Quiz 1 Flashcards
(271 cards)
1
Q
what is clinical reasoning?
A
the result of intentional “pondering” and the sum of all critical decsion-making processes that are associated with clinical practice
2
Q
clinical reasoning enables practitioners to…
A
take the “best” action in a specific context
3
Q
clinical reasoning permeates clinical practice by…
A
informing decisions
4
Q
t/f: clinical reasoning promotes individualized care
A
true!
5
Q
what are heuristics?
A
mental shortcuts that allow ppl to solve problems and make judgements quickly and effectively
6
Q
what are the 3 dimensions of clinical reasoning?
A
remember/review (knowledge)
refine (cognition)
reflect (metacognition)
7
Q
what is the knowledge dimension?
A
strong, discipline-specific knowledge base derived from theory/research and personal experience
8
Q
what is the cognition dimension?
A
reconciling clinical data with the clinician’s existing knowledge in the moment
9
Q
what is the metacognition dimension?
A
considering the patient’s response after an encounter bringing the clinician to the realization that knowledge and skills may be insufficient and adjustments are required or hypothesis is confirmed (think about thinking)
10
Q
what is self-reflection?
A
constant, thoughtful, self-reflection
11
Q
what is the single most important attribute found among expert clinicians that is deemed to be the most important skill for developing clinicians?
A
self-reflection
12
Q
what is the hypothetico-deductive reasoning model?
A
clinical data used to generate a hypothesis through further inquiry
13
Q
what are the 2 types of reasoning under the hypothetico-deductive reasoning model?
A
inductive and deductive reasoning
14
Q
what is inductive reasoning?
A
moving from specific to general
ie: all basketball players in your school are tall, so all basketball players must be tall
15
Q
what is deductive reasoning?
A
moving from generalizations to a specific conclusion
ie. you’re so tall so you must be a basketball player
16
Q
who is the hypothetic-deductive reasoning model primarily used by?
A
novices and experts in challenging situations
17
Q
what is the knowledge reasoning integration model?
A
parallel developments of knowledge acquisition and clinical reasoning expertise that requires domain specific knowledge and an organized knowledge base
18
Q
clinical reasoning involves the integration of _____, _____, and _____
A
knowledge, reasoning, metacognition
19
Q
who uses the knowledge-reasoning integration model?
A
primarily experts
20
Q
what is the intuitive reasoning model?
A
knowledge used unconsciously in inductive reasoning
intuitive knowledge is related to past experiences with specific cases
21
Q
who are the only people that can use the intuitive reasoning model?
A
experts
22
Q
what is the pattern recognition model?
A
direct and automatic retrieval of info where new cases are categorized in relation to previously experiences clinical cases
23
Q
the pattern recognition model is characterized by ____ and ____
A
speed and efficiency
24
Q
who frequently uses the pattern recognition model?
A
experts in typical clinical situations
25
what is the hypotheses-oriented algorithm for clinicians (HOAC)?
a graphically represented step-by-step guide to assist clinicians in problem solving
26
what is narrative reasoning?
a frame used to understand the patient's perspective and experiences of their problem to understand the context of the problem
27
what components are a part of the narrative model?
the patient's attitudes, understanding, beliefs, emotions, and expectations
28
what are the 4 cognitive paradigms?
hypothetico-deductive reasoning
pattern recognition
knowledge reasoning integration model
intuitive reasoning
29
are cognitive paradigms more practitioner driven or patient driven?
practitioner driven
30
what are the 5 interactive paradigms?
narrative reasoning
multidisciplinary reasoning
collaborative reasoning
ethical reasoning
teaching as reasoning
(all very similar to narrative reasoning)
31
t/f: the interactive paradigms build consensus b/w clinician and patient
true!
