Adult/hospital based midterm

pain

"an unpleasant sensory or emotional experience associated with or resembling that associated with, actual, or potential tissue damage

acute pain

-occurs suddenly

-associated with a specific event

-can result in adverse effects

-flare ups may occur

chronic pain

-uncontrolled, persistent and progressive

-occurring 3 to 6 months after original injury healed

-may create changes in psychological state, relationships, quality of life

-long term consequences (mental health conditions, poor sleep, etc.)

acute on chronic exaburation

flare ups of chronic systems

types of pain

-nociceptive

-neuropathic

-nociplastic

nociceptive pain

-most common type

-results from actual damage tissue caused by activation of nociceptors

-described as aching, burning, cramping, stabbing, throbbing

-2 main types (somatic nociceptive and visceral nociceptive)

somatic nociceptive pain

when person can point to specific location of pain

visceral nociceptive pain

when person cannot pinpoint pain because it effects internal organs

neuropathic pain

-"nerve pain"

- caused by lesions or diseases in somatosensory nervous system

-symptoms include burning, pins and needles, shooting, prickling

- two types (peripheral neuropathic pain and central neuropathic pain)

peripheral neuropathic pain

typically involves pain in a dermatomal or cutaneous distribution (ex carpal tunnel) due to consistent trauma to the peripheral sensory nerve

central neuropathic pain

ex: central post stroke pain, SCI, MS

nociplastic pain

- AKA central sensitization pain

-occurs because of altered nociception without evidence of threatened actual tissue damage

-symptoms: pain and sensory dysfunction

-pain is diffused and no identifiable location

-ex: fibromyalgia, migraine, CRPS

hyperalgesia

increased pain from a painful stimulus

allodynia

pain from a normally non-painful stimulus

chronic primary pain syndromes

associated with significant functional debility or emotional affect and cannot be explained by a different condition (fibromyalgia, CRPS, chronic migraine, IBS)

chronic secondary pain syndrome

involve pain that may have begun as symptom of another disease but has now transitioned beyond the successful treatment of the initial cause (surgery, injury, chronic pain due to cancer)

NSAID

nonsteriodal anti-inflammatory drug

is it safe to use a heat pad when a person has recently applied an analgesics (icy hot, etc.)?

NO! Could cause second degree burns

what is the 5th vital sign

pain

how do you test functional ROM

-raise arms above head

-bring them out of from of you

-supinate hands

-put them behind your back

-touch your nose

-open and close a fist

-flex elbows to touch shoulders

WNL

within normal limits

WFL

within functional limits

Gross MMT

-check ROM first

- if someone is NWB do not do MMT

-resist shoulder flexion/extension

-resist elbow flexion/extension

-squeeze therapists fingers

MMT muscle grades

0 - no movement

1 - contraction felt

2 - full ROM (gravity minimized)

3 - full ROM (against gravity)

4 - full ROM (against gravity and moderate pressure)

5.- full ROM (against gravity and maximal pressure)

Balance grades

- poor

- poor+

- fair

- good- or fair+

- good

- normal

levels of assistance

-Independent (Ind)

-Modified independence (Mod I)

-Set up

-Supervision (Sup)

-Contact guard/standby (Con. gd/Stby)

-Minimum assistance (Min.)

-Moderate assistance (Mod.)

-Maximum assistance (Max.)

-Dependent (Dep.)

frequency

percentage of time

duration

reps, # of seconds/minutes

assistance

supervision, min, mod, etc.

quality of performance

accuracy, adherence to safety, "x out of y trials"

level of complexity

amount of instruction, # of steps in the process

participation

attend, engage, initiate, transition, "x out of your trials"

strength

muscle grades, reps on ACT, lbs of pinch/grip

balance

balance grades, performance on FRT

activity tolerance

minutes, RPE/Borg, maintaining vitals, "tolerate"

national institute for occupational safety and health (NIOSH)

guidelines for evaluating occupational safety and health programs in hospitals

occupational safety and health administration (OSHA)

set of guidelines to help hospital administration and employees create a safer environment for patients and staff

noninvasive vitals

telemetry, pulsox, ultrasound, ECG

invasive vitals

Foley catheter, central lines, arterial lines

basic vital signs

- HR

- BP

- RR (respiratory rate)

- oxygen saturation

screening

the process of reviewing data, observing a patient, and using screening tools to identify the individuals potential to benefit from further assessment

assessment

a particular tool, systematic observation, or instrument used to collect data about the patient during the evaluation process

evaluation

encompasses the many means of obtaining, interpreting, and synthesizing data to understand the patient, the situation, and system factors that may influence the therapeutic intervention

focus areas of eval

-cognitive

-visual perceptual

-physiological performance factors

-ability to participate in basic ADLs

- facilitate safe d/c

mandates for an eval

-eval orders

-pain

-fall prevention

-medication safety

-physician sign off

-patient and caregiver agreement with the POC

diagnostic test

used to determine the severity of a disease, monitor the stage and course of a disease, detect recurrence, estimate prognosis, and help make decisions about the best POC

blood tests

used to examine specific elements dissolved in the blood

cardiac stress test

noninvasive test that evaluates heart health while it is being stressed chemically

computed tomography (CT) or computerized axial tomography (CAT)

noninvasive imagine system in which multiple x-ray beams and computer calculations provide a cross sectional view of the body

transthroacic echocardiogram (TTE) (echo)

