, uncoordinated, impulsive)
7
Q
Mixed Dementia
A
- Two or more types of dementia
- More than one type occurring together
- Often Alzheimer’s and Vascular
8
Q
Stage 1 Dementia
A
- normal
- NO cognitive changes
- NO decline in functioning
9
Q
Stage 2 Dementia
A
- normal age related changes
- NO dx
- subjective deficits in word-finding or recalling location of objects
10
Q
Stage 3 Dementia
A
- mild COGNITIVE impairment
- mental age = 12+ years
- aware of deficits
- try to hid deficits
- own strategies to compensate
- can become angry when asked questions they have difficulty with (hiding deficit)
- forgets if they do not write it down
- usually still driving
- trouble with directions in new places
- home is stills safe
- independent in ADL, IADL (may question judgement)
- slight judgement issues
- descriptions lack detail
- unable to recall names of people and objects
11
Q
Stage 4 Dementia
A
- mild dementia
- mental age = 8-12 years
- challenges set in
- things are difficult (i.e. forget to pay bills)
- repeating stories
- having trouble staying on topic in conversations
- distracted by surrounding environment
- can still learn
- good stage for implementing new learning (i.e. mobility device, checklist)
- assistance in IADLs
- still independent in ADLs
- supervision in cooking
- assisted living, suite in fam home
- asks questions over and over
- impaired comprehension
- greater effort to perform tasks
12
Q
Stage 5 Dementia
A
- moderate dementia
- mental age = 5-7 years
- cross over of being aware to not being aware
- caregiver responsibility
- NOT safe living at home alone
- live in caregiver, supervised institution
- can dress but not aware of weather outside
- disheveled look
- will not remember to wash clothes
- can bathe and toilet but hygiene is questionable (i.e. wash front but not back)
- changes can become evident in tone, reaction time, movement time, and gait
13
Q
Stage 6 Dementia
A
- moderate to severe dementia
- mental age = 2-5 years
- same level of assist for BADLs
- difficulty with utensils
- toileting program
- assistance in dressing, help with getting clothing on
- 24 hour supervision for safety
- assistance in basic tasks (dressing, eating, toileting)
14
Q
Stage 7 Dementia
A
- severe dementia
- mental age = 2 months-1.2 years
- primitive reflexes come back
- incoherent
- incapable of speech
- completely disoriented
- cannot recognize relatives
- incontinent in both bowel and bladder
- dependent on others for ALL tasks
- will not remember to breathe
- cannot sit up and hold head up
- trouble swallowing
- primitive reflexes: rooting, palmar, babinski
- contractures are most common in this stage
15
Q
ARMD (amacular degeneration)
A
- inability to see centrally
- central vision loss
- straight lines look wavy
- corrective lens surgery
- special vitamins and healthy diet can help with dry management to less the change of sx worsening
16
Q
Dry ARMD
A
- common
- macula gets thinner with age
- tiny clumps of protein growing
- can develop into wet form
- can learn to read out of periphery
17
Q
Wet ARMD
A
- less common
- more serious
- new abnormal blood vessels grow
- scarring of macula
18
Q
Cataracts
A
C=Cloudy
- cloudy lens
- common dx
- decreased color sensitivity and glare
- alot of sunlight is too bright
- surgical procedure
19
Q
Diabetic Retinopathy
A
- vision loss in diabetes
- spots or blotches
- blood vessels in retina bleed
- injections
- laser tx
- eye surgery
- important to control blood glucose level
20
Q
Glaucoma
A
- progressive optic nerve damage
- loss of peripheral vision
- headaches
- tunnel vision
- surgery
- open angle
- closed angle
21
Q
Glaucoma: closed angle
A
- not as common
- medical emergency
- increase in pressure
- bad headache
- halo around lights
- pain in the eye
22
Q
Visual Acuity
A
- the smallest high contrast detail that one can resolve
- decline in near vision is inevitable by age 40-45
- cataracts affects acuity
23
Q
Contrast Sensitivity
A
- ability to see larger low-contrast objects
- measures how faded or washed out an image can be before it becomes indistinguishable
- cataracts affected the most with contrast
- impairments in: driving, mobility, face recognition, additional ADLs
24
Q
Visual Field
A
- the amount an individual can see while looking straight ahead while fixated on one point
- when closing one eye it opens up the visual field more