32
what are the 5 biases?
confirmation bias
availability bias
attentional bias
anchoring bias
selective exposure bias
33
what is confirmation bias?
configuring info that confirms to existing beliefs
34
what is availability bias?
the 1st thing that comes to mind and sticking with it
35
what is attentional bias?
paying attention to some things and ignoring others
36
what is anchoring bias?
relying too heavily on the 1st thing that you learn
37
what is selective exposure bias?
seeking info that only confirms our bias
38
what are biases?
systematic error in thinking that effects decisions and judgement
39
when does the examination begin?
when the patient walks into the waiting area
40
what is forward reasoning
pattern recognition which is good for speed and accuracy
41
what is backward reasoning?
a hypothesis guided reasoning
42
what are the 3 steps in the PT exam?
initial impressions and observations
data gathering
diagnosis and treatment planning
43
what are concept maps good for identifying?
problems most important to the patient
largest barriers to the next level of function
problems most affected by the PT
44
what is the intervention portion?
selection of specific procedures/interventions after appraising the evidence to select the most appropriate treatment
45
what are some things that can provide guidance for the PT intervention?
guidance from colleagues, mentors, and past experiences in addition to evidence
46
what are the key components in successful outcomes?
collaboration w the patient
emphasis on patient empowerment
use of standardized outcome measures
47
what are the 2 types of reflection?
reflection in action and reflection on action
48
what is the think aloud process?
speaking your process out loud to identify your thought process, assist in taking corrective action, and facilitate the metacognition process
49
what are the 9 points for reflection?
1. initial data gathering/interview
2. generation of initial hypothesis
3. examination
4. evaluation
5. plan of care
6. interventions
7. reevaluation
8. outcomes
9. mentor feedback
50
what is the PT examination?
the vigorous pursuit of valid, reliable, and clinically relevant data that's comprehensively obtained and used to inform intervention and provide an objective measure of progress toward functional outcomes that are meaningful to the patient
51
what is the primary objective of examination?
to establish an accurate PT diagnosis which guides intervention
52
t/f: the PT diagnosis is a work in progress and is an ongoing process
true!
53
when applying a low dose intervention, the patient gets worse, what 2 things can you do?
decrease 1 variable and/or monitor and if good repeat
54
when applying a low dose intervention, the patient gets slightly better, what should you do?
repeat
55
when applying a low dose intervention, the patient gets dramatically better, what should you do?
monitor
56
when applying a low dose intervention, the patient shows no change, what should you do?
increase 1 variable and repeat if good
57
what tools are in our toolbox as PTs?
1. diagnostic imaging
2. lab test values
3. patient's response to medication
4. patient's response to performance measures
5. patient's response to self-report measures
6. patient's response to last intervention
7. evidence-based standards
8. therapist experience, intuition
58
what is the prognosis?
the predicted optimal level of improvement in function and the amount of the time needed to reach that level
59
when is the prognosis established?
at the onset of treatment
60
can the prognosis be modified over time?
yes!
61
what are the essential components of the plan of care (POC)?
1. goals and expected outcomes
2. prognosis
3. general statement of the interventions to be used
4. proposed duration
5. frequency required to reach the goals
6. anticipated discharge plans
62
when should the PT exam be performed?
at the start of care
at regular intervals throughout care
at the times of each visit
at the conclusion of care
63
the PT exam should be used to ____, _____, or _____ the POC
guide, modify, alter
64
what is the history?
a systematic gathering of data from both the past and present related to why the individual is seeking the services of the PT
65
how is the history obtained?
through the gathering of data, consultation with other members of the team and through review of the individual's medical or PT record
66
what components should be gathered in the history?
the patient's history of present illness and past medical history
67
what is an open-ended question?
a question that elicits more than a one-word response that should be used at the beginning of the interview
68
what kind of question allows a "patient-guided" response?
open-ended
69
what is a closed-ended question?
a question that warrants a "yes" or "no" answer or other specific options
70
what kind of question allows for a "therapist-controlled" response?
closed-ended
71
what is the funnel technique?
start the interview with open-ended questions then move towards more closed-ended questions
72
what is the most efficient method of collecting data?
using the funnel technique
73
are follow up questions open or closed ended?
they can be either!
74
what is the purpose of follow up questions?
to clarify responses or data
75
what is the paraphrasing technique?
when the therapist repeat info to gain clarity
76
what is the review of systems?
the search for info regarding all major body systems using a series of questions or checklists to identify symptoms, medical conditions, and/or adverse medication events that may mimic conditions that are amenable to PT intervention
77
what are some examples of general review of systems questions?
is there any unexplained
- weight loss/gain?
- fever, chills, sweating?
- nausea, vomiting, loss of appetite?
- dizziness, lightheadedness, or falls?
- fatigue?
- weakness?
- numbness or tingling?
- malaise
- changes in cognition or mental activity?
