Week 3: Vitals, OTF, FIM Flashcards
(150 cards)
1
Q
What type of clients were baseline vitals are needed?
A
- Clients recovering from recent trauma/illness/hospitalization/secondary diagnoses
- Clients with current or previous cardiovascular/cardiopulmonary conditions
- Clients who are not very active or who have limited aerobic activities
- Client’s with general fatigue or debility
The very young and very old (older than 65)
2
Q
- Level or amount of activity
- Emotional status of person
- Physiological status of client
- Environmental temperature
- Client’s age
A
Factors influencing vital signs
3
Q
What are some things contributing to physiological status of client?
A
Illness, disease, use of medication, trauma
4
Q
What are some possible adverse and potentially dangerous responses to activity and exercise?
A
- Confusion
- Slow reactions of movement or response to directions
- Lethargy
- Fatigue
- Decreased response to verbal or tactile stimulus
- Fixed gaze or eyes rolling back in someone’s head
- Complaints of nausea, vertigo, decrease in BP, pupil constriction/dilation
- Loss of consciousness/fainting
- Diaphoresis (profuse sweating)
5
Q
Blood pressure is at which pressure?
A
brachial arterial pressure (major vessel which takes blood away from heart)
6
Q
T/F: Pressure of circulating blood increases as it moves further away from heart
A
False. Pressure of circulating blood decreases as it moves further away from heart
7
Q
is BP at the time of contraction of left ventricle heart
A
Systolic pressure
8
Q
is the BP at the time of the rest period of the heart
A
Diastolic pressure
9
Q
5 phases of Korotkoff’s Sound
A
Phase 1: first, faint, clear tapping sound which gradually increases (first indication of systolic pressure of an adult)
Phase 2: murmur or swishing quality present
Phase 3: sounds become crisp and louder than before
Phase 4: distinct and abrupt muffling of sounds until a soft, blowing sound is heard (initial indicator of the diastolic BP)
Phase 5: muted sound, disappearance of sound, also known as second diastolic pressure phase
10
Q
distinct and abrupt muffling of sounds until a soft, blowing sound is heard (initial indicator of the diastolic BP)
A
Phase 4
11
Q
Faint, clear tapping sound which gradually increases (first indication of systolic pressure of an adult)
A
Phase 1
12
Q
sounds become crisp and louder than before
A
Phase 3
13
Q
muted sound, disappearance of sound, also known as second diastolic pressure phase
A
Phase 5
14
Q
murmur or swishing quality present
A
Phase 2
15
Q
What are 2 specific Korotkoff sounds to record in BP?
A
Second sound and the first faint/muted sound… that is the BP to record
For more accurate reading, client can’t have coffee ,cigarette, or done strenuous exercise in last 30 mins
16
Q
Normal BP?
A
120 mm of mercury/80 mmHg
17
Q
Systolic 120-139
Diastolic 80-89
A
Pre-Hypertension
18
Q
Systolic 140-159
Diastolic 90-99
A
Stage 1 Hypertension
19
Q
Systolic 160+
Diastolic 100+
A
Stage 2 Hypertension
20
Q
Age, obesity, physical inactivity, nicotine/salt/alcohol use, arteriosclerosis, DM, kidney disease, race, diet, dehydration, size & condition of arteries, arm position, cardiac output, etc…
A
Factors contributing to HTN
21
Q
known as the “silent killer”
A
Hypertension
22
Q
Abnormal when Diastolic pressure increases more than _____ mmHG during the activity
A
Diastolic pressure increases more than 10-15 mmHg during the activity
23
Q
Systolic BP with vigorous exercise is normal to go up by _____ mmHG. Anything greater would be significant.
A
Systolic BP with vigorous exercise is normal to go up by 40-60 mmHG.
24
Q
T/F: It is normal with exercise for systolic BP to go up by 50-60 mmHG
A
False. 40-60
25
Diastolic pressure increase by how many mmHG during exercise?
10-15
26
Can assess by observation or touch: rate, rhythm, depth, character
Respiration Rate
27
What is normal RR for adults?
12-18 respirations per minute
28
What is normal RR for kids?
30-50 respirations per minute
29
Can assess by observation or touch:
Rate = number of breaths per minute
Rhythm = regularity of the pattern
Depth = amount of air exchanged with each respiration
Character = deviations from normal, resting, or quiet respiration
Respiration Rate
30
RR, what is number of breaths per minute?
