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178 Cards in this Set
- Front
- Back
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Exam is when you conduct your tests and measures. What are three things you want to know before you conduct the exam?
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ROS
PMHx PSHx red flags |
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After examination, you gather all your information and make a clinical judgement. This process is called _________________
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Evaluation!
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Diagnosis =
prognosis = outcome = |
giving the patient a label - a clustre of catagories of syndromes
what youd expect what actually happened |
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Strong and painful =
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non contractile structures are hurt
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Two formulas for the definition of health care malpractice=
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traditional - care related negligence only
broad - any potential legal basis for positiong of liability |
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examples of liability
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1. neglegance
2. breach of contract 3. dangerous care 4. intentional misconduct |
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Professional negligence =
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falling below a standard of care that you would have expected from any other physcial therapist
even forgetting to write in the chart or documenting wrong. |
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Progessional negligence is determined by:
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expert testimony
1. indepth knowledge of related issues 2. knowledge of applicaple standard of care at that time. |
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The burden of proof in a professinoal negligance case is on...
what are four elements of proof? |
the patient: but only has to proove "more likly than not"
1. sepecial duty to repform 2. pt didnt get it 3. led to injury 4. entitled to money |
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Neglagant abandonment =
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- leaving a patient unattended
- leaving work and not staying overtime |
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Intentional abandonment
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- not giving patient notice when their insurnace is going to end and then not seeing them.
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when can a health care provider stop seeing a patient
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- medical condition has resolved or platued
- dr moves away |
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List some reasons for documentation
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1. immenent need to know
2. inssurance 3. research 4. basis for care planning |
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number one most common documentation problem
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illegible notation
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Advantages for computerized records
deisadvantages- |
- video tape using a new prosthesis
- get consent - patient confidentiality - firewall, hackers - changes in records |
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POMR =
C = where in soap do you write the diagnosis? |
problem oriented medical record
- of what you did - from most severe to least severe continuous in the assessment, since its the interpretation of results. |
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Qualitity Improvement (QI) is aka-
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quality assurance (QA)
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ABC's of documentation
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- Accuracy: dont record false info. even spelling and grammer errors count.
- Brevity: short, susinct, fragments are ok. Stay away from hyphens - Clarity: must be immediatly clear |
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so =
c/0 = |
significant other
complaining of |
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Because of insurance companies, make sure your goals are
goals should include: |
functional!
audience (patient, nurse?) Behavior condition degree - awssistance short term / long term |
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On your chart, dont write I =
frequency of notes depends on... the critical paths set.. |
write - this therapist
the setting your goals for you |
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When do you fill out an incident report-
where do they go? |
when something happens OR when something doesnt happen
risk management. NOT IN CHART |
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Interim notes =
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slimmed down soap
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what should your discharge notes have in them?
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- goals have been achieved
- or why youre not going to see them anymore. |
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CODE BLUE =
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breathless and pulseless
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Babinski =
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toes flex, BIG toe extends and slight withdrawl
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PAT =
NKA = VNA = |
pre admission testing
no known allergies visiting nurses association |
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CHOLE =
STN = LTG = cxr = |
gall bladder removed
short term memory long term goal chest x ray |
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List some catagories that you can check to evaluate cerebal functioning..
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- general behavior and appearance
- LOC - intellectual functioning - emotion - cortical sensory inhibition - cortical motor in integration - language skills |
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General Behavior signs
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motor deficits
functional deficits (posture) cognitive deficits |
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AAO X ______
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first to go is time
then place then person |
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how do you know if their cortical sense is intact?
what about cortical motor? |
ability to interpret sensory information and produce a proper response
ability to plan and exceute motor acts |
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___ cant speak out =
___ cant speak because of tongue |
aphasia
dysarthria |
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fyi-
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proprioception is a form of kinomatic sense
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stereognosis =
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recognize shape of object by touch
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combined cortical proprioceptive sense-
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tactile location
two point bilateral dorsal columns tests |
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LLPS =
NDT = |
low load prolonged stretched
neural developmental training |
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Agnosia =
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cant process in coming informtaion dispite intact sensory capabilities
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Allesthesia =
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sensation experiened at a site rmort from poistn of stimulae
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Hypalgesia =
paresthesia = thermalanalgesia = |
dec sensitivity to pain
tingling without any cause inabiility to percieve heat |
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Dermatome =
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represetns the cutaneous area supplied by a single dorsal root and its ganglia
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If you loose CNA inhibition what will happen to your reflexes?