78
what are some examples of questions about the musculoskeletal system?
any unrelated/unexplained:
- joint pain, swelling, or stiffness?
- muscle weakness?
- muscle wasting?
- pain that never changes?
79
what are some examples of questions about the neuromuscular system?
any unrelated/unexplained:
- coordination/balance problems?
- changes in vision/hearing?
- involuntary movement/tremors?
- severe headaches?
80
what are some examples of questions about the cardiovascular and pulmonary system?
any unrelated/unexplained:
- heart palpitations?
- chest pain/heaviness?
- SOB?
- coughing or hoarseness?
- cold/blue fingers or toes?
81
what are some examples of questions about the integumentary system?
any unrelated/unexplained:
- rashes/other skin changes? - new/changing moles?
- sores that won't heal?
- changes in nail beds?
82
what types of questions should you ask about pain?
location, description, frequency, duration, intensity, pattern, aggravating factors, relieving factors, anxiety/depression
83
what are the 2 broad categories of pain etiologies?
organic and non-organic
84
what are the organic pain etiologies?
somatic, vascular, neuropathic, and visceral
85
what are the non-organic pain etiologies?
affective/behavioral (depression/anxiety)
86
what is the systems review?
a brief exam of anatomical and physiological status of all body systems
87
what things would be examined in the cardiovascular and pulmonary system?
HR, BP, respiratory rate, edema
88
what things would be examined in the musculoskeletal system?
gross symmetry, gross strength, gross ROM, height, and weight
89
what things would be examined in the neuromuscular system?
gross coordinated movements, balance, gait, locomotion, bed mobility, transfers, motor function (control and learning)
90
what things would be examined for cognition?
consciousness, orientation to person place and time, cognition, expected emotional/behavioral responses, learning preferences
91
what things would be examined in the integumentary system?
skin integrity, pliability (texture), presence of scar formation, skin color, moles and blemishes
92
what things would be examined for communication?
language, ability to produce and understand speech, communication of thought and feelings
93
what things would be examined in the endocrine system?
type 2 diabetes, thyroid conditions
94
what is the pathophysiology of edema?
hydrostatic pressure pushes fluid against the interior walls of the capillaries caused by BP
OR
osmotic pressure putting fluid pressure against the exterior walls of capillaries causing fluid to enter them at the venule end
95
is hydrostatic pressure greater at the arteriole or capillary end?
arteriole end
96
what is edema?
fluid remaining in the interstitial spaces due to injury, infection, insufficient heart or vessels, or insufficient lymphatic system causing an imbalance b/w osmotic and hydrostatic pressure
97
t/f: increase capillary permeability in edema may be triggered by an inflammatory response
true
98
what is venous insufficiency?
valve insufficiency leading to a backflow of blood and pooling of fluids due to the effects of gravity
the overload in the venous and capillary systems cause fluids to leave vessels and enter the interstitial space
99
80% of leg ulcer are due to _____ insufficiency
venous
100
what is lymphedema?
insufficient lymphatic system that causes chronic fluid buildup in the interstitial space
101
what is post-injury edema?
edema caused by fractures, contusions, sprains, muscle/tendon/ligament tears or ruptures, burns, or cuts
102
what is osteomyelitis?
a bone infection
103
what is dactylitis?
swelling of the toes
104
what are the IFEE signs of infection?
induration
fever
erythema
edema
105
what is induration?
dense edema causing hardness or firmness
106
what is erythema?
redness
107
what are additional signs of infection other than IFEE?
purulent exudate (pus) and pain
108
what are the s/s of traumatic edema?
erythema, warmth, non-pitting edema, and local tenderness
109
what are the s/s of lymphatic edema?
pitting or non-pitting edema, soft or hard, local tenderness along the lymph canal
110
what are the s/s of venous edema?
skin is thick and shiny, pitting edema, distal swelling in extremities
111
where does lymphedema occur?
in the upper and lower extremities
112
who is more prone to lymphedema?
women who've had a mastectomy w/resection of the lymph nodes and/or damage of lymph nodes by radiation
113
what are the s/s of lymphedema?
edema, pain, numbness, paresthesia, heaviness, fibrosis
114
what are the limitations in lymphedema?
proprioception, AROM, strength, manual dexterity, lifting, and other functional skills
115
where is the apex (inlet) of the axilla?