Rate
31
RR, what is Depth?
Amount of air exchanged with each respiration
32
RR, what is rhythm?
regularity of pattern
33
RR, what is character?
deviations from normal, resting, quiet respiration
34
2 ways people breathe?
Upper thoracic or abdominal breather
35
T/F: With respiratory distress, a person can demonstrate both thoracic and abdominal breathing
True
36
```
Age
Emotional status
Physical activity
Air quality
Altitude
disease/illness
```
Factors Affecting respiration
37
indirect measure of the contraction of the left ventricle of the heart
Heart Rate
38
Normal Adult HR
60-100
39
Normal newborn HR
100-130
40
Normal kid HR
80-120
41
```
Medications
Emotional status
Age and gender
Temperature of environment
Infection (recall dysphagia signs and symptoms)
Physical activity/condition
Cardiopulmonary disease
```
Factors affecting HR
42
Pulse rate should return to normal pulse rate approximately ___ minutes after activity.
3-5 mins
43
What arteries used for HR?
Carotid and Radial
44
even beats w/good force to each beat
strong and regular
45
even beats w/weak force to each beat
weak and regular
46
both strong and weak beat/force but regular beat
irregular
47
weak force to each beat, and irregular heart beats
thready
48
HR under 60
bradycardia
49
HW over 100
tachycardia
50
For adults, acceptable normal range for temperature
96.8 to 99.3
51
Time of day
Age
Emotional status
Environmental temperature
Infection (remember dysphagia signs & symptoms)
Site of assessment (oral cavity can fluctuate depending on hot/cold food or beverage)
Physical activity
Factors affecting Temperature
52
What is oxygen saturation?
Measures the client’s oxygen saturation level in the blood
53
T/F: Should be maintained above 90% at rest & during activity
True
54
Pain Analog Scale
1-10 (10 being most pain)
55
Biomechanical FOR Concerned with:
Musculoskeletal capacity
Peripheral nerve involvement/dysfunction
Cardiopulmonary system dysfunction (related to endurance)
56
Best suited for clients with isolated/selective motor control
Biomechanical FOR
57
T/F: Biomechnical best suited for clients with an intact central nervous system (Pedreti & Pasquinelli, 1990) because clients must be able to perform smooth, isolated movements.
True
58
True or False: After ROM, strength, and endurance are regained, the client will automatically regain function
False. Research shows that improvement of biomechanical components alone does not necessarily improve engagement in occupation.
59
What assumptions of biomechanical FOR?
- Occupational performance requires the ability to move the limbs and the endurance to sustain activity/movement until a goal is accomplished.
- Purposeful activities can be used to treat loss of ROM, strength, and endurance
60
Assessing endurance...
Part of the Biomechanical FOR, but mainly done during occupational performance evaluation & linked to the Rehabilitation FOR “Activity tolerance”
61
What is definition of endurance?
Sustain effort and resist fatigue
62
- Related to cardiopulmonary and muscular function
| - Related to intensity, duration, and frequency of activity
Endurance
63
3 things related to endurance?
intensity, duration, frequency
64
______ endurance is the ability of the whole body to sustain prolonged rhythmical activity”
“Cardiopulmonary endurance is the ability of the whole body to sustain prolonged rhythmical activity” Relates to the demand for oxygen created by muscular work: Muscular work à need for oxygen
65
_____ Ability (of a muscle or muscle group) to sustain intensive activity”
muscular
66
of repetitions per unit of time
dynamic assessment
67
Amount of time a contraction can be held
static assessment
68
Intensity: rated as light, moderate, or heavy work or based on WHAT LEVELS?
MET
| metabolic equivalent levels
69
MET light house keeping?
1.5-4
70
MET heavy home maintenance?
4.5-6
71
APHRO
```
activity
position of activity
heart rate
rest break needed?
other signs of fatigue
```
72
“Patient tolerated 60 mins. of seated activity for OT assessment without rest breaks. No c/o fatigue.”
Sample documentation
73
How to increase endurance?
To increase muscle endurance, the OT must increase the # of repetitions of a specific motion, or add to the resistance of the activity…cardiopulmonary precautions must be considered!
