Comprehensive Study Flashcards for Adults Exam 1 in Medicine

(assist levels) independent

no assistance from devices or staff

Assist levels: Modified Independent

utilizes adaptive equipment to complete task

(assist levels) set up

helper does not need to be physically present during task but must provide set up of equipment for successful completion. (Places all items for grooming visible on sink, opens containers when delivering meal tray)

(assist levels) supervision or standby assist

needs cues, encouragement to complete. verbal or demonstration, no physical assistance is provided. Used if there are safety concerns

(assist levels) close supervision

physically present in room, within visual regard at all times

(assist levels) distant supervision

within visual regard most of the time, may not be physically present in room by standing where the helper can hear the person

(assist levels) contact guard assist

hand is place on the person some to all of the time, sometimes CGA is holding the gait belt or clothing item

(assist levels) min assist

client completes 75-99% of the task, may be a large task or the component of a task

(assist levels) mod assist

client completes 50-74% of the task

(assist levels) max assist

client completes 25-49 % of the task

(assist levels) dependent

client completes less than 24% of the task or does not participate

(process) initial interview

develop occupational profile by reviewing hisotry, needs, values, goals

(process) activity analysis

essential skill for OTs to understand components and skill requirements of a task

what is the goal of an activity analysis

client independence, discharge

therapeutic grading

the modification of activity demands to reduce or increase the activity's challenge level

what is the purpose of therapeutic grading

promoting psychomotor learning and increase occupational performance (grading up and down)

activity adaptation

Modifying or substituting objects used in performing the activity. (How they are always going to do the activity or use a tool)

Ex: apply velcro fastener on a purse, color code files for quick ref., wear a walkman/ipod to drown out background noise.

considerations of activity adaptation

make the activity therapeutic

grade the exercise

enable performance for those with physical impairments

address activities with long term participation to prevent cumulative trauma

biomechanical approach

principles of kinetics and kinematics are applied to understand normal movement. Effective interventions include working on ROM, strength, and endurance.

rehabilitation approach

uses approaches of remediation, compensation, adaptation or a combination of these approaches.

Neurodevelopmental approach

Definition-emphasizes individualized therapeutic handling based on movement analysis for habilitation and rehabilitation of individuals with neurological pathology.

Task oriented approach:

emphasizes the dynamic interaction between the person, the environment, the occupational performance task, and role performance and it suggests that behavior emerges from this dynamic interaction.

Motor learning theory

takes into consideration how skilled actions are acquired, modified, retained, and transferred as the result of practice. It promotes skill acquisition and generalization of learning.

Pain assessments

mcgill pain questionnaire

body diagrams

rating scales

face, legs, activity, cry, consolability behavioral scale

functional outcome measures

DASH, UEFI, american shoulder and elbow form, patient related tennis elbow evaluation, patient related wrist/hand evaluation, michigan hand questionnaire, patient related ulnar nerve eval, carpal tunnel symptoms severity scale and functional scale, barthel

DASH is higher the score, the

greater the disability

UEFI is higher the score

greater the ability, less disability

edema assessment

circumferential, figure 8, or volumetric

end feel

the quality of the movement a person senses when pressure is applied passively to a joint at the end of its available range of motion

normal end feels

soft, firm, hard

abnormal end feels

empty, capsular, hard, springy block, muscle spasm

muscle length test

a provedure to asses the length or passive extensibility of a muscle

determined by the distance between the proximal and distal ends of the muscle

muscle strength test

procedure used to test the motor strength of certain muscle groups

special tests are used to

confirm or deny a hypothesis

special tests result in varying specificity and sensitivity - specificity means

How well a test identifies clients who do not have the condition and correctly shows up as negative on the special test; when the test is positive you can be confident the condition is present (rules in the condition)

special tests result in varying specificity and sensitivity - sensitivity means

How well a test identifies clients with the condition and correctly shows up as a positive on the special test; when the test is negative, you can be confident the condition is not present (rules out the condition)

semmes weinstein is a standardized assessment is good for

identifying compression injuries such as carpal tunnel

two point discrimination is a standardized assessment good for

assessing sensibility after nerve laceration

vascular assessments

allen's test, capillary refill, adson's test

allen's test

A test for the patency of the radial artery after insertion of an indwelling monitoring catheter

capillary refill test

Assessed by observing the repercussion of the nail bed after the blood has been forcibly squeezed out by pressure. The clinician compresses the fingertip for several seconds until the nail bed has blanched. The clinical observes the length of time it takes to refill the capillary bed. Normal is less than 3 seconds. Any time equal or greater than 3 seconds is considered abnormal. This test is done to look for different vascular diseases, dehydration, hypothermia, and shock.

adson's test

thoracic outlet syndrome

(EKG) atrial depolarization

electrical impulse travels through the atria

(EKG) PR interval

AV conduction time; impulse travels from the atria to the AV node, and down the. bundle branches, to where the ventricles contract

