PT Procedures written exam 1

Standard Precautions

Use with ALL patients. Treat open skin, mucous membranes, and all body fluids except sweat as potentially infectious.

6 links in the chain of infection

Infectious agent → reservoir → portal of exit → means of transmission → portal of entry → susceptible host.

Direct vs indirect contact transmission

Direct = person-to-person. Indirect = person → contaminated object/equipment → person.

Main ways to prevent infection spread

Hand hygiene, appropriate PPE, and cleaning/disinfecting equipment and surfaces between patients.

When should hand hygiene be performed?

Before and after patient contact, before donning and after removing gloves, and after possible contamination/body fluid exposure.

When is alcohol-based hand sanitizer preferred?

In most routine clinical situations when hands are not visibly soiled.

When must soap and water be used?

When hands are visibly dirty or with enteric infections such as C. difficile.

Basic body mechanics

Wide/stable BOS, get close to patient/load, neutral spine, bend hips/knees, avoid twisting, pivot feet, adjust bed height, and get help/equipment when needed.

First communication steps with a patient

Introduce yourself and your role, explain what you will do, use clear/simple language, and encourage participation.

Major subjective interview information

Current condition, onset/course, treatments/medications, PMH/surgical history, prior function, activities/participation, living environment/support, social history, and patient goals.

How should subjective questioning begin?

Start with open-ended questions, then clarify with more specific questions.

Basic cognition/mental status screen

Determine alertness, orientation to person/place/time, ability to communicate, and ability to understand/follow directions.

Why screen cognition?

It determines whether the patient can safely understand instructions and participate. Poor cognition may require simpler cues, more help, or slower mobility progression.

Basic skin screen

Inspect for redness, wounds, grafts, pressure areas, discoloration, and other abnormal areas, especially over bony prominences.

Blanch test concept

Pressure-related redness that does NOT blanch is concerning for pressure injury.

Goals of good positioning

Safety, alignment, support, pressure protection, airway maintenance, comfort, contracture prevention, and function.

Main goals of draping

Preserve modesty/dignity, provide warmth/comfort, and expose only the area that needs examination/treatment.

Signs of poor positioning

Poor alignment, unsupported limbs, pressure over bony areas, shear, prolonged contracture-producing positions, or unsafe/uncomfortable positioning.

Why do PTs measure vital signs?

Establish baseline, assess hemodynamic stability/readiness for activity, monitor response to treatment, and guide clinical decisions.

Normal adult heart rate

60-100 bpm.

Tachycardia vs bradycardia

Tachycardia = HR >100 bpm. Bradycardia = HR

How do you measure a radial pulse?

Use index and middle fingers, not thumb. Check rhythm first. If regular, count 15 sec ×4; if fast/slow/irregular, count 60 sec.

Normal adult respiratory rate

12-18 breaths/min.

Bradypnea vs tachypnea

Bradypnea =

How do you screen respiratory rate?

Observe chest/abdomen without making the patient consciously change breathing; note rate, rhythm, quality, and effort.

Normal blood pressure category

Systolic vs diastolic BP

Systolic = pressure during cardiac contraction. Diastolic = pressure during cardiac relaxation.

Key manual BP technique

Correct cuff size, cuff over brachial artery, arm supported near heart level, patient relaxed, and deflate about 2-3 mmHg/sec.

Orthostatic hypotension

Drop of ≥20 mmHg systolic OR ≥10 mmHg diastolic within 3 minutes of standing.

Symptoms of orthostatic hypotension

Dizziness, lightheadedness, or fainting.

Normal SpO₂

Generally >95%.

Concerning SpO₂

Around 90% or below is concerning; a 2-3% drop with activity is abnormal, especially if it falls below 90%.

What should you do with unsafe vitals/symptoms during mobility?

Stop progressing, return the patient to a safer level/position, monitor, and reassess.

Effects of prolonged bed rest

Weakness/deconditioning, decreased endurance, orthostatic hypotension, ROM loss/contracture, pressure injury, venous stasis/DVT risk, and reduced functional mobility.

Purpose of a premobility screen

Determine whether the patient has enough physical and cognitive capacity to safely progress mobility.

