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DPT 509 > Quiz 1 > Flashcards

Quiz 1 Flashcards

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

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2
Q

clinical reasoning enables practitioners to…

A

take the “best” action in a specific context

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3
Q

clinical reasoning permeates clinical practice by…

A

informing decisions

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4
Q

t/f: clinical reasoning promotes individualized care

A

true!

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5
Q

what are heuristics?

A

mental shortcuts that allow ppl to solve problems and make judgements quickly and effectively

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6
Q

what are the 3 dimensions of clinical reasoning?

A

remember/review (knowledge)

refine (cognition)

reflect (metacognition)

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7
Q

what is the knowledge dimension?

A

strong, discipline-specific knowledge base derived from theory/research and personal experience

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8
Q

what is the cognition dimension?

A

reconciling clinical data with the clinician’s existing knowledge in the moment

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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)

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10
Q

what is self-reflection?

A

constant, thoughtful, self-reflection

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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

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12
Q

what is the hypothetico-deductive reasoning model?

A

clinical data used to generate a hypothesis through further inquiry

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13
Q

what are the 2 types of reasoning under the hypothetico-deductive reasoning model?

A

inductive and deductive reasoning

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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

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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

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16
Q

who is the hypothetic-deductive reasoning model primarily used by?

A

novices and experts in challenging situations

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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

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18
Q

clinical reasoning involves the integration of _____, _____, and _____

A

knowledge, reasoning, metacognition

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19
Q

who uses the knowledge-reasoning integration model?

A

primarily experts

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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

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21
Q

who are the only people that can use the intuitive reasoning model?

A

experts

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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

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23
Q

the pattern recognition model is characterized by ____ and ____

A

speed and efficiency

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24
Q

who frequently uses the pattern recognition model?

A

experts in typical clinical situations

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25
Q

what is the hypotheses-oriented algorithm for clinicians (HOAC)?

A

a graphically represented step-by-step guide to assist clinicians in problem solving

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26
Q

what is narrative reasoning?

A

a frame used to understand the patient’s perspective and experiences of their problem to understand the context of the problem

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27
Q

what components are a part of the narrative model?

A

the patient’s attitudes, understanding, beliefs, emotions, and expectations

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28
Q

what are the 4 cognitive paradigms?

A

hypothetico-deductive reasoning

pattern recognition

knowledge reasoning integration model

intuitive reasoning

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29
Q

are cognitive paradigms more practitioner driven or patient driven?

A

practitioner driven

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30
Q

what are the 5 interactive paradigms?

A

narrative reasoning

multidisciplinary reasoning

collaborative reasoning

ethical reasoning

teaching as reasoning

(all very similar to narrative reasoning)

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31
Q

t/f: the interactive paradigms build consensus b/w clinician and patient

A

true!

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32
Q

what are the 5 biases?

A

confirmation bias

availability bias

attentional bias

anchoring bias

selective exposure bias

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33
Q

what is confirmation bias?

A

configuring info that confirms to existing beliefs

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34
Q

what is availability bias?

A

the 1st thing that comes to mind and sticking with it

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35
Q

what is attentional bias?

A

paying attention to some things and ignoring others

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36
Q

what is anchoring bias?

A

relying too heavily on the 1st thing that you learn

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37
Q

what is selective exposure bias?

A

seeking info that only confirms our bias

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38
Q

what are biases?

A

systematic error in thinking that effects decisions and judgement

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39
Q

when does the examination begin?

A

when the patient walks into the waiting area

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40
Q

what is forward reasoning

A

pattern recognition which is good for speed and accuracy

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41
Q

what is backward reasoning?

A

a hypothesis guided reasoning

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42
Q

what are the 3 steps in the PT exam?

A

initial impressions and observations

data gathering

diagnosis and treatment planning

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43
Q

what are concept maps good for identifying?

A

problems most important to the patient

largest barriers to the next level of function

problems most affected by the PT

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44
Q

what is the intervention portion?