74
FIM - 4
Minimal Assistance - performs 75%
75
FIM - 6
Modified independence
76
FIM - 1
Total assistance - less than 25%
77
FIM - 7
Complete independence
78
FIM - 2
Maximum assistance - patient performs 25%-49%
79
FIM - 3
Moderate Assistance - patient performs 50-74%
80
What does grooming consist of?
oral care (brushing only), hair grooming (brushing only), washing face, washing hands (drying too) - also shaving and make up
81
What does bathing consist of?
washing, rinsing, drying body from neck down (exclude neck and back) in tub, shower, or sponge bath
82
Dressing PJ/hospital gown does not count!
Only clothes they wear in public
83
What does toiling consist of?
Maintaining perineal hygiene, adjusting clothes before and after using toilet
84
What consists of toilet transfer?
getting on and off toilet
85
What consists of social interaction?
getting along and participating with others, represents how one deals with one's needs and with others
86
Social Interaction FIM: patient interacts appropriately in most situations, only occasionally loses control. May require more time to adjust
6 - modified independence
87
Social Interaction FIM: may require encouragement to initiate participation
5 - supervision
88
Problem Solving: solves routine problems 75% time
4 - minimal assistance
89
Problem solving: recognizes problems when present, make appropriate decisions, carries out steps to solve complex problems until task completed
7 - complete independence
90
Activities such as managing checking account, participating in discharge plans are called...
complex problem solving
91
Includes asking for assistance during transfer, asking for new milk when milk is missing, asking for utensils when missing
routine problem solving
92
Memory: patient appears to have mild difficulty recognizing faces, remembering daily routines. May use self initiated or environmental cues, aids.
6 - modified independence
93
Memory; require prompting only under stressful conditions but no more than 10% of time
5 - supervision
94
List Client Factors
Values, beliefs, spiritual, body functions, body structures
95
List occupations
work, play, leisure, rest and sleep, social participation, education, ADL, IADL
96
List performance skills
motor skills, process skills, social interaction
97
List performance patterns
habit, routine, ritual, roles
98
Lis context and environment
cultural, personal, temporal, virtual, social, physical
99
Dressing, feeding, functional mobility, bladder, sex, eating
ADLs
100
care of others, child rearing, driving, computers, cooking
IADLs
101
What is goal of ADL/IADL training?
client and family learn to adapt to the life changes or situations and to participate as fully as possible in those occupations that are meaningful.
102
What 5 things to consider when analyzing ADL?
```
O Assessing client factors
O Performance skills
O Performance patterns
O Physical and social environment
O Clients contextual framework
```
103
describes client’s occupational history, patterns of living, interests, values, and needs
occupational profile
104
T/F: Feasibility of ADL assessment or ADL training should be determined by the OT in concert w/ client, supervising physician, and others rehab team members
True
105
T/F: Partial/complete performance analysis important to assess ADL performance; interview not enough
true. Ideally OT assess performance of activities in the context/environment where they usually take place or under simulated conditions
Should start with relatively simple/safe tasks from ADL/IADL list and progress to more difficult/complex
106
requires 25% physical or verbal assistance of one person to complete safely (performs 75% or more of task)
minimal assistance
107
requires 50% physical or verbal assistance of one person to complete safely (performs 50-74% task)
moderate assistance
108
client requires physical or verbal assistance for 51-75% of an activity by one person (performs 25-49% of task)
maximal assistance
109
client requires more than 75% physical or verbal assistance (performs less than 25% of task); Ex. Performs 1 or 2 steps of the activity or very few steps)
dependent/total assistance
110
standard assessment to evaluate executive skills required to perform IADLs; can be used to determine is person safe to remain at home and how much assistance is required
Executive Function Performance Test
111
Most basic IADLs required to stay home alone?
prepare/retrieve a simple meal, employ safety precautions and exhibit good judgment, take medication, get emergency aid if necessary, system for managing toileting , method to allow for rest periods
112
the most common type of heart disease in which there is a narrowing of the blood vessels that supply the heart due to the buildup of plaque, which can eventually lead to myocardial infarction (MI), angina (chest pain, discomfort, or tightness), or other complications.
Coronary heart disease (CHD
113
The average age at first MI for men?
64.5
114
The average age at first MI for women?
70.3
115
is the leading cause of death for both genders in the United States?
heart disease
116
high cholesterol, hypertension, diabetes, cigarette smoking, overweight & obesity, poor diet, physical inactivity, and alcohol use main factors for...
coronary heart disease
117
___ can be caused by heart disease, myocardial infarction, or any other condition in which the cells responsible for the electrical conduction of the heart are affected.