Main clinical reasoning sequence

Subjective → cognition → vitals → ROM/strength/sensation/coordination → bed mobility → sitting balance → standing/transfer ability → Egress Test → gait if safe.

What if a patient fails one stage of mobility progression?

Do NOT automatically continue. Treat the limitation with a lower-level intervention and reassess.

Gross ROM screen

Assess AROM/PROM of major joints in sitting or supine. Document normal/full, limited, or severely limited.

Why screen ROM?

Determine whether enough motion is available for positioning, bed mobility, transfers, standing, and gait; identify restrictions/contractures.

What happens if a gross ROM screen is abnormal?

Perform a more specific test/measure such as goniometry if appropriate.

Gross strength screen

Assess major muscle groups in sitting or supine; describe as normal, against-gravity strength, or very weak.

Why screen strength?

Determine whether the patient has enough force for bed mobility, sitting, standing, transfers, and gait and how much assistance/equipment may be needed.

What happens if gross strength is abnormal?

A formal MMT may be performed as a more specific test/measure.

Basic sensation screen

Test light touch in RUE, LUE, RLE, and LLE.

Sensation documentation terms

Intact, impaired, absent, or hyperesthesia.

Why screen sensation?

Impaired sensation affects safety, balance, mobility, and skin protection and may require additional guarding/pressure precautions.

Examples of coordination tests

Finger-to-nose, finger-to-PT finger, finger opposition, pronation/supination, tapping, heel-to-shin, toe-to-PT finger.

What are you looking for during coordination testing?

Quality, smoothness, timing, sequencing, speed, and accuracy.

Why screen coordination?

A patient may have adequate strength but still be unsafe with transfers, standing, or gait because movement control is impaired.

Ways to challenge sitting balance

Head movements, weight shifts, reaching, perturbations, and eyes closed.

Ways to challenge standing balance

Stand about 30 sec, then head movements, weight shifts, reaching, perturbations, and eyes open/closed as appropriate.

Why test balance?

Determine whether the patient can maintain posture and respond safely to movement/challenges and whether they are ready to progress mobility.

Egress Test purpose

Screen transfer/standing ability and readiness to progress toward gait.

Egress Test sequence

Sit-to-stand → march in place → step forward and return.

What does the Egress Test assess?

LE strength, endurance, stability, weight-bearing ability, and readiness for ambulation.

If a patient cannot safely complete the Egress Test

Consider a mechanical/full-body lift rather than forcing standing or gait.

Posterior THA precautions

No hip flexion >90°, no internal rotation past midline, no adduction past midline, and no lifting >20 lb.

Posterior THA positioning/use of wedge

Maintain hip precautions and use an abduction wedge/pillow as needed to prevent excessive adduction.

Abdominal precautions

No lifting >10 lb, log roll, and avoid bending/twisting.

Thoracic/lumbar spine precautions

Log roll, neutral spine, no trunk rotation/bending, brace if ordered, and generally no lifting >10 lb.

Sternal precautions

Avoid shoulder flexion/abduction >90°, no UE strength/resistance, no lifting/pushing/pulling >8 lb, no trapeze, log roll/side-lying to sit, avoid Valsalva, brace chest to cough/sneeze.

Indication

Reason an intervention SHOULD be used.

Contraindication

Reason an intervention should NOT be used or progressed.

Precaution

A restriction or condition you must protect or modify around.

Tilt table main indication

Patient cannot tolerate normal standing/upright mobility and needs gradual progression to upright, especially with orthostatic hypotension.

Tilt table benefits

Improves upright tolerance, provides LE weight bearing, may help orthostatic hypotension, stretches heel cords, and allows exercise while upright.

Tilt table setup

Patient supine, feet flat on footplate, straps at chest, pelvis NOT abdomen, and below patella; obtain baseline vitals.

Basic tilt table progression

Start around 35° for 5-10 min, reassess vitals/symptoms, then gradually progress toward 45°, 50°, and eventually 70-80° if tolerated.

What if a patient does not tolerate the tilt table?

Return toward supine, monitor/reassess, and do not leave the patient unattended.