A

selection of specific procedures/interventions after appraising the evidence to select the most appropriate treatment

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45
Q

what are some things that can provide guidance for the PT intervention?

A

guidance from colleagues, mentors, and past experiences in addition to evidence

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46
Q

what are the key components in successful outcomes?

A

collaboration w the patient

emphasis on patient empowerment

use of standardized outcome measures

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47
Q

what are the 2 types of reflection?

A

reflection in action and reflection on action

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48
Q

what is the think aloud process?

A

speaking your process out loud to identify your thought process, assist in taking corrective action, and facilitate the metacognition process

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49
Q

what are the 9 points for reflection?

A
  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
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50
Q

what is the PT examination?

A

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

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51
Q

what is the primary objective of examination?

A

to establish an accurate PT diagnosis which guides intervention

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52
Q

t/f: the PT diagnosis is a work in progress and is an ongoing process

A

true!

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53
Q

when applying a low dose intervention, the patient gets worse, what 2 things can you do?

A

decrease 1 variable and/or monitor and if good repeat

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54
Q

when applying a low dose intervention, the patient gets slightly better, what should you do?

A

repeat

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55
Q

when applying a low dose intervention, the patient gets dramatically better, what should you do?

A

monitor

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56
Q

when applying a low dose intervention, the patient shows no change, what should you do?

A

increase 1 variable and repeat if good

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57
Q

what tools are in our toolbox as PTs?

A
  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
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58
Q

what is the prognosis?

A

the predicted optimal level of improvement in function and the amount of the time needed to reach that level

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59
Q

when is the prognosis established?

A

at the onset of treatment

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60
Q

can the prognosis be modified over time?

A

yes!

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61
Q

what are the essential components of the plan of care (POC)?

A
  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
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62
Q

when should the PT exam be performed?

A

at the start of care

at regular intervals throughout care

at the times of each visit

at the conclusion of care

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63
Q

the PT exam should be used to ____, _____, or _____ the POC

A

guide, modify, alter

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64
Q

what is the history?

A

a systematic gathering of data from both the past and present related to why the individual is seeking the services of the PT

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65
Q

how is the history obtained?

A

through the gathering of data, consultation with other members of the team and through review of the individual’s medical or PT record

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66
Q

what components should be gathered in the history?

A

the patient’s history of present illness and past medical history

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67
Q

what is an open-ended question?

A

a question that elicits more than a one-word response that should be used at the beginning of the interview

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68
Q

what kind of question allows a “patient-guided” response?

A

open-ended

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69
Q

what is a closed-ended question?

A

a question that warrants a “yes” or “no” answer or other specific options

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70
Q

what kind of question allows for a “therapist-controlled” response?

A

closed-ended

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71
Q

what is the funnel technique?

A

start the interview with open-ended questions then move towards more closed-ended questions

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72
Q

what is the most efficient method of collecting data?

A

using the funnel technique

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73
Q

are follow up questions open or closed ended?

A

they can be either!

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74
Q

what is the purpose of follow up questions?

A

to clarify responses or data

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75
Q

what is the paraphrasing technique?

A

when the therapist repeat info to gain clarity

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76
Q

what is the review of systems?

A

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

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77
Q

what are some examples of general review of systems questions?

A

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?

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78
Q

what are some examples of questions about the musculoskeletal system?

A

any unrelated/unexplained:
- joint pain, swelling, or stiffness?
- muscle weakness?
- muscle wasting?
- pain that never changes?

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79
Q

what are some examples of questions about the neuromuscular system?

A

any unrelated/unexplained:
- coordination/balance problems?
- changes in vision/hearing?
- involuntary movement/tremors?
- severe headaches?

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80
Q

what are some examples of questions about the cardiovascular and pulmonary system?

A

any unrelated/unexplained:
- heart palpitations?
- chest pain/heaviness?
- SOB?
- coughing or hoarseness?
- cold/blue fingers or toes?

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81
Q

what are some examples of questions about the integumentary system?

