physical therapy-exam 1

physical therapist

the only provider who can evaluate patients or change a plan of care

physical therapist assistant

licensed or certified

physical therapy aid

must be directly supervised

specialization in PT

does not occur in DPT school, must be after

elements of patient/client management

examination, evaluation, diagnosis, prognosis, intervention, outcomes

bursitis

-an over use injury

-inflammation of bursae (fluid filled sacs that decrease friction)

tendinopathy

-overuse injuries

-tendinitis (inflamation of the tendon)

-tendinosis (degenerative changes from overuse

nerve entrapment

-overuse injuries

-pressure on peripheral nerve from surrounding structures

ligament

-traumatic injuries

-overstretched

fracture

-traumatic injuries

-bone breaks

muscle strain

-traumatic injuries

-tear of muscle fiber

musculoskeletal surgical conditions

total joint arthroplasty and amputation

musculoskeletal medical conditions

rheumatoid arthritis, obesity, cancer, may cause pain, weakness, and loss of function

systems review of a patient examination

brief examination of other systems as needed, we consisder the whole patient

tests and measures of a patient examination

observation, ROM, strength, joint mobility

types of ROM

active or passive

types of strength

manual muscle testing, 0-5 scale, dynamometry- strength of specific muscles

types of joint mobility

glide, roll, spin

interventions: manual therapy

joint mobilizations and soft tissue mobilization

interventions: therapeutic exercise

flexibility, strength, activity tolerance

other interventions:

aquatic training, gait training, neuromuscular, re-education, education

interventions: therapeutic activity

posture training, transfer training

the evaluation is based on an examination of 3 different findings:

impairments, activity limitations, participation restrictions

diagnosis

whats wrong

prognosis

how will this go?

SOAP NOTE: subjective 

what the patient says

SOAP NOTE: objective

measurements, treatments

SOAP NOTE: assessment

evaluation-how the impairments limits the patient from participating in work, rec, or life

SOAP NOTE: P__

Plan

negative risk factor for cardiovascular disease

high-density lipoprotein cholesterol (HDL)

-decreases the friction in our arteries

cardiovascular system is comprised of

the heart, conduction, coronary arteries, peripheral circulation

peripheral circulation

getting blood to our muscles, nerves, skin, and other structures

stagnation in peripheral circulation

stoppage of blood flow

aretrioclerosis

hardening of the arteries, increases resistance and makes the heart work harder

perepheral artey disease (PAD)

pain in legs, numbness, weak pulse in legs

-increases risk of having a stroke or heart attack

grading pulse: 0

absent 

grading pulse: 1+

barely palpable, diminished

grading pulse: 2+

easily palpable, normal

grading pulse: 3+

increased strength, full pulse, bounding

grading pulse: 4+

too strong to obliterate, bounding

maximum heart rate 

220-age=

target heart rate

-60-80% of max heart rate

max HR x .6=

dorsalis pedis pulse

-on the dorsum of foot over cuboid bone

posterior tibial pulse

posterior to the malleolus

capillary refill time

2-3 seconds

>1.4

rigid arteries-US required

1-1.3

normal, no blockage

.8-.99

mild blockage, beginnings of PAD

.4-.79

moderate blockage, pain with exercise

<.4

severe blockage, pain at rest

coronary artery disease

narrowing of the arteries on the heart that supply blood to the heart muscle

myocardial infarction

complete blockage of a coronary artery resulting in death of the heart tissue

congestive heart failure

weakening of the pump function of the heart

left heart failure

backup fluid into the lungs

right heart failure

backup fluid into the legs

ventilation

-exchange air between atmosphere and lungs

-consists of inspiration and expiration

respiration

exchange of oxygen and carbon dioxide at the cellular level

conducting airways and lungs

-upper and lower airways

-lungs compartmentalize into lobes

restrictive lung disease

-can’t get O2 in

-lungs unable to fully expand

obstructive lung disease

-can’t get CO2 out

-lungs unable to expel air properly

COPD

-condition where lung elasticity is effected

-air is stuck

examples of restrictive lung diseases

scoliosis, fibrosis, neuromuscular diseases, pneumonia

examples of obstructive lung diseases

COPD, ephysema, chronic bronchitis, asthma

functional tests in examination

sit to stand

outcome measures in examination

20 question survey

special tests in examination

gives a name to pain

epidermis

-outermost layer of integument

-avascular-no blood vessels

-provides protection

-thick in certain areas(soles of feet, palms)

dermis

-inner layer of integument

-collagen fibers provide strength, gel like ground substance cusions

-provides sensory input and temperature regulation 

subcutaneous tissue is beneath ___

-dermis

-loose connective tissue and fat

-anchors the skin to deeper structures

abrasion

scrape or shearing off of skin

blister

separation/ accumulation of fluid or blood between superficial skin layers

inscision

a cut through all layers of the skin by a sharp object or an instrument 

laceration

tearing of the skin by blunt trauma to the skin over a bony prominence

puncture

sharp penterating obect with little disruption to the skin

avulsion

tearing off or complete dissassociation of a portion of skin

amputation

the loss or removal of all or part of a limb or extremity

four phases of wound healing

hemostasis, inflammatory, proliferation, remodeling and maturation

hemostasis phase

clot formation

-stops bleeding

-contains invader pathogens

-begins attracting phagocytes

-vasoconstriction

-pressure

inflammatory phase

normal part of healing

-vasodilation

-local edema, which could restrict motion

proliferation phase

collagen produced by fibroblasts

angiogenesis-vascular growth

granulation tissue

epithelialization-wound contracts

remodeling and maturation phase

reduction in blood vessels and fibroblasts

collagen reorganization

scar contraction

arterial insufficiency

inadequate blood flow to the tissues

venous insufficiency

venous blood accumulates-does not return to the heart as it should

pressure ulcer

pressure reduces blood flow ischemia

neuropathic ulcer

insensitivity of skin may result in lack of position adjustments and continued pressure to same area

ischemia

so much pressure that cellular death occurs

arterial ulcers

dry, punched out shape, pulse is weak or absent

venous ulcers

swelling, weeping, dialated veins, pulse is present

neuropathic ulcers

painless wounds that develop over peripheral points, deep, skin adjacent appears normal but sensory deficit

non-blanchable erythema

discoleration of the skin that does not turn white when pressed

TBSA-total body surface area

% out of 100

ABCDEs of skin cancer

Asymmetry, border, color, dimension, evolving

arterial and neuropathic wound management

topical agents to maintain moisture at wound

venous wound management

compression and positioning to reduce edema along with semiabsorbent dressings

pressure ulcer wound managements

body should be turned every 2 hours

changes over time and with maturation

skills , behaviors, physical changes

torticollis

-tightness in neck muscles

-typically begins in early infancy

=acquired at birth, musculoskeletal

plagiocephaly

-skull deforming on one side

-cranio-moulding helmet

=acquired at birth, musculoskeletal

osgood schlatter

-tendon from patella attaches to the tibial tuberosity

-local swelling

-overuse injury

=acquired after birth, musculoskeletal

brachial plexus birth injury

-loss of arm function

=acquired after birth, neurological