Sit-to-stand lift purpose

Assist sit-to-stand/transfers and provide therapeutic upright/standing tolerance.

Requirements for sit-to-stand lift

Some safe LE weight bearing, some sitting balance in midline, ability to cooperate, able to start with hips/knees/ankles flexed, and no severe back pain worsened by the lift.

Course-specific sit-to-stand lift scenario requirements

About 3/5 strength in at least one LE and full weight bearing through both LEs.

Basic sit-to-stand lift setup

Patient seated → sling around lower torso → feet on footplate → tibias at leg pad → secure/attach sling → patient holds handles if able → activate lift.

Therapeutic uses of sit-to-stand lift

Standing endurance, upright tolerance, midline posture, breathing exercises, UE ROM, quad/glute activation, and appropriate standing exercise.

Full-body mechanical lift indication

Use when the patient cannot safely provide enough assistance for standing or cannot complete the mobility screen/Egress Test safely.

Low-mobility interventions

Positioning, bed modifications, bed exercise, PROM/AAROM/AROM, sitting EOB, sitting balance/endurance, compression, tilt table, sit-to-stand lift, and standing tolerance.

Why use compression/TED hose?

Assist venous/lymphatic flow, reduce venous pooling, aid DVT prevention, and sometimes improve upright tolerance.

Why sit a patient at EOB?

Improve tolerance to upright, sitting endurance, sitting balance, and readiness for standing.

Why perform bed exercises?

Maintain/improve ROM, strength, circulation, and activity tolerance when the patient is not yet ready for higher-level mobility.

Uses of rolling in bed

Repositioning/pressure relief, skin inspection, bed mobility training, exercise/strengthening, and preparation for supine-to-sit.

CVA/hemiplegia big picture

One-sided weakness/flaccidity may affect sensation, balance, cognition, and mobility. Guard the affected side and protect the involved arm.

Key rule for hemiplegic arm

Do NOT pull on the involved/flaccid UE; support and protect it.

Hemiplegia positioning goals

Support affected extremities, protect shoulder, encourage symmetry/equal weight bearing, and prevent contractures.

Quadriplegia/SCI big picture

Expect major weakness, possible sensory loss, poor trunk control, high assistance needs, and possible orthostatic hypotension.

SCI bed mobility consideration

If UE function is available, use head/UE momentum; guard paralyzed extremities. Rolling may be contraindicated until the spine is stable.

Amputation positioning goal

Prevent hip and knee flexion contractures.

BKA positioning

Keep hip neutral, encourage knee extension, avoid prolonged knee flexion, and protect the healing surgical site.

Burn positioning principle

Use anti-deformity positioning and place burned tissues on stretch rather than simply positioning for comfort.

Burn positioning basics

Neck extension; shoulders ~90° abduction/ER; elbows extended; wrists ~30° extension; hips extended/abducted; knees extended; ankles neutral.

Burn/graft precautions

Avoid pressure and shear over recent grafts; elevate involved limbs when appropriate for edema.

General deconditioning big picture

Expect weakness, poor endurance/activity tolerance, and possible abnormal HR/RR/BP/SpO₂ response; progress mobility gradually.

Patient of size/obesity big picture

Prioritize safety, appropriate equipment, adequate staff, skin protection, and reduction of friction/shear.

Equipment considerations for a patient of size

Ensure equipment/bed is appropriately sized and rated; consider mechanical assistance rather than unsafe manual handling.

Independent assistance level

Patient safely completes the activity without physical assistance.

Supervision/SBA

No physical assistance; therapist stays nearby for safety, cueing, or monitoring.

Contact Guard Assist (CGA)

Light hands-on contact for safety/balance without providing meaningful lifting assistance.

Minimal Assist (Min A)

Patient performs most of the activity; therapist provides a small amount of physical help.

Moderate Assist (Mod A)

Patient and therapist share the work substantially; your lab uses approximately 50/50 assistance as an example.

Maximal Assist (Max A)

Therapist provides most of the physical assistance; patient contributes a smaller amount.

Total Assist/Dependent

Patient contributes little to none of the movement and requires essentially full assistance.