A

any unrelated/unexplained:
- rashes/other skin changes? - new/changing moles?
- sores that won’t heal?
- changes in nail beds?

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82
Q

what types of questions should you ask about pain?

A

location, description, frequency, duration, intensity, pattern, aggravating factors, relieving factors, anxiety/depression

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83
Q

what are the 2 broad categories of pain etiologies?

A

organic and non-organic

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84
Q

what are the organic pain etiologies?

A

somatic, vascular, neuropathic, and visceral

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85
Q

what are the non-organic pain etiologies?

A

affective/behavioral (depression/anxiety)

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86
Q

what is the systems review?

A

a brief exam of anatomical and physiological status of all body systems

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87
Q

what things would be examined in the cardiovascular and pulmonary system?

A

HR, BP, respiratory rate, edema

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88
Q

what things would be examined in the musculoskeletal system?

A

gross symmetry, gross strength, gross ROM, height, and weight

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89
Q

what things would be examined in the neuromuscular system?

A

gross coordinated movements, balance, gait, locomotion, bed mobility, transfers, motor function (control and learning)

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90
Q

what things would be examined for cognition?

A

consciousness, orientation to person place and time, cognition, expected emotional/behavioral responses, learning preferences

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91
Q

what things would be examined in the integumentary system?

A

skin integrity, pliability (texture), presence of scar formation, skin color, moles and blemishes

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92
Q

what things would be examined for communication?

A

language, ability to produce and understand speech, communication of thought and feelings

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93
Q

what things would be examined in the endocrine system?

A

type 2 diabetes, thyroid conditions

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94
Q

what is the pathophysiology of edema?

A

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

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95
Q

is hydrostatic pressure greater at the arteriole or capillary end?

A

arteriole end

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96
Q

what is edema?

A

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

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97
Q

t/f: increase capillary permeability in edema may be triggered by an inflammatory response

A

true

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98
Q

what is venous insufficiency?

A

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

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99
Q

80% of leg ulcer are due to _____ insufficiency

A

venous

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100
Q

what is lymphedema?

A

insufficient lymphatic system that causes chronic fluid buildup in the interstitial space

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101
Q

what is post-injury edema?

A

edema caused by fractures, contusions, sprains, muscle/tendon/ligament tears or ruptures, burns, or cuts

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102
Q

what is osteomyelitis?

A

a bone infection

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103
Q

what is dactylitis?

A

swelling of the toes

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104
Q

what are the IFEE signs of infection?

A

induration
fever
erythema
edema

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105
Q

what is induration?

A

dense edema causing hardness or firmness

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106
Q

what is erythema?

A

redness

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107
Q

what are additional signs of infection other than IFEE?

A

purulent exudate (pus) and pain

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108
Q

what are the s/s of traumatic edema?

A

erythema, warmth, non-pitting edema, and local tenderness

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109
Q

what are the s/s of lymphatic edema?

A

pitting or non-pitting edema, soft or hard, local tenderness along the lymph canal

110
Q

what are the s/s of venous edema?

A

skin is thick and shiny, pitting edema, distal swelling in extremities

111
Q

where does lymphedema occur?

A

in the upper and lower extremities

112
Q

who is more prone to lymphedema?

A

women who’ve had a mastectomy w/resection of the lymph nodes and/or damage of lymph nodes by radiation

113
Q

what are the s/s of lymphedema?

A

edema, pain, numbness, paresthesia, heaviness, fibrosis

114
Q

what are the limitations in lymphedema?

A

proprioception, AROM, strength, manual dexterity, lifting, and other functional skills

115
Q

where is the apex (inlet) of the axilla?

A

connected to the neck

116
Q

where is the base (outlet) of the axilla?

A

the armpit

117
Q

what makes up the anterior wall of the axilla?

A

pec major, subclavius, pec minor, clavipectoral fascia, and suspensory ligament of the axilla

118
Q

what makes up the posterior wall of the axilla?

A

subscap, lats, and teres minor

119
Q

what makes up the medial wall of the axilla?