Arrhythmia
118
____ can cause MI, cardiac arrest, or stroke.
Arrhythmia
119
Change in pattern of angina or shortness of breath
Heart palpitations or “fluttering” feeling in chest
Feeling lightheaded, dizzy, or confused; fainting or near-fainting spells
Experiencing more fatigue than expected
Unusual pain or discomfort in muscles or joints after exercise
Sweating
Blood pressure falls 20 mm Hg or more, or heart rate is 20 beats per minute or more over resting heart rate
Signs of cardiac event
120
What is first sign of CHD?
MI (heart attack)
121
shortness of breath, persistent coughing or wheezing, edema, fatigue, lack of appetite, nausea, confusion, impaired thinking, and increased heart rate
Sign of CHF (heart failure)
122
blue skin, low blood pressure, difficulty breathing, feeding problems, and inability to gain weight. (Minor heart defects often do not produce noticeable symptoms.)
Congenital heart disease
123
pain/discomfort in the jaw, neck, or back; feeling weak, lightheaded, or faint; chest pain/discomfort; pain or discomfort in arms or shoulder; shortness of breath
myocardial infarction
124
Role Checklist, Occupational Performance History Interview II (OPHI-II), Performance Assessment of Self-Care Skills (PASS), COPM
Occupation Focused assessments for CHD
125
Beck Depression Inventory-II (BDI-II), measures of pain, measures of muscle strength, monitoring vital signs (e.g. blood pressure, heart rate)
Client factor assessment for CHD
126
Teaching energy conservation techniques to minimize stress placed on heart
Retrain in ADLs
Environmental adaptations
Educating client and family member about risk factors of cardiac conditions
Lifestyle modifications - ex. Identify new occupations that allow client to participate satisfactorily without inducing cardiac stress
Medication management
Recommendations of support group and resources within community
Common OT interventions for CHD
127
muscles are stiff and weak (most common)
Spastic CP
128
slow, writhing, involuntary movement
Athetoid CP
129
muscle weakness, poor coordination, tremors
Ataxic CP
130
combines spastic and athetoid
Mixed
131
premature birth, low weight, inadequate nutrients in utero, blood type incompatibility, bacterial infections, oxygen deprivation, severe jaundice
Risk factors for CP
132
motor disorders characterized by impaired voluntary movement and muscle control. Can result from prenatal, perinatal, or postnatal brain injury occurring before age 5
CP
133
combines spastic and athetoid
Mixed CP
134
Difficulties with CP?
```
cognitive delays
speech difficulty
seizure disorders
feeding problems
impaired vision & hearing
abnormal sensation and perception
difficulty with bowel control
breathing problems secondary to poor posture
skin conditions
```
135
Secondary conditions in adults?
```
musculoskeletal changes (increased spasticity and decreased strength, endurance, flexibility)
Pain
Fatigue
Arthritis
Fractures
Osteoporosis
```
136
CP precautions?
Seizure disorders
Difficulty breathing
Impaired vision/hearing
Abnormal sensation/perception
137
What decrease muscle stiffness and allow for more controlled movement & increased function when used with OT?
Botox
138
Anticonvulsant drugs do what to CP?
treat seizures
139
Baclofen pumps for CP?
relax muscles and control tremors & spasticity
140
Benzodiazepines?
manage spasticity
141
Selective dorsal rhizotomy surgery?
reduce muscle tone
142
any condition or disease that affects or is located in the lungs
Pulmonary conditions
| emphysema, asthma, cystic fibrosis, pneumonia, tuberculosis
143
COPD?
chronic obstructive pulmonary disease, includes emphysema and chronic
bronchitis.
144
more than 4% of adults aged 18 and older were living with a diagnosis of _____
chronic bronchitis
145
_____ diseases are the fourth leading cause of death in the US
chronic lower respiratory
146
T/F: Almost all causes of COPD are due to long term exposure to lung irritants, most commonly cigarette smoke.
true
147
Comorbidity with depression, hypertension, high cholesterol, and osteoporosis
Pulmonary disease
148
Medication therapy for pulmonary disease?
inhaler
149
Interdisciplinary Interventions for PD?
pulmonary rehab, medication therapy, oxygen therapy
150
Interventions for PD?
energy conservation teaching, i.e. breathing techniques, retraining in
ADLs (grading to reduce excessive strain), upper extremity strength and ROM training,
education, lifestyle modification, medication management, recommendation of support
groups
