Week 4 Flashcards

Question

How is DM diagnosed?

Answer 1

• Classic symptoms + plasma glucose concentration ≥ 200 mg/dL • Fasting plasma glucose ≥ 126 mg/dL • A1c > 6.5%

Answer 2

Retinopathy: damage to retina due to abnormal blood flow

Answer 3

Leading cause of end-stage renal disease

Answer 4

* Distal joints/segments * Syndrome of limited joint mobility and stiff hand syndrome * Dupuytren contracture * Adhesive capsulitis * Diffuse idiopathic skeletal hyperostosis (DISH) * Arthritis * Osteoporosis

Answer 5

Sensory, motor and autonomic neuropathy

Answer 6

* CVD leading cause of M/M in DM * 1.5-4 fold increased risk of CAD, stroke, or MI * Diabetic cardiomyopathy * Atherosclerosis begins earlier and is more extensive in Type 1 * Higher risk of CAD, stroke, and PVD in those with Type 2

Answer 7

Neuropathic Ulcers

Answer 8

At blood glucose of <70 mg/dl

Answer 9

Overdose of insulin, late or skipped meals, or | overexertion in exercise

Answer 10

Headache, weakness, irritability, poor muscular | coordination, inability to respond to verbal commands

Answer 11

Need to ingest carbohydrates

Answer 12

Infection, missed insulin doses, surgery, pregnancy, | renal failure, uncontrolled DM

Answer 13

Can occur in those with/out DM | • High intensity aerobic exercise

Answer 14

Typically occurs with prolonged | hyperglycemia (more common in type I)

Answer 15

Fruity breath (acetone), dehydration, weak and rapid pulse, Kussmaul respirations

Answer 16

• To control DM, exercise must be done with no more than 2-3 days between sessions • Avoid exercise late at night - Delayed hypoglycemic reactions can occur during sleep • Blood glucose levels of 250-300 mg/dl- CAUTION - Do not exercise if >250 with evidence of ketoacidosis - >300 generally considered a no go point - < 100 mg/dl consider a snack and retest or make decision based on symptoms • Exercise is best about 1 hour after meal • Do not inject insulin in muscles that will be involved in exercise • Those with DM should not exercise alone

Answer 17

* Improved skeletal muscle glucose transport * Improved whole body glucose homeostasis * Increase insulin sensitivity 12-72 hours post exercise * Increases carbohydrate metabolism * Reduced risk of cardiovascular mortality

Answer 18

• Educate: - Online resource: diabetesselfmanagement.com • Exercise: Glucose before and after to determine needed levels of intake • Safety: higher risk for falls secondary to peripheral neuropathy • Exercise!!!

Answer 19

* Onset: Rapid * Mood: Labile, irritable, nervous, weepy * Mental Status: Difficulty: concentrating, speaking, focusing, coordinating * Skin: Pale, sweating * Pulse: Tachycardic * Respirations: Shallow * Breath: Normal

Answer 20

* Onset: Gradual * Mood: Lethargic * Mental Status: Dulled sensorium, confused * Skin: Flushed, dehydrated * Pulse: Less rapid, weak * Respirations: Deep, rapid (Kussmaul) * Breath: Fruity

Answer 21

The system of services supporting the well-being of older adults at every stage of function

Answer 22

• Doesn’t necessarily start w/an entry point in the hospital • Services range from adults w/o service needs to those requiring total care or assist • Services vary from community-based, transportation needs, housing, medical facilities, and so on • May require a comprehensive assessment to determine specific needs - Usually interdisciplinary in nature - Essential that older adults receive the level and type of services required to address needs

