NPTE FINAL QUIZLET REVIEW WITH SH*T I CANNOT REMEMBER AND NEED TO MEMORIZE FOR THE LIFE OF ME

Phase II of cardiac rehab requires what intensity level in METs?

4-9 METs

They need to be at 4-5 to d/c from Phase I

Wrist Fractures from FOOSH

Smith's Fracture: radius dislocates in volar direction (garden spade deformity)

Colle's Fracture: radius dislocations in dorsal direction (dinner fork deformity)

Painful Arc

45/60-120 deg = GH

70-120 deg = supraspinatus tendinitis

170-180 deg= AC joint dysfunction

OA Nodules

Herbeden's (DIP) and Bouchard's (PIP)

RA Deformities

Ulnar drift

Boutonniere's deformity

Hallux valgus and bunion

swan neck deformity

Hammer Toes

Rheumatoid nodules

SCFE has what ROM limitations

Flex, ABD and IR

LCP has what ROM limitations

Ext, ABD, and IR

GCS

Eye Opening

4-Spontaneous

3-To sound

2-Pain

1-Never

Motor Response

6-Obeys commands

5-Localizes to pain

4-Normal flexion withdrawal

3-Abnormal flexion

2-Extension

1-None

Verbal Response

5-Oriented

4-Confused conversation

3-Inappropriate words

2-Incomprehensible sounds

1-None

PNF for Gait

LE D1 Flexion bc flexion, ADD and ER are needed most for gait?

PNF Techniques for Mobility:

Contract-Relax

Hold-Relax

Hold-Relax Active Movement

Joint distraction

Repeated contractions (initiate movement patterns)

Rhythmic Initiation (RI)

Rhythmic Stabilization

Rhythmical Rotation (hypertonia)

PNF techniques for stability

Alternating Isometrics

Rhythmic Stabilization

Slow reversals

Slow reversal holds

FITT for pt with cancer

Strength

F: 2-3x/week

I: 8-15 reps < 70% 1RM (maintaining strength)

T: n/a

T: light weights, resistance bands, bodyweight

Aerobic Capacity

F: 3-4x/week

I: 40-59% VO2max but up to 60-80% VO2 max

T: 30-60 min

T: walking, biking, aquatics

Contraindications for Exercising pt with Cancer

-Day of chemo or within 24hrs after

-Severe reaction to radiation

-Severe nausea, vomiting, or diarrhea in last 24-36 hrs

-Unusual fatigue

-Platelets <20,000 can only do ADLs and AROM

-Caution at 20,000-50,000

Caution when pt platelet levels are low, at risk of bone fractures, ecchymosis, anemia, and possible spontaneous bleeding

Contraindications to Exercise a Pregnant Patient

-Preeclampsia

-Restrictive Lung Disease

-Severe anemia

-Incompetent cervix

-placenta previa

-vaginal bleeding

-rupture of membranes

-hemodynamic signs of heart disease

Obesity Classifications (BMI kg/m)

Overweight= 25-29.9

Obese= > or equal to 30

Morbidly obese= > or equal to 40

Obesity is

BMI of 30 or higher

Exercise Rx for Obese patients (FITT)

F= 5-7 days/week (more is better to maximize expenditure)

I= 40-60% and work up to 70%

T= 30/45 - 60 mins

T= aerobic + resistance, aquatics3

FITT for resistance training: Muscular strength and hypertrophy (muscle gains)

F= 2-4x/week

I= 70-90% 1RM for 2-3 sets of 8-12 reps

T= 2-3 min rest between sets

T= weights, resistance bands

FITT for resistance training: Muscular Endurance

F= 2-4x/week

I= 50-70% 1RM for <2 sets of 15-20 reps

T= less rest btw sets

T= bands and weights

FITT for resistance training: Muscular Power

F= 2-4x/week

I= 30-70% 1RM with fast velocity for 3-5 sets of 3-6 reps

T= 3-5 min rest btw

T= multi-joint, total body exercises, olympic lifts

Strength training sequencing

Large muscle groups and multi-joint muscles first along with more complex or higher intensity and finish with smaller group muscles

Aquatics: Ways to use water to assist in motion for weaker patients

-Go horizontal to water or go up toward surface away from the body

-use a floatie (+ go horizontal or toward surface)

-move slower

Aquatics: Ways to use water to increase strength in patients

-Increase speed

-Use turbulent water

-Movements toward the body or away from the surface

-Add a floatie (+ move toward body or away from surface)

-Add paddle/increase surface area of the extremity or limb=

Contraindications to Aquatic therapy

-Bowel or bladder incontinence

-Severe kidney disease (ESRD)

-Severe Epilespy

-Severe cardiac or respiratory dysfunction (severe CHF or severe COPD with very low vital capacity)