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hyperreactive
but if you damamge your PNS - hypoactive DTRs |
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Dysmetria=
Dystonia = |
cant judge distanceor ROM
sustained involuntary contractions of agponist and antagonist mucles, fluctuating tone |
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How do you document for coordination tests?
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0= unable to perform
1- severe difficulty 2- slight difficulty 3- moderate difficulty 4- normal |
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How do you document Balence?
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normal = maintain balance without support with maximal changes
good - maintain support and mod changes fair- maintain support no challanges poor- maintain balance with support zero - max assisst |
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What kinds of things should you inspect while giving the interview?
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- posture
- gait - skin color - willingness to move. |
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hemoptosis =
orthopnia = syncopy = dyspnea = |
cough up blood
SOB when supine room spinning difficulty breathing |
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Posture =
why dont muscles have to work hard when you slouch? |
relative position and allignment of body parts
youre not creating any flexion or extension movements, but your ligaments streatch and can cause nerve impingement abd bone stress |
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External forces effecting posture
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gravity
inertia GRF |
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types of mobility exericses-
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joint mobs
passive stretch flexibility exercises inhibition techniques |
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general indication for TKA
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- osteoarthrisitis
- RA - post traumatic stress disorder - osteonecrosis |
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advantages of a medial parapatellar TKA
advantages of subvastus (southern) TKA - advantages of midvastus approach- |
allows maximun exspoure for bone cut linesm ligement balencing and prosthesis fitting
-extensor mechanism left intact - more rapid retuen of quad length - preserves vasculatiry of patella - decreases need for lateral release - patellar eversion is easier - LEASED distrubed extensior mechanism |
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If you do Knee surgery posterior what might you sacrafice-
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the pcl since its easier to get inthe prosthesis.... but then stability of the knee relies on it.
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whats the difference between fixed bearing and mobile bearing?
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fixed- polyethylene part is fixed to tibia
mobile- not fixed to tibia |
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non cemented aka-
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biological fixation
- usualy femor is biologicly fixed and the tibia is cemented |
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Why is CPM good?
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- prevent scar tissue
- normal ROM and strength - improves healing, dec dvt - shorter los |
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MUA =
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manipulation under anesthesia
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where do you put the pillow after tka?
how long do you have to wait to weight bear with biofix tka? |
under DISTAL knee
TDWB for first 6 weeks |
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side effects of pain meds-
sign of dehydration= |
change in MS
constipation vomiting weakness, change in mental status, skin integrity |
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frequent systemic complications after TKA
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1. heart attack
2. PE 3. bowel obstruction 4. retention of urine 5. confusion |
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TKA failure due to....
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- primary lesions
- trauma - chronic progressive joint disease - loosening of the prosthetics - infection (knees fail more than hip) |
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Moore is famous for
Charnley is famous for |
contractions?
low friction arthroplasty |
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General indications of THA
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osateoarthritis
RA avascular necrosis nonunion of femoral neck overuse discomfort |
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discribe weight bearing for bone cement THA patients
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1/3 body weight first 6 weeks
2/3 after 8 weeks full after 10 weeks |
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early complications of THA
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nerve palsy
hemarthrosis thrombolism************ |
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Risk factors for thrombolis
signs: prevention: |
- prior episodes
- prior venous surgery - varicose veins - malignancy - LE sitting edma - immobilizationb - obesity - BCPS - excessive blood loss homans unilateral leg edema low greade fever mobilization active exercise compression boots |
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LATE THA complications
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- infection
- dislocation - femoral fractures - ossification - leg length |
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when do THA dislocations tend to happen
signs--> |
in first three months
- pain - abnormal rotation with limited rom - limb shortening (dislocated superioly) |
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porous bio fit =
press fit = hemiarthroplsaty |
biological fixation
bone tissue grows right into structure when acetabular cartiledge isnt damaged. best kind is bipolar with metial cup to decrease wear. |
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Discribe anterolateral approach THA
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- patient supine
- anterior dislocation - heard to reattach greater trochanter - disrupts anterior abductors |
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Discribe direct lateral appraoch to THA
discribe posterolateral approach |
- patient supine and lateral
- anterior dislocation **mnost prefered - |
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posterior dislocation =
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hip flexed
add IR |
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normal rom o2 saturation
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100mg
below 90 is a red flag so contraindicate exercise |
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NC
S CG |
nasal canulate
supervised contact guard |
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CRF
PVD N.H. |
chronic renal failure
peripheral vascular disease nursing home |
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AD
SR |
assistive device
sinus rhythem |
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does every page of documentation have to contain the patients full name?