Answer 23

``` • Acute Care • Subacute Care - Long term acute care (LTAC) - Inpatient rehabilitation hospital (IPR) - Skilled nursing facility (SNF) • Post-acute Care or Home Care - Long term care (nursing home) (LTC) - Assisted living (ALF)/ group home - Memory care home - Personal home - Family home ```

Answer 24

Allowing an older adult to live in their residence of choice for as long as they are able.

Answer 25

• Provision for daily life needs • Maintain quality of life • Requires planning • Living in a community with some level of independence instead of residential care • Community-based collaborations between healthcare and social service agencies

Answer 26

Can involve livable communities, facilities with range of care options, or personal home: • Available alternative modes of transportation • Increase opportunities for safe, regular physical activity • Increase accessibility of home • Develop walkable communities • Promote pedestrian safety and safe driving for older adults • Funding for home and community-based services • Improve end of life and palliative care services

Answer 27

Diagnosis, ability to tolerate intensity of services, | and insurance arrangements

Answer 28

In general, more complicated dx and ability to tolerate at least 3 hrs/day therapy

Answer 29

Single joint replacements, conditions requiring much longer recovery period, or pt who cannot tolerate 3 hrs/day therapy

Answer 30

* Both covered by Medicare Part A * Both serve as bridge between living at home and being hospitalized, especially those with functional decline (sometimes serve as “testing ground” for whether home even an option ultimately)

Answer 31

• Patient may need 24 hour care, but has no primary need or does not quality for skilled nursing therapy - Nursing staff available around the clock - Rehabilitation services available as an outpatient for residents (services billed under part B) • Patients may initially have Part A services either by being admitted to facility: - As a prior non-resident under skilled nursing status and then transition to residency - As a resident with a qualifying hospital stay that requires follow-up skilled nursing services and/or rehabilitation with eventual transition back to LTC status

Answer 32

``` • Patients who need housing, support services, and health care • Services/Amenities (Facility dependent) - 3 Meals/day in common dining area - Housekeeping - Transportation - Laundry services - Exercise/Wellness programs - Social/Recreational activities - Assistance with ADL’s - Medication assistance - Rehabilitation services - Emergency call systems • Not to be confused with senior independent living apartment communities - Often house ALF’s - Some offer continuum of care ```

Answer 33

Some in form of apartment communities or group residential homes

Answer 34

* Usual residence in house– age-restricted communities w/high level of amenities and activities becoming popular * Apartment/townhome– age-restricted apartments growing in popularity * Alone, with significant other, or family

Answer 35

>/ 65 years old and some disabled

Answer 36

Hospital, SNF, Hospice, some HHC | • Automatic- pay into the system while working

Answer 37

Doctor’s services, OP care, some HHC, labs, x-rays, DME | • Premium, deductible, co-insurance, co-pay

Answer 38

Medicare Advantage Plans • Provide both part A and B and other services • Provided through private insurance companies • Locked in for certain periods of time, not able to use Original Medicare

Answer 39

Prescription Drug Coverage | • Premium

Answer 40

• Low income coverage for those over age 65 - < $1025/month • Provides coverage for premiums, out of pocket expenses, nursing home care, prescription drugs • Medicare pays first then Medicaid pays • Administered by federal and state governments • May have different names • Must check eligibility often

Answer 41

• Free for veterans with service-connected condition • Must apply and qualify • Must receive services at a VA facility • Co-pays for veterans with non-service connected conditions and based on income

Answer 42

``` Inpatient Perspective Payment System • Diagnostic Related Group (DRG) Method • Medicare Part A • Lump sum based on diagnosis • Severity of illness considered • Co-morbidities considered ```

Answer 43

Must be cost effective, productivity matters | • PT does not impact payment

Answer 44

• Medicare Part A • PPS based on length of stay >/ 25 days • # of days based on dx and co-morbidities • Full payment received at 5/6th of stay - Money made this way - Money lost if patient stays past assigned length of stay

Answer 45

Must be cost effective, productivity matters | • PT does not impact payment

Answer 46

* Medicare Part A * Perspective Payment System (PPS)- predetermined fixed amount * Payment based on Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) - FIM Scores * Distinct groups based on clinical characteristics and expected needs

Answer 47

If patient unable to be seen 3 hours a day on average 5-7 days a week, payment will be impacted • Patient will need to DC to another location • Therapy impacts payment

Answer 48

• Medicare Part A - 100 days of coverage: Days1-20 paid in full, Days 21-100 copay up to $164.50/day • Per Diem PPS - Covers all cost (routine, ancillary, capital) - Resource Utilization Groups III (RUG’s) • Based on resident assessment and classification using MDS 3.0 • Number of therapy minutes and days impacts reimbursement

Answer 49

• Medicare Part A • PPS • 60 day national episode payment (certification period) - Outcome and Assessment Information Set (OASIS)- assessment tool - Health condition and Care needs - In the past, therapy has impacted payment for HHC, however this is changing

Answer 50