-Unstable blood pressure

-Peripheral vascular disease

EMG (electromyography)

-used to examine electrical activity of a muscle

Findings on EMG

-Silence= normal resting muscle (nothing should be on the EMG)

-Burst Action potential when needle is inserted= insertional activity (increased in acute denervated mm or decreased in chronic neuropathies/myopathies

-Fibrillation, positive sharp wave potentials and fasciculations while a muscle is at rest is all hallmark signs of denervated or diseased muscle'

-Polyphasic potentials (rapid firing of motor units with multiple phases are suggestive of reinnervation and collateral sprouting

-Decreased MUPs in lower motor neuron injury

-Myopathic potentials: small amplitude and rapidly spatially summate on minimal activation indicates myopathy

EMG Spontaneous activity

See photo for examples

(in general is pathological)

Burns (5 types)

Epidermal

-only epidermis

-pink or red, dry, no blister

-min edema

-tenderness

-no scarring, 3-7 days

Superficial Partial Thickness

-epidermis and up to dermis

-pink or red

-blanches with quick refill

-blister and weeping

-mild edema

-painful to touch

-min scar (7-21 days)

Deep Partial Thickness

-epidermis and dermis

-nerve endings, hair follicles and sweat glands affected

-blanches but slow refill

-sensitive to pressure but not to LT or soft PP

-possible excessive scarring

Full Thickness

-white, charred

-no blanching

-little pain

-most likely get keloid scarring

-grafts maybe needed

Subdermal

-often due to electrical burns

-Requires skin graft or possible amputation

TSA ROM restrictions

Phase 1/into 2

-NO elevation above 120 deg and ER >30 deg when arm is by side

-NO active IR for 6 weeks

-NO GH ext past neutral up to 6 weeks

rTSA ROM restrictions

For up to 12 weeks

-NO GH ext or IR past neutral

-NO ER >20 deg

-elevation allowed up to 90-120 deg in scap plane

-NO combined Ext+IR+ADD (reaching back for bra strap)

SLAP Repair ROM restrictions

Phase 1 (first 6 weeks)

-NO elevation past 60 deg for 2 wks

-NO elevation past 90 deg for 3-4 weeks

-Weeks 3-4 ER up to 30 deg and IR 60 deg

-No active elbow flexion for 6 weeks and no resistive until 8 weeks

-No ABD with ER of GH

Wrist Flexor Tendon Repair ROM restrictions

Phase 1

-Immobilize in 10-45 deg wrist flexion and 40-70 deg MCP flexion with IP joints in full extension

-DO TENDON gliding to prevent adhesions

Extensor Tendon Repair ROM restrictions

Phase 1

-immobilize in extension

-EARLY controlled active motion is good

ACL Repair ROM restrictions

Phase 1

-NO knee flexion past 60 deg (mini squats) in CKC

-No knees over toes

-No OKC (LAQ or SAQ) with resistance at ankle from 30-45 deg flexion to full extension

Achilles Tendon Repair Restrictions

WB

-Full WB not until weeks 4-6 in CAM boot

-Full WB in normal shoes with heel lift at 6-8 weeks

-Wean heel lift by 10 weeks post-op

ROM

-no DF >10 deg until 8 weeks

-stretch in sitting first on rocker board and progress to BL standing and no UL until 12 weeks

Respiratory Alkalosis vs Acidosis

Acidosis: CARBS

-Confusion

-Agitation

-Restlessness

-Blurred Vision

-Seizures

Seen in pt with COPD and those that are hypoventilating

Alkalosis: NO CARDS

-Numbness/tingling

-Orthostatic hypotension

-Confusion

-Anxiety

-Rapid Breathing (hyperventilation)

-Dizziness

-Seizures

Seen in pt with CHF or PE, hyperventilating

Metabolic Acidosis vs Alkalosis

Acidosis: SHAMED

-Stupor (unconsciousness)

-Hyperkalemia

-Arrthymias

-Muscle twitching

-Emesis

-Decreased CO

Alkalosis: Quad T

-Tetany

-Tachycardia

-Tremors

-Tingling

Hyperkalemia

Associated with Diff Dx:

-Addison's Disease

Associated with Medication use:

-Digitalis (Used in pt with CHF)

-Spirnolactone with ACE inhibitors (HTN and CHF)

-Angiotensin II blocker (ARBs) - CHF and HTN

ECG changes:

-Flat P-waves, wide QRS, Peaked T waves bc decrease rate and force of heart contraction

Hypokalemia

Associated with Diff Dx:

-Cushing's

Associated with Medication use:

-Lasix, Thiazides, Digitalis - CHF, HTN,

ECG changes:

-Flat or inverted T waves

Hypercalemia

ECG Changes

-wide QRS and short QT

-increased heart actions

Hypocalemia

ECG Changes

-prolonged QTR