connected to the neck
116
where is the base (outlet) of the axilla?
the armpit
117
what makes up the anterior wall of the axilla?
pec major, subclavius, pec minor, clavipectoral fascia, and suspensory ligament of the axilla
118
what makes up the posterior wall of the axilla?
subscap, lats, and teres minor
119
what makes up the medial wall of the axilla?
upper 4-5 ribs, intercostal spaces covered by serratus anterior
120
what makes up the lateral wall of the axilla
coracobrachialis and biceps
121
what is intermittent claudication?
ischemia with exercise causing pain and cramping often in the gastroc and glutes
122
if the pain is eliminated with rest, what should you suspect?
claudication
123
is intermittent claudication synonymous to neurogenic claudication?
no!
124
edema pitting scale
0: no putting
1+: mild pitting; 2 mm depression that disappears rapidly
2+: moderate pitting edema; 4 mm depression that disappears in 10-15 seconds
3+: moderately severe pitting; 6 mm depression that may last more than 1 minute
4+: severe pitting edema; 8mm depression that can last more than 2 minutes
125
what are some accessory organs?
hair follicles, glands, nails
126
what are the functions of the integumentary system?
protection, temp regulation, nutrient storage, sensory reception, excretion/secretion, synthesis
127
what is the storage component of the integumentary system?
adipose tissue stores lipids
128
what is secretion/excretion component of the integumentary system?
salt, water, and organic wastes are excreted
mammary glands produce and secrete milk
129
what does the integumentary system synthesize?
melanin, keratin, and vit D
130
what are some common conditions affecting the integumentary system?
aging, cardiopulmonary and vascular changes, pressure, neuropathy, trauma, inflammatory skin disease, and neoplastic skin disease
131
what are some effects of aging?
wrinkles, skin dehydration, slower healing, diminished temp regulation, decreased immunologic responses, decreased UV protection, impaired sensory perception and pain threshold, decreased immune responsiveness, decreased sweat production, gray hair, atypical skin pigmentation, decreased skin thickness, increased susceptibility to pathological conditions, and decreased hair and nail growth
132
what causes wrinkles?
elastic tissue becomes less resilient and the fat layer and supportive tissues beneath the dermis decrease in thickness
133
why does the skin become dehydrated with age?
sebaceous (oil) glands and sweat glands decrease in activity
134
why does healing slow down with age?
blood supply to the dermis is diminished
135
why is there a decreased immunological response as you age?
decreased # of Langerhan's cells
136
why does skin have decreased UV protection as you age?
decrease in melanocytes
137
why is there impaired sensory perception and pain threshold in aging?
decreased # of nerve endings and distorted structure of nerve endings
138
why is there a decrease in temp regulation as you age?
decrease is sweat production and loss of subcutaneous fat
139
why does hair gray and skin get atypical pigmentation with age?
decreased # of functional melanocytes
140
what are you looking for in an integumentary screening?
presence of edema, scar tissue, skin discoloration, nail abnormalities, integrity, and signs of infection
141
what is arterial insufficiency?
loss of vascular flow to lower extremities leading to tissue death
often seen in the foot and ankle
142
what is venous insufficiency
results from venous hypertension, venous thrombosis, varicose veins, or poorly functioning valves, obstruction within venous systems.
143
what is venous stasis?
results from increase in capillary leakage of fibrinogen secondary to venous hypertension
144
what is white cell trapping?
trapped cells occlude capillaries leading to ischemic damage
145
what is a pressure injury?
localized injury to the skin and/or underlying soft tissue usually over a bony prominences.
146
intense or prolonged pressure or pressure in combination with sheer can cause what?
a pressure injury
147
what is dermatitis?
acute/chronic inflammation, itching, and scaling of the epidermis
148
what is staph aureus?
skin boil
149
what is impetigo?
staph aureus/streptococcus pyogenes
150
what is cellulitis?
a bacterial infection of the skin that affect the dermis and subcutaneous fat
151
what is ring worm?
a fungal infection of the skin that causes a round shaped mark
no this is not an actual worm
152
what causes Lyme disease?
a tic bite that causes neuro and muscular symptoms
153
what are the 3 most common types of neoplastic skin diseases?
1. basal cell carcinoma
2. squamous cell carcinoma
3. malignant melanoma
154
what is the ABCD rule with skin lesions?