A

upper 4-5 ribs, intercostal spaces covered by serratus anterior

120
Q

what makes up the lateral wall of the axilla

A

coracobrachialis and biceps

121
Q

what is intermittent claudication?

A

ischemia with exercise causing pain and cramping often in the gastroc and glutes

122
Q

if the pain is eliminated with rest, what should you suspect?

A

claudication

123
Q

is intermittent claudication synonymous to neurogenic claudication?

A

no!

124
Q

edema pitting scale

A

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
Q

what are some accessory organs?

A

hair follicles, glands, nails

126
Q

what are the functions of the integumentary system?

A

protection, temp regulation, nutrient storage, sensory reception, excretion/secretion, synthesis

127
Q

what is the storage component of the integumentary system?

A

adipose tissue stores lipids

128
Q

what is secretion/excretion component of the integumentary system?

A

salt, water, and organic wastes are excreted
mammary glands produce and secrete milk

129
Q

what does the integumentary system synthesize?

A

melanin, keratin, and vit D

130
Q

what are some common conditions affecting the integumentary system?

A

aging, cardiopulmonary and vascular changes, pressure, neuropathy, trauma, inflammatory skin disease, and neoplastic skin disease

131
Q

what are some effects of aging?

A

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
Q

what causes wrinkles?

A

elastic tissue becomes less resilient and the fat layer and supportive tissues beneath the dermis decrease in thickness

133
Q

why does the skin become dehydrated with age?

A

sebaceous (oil) glands and sweat glands decrease in activity

134
Q

why does healing slow down with age?

A

blood supply to the dermis is diminished

135
Q

why is there a decreased immunological response as you age?

A

decreased # of Langerhan’s cells

136
Q

why does skin have decreased UV protection as you age?

A

decrease in melanocytes

137
Q

why is there impaired sensory perception and pain threshold in aging?

A

decreased # of nerve endings and distorted structure of nerve endings

138
Q

why is there a decrease in temp regulation as you age?

A

decrease is sweat production and loss of subcutaneous fat

139
Q

why does hair gray and skin get atypical pigmentation with age?

A

decreased # of functional melanocytes

140
Q

what are you looking for in an integumentary screening?

A

presence of edema, scar tissue, skin discoloration, nail abnormalities, integrity, and signs of infection

141
Q

what is arterial insufficiency?

A

loss of vascular flow to lower extremities leading to tissue death

often seen in the foot and ankle

142
Q

what is venous insufficiency

A

results from venous hypertension, venous thrombosis, varicose veins, or poorly functioning valves, obstruction within venous systems.

143
Q

what is venous stasis?

A

results from increase in capillary leakage of fibrinogen secondary to venous hypertension

144
Q

what is white cell trapping?

A

trapped cells occlude capillaries leading to ischemic damage

145
Q

what is a pressure injury?

A

localized injury to the skin and/or underlying soft tissue usually over a bony prominences.

146
Q

intense or prolonged pressure or pressure in combination with sheer can cause what?

A

a pressure injury

147
Q

what is dermatitis?

A

acute/chronic inflammation, itching, and scaling of the epidermis

148
Q

what is staph aureus?

A

skin boil

149
Q

what is impetigo?

A

staph aureus/streptococcus pyogenes

150
Q

what is cellulitis?

A

a bacterial infection of the skin that affect the dermis and subcutaneous fat

151
Q

what is ring worm?

A

a fungal infection of the skin that causes a round shaped mark

no this is not an actual worm

152
Q

what causes Lyme disease?

A

a tic bite that causes neuro and muscular symptoms

153
Q

what are the 3 most common types of neoplastic skin diseases?

A
  1. basal cell carcinoma
  2. squamous cell carcinoma
  3. malignant melanoma
154
Q

what is the ABCD rule with skin lesions?

A

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
Q

what is a keloid scar?

A

a raised scar that doesn’t stay within the boundary of the og wound

156
Q

what is senile purpura?

A

purple bruising due to aging

157
Q

what is the difference b/w a blister and a callus?

A

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
Q

don’t SCIP the skin screen! what does SCIP stand for?

A

Scar
Color
Integrity
Pliability

159
Q

what does the 6 minute walk test measure?

A

cardiorespiratory endurance, gait speed, and functional mobility

160
Q

what does reliability mean?

A

reproducible and dependable

161
Q

what is reliable patient behavior?

A

consistent responses under given conditions

162
Q

what is a reliable examiner?

A

able to measure repeated outcomes w/consistent scores

163
Q

what is a reliable instrument?

A

performs with predictable consistency under set conditions

164
Q

what is test-retest reliability?

A

an instrument can measure a variable w/consistency against itself under repeated consistency

165
Q

what is intrarater reliability?

A

stability of data recorded by one individual across 2 or more trials

166
Q

what is interrater reliability?

A

agreement b/w 2 or more examiners who measure the same group of subjects

167
Q

what needs to be established first, intrarater reliability or interrater reliability?

A

intrarater reliability

168
Q

what is a good reliability coefficient?

A

greater than .75

169
Q

what is generalizability?

A

ability to apply data obtained from one population to all/other populations

170
Q

what is validity?

A

a test that measures what it is intended to

171
Q

are valid measures considered to be reliable?

A

yes!

172
Q

are reliable measures considered to be valid?

A

not all the time

173
Q

what is content validity?

A

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
Q

what is face validity?

A

instrument appears to test what it’s supposed to and is a plausible method for doing so

175
Q

what is criterion-related validity?

A

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
Q

what is concurrent validity?

A

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
Q

what is construct validity?

A

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
Q

what is predictive validity?

A

the outcome of the target test can be used to predict a future criterion score/outcome

ie. gait velocity in predicting discharge location

179
Q

why is the ability of an instrument to detect change over time important?

A

bc it assess the effects of an intervention, the score must change in proportion to the patient’s status change

180
Q

what is minimal detectable change (MDC)?
VERY IMPORTANT CONCEPT

A

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
Q

what is minimally clinically important difference (MCID)?
VERY IMPORTANT CONCEPT

A

the smallest difference that signifies an important difference in a patient’s condition

the smallest difference a patient perceives as beneficial

182
Q

should the MDC or MCID be larger?

A

the MCID

183
Q

which is the more important change: MDC or MCID?

A

MCID

184
Q

what are the 4 possible outcomes of a diagnostic test?

A
  1. true positive
  2. false positive
  3. false negative
  4. true negative
185
Q

what is sensitivity?

A

the ability to get a positive result when a condition is truly present

186
Q

what is specificity?

A

negative result when the condition is truly absent

187
Q

SpPin and SnNout

A

SPecificity, Positive test rules IN a diagnosis

SeNsitivity, Negative test rules OUT a diagnosis

188
Q

a high post-test probability allows us to ____ the diagnosis when a test is positive and ____ it when the results is negative

A

confirm, abandon

188
Q

what are post-test probabilities?

A

revised likelihood of the diagnosis based on the outcome of a test that increases our confidence in the diagnosis

189
Q

t/f: likelihood ratios always refer to the likelihood of the disorder being present

A

true!

190
Q

what is a positive likelihood ratio?

A

how many times a positive test is likely to be seen in those with the disorder than those w/out it

191
Q

a good test with have a ____ positive likelihood ratio

A

high

192
Q

what does a positive likelihood ratio indicate?

A

that the disorder is likely to be present with a positive test

193
Q

what does a high LR+ mean?

A

the disorder is likely present with a positive test

194
Q

what does a low LR- mean?

A

the disorder is not likely present with a negative test

195
Q

what is a negative likelihood ratio?

A

how many times more likely a negative test will be seen in those w/ the disorder than those w/it

196
Q

a good LR- test will have a ____ LR

A

low

197
Q

what does a negative likelihood ratio indicate?

A

that the disorder has a low likelihood of being present with a negative test

198
Q

a LR+ of >___ and a LR- of <____ has relatively important effects

A

5, 0.2

199
Q

a LR b/w ____ or ____ may be importatn

A

2-5, 0.2-0.5

200
Q

t/f: values close to 1.0 in LR have unimportant effects

A

true!

201
Q

are cardiovascular and lung problems or LBP more prevalent?

A

cardiovascular and lung problems

202
Q

why do we do cardiovascular and pulmonary screenings?

A

to see if it’s an active issue

203
Q

what is congestive heart failure (CHF)?

A

the heart is unable to pump a sufficient amount of blood to the body to supply its needs

204
Q

what can CHF lead to?

A

pulmonary congestion, edema, and hypertension

205
Q

what is left sided heart failure?

A

L ventricle fails to pump enough blood to meet the body’s needs

206
Q

what does left sided heart failure lead to?

A

pulmonary edema !!!!

muscle weakness, tachypnea, renal changes, and cerebral hypoxia and sequela

207
Q

pulmonary edema varies based on…

A

position, activity, emotional/psychological stress

208
Q

what is right sided heart failure?

A

failure of the R ventricle to pump blood to the lungs causing congestion in the R atrium and throughout the venous system

209
Q

what right sided heart failure lead to?

A

peripheral edema !!!!

venous congestion of the organs, dependent edema, jugular vein distension, abdominal pain and distension, weight gain, and liver congestion

210
Q

what is dependent edema?

A

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
Q

which sided failure is easy to identify? why?

A

right sided heart failure is easier to recognize bc left sided is more just breathing difficulties

212
Q

what are the essential components of the cardiovascular screen?

A

HR, BP, SpO2, respiration rate, and edema (especially pitting)

213
Q

what are the average resting heart rates?

A

adults: 60-100 bpm
children (1-8): 80-100 bpm
infants (<1): 100-120 bpm
highly trained athletes: 40-60 bpm

214
Q

at the initial encounter, the assessment of HR and RR should last ____ and then after that it should last _____

A

1 minute, 30 seconds

215
Q

what is tachycardia rate in adults?

A

> 100 bpm

216
Q

what is bradycardia rate in adults?

A

<60 bpm

217
Q

what is regular pulse rhythm?

A

felt at typical intervals

218
Q

what is irregular pulse rhythm?

A

felt at variable intervals

219
Q

what are the 6 vital signs?

A

pulse (HR, rhythm, and force)

respiration (rate, rhythm, and depth)

BP

temp (core)

pain

walking speed

220
Q

what is a 0 pulse force?

A

absent (unpalpable)

221
Q

what is a 1+ pulse force?

A

weak or diminished (barely palpable)

222
Q

what is a 2+ pulse force?

A

normal (easily palpable)

223
Q

what is a 3+ pulse force?

A

increased force (very easily palpable)

224
Q

what is a 4+ pulse force?

A

bounding (unable to obliterate w/palpation pressure

225
Q

fever leads to _____ in the periphery, which leads to _____ in BP, which makes the heart pump _____

A

vasodilation, decrease, harder

226
Q

measure of arterial blood

A

O2 carried in arterial blood by hemoglobin is measured as PaO2 (partial pressure of oxygen)

227
Q

pulse oximetry

A

measures arterial blood oxygen saturation (% of O2 combined with Hgb)

reported as SpO2

measured at the peripheral pulse (usually a finger)

228
Q

what are normal SpO2 values?

A

96-100%

229
Q

SpO2 less than ___ warrants further testing

A

90%

230
Q

what is hypoxemia?

A

deficient oxygenation of the blood

231
Q

what is hypoxia?

A

diminished availability of O2 to tissues

232
Q

what is anoxia?

A

complete lack of O2

233
Q

what are some causes of reduced blood O2 saturation?

A

alterations in heart function

impaired ability of the lungs to oxygenate blood

anemia (reduced Hgb)

hypoventilation

diffusion impairments that affect blood-gas exchange

234
Q

what are the 2 light sources in the pulse ox device?