``` • Medicare Part B – Outpatient Therapy - 80% covered • Cap- No more!!! - $1980 PT and ST combined - $1980 OT - $3700 Manual Medical Review • PT bills for services for reimbursement. Reimbursement is based on the Medicare Fee Schedule ```

Answer 51

* Insurance * Private Pay * Medicaid * Note: Rehab services covered under Part B Medicare if the patient has it.

Answer 52

* Insurance * Private Pay * Note: Rehab services covered under Part B Medicare if the patient has it

Answer 53

- Achieve goals (function, participation, etc.) - To have control of their circumstances

Answer 54

- Please someone else - Praise, attention - Punishment (negativity)

Answer 55

``` • Greater self-regulatory capacity • Focus on positive - Immediate benefits of behavior • Stronger adherence • Positive self-concept • Social supports • Information-seeking behavior ```

Answer 56

• Self-efficacy expectations - Belief in capabilities • Outcome expectations - Belief personal action will produce certain consequence

Answer 57

* Successful performance * Verbal encouragement – “you are capable of this” * Vicarious experience * Physiologic and affective states

Answer 58

``` • Caring and confidence • Patient Centered • Ensure success • Attend to the setting • Challenges: Overcoming Fear - Graded exposure - Building on baseline tolerance • Apathy - Medication may be necessary first step - Focus on activities that can be done successfully ```

Answer 59

Goals should be: - Related to specific behavior - Challenging, but realistically attainable - Achievable in the near future

Answer 60

• Need to investigate and understand what their social support is • Teach those involved in supporting patient • Use social supports in goal setting

Answer 61

* Patient-centered goal setting is primary way of enhancing patient centeredness * Improves outcomes and satisfaction * Recommended and/or required in practice * Highly personal * Can be critical for motivation

Answer 62

Emphasizes the person first not the disability by starting | the phrase with the words “person who” or “person with.”

Answer 63

* Patient’s values and preferences guide plan of care * Focus on the PERSON, not the illness * Quality and value defined by respect for personal choices * Goals driven by the patient and their functional desires * Patient empowerment to take an active role in care plan

Answer 64

Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.

Answer 65

* Recognizing individual needs and differences * Using kindness and humor * EMPOWERING to take active part * Gentle verbal persuasion * Positive reinforcement * Be genuinely interested

Answer 66

• Verbal encouragement of capability • Expose to role models • Decrease unpleasant sensations associated with activity • Encourage actual PRACTICE • Educate on benefits and reinforce those benefits

Answer 67

Limitation in the ability to obtain, process, & understand basic health information & services necessary to make appropriate health decisions and follow treatment instructions

Answer 68

• Older adults at especially high risk for misunderstanding • Health literacy declines with age • Independently associated with greater risk of hospital admission, lower use of preventative health services, poor physical and mental health and higher all-cause mortality

Answer 69

* Sensory deficits * High stress and/or anxiety * Language barrier * Communication at TOO HIGH LEVEL * Lower health literacy