A-asymmetry of the pigmented lesion
B-borders that are irregular
C-color (dark black to dark brown to red)
D-diameter over 6mm
155
what is a keloid scar?
a raised scar that doesn't stay within the boundary of the og wound
156
what is senile purpura?
purple bruising due to aging
157
what is the difference b/w a blister and a callus?
a blister is a fluid filled bubble on the skin caused by friction b/w the skin and another surface
a callus is an area of hardened skin the often occurs due to friction b/w bone and skin
158
don't SCIP the skin screen! what does SCIP stand for?
Scar
Color
Integrity
Pliability
159
what does the 6 minute walk test measure?
cardiorespiratory endurance, gait speed, and functional mobility
160
what does reliability mean?
reproducible and dependable
161
what is reliable patient behavior?
consistent responses under given conditions
162
what is a reliable examiner?
able to measure repeated outcomes w/consistent scores
163
what is a reliable instrument?
performs with predictable consistency under set conditions
164
what is test-retest reliability?
an instrument can measure a variable w/consistency against itself under repeated consistency
165
what is intrarater reliability?
stability of data recorded by one individual across 2 or more trials
166
what is interrater reliability?
agreement b/w 2 or more examiners who measure the same group of subjects
167
what needs to be established first, intrarater reliability or interrater reliability?
intrarater reliability
168
what is a good reliability coefficient?
greater than .75
169
what is generalizability?
ability to apply data obtained from one population to all/other populations
170
what is validity?
a test that measures what it is intended to
171
are valid measures considered to be reliable?
yes!
172
are reliable measures considered to be valid?
not all the time
173
what is content validity?
items that make up an instrument adequately sample the universe of content that defines the variable being measured
test contains all elements of the variable being tested
174
what is face validity?
instrument appears to test what it's supposed to and is a plausible method for doing so
175
what is criterion-related validity?
outcome of one instrument, the target test, can be used as a substitute for an established reference standard (gold standard) test
high correlation b/w the target test and the criterion
criterion test and target test measure the same thing
176
what is concurrent validity?
it establishes validity when 2 measures are taken at relatively the same time, most often when the target test is considered more efficient/less costly than the gold standard test
the degree to which 2 tests agree on the same phenomenon (ie. self report vs clinician rating)
177
what is construct validity?
the ability of an instrument to measure an abstract construct and the degree to which the instrument reflects the theoretical components of the construct
does the measure relate to things that we would expect?
178
what is predictive validity?
the outcome of the target test can be used to predict a future criterion score/outcome
ie. gait velocity in predicting discharge location
179
why is the ability of an instrument to detect change over time important?
bc it assess the effects of an intervention, the score must change in proportion to the patient's status change
180
what is minimal detectable change (MDC)?
VERY IMPORTANT CONCEPT
the amount of change in a variable that must be achieved to reflect a true difference b/w 2 time points
the smallest amount of difference that passes the threshold of error
determines if a change is meaningful
181
what is minimally clinically important difference (MCID)?
VERY IMPORTANT CONCEPT
the smallest difference that signifies an important difference in a patient's condition
the smallest difference a patient perceives as beneficial
182
should the MDC or MCID be larger?
the MCID
183
which is the more important change: MDC or MCID?
MCID
184
what are the 4 possible outcomes of a diagnostic test?
1. true positive
2. false positive
3. false negative
4. true negative
185
what is sensitivity?
the ability to get a positive result when a condition is truly present
186
what is specificity?
negative result when the condition is truly absent
187
SpPin and SnNout
SPecificity, Positive test rules IN a diagnosis
SeNsitivity, Negative test rules OUT a diagnosis
188
a high post-test probability allows us to ____ the diagnosis when a test is positive and ____ it when the results is negative
confirm, abandon
188
what are post-test probabilities?
revised likelihood of the diagnosis based on the outcome of a test that increases our confidence in the diagnosis
189
t/f: likelihood ratios always refer to the likelihood of the disorder being present
true!
190
what is a positive likelihood ratio?
how many times a positive test is likely to be seen in those with the disorder than those w/out it
191
a good test with have a ____ positive likelihood ratio
high
192
what does a positive likelihood ratio indicate?
that the disorder is likely to be present with a positive test
193
what does a high LR+ mean?
the disorder is likely present with a positive test
194
what does a low LR- mean?
the disorder is not likely present with a negative test
195
what is a negative likelihood ratio?
how many times more likely a negative test will be seen in those w/ the disorder than those w/it
196
a good LR- test will have a ____ LR
low
197
what does a negative likelihood ratio indicate?
that the disorder has a low likelihood of being present with a negative test
198
a LR+ of >___ and a LR- of <____ has relatively important effects
5, 0.2
199
a LR b/w ____ or ____ may be importatn
2-5, 0.2-0.5
200
t/f: values close to 1.0 in LR have unimportant effects
true!
201
are cardiovascular and lung problems or LBP more prevalent?
cardiovascular and lung problems
202
why do we do cardiovascular and pulmonary screenings?
to see if it's an active issue
203
what is congestive heart failure (CHF)?
the heart is unable to pump a sufficient amount of blood to the body to supply its needs
204
what can CHF lead to?
pulmonary congestion, edema, and hypertension
205
what is left sided heart failure?
L ventricle fails to pump enough blood to meet the body's needs
206
what does left sided heart failure lead to?
pulmonary edema !!!!
muscle weakness, tachypnea, renal changes, and cerebral hypoxia and sequela
207
pulmonary edema varies based on...
position, activity, emotional/psychological stress
208
what is right sided heart failure?
failure of the R ventricle to pump blood to the lungs causing congestion in the R atrium and throughout the venous system
209
what right sided heart failure lead to?
peripheral edema !!!!
venous congestion of the organs, dependent edema, jugular vein distension, abdominal pain and distension, weight gain, and liver congestion
210
what is dependent edema?
any position where a limb is hanging down and is under the influence of gravity that often occurs in the ankle or pre-tibia (anterior tibia)
211
which sided failure is easy to identify? why?
right sided heart failure is easier to recognize bc left sided is more just breathing difficulties
212
what are the essential components of the cardiovascular screen?
HR, BP, SpO2, respiration rate, and edema (especially pitting)
213
what are the average resting heart rates?
adults: 60-100 bpm
children (1-8): 80-100 bpm
infants (<1): 100-120 bpm
highly trained athletes: 40-60 bpm
214
at the initial encounter, the assessment of HR and RR should last ____ and then after that it should last _____
1 minute, 30 seconds
215
what is tachycardia rate in adults?
>100 bpm
216
what is bradycardia rate in adults?
<60 bpm
217
what is regular pulse rhythm?
felt at typical intervals
218
what is irregular pulse rhythm?
felt at variable intervals
219
what are the 6 vital signs?
pulse (HR, rhythm, and force)
respiration (rate, rhythm, and depth)
BP
temp (core)
pain
walking speed
220
what is a 0 pulse force?
absent (unpalpable)
221
what is a 1+ pulse force?
weak or diminished (barely palpable)
222
what is a 2+ pulse force?
normal (easily palpable)
223
what is a 3+ pulse force?
increased force (very easily palpable)
224
what is a 4+ pulse force?
bounding (unable to obliterate w/palpation pressure
225
fever leads to _____ in the periphery, which leads to _____ in BP, which makes the heart pump _____
vasodilation, decrease, harder
226
measure of arterial blood
O2 carried in arterial blood by hemoglobin is measured as PaO2 (partial pressure of oxygen)
227
pulse oximetry
measures arterial blood oxygen saturation (% of O2 combined with Hgb)
reported as SpO2
measured at the peripheral pulse (usually a finger)
228
what are normal SpO2 values?
96-100%
229
SpO2 less than ___ warrants further testing
90%
230
what is hypoxemia?
deficient oxygenation of the blood
231
what is hypoxia?
diminished availability of O2 to tissues
232
what is anoxia?
complete lack of O2
233
what are some causes of reduced blood O2 saturation?
alterations in heart function
impaired ability of the lungs to oxygenate blood
anemia (reduced Hgb)
hypoventilation
diffusion impairments that affect blood-gas exchange
234
what are the 2 light sources in the pulse ox device?
red and infrared
235
measurement of pulse ox allows...
indentification of hypoxemia
monitoring of tolerance of activity
evaluates patient's response to treatment
236
what are average respiration rates?
adult: 12-20 breaths/min
child (1-8): 15-30 breaths/min)
infant(<1): 25-50 breath/min
highly trained athlete: 8-10 breaths/min
237
what are tachypnea rates?