- Amsler grid test (dot test, ARMD = if lines are contured or distorted it has become the WET form of ARMD)
25
Medicare
health insurance for:
- over the age of 65 years
- under the age of 65 years with a specified disability
- federally funded health insurance
- pays for health care services
- end stage renal disease
- ALS
26
Medicare: Automatic Eligibility
- over 65 years and older and receives social security benefits or railroad retirement board
- younger than 65 years with certain disability if receiving social security benefits or railroad retirement board for 2 years
- ALS (within the month that disability benefit starts)
- paid into social security for a certain amount of years
27
Medicare: Requires Enrollment
- over 65 years and not current getting social security benefits or railroad retirement board
- has end stage renal disease
- is not eligible and wants to buy in
28
Medicare Part B: Durable Medical Equipment (DME) Coverage
- w/c
- walker
- 3 in 1 commode
29
Therapy: Medicare Part A
- has to have a minimum of 3 day stay at the hospital
- 100 day per benefit period
- day pt gets to the SNF is when benefits start
- re-access if readmitted to SNF within 30 days
- inpt hospital care
- surgical procedures
- lab tests
- skilled nursing facility
- hospice care
- home health care
30
Therapy: Medicare Part B
- has a therapy cap every year
- once cap is up there is a kx modifier for justification of services
- preventative services
- MD and other health care services and tests
- outpatient care
- DME
- ambulance services
31
Therapy: Medicare Part C
-health coverage option run by private insurance companies approved by and under medicare contract
32
Therapy: Medicare Part D
- D = Drugs
- prescription drug coverage option run by private insurance companies approved by and under contract with Medicare
- helps to cover cost of prescription drugs
33
Individual
- treatment of one pt at one time by one therapist
- the pt is receiving the therapists full attention
- Medicare part A and B: tx session mins may be billed in full
- what we should be planning for
34
Co-treatment
- only one pt
- 2 different disciplines treating pt as a team
- both disciplines have different treatment focus
- identify why we provide co-treatment (justification)
35
Co-treatment: Medicare part A
-both disciplines with different focus can bill tx in full
36
Co-treatment: Medicare part B
- entire time billed for day cannot exceed actual time the pt got
- time must either be divided by disciplines or one therapist may bill for the entire time
37
Concurrent
- tx of 2 pts by same therapist at same time performing DIFFERENT TASKS with one therapist
- OT splitting attention between pts
38
Concurrent: Medicare part A
-bill full time under concurrent tx
39
Concurrent: Medicare part B
- does NOT exist
| - have to bill as group
40
Group: Medicare part A
- tx of 4 or more pts by one OT
| - tx of 4 ore more pts at the same time who are doing the same or similar activities with one therapist
41
Group: Medicare part B
- tx of 2 or more pts (no more than 4) by one OT
| - tx of 2 or more pts at the same time who are doing the same, similar, or different activities with one therapist
42
Skilled Services (Billable)
- set up time if it proceeds tx
- rehab aide bringing over equip
- education if pt is present and involved
- re-eval as long as pt is involved and it is part of tx process
- attended modalities (i.e. ultrasound)
- development of maintenance program and caregiver training with the pt present in preparation for d/c
- time spent incorporating documentation into tx if pt is involved for educational purposes
- point of care services (iPad, computers)
43
Non-Skilled Services (NOT Billable)
- actual time on modality that is unattended
- demonstration and performance of HEP
- initial eval
- time spent talking to pt if they refuse tx
- non-therapeutic rest break (i.e. bathroom)
- working outside requirements of the therapy mode
- services requested by family
- documentation when pt is not present
- non-skilled portion of administering modality
44
Medicare Part B (8 min rule)
- reimbursement based on 8 min rule
- bill for whatever modalities (CPT codes) we are providing for exact amount of mins
- reimbursement is based on value of CPT codes
45
Medicare Part B: Untimed Codes
- group
- modalities
- evaluation