A

red and infrared

235
Q

measurement of pulse ox allows…

A

indentification of hypoxemia

monitoring of tolerance of activity

evaluates patient’s response to treatment

236
Q

what are average respiration rates?

A

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
Q

what are tachypnea rates?

A

> 20 breaths/min

238
Q

what are bradypnea rates?

A

<12 breaths/min

239
Q

what are regular breathing rhythms?

A

breaths observed at typical intervals

240
Q

what are irregular breathing rhythms?

A

breaths observed at variable intervals

241
Q

what are the 3 components of a pitting edema screen

A

is it…
1. new?
2. bilateral?
3. pitting?

242
Q

what are the essential components of a pulmonary screening?

A
  1. SpO2
  2. breathing pattern
  3. posture
  4. respiration rate
243
Q

what is dyspnea?

A

difficulty/uncomfortable breathing that may be described as SOB and may see accessory breathing

244
Q

what is orthopnea?

A

difficulty breathing when lying flat

245
Q

how is orthopnea measured?

A

in the # of pillows needed to be able to breath kore comfortably

246
Q

what is paroxysmal nocturnal dyspnea?

A

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
Q

what is apnea?

A

absence of breathing (frequently while sleeping) caused by obstruction or dysfunction of the NS

248
Q

is chest breathing or diaphragmatic breathing the goal in PT?

A

diaphragmatic breathing

249
Q

what are some accessory muscles?

A

SCM, lev scap, scalenes, pec major

250
Q

why does leaning forward on something help with breathing?

A

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
Q

what can SpO2 readings help gives insights into?

A

possible pulmonary conditions like COPD

252
Q

you need regular participation in physical activity that…

A
  1. involves large muscles groups
  2. challenges the cardiorespiratory system
253
Q

what is VO2 max?

A

max O2 consumption that measures the body’s capacity to use O2 measured in mL/kg/min

254
Q

what 5 factors does VO2 depend on?

A
  1. transport of O2
  2. O2 binding capacity of the blood
  3. cardiac function
  4. O2 extraction capability
  5. muscular oxidative capacity
255
Q

what is endurance?

A

the ability to work for prolonged periods of time and to resist fatigue

256
Q

what is muscle endurance?

A

ability of an isolated muscle group to perform repeated contractions over period of time

257
Q

what is CV endurance?

A

ability to perform large muscles dynamic exercises over long periods of time

258
Q

what determines the need/demand of myocardial O2 consumption?

A
  1. HR
  2. systemic BP
  3. myocardial contractility
  4. afterload
259
Q

what is afterload?

A

ventricular force need to open the aortic valve at the beginning of systole

260
Q

afterload is determined by ___ ventricular wall tension and _____ wall tension

A

left, aortic

261
Q

what is myocardial O2 supply dependent on?

A
  1. O2 content
  2. Hgb O2 dissociation
  3. coronary blood flow
262
Q

what is coronary blood flow determined by?

A
  1. aortic diastole
  2. duration of diastole
  3. coronary artery resistance
  4. collateral circulation
263
Q

what happens if the myocardial demand for oxygen exceeds the supply?

A

ischemia

264
Q

where is the main supply of O2 during exercise coming from?

A

increased coronary blood flow

265
Q

what is deconditioning?

A

decrease in max O2 consumption that results from prolonged bedrest due to illness, bedrest w/o disease, lifestyle, or aging

266
Q

what are 4 examples of fitness field tests?

A
  1. 1 mile walk test
  2. 6 minute walk test
  3. 1.5 mile run
  4. 12 minute run
267
Q

what are 4 fitness tests?

A
  1. field tests
  2. treadmill tests
  3. cycle ergometry
  4. step tests
268
Q

what are the advantage of field testing?

A

easy to administer to a large group at one time with little equipment needed

269
Q

what are the disadvantages of field testing?

A

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
Q

when should you stop a test?

A
  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

DPT 509 (7 decks)

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