(EKG) QRS complex

ventricular depolarization

(EKG) T-Wave

ventricular repolarization

(EKG) ST segment

Represents early ventricular repolarization

Measured from end of S wave to beginning of T wave

tachycardia

heart rate over 100

bradycardia

slow heart rate (less than 60 bpm)

atrial fibrilation

irregularly irregular. rate varies and depends on the conduction rate. no identifiable P waves. Baseline shows fibrillartory waves.

role of OT: levels of care in acute care

ER, ICU, acute general care unit

role of OT: goals

Improve client's independence, prevent complications like bedsores or delirium, and prepare for discharge

impacts of extended bedrest

loss of muscle strength, joint cnotractures, and decreased functional independence

typical preparation for a treatment session

review chart for status changes, appropriateness for therapy

inpatient acute rehab

requires three hours of therapy a day

sub acute rehab

one to three hours of therapy a day

24 hr supervision

long term acute rehab

for less medically stable patients, long term care

day rehab

up to three hours of therapy a day in an outpatient setting

outpatient OT

safe at home, able to travel, community access

home health therapy

home bound patients receiving therapy at home

Foley Catheter

flexible plastic tube used to drain the urinary bladder

Foley Catheter; implications for therapy

Be cautious not to dislodge the catheter during mobility. Ensure the drainage bag is kept below the bladder level and the tube is off the floor to minimize infection risk.

texas catheter

condom catheter; for males; more temporary - this can dislodge easily

Nasogastric tube (NG)

tube inserted through the nose into the stomach

NG tube; implications for therapy

secure with tape, which may need re-securement if it comes loose.

Gastronomy Tube (G-Tube)

tube placed through the abdomen directly into the stomach and used to provide nourishment

G-tube: implications for therapy

monitor for signs of infection around the tube site and avoid pulling or irritating the tube during mobility

peripheral IV

short catheter inserted into any vein that is not in the chest or abdomen

peripheral IV; implications for therapy

keep the IV pump and pole in front of the payient to avoid tangling, be cautious of movement discomdort and consult with the nurse about disconnecting the IV if needed

Arterial line (a-line)

• Thin catheter inserted into an artery (commonly the radial a.) in order to monitor blood pressure and mean arterial pressure in real time. This catheter is more firm than an intravenous line (IV).

• Also used for collection of arterial blood gas.

• Displayed as a red wave form usually near the bottom on the monitor.

PICC line

a long term IV catheter inserted into a peripheral vein and advanced to larger veins near the heart for extended medicatino or nutrient delivery

central venous catheter

central IV line interseted into major veins terminating into the atrium

dialysis catheter

specialized central catheter used for dialysis, either inserted into the jugular or subclavian vein

nerve block

injection of regional anesthetic to stop the passage of sensory or pain impulses along a nerve path

Jackson Pratt Drain

hollow bulb-like device used to collect drainage

implications for therapy JP drain

secure the drain to prevent accidental bursting or pulling, attach it to the gown or hold it during mobility

chest tube

Catheter inserted through the thorax into the chest cavity for removing air or fluid; used after chest or heart surgery or pneumothorax.

implications for therapy; chest tube

keep the drainage system upright and below the level of insertion, there are no restrictions on movement but be mindful of patient discomfort

wound VAC

a device that uses negative pressure to promote wound healing and remove fluid and infectious waste

cardiac telemetry

monitors heart rhythms using 5-12 leads attached to the patients trunk

pulse ox

measures oxygen saturation in the blood

cardiac monitor

displays various vital signs including heart rate, blood pressure, respiratory rate, and Sp O2

therapy tolerance of inpatient rehab

must tolerate 3 hrs of therapy per day 5 days a week

(inpatient rehab) medical stability

patients transferred from hospitals or nursing homes

inpatient rehab - diagnosis requirement

stroke, spinal cord injury, major trauma, etc

ortho rehab - UE Eval

- Take history and occupational profile

- Observation : Posture, UE, spontaneous use, guarding, scar, wounds, trophic status

- Palpation (gentle): tenderness/pain, adhesions, pitting/brawny edema

- Perform specific tests or assessments: ROM, joint end feel, edema, vascular, sensation, strength, coordination, muscle length tests, functional assessments

adhesive capsulitis (frozen shoulder)

Decreased passive and active range of motion

More stiffness than pain

phases of frozen shoulder

freezing, frozen, thawing

frozen shoulder - freezing

2-9 months

frozen shoulder - frozen

up to 1 year

frozen shoulder - thawing

up to 26 months

in frozen shoulder, does a client go through all the phases

not always

frozen shoulder creates loss of motion

in external rotation , internal rotation , and abduction

treatment for frozen shoulder - non operative

pain management, stretching, strengthening

treatment for frozen shoulder - operative

manipulation under anesthesia or arthroscopic release

rotator cuff tear

traumatic rip of one or more of the muscles or tendons within the rotator cuff of the shoulder; can be partial or full thickness

rotator cuff tear - non operative treatment

early PROM, strengthening RC muscles, activity modification

rotator cuff tear - operative treatment

focus on regaining full ROM and progressing to ADL performance

which muscle is the most vulnerable to tearing in a rotator cuff tear?

supraspinatus

proximal humerus fracture

most common, most occur as a direct result of a fall on the shoulder or a direct blow to the humeral region