noninvasive ultrasound scan that uses high frequency sound waves to penetrate the heart which creates an image that is used in determine the size, structure, and movement of the heart

electrocardiography (EKG or ECG)

a record of the electrical conduction of the heart generated during a cardiac cycle (used to identify cardiac rhythm abnormalities)

electroencephalogram (EEG)

electrodiagnostic test that records the brains electrical activity, commonly ordered for patients with epilepsy or seizures

electromyography (EMG)

assists with determining the source of neuromuscular weakness and atrophy identifying muscle diseases, peripheral neuropathies, radiculopathies, entrapment neuropathies, and differentiating between myopathic and neuropathies

electronystagmography (ENG)

used for patients with vertigo, dizziness, or problems with balance

electrophysiologic study (EPS)

used to identify the location of a conduction problem that causes arrhythmias or to monitor anti arrhythmic medication therapy (results may indicate if patient needs a pacemaker)

endoscopy

allows direct visualization of body organs and cavities through the use of a fiberoptic lens attached to a rigid or flexible tube

evoked potentials (EP)

noninvasive test that records brain electrical activity in response to sight, sound, or touch stimulation

fluid analysis

refers to the microscopic examination of a sample of fluid taken from anywhere in a patients body

holter monitor

type of ambulatory electrocardiography used after surgery, cardioversion, suspected or confirmed acute coronary syndrome, arrhythmia, heart failure, pulmonary edema, and pacemaker placement

lumbar puncture (spinal tap)

performed by inserting a needle into the subarachnoid space (L3-L4) and collecting a sample of cerebrospinal fluid (CSF)

magnetic resonance imaging (MRI)

noninvasive test that uses superconductive magnets, radio frequency waves, and computers to provide a detailed sectional image of the body

microbiological tests

examine tissue for presence of disease or infection

nuclear medicine scans

patient receives a small dose of a radioactive chemical tracer with a transport molecule (usually through IV)

positron emission tomography (PET)

nuclear medicine imagine technique that may be ordered for oncology, neurology, or cardiology patients

pulmonary function test (PFT)

noninvasive test used in the diagnosis and screening of pulmonary restrictive and obstructive diseases that impact breathing

radiographic studies (X-rays)

examine soft tissue and body structures of the body

stool cultures

tested when patients have enteric disorders, severe diarrhea, abdominal bloating, and fever

transesophageal echocardiogram (TEE)

invasive endoscopic test in which a probe with a transducer is inserted through the mouth and into the esophagus and positioned behind the heart

ultrasound

noninvasive procedure for studying soft tissue structures, and provides information on size, shape, and position of organs

doppler ultrasound

used to study blood flow

venous ultrasound

indicated for patents with swollen, painful extremities

arterial ultrasound

may be used for patients with signs of arterial insufficiency, claudication, pulseless extremity, and cold/pale skin

duplex ultrasound scanning

combination of real time and doppler ultrasonography used to study anatomical structures and the blood flow through them

urinalysis

fluid biopsy of the urinary tract (usually collected in a cup)

allergy and immunology

root causes from allergic reactions to immune system dysfunction

cardiology

specializing in treatment of heart disease

dermatology

specialize in the treatment of diseases of the skin

endocrinology

bodys system of glands that produce internal and external secretions, mainly hormones

gastroenterology

dysfunction of the stomach, intestines, esophagus, liver, gallbladder, and pancreas

gerontology

specialize in care of the elderly

hematology

study conditions and diseases of the blood, blood cells, and blood forming tissues

hospice and palliative care

supportive care and comfort services that address the physical, spiritual, social, and economic needs of terminally ill patients and their families

hospitalist

usually the primary physician caring for patients and coordinating all of the patients care during hospital stay

infectious disease

doctors of internal medicine who diagnose and treat diseases cause by bacteria, parasites, and viruses

internal medicine (AKA internists or diagnostician)

apply scientific knowledge and clinical training to the diagnosis, treatment, and care of adults across the spectrum of general health to complex illnesses

nephrology

treat dysfunction of the kidneys

what do OTs need to be aware of when working with a patient on dialysis

dialysis lowers BP, could be an issue for someone who already has hypotension

oncology

treatment of patients with cancer and tumors

opthamology

diagnosis, management, and treatment of conditions and diseases of the eyes and visual system

otolaryngology

medical/surgical management of diseases and disorders of the ear, nose, and related structures of the head and neck (ENT)

orthopedics

conditions and diseases related to the musculoskeletal system

psychiatriy/psychology

specialize in coping, addiction, and mental health problems

pulmonology

specializes in disease of the upper and lower respiratory tracts and the cardiopulmonary system

radiology

interpret medical imagine to diagnose and treat diseases and injuries such as bone fractures, ligament tears, and cancer

rheumatology

diagnose and medically manage rheumatic diseases that affect joints, muscles, and bones and can also have system effects

urology

specialize in diseases of the male and female urinary tract and reproductive organs

*OT needs to be area of input and output monitoring when working with these patients*

physicians assistant

practice under the supervision of a physician

physical therapist

provides treatment to prevent disability or restore function through the use of exercise, heat, massage, or other techniques

speech language pathologist (SLP)

swallowing disorders, cognitive deficits, speech/language difficulties

respiratory therapist

oxygen therapy, breathing treatments, pulmonary drainage procedures, mechanical ventilation