Answer 70

``` • Slow down, allow extra time • Use plain, nonmedical language • Show or draw pictures • Limit amount of information and repeat it • Use the teach-back technique • Create shame-free environment; encourage questions • Sit face to face, use eye contact • Listen without interrupting • Frequently summarize key points • Frame conversation first • Encourage older adult to bring a friend or family member • Plain language info in writing - What to do - How to do it - Why • Give patient chance to ask questions • Don’t assume the patient can’t hear you! ```

Answer 71

* Accurate, up-to-date, LIMITED | * Focus on behavior

Answer 72

• Don’t assume learning occurred just because you taught! • Must evaluate the effectiveness of your teaching • Must document whether learning has occurred and to what extent • How do we do this: - Return demo - Repeat back - Checklists and diaries

Answer 73

• Our desire to exert control • Cure model versus Care model - Cure = Paternalism – we are acting in “best interest of patient” - Care = Values autonomy and collaboration of /with pt • Self perception of older adult - Don’t really see themselves as learners - Sensitive to failure - Resistance to change and skepticism • And, honestly, impatience on both parts!

Answer 74

• Accommodate for slower speed of mental processing • Present one new item at a time, if possible, before moving to the next item • Encourage “errorless” learning • Incorporate compensatory strategies as needed • Incorporate multimodal sensory inputs • Encourage formation of a “habit” • Have older adult verbalize new habit to encourage formation of intentions to be completed in the future (prospective memory) • Have older adult paraphrase the information or demonstrate the new skill

Answer 75

Geragogy • Teaching approach recognizing special needs of older adults related to learning • Refers to need to fine-tune adult teaching & instructional styles for older adults who: - Are post-career - No longer raising families - Are often frail • Recognizes older adulthood as a developmental stage with key elements concerning age-related sensory, physical, psychological, cognitive, and psychosocial changes

Answer 76

* Attractive * Easy to read * Smallest font 14 point type (might even go higher)

Answer 77

* Talk directly to reader * Positive, friendly tone * Short words common in spoken language * Clearly explain any medical terms * Short sentences * Active voice * Provide examples

Answer 78

* Most important info first * Create small chunks * Clear action messages

Answer 79

* Former Competitive Athletes * Lifelong athletes * Non-athletes

Answer 80

* Sedentary * Recreational * Competitive * Elite

Answer 81

Masters athletes are *not always* older adults

Answer 82

• OA- common with normal age related changes • Bone mineral density loss - Less loss in the older athlete with weightbearing and resistance exercise • Changes result in an athlete that looks a little different - Muscle fiber changes, addition of fat • Less force production secondary to less type II fibers, somewhat activity specific - Weight lifters experience less strength decline - Runners experience less of a decline in endurance

Answer 83

* Physically active show less decline in VO2 max | * Smaller changes in physiologic functional capacity are seen in those who exercise with increased volume and intensity

Answer 84

• Trauma occurs less frequently - Participation in less contact sports - Exceptions: cycling, hiking, climbing, skiing (falls and accidents common with these sports) • More likely to sustain a fracture than rupture ligament - Secondary to decreases in bmd • More likely to tear or avulse muscle than strain muscle - Increased collagenous stiffness • Increased recovery time needed - Deconditioning occurs faster secondary to normal age related changes

Answer 85

• Muscles strains, bursitis, tendinopathies • May be more prone to these injuries when compared to younger athletes - Stiffer, less flexible - Arthritic changes - Less shock absorption and protection • Joint pain and edema more common in older athletes as compared to their younger counterparts - Structural changes

Answer 86

• Common in the aging adult - Equally common in the older athlete • Strong flexible muscles act as shock absorbers - Treatment should focus progressive resistance exercise, patient education on functional activities that minimize compression and shear - Cycling, rowing, swimming, walking, cross training • Increase in total joint arthroplasties being seen with expectation of return to sport - Procedures at younger ages - Associated with improved function, quality of life, and longer life - Return to sport can take up to 6 months after surgery

Answer 87

``` • Norm Referenced Tests - Senior Fitness Test - YMCA Fitness Test - ACSM Fitness Test • Sport or movement specific examination - Selective Functional Movement Assessment - Whole body functional approach ```

Answer 88

• Recovery is slower; rate of tissue repairs slows with age. • Treat the injury not the age • Be aware of co-morbidities and screen/monitor/educate • Don’t be too quick to blame OA as the cause of an older athlete’s problem • Joint mobility and soft tissue restrictions can be addressed with manual therapy as long as not contraindicated - Once mobility is improved corrective exercises can be initiated • Don’t forget stability - Taping, supports, braces, stabilization techniques, functional corrective exercises

Answer 89

• Proximal stability will facilitate distal mobility - Don’t forget the core • Generalized strengthening is important - Don’t forget appropriate exercise prescription • Stretching - Warm up is imperative and may include some stretching - Cool down stretching is better - 60 seconds is better than 30 in the older adult

Answer 90

* “Intentional act, or failure to act, by a caregiver or another person in a relationship involving the expectation of trust that causes or creates a risk of harm to an older adult.” * “Physical, sexual, or psychological abuse as well as neglect, abandonment, and financial exploitation of an older person by another person or entity that occurs in any setting either in a relationship where there is an expectation of trust or when an older person is targeted based on age or disability.”

Answer 91

* Physical- bodily harm * Emotional (psychological)- verbal: hurtful words, yelling, threatening, ignoring; isolation * Neglect: caregiver fails to respond to needs * Abandonment: left alone without plan for care * Sexual: forcing to watch or partake * Financial: money or belongings are stolen – forging checks, retirement or SS benefits, credit cards or bank accounts without consent, etc.

Answer 92

• Physical: injuries/trauma, bruises, emaciation - Challenging • Behavioral: anger, helplessness, suicidal actions • Psychological: fear, anxiety, depression • Social: limited contacts, withdrawal • Others: has trouble sleeping, messy look or unwashed hair or dirty clothes, develops preventable conditions

Answer 93

Report it! • Most states require mandatory reporting by healthcare workers of suspected elder abuse to Adult Protective Services (APS). • Immediate danger: 911 • Local APS • Eldercare Locator

Answer 94

* Pain or discomfort free * With those they love * Location or environment of choice

Answer 95

Assist in pain reduction, optimizing function, and addressing quality of life remaining • Safe mobility • Energy efficiency • Sleep quality • Stress • Respiratory function • Reduction in medications needed for pain

Answer 96

Decline or failure of all major organ systems

Answer 97

* Confusion, delirium, disorientation * Increased time sleeping * Anxiety, restlessness * Weakness, functional loss, fatigue * Reduction in BP, variable irregular heart rate * Rapid breathing with periods of apnea * Cool distal extremities * No interest in food * Constipation, diarrhea, incontinence, reduced urine output

Answer 98

Advance Directives • Legal document • States patients desires in the event of imminent death • Appoints a medical power of attorney - Decision maker on the patients behalf if the patient becomes incapacitated • Optional element of orders for “Do not resuscitate” (DNR)- Note not required for hospice care - Physical therapists need to be aware of the DNR • Also known as a Living Will

Answer 99

``` • Death is a physical, psychological, and spiritual event • Covered by Medicare part A - Terminal condition with 6 or less months to live - No longer seeking cure • Interdisciplinary team: - Nurse - Chaplain - Social Worker - Physical Therapist - Volunteers (caregiver respite) ```

Answer 100

• Rehabilitation Light - PT once a week or biweekly - Slow, easy, strengthening exercises and functional activities - Issue an HEP…very light, but essential to slow progression • Rehabilitation in Reverse - Assisting a patient and caregivers as their mobility declines. May include equipment recommendations, bed mobility for positioning and comfort, PRN visits may be indicated • Skilled Maintenance - Maintenance of quality of life unable to be performed safely by other caregivers Example: Ambulation and transfers that a caregiver can not manage secondary to severe weakness and balance limitation in conjunction with caregiver limitations

Week 4 Flashcards

(124 cards)