>20 breaths/min
238
what are bradypnea rates?
<12 breaths/min
239
what are regular breathing rhythms?
breaths observed at typical intervals
240
what are irregular breathing rhythms?
breaths observed at variable intervals
241
what are the 3 components of a pitting edema screen
is it...
1. new?
2. bilateral?
3. pitting?
242
what are the essential components of a pulmonary screening?
1. SpO2
2. breathing pattern
3. posture
4. respiration rate
243
what is dyspnea?
difficulty/uncomfortable breathing that may be described as SOB and may see accessory breathing
244
what is orthopnea?
difficulty breathing when lying flat
245
how is orthopnea measured?
in the # of pillows needed to be able to breath kore comfortably
246
what is paroxysmal nocturnal dyspnea?
episodes of sudden dyspnea and orthopnea usually at the same time each night that often wakes the patient and subsides with sitting or standing
247
what is apnea?
absence of breathing (frequently while sleeping) caused by obstruction or dysfunction of the NS
248
is chest breathing or diaphragmatic breathing the goal in PT?
diaphragmatic breathing
249
what are some accessory muscles?
SCM, lev scap, scalenes, pec major
250
why does leaning forward on something help with breathing?
allows for stabilization so accessory muscles can work to elevate the ribs and thorax, increases abdominal pressure (pushes the diaphragm up for better strength of contraction)
251
what can SpO2 readings help gives insights into?
possible pulmonary conditions like COPD
252
you need regular participation in physical activity that...
1. involves large muscles groups
2. challenges the cardiorespiratory system
253
what is VO2 max?
max O2 consumption that measures the body's capacity to use O2 measured in mL/kg/min
254
what 5 factors does VO2 depend on?
1. transport of O2
2. O2 binding capacity of the blood
3. cardiac function
4. O2 extraction capability
5. muscular oxidative capacity
255
what is endurance?
the ability to work for prolonged periods of time and to resist fatigue
256
what is muscle endurance?
ability of an isolated muscle group to perform repeated contractions over period of time
257
what is CV endurance?
ability to perform large muscles dynamic exercises over long periods of time
258
what determines the need/demand of myocardial O2 consumption?
1. HR
2. systemic BP
3. myocardial contractility
4. afterload
259
what is afterload?
ventricular force need to open the aortic valve at the beginning of systole
260
afterload is determined by ___ ventricular wall tension and _____ wall tension
left, aortic
261
what is myocardial O2 supply dependent on?
1. O2 content
2. Hgb O2 dissociation
3. coronary blood flow
262
what is coronary blood flow determined by?
1. aortic diastole
2. duration of diastole
3. coronary artery resistance
4. collateral circulation
263
what happens if the myocardial demand for oxygen exceeds the supply?
ischemia
264
where is the main supply of O2 during exercise coming from?
increased coronary blood flow
265
what is deconditioning?
decrease in max O2 consumption that results from prolonged bedrest due to illness, bedrest w/o disease, lifestyle, or aging
266
what are 4 examples of fitness field tests?
1. 1 mile walk test
2. 6 minute walk test
3. 1.5 mile run
4. 12 minute run
267
what are 4 fitness tests?
1. field tests
2. treadmill tests
3. cycle ergometry
4. step tests
268
what are the advantage of field testing?
easy to administer to a large group at one time with little equipment needed
269
what are the disadvantages of field testing?
it can be near the max in ppl w/low aerobic fitness
there is a potential to be unmonitored for test termination criteria, BP, or HR
it may not be appropriate for sedentary individuals or those at risk for CV/MSK complications
270
when should you stop a test?
1. onset of angina/angina-like symptoms
2. drop in SBP of >/=10mmHg with an increase in work rate
3. SBP drops below the value obtained at rest in the same position before the test
4. increase in SBP>/=250 mmHg and/or DBP>115 mmHg
5. SOB, wheezing, leg cramps, or claudication
6. signs of poor perfusion: lightheadedness, confusion, ataxia, pallor, cyanosis, nausea, cold/clammy skin
7. HR doesn't increase with exercise
8. noticeable change in heart rhythm
9. subject requests to stop
10. physical/verbal manifestation of severe fatigue (inability to talk)
11. failure of testing equipment