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YES
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the best way to avoid inconsistant documentation
can you skip lines on a chart |
is to have stadardized forms
no |
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what happens if your pen runs out of ink?
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you should precede the second part of the entry however with a breif parenthetica lphrase stating that your first pen ran out of ink at that point. initial it.
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whats the difference between pt and dpt
difference between slandar and liable |
pt = professional credential
dpt = academic credential slander = spoken liable = written |
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how do doctors orders over the phone become legal?
how can you label a late entry made is a chart |
doctor must come and sign it
"addendum" or "follow up entry" |
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how can you put in the chart that the patient work related back pain is better?
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quote him rather than paraphrase
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what should you do if a paitent says they're faking symptoms
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tell your supervisor
fyi- dont write reflexes WNL, you have to write extactly which reflexes were. |
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hearsay =
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legal term of art used to discribe any thing spoken out of court as evidecne IN court
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Do you have to document the patients informed consent to treatments and intervention
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YES
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what is the theme of the legal concept res ipsa loquiter?
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professional neglect- its your fault unless you can proove it on a family member
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List HOAC bullshit in order-
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1. collect data
2. PIPS 3. exam 4. NPIPS 5. hypothesis 6. refine problems list 7. goals 8. intervention 9. reassess |
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diaphoresis=
ABGs ac = |
cold sweats
arterial bloog gases before meals |
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AD =
ad lib = AE = |
right ear
as desired above elbow |
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AKA =
AMA = A&P = |
above knee amputation
american medical association assculation and percussion |
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ARDS =
AS = BE = |
adult respiratory syndrome
aortic stensosis below knee |
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bid =
CHF = CPT = |
twice a day
congestive heart failure carpal tunnel syndrome |
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dc =
DC = |
discontinue
discharge |
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FIM 7 =
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complete independance
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dysphagia =
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difficulty swallowing
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stages of ulcers (skin)
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1. red skin
2. down to dermis 3. necrosis but not through facial layer 4. tissue loss to bone |
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first pt president
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mary mcmillan
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when was apta independanct of ama?
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1983
(1946 acredited by ama) |
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other than doctors who else has direct access?
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DO
dentists podiatrists |
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_____ = a group of disorders of the heart muscle itself =
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cardiomyopathy
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Most Common cause of Dialated cardiomyopathy is either=
20% - 30% have _____origin 2 other reasons this group of disorders can develope = |
ischemic heart disease or valvular disease
family drugs from chemo alcholism |
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3 ways alcohol can cause DIALATED cardiomyopathy-
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direct effect
nutritional deficiets additive toxicity |
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whats the difference between hypertrophic and restrictive cardiomyopathy-
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hypertrophic - cant feed muscle cells
restrict- think scar tissue |
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Dialated Cardiomyopathy results in 4 things-
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1. dec ejection fraction EF
2. INC EDV, ESV 3. DEC SV 4. biventricular failure! |
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Ejection Fraction EF=
when this is less than ____% you see heart problems |
% of EDV thats ejected in a heart beat
40% |
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Symptoms of Dialated Cardiomyopathy-
treatment? |
dyspnea
fatigue palpitations dysrthymia emboli salt restrict digitalis anticoagulants |
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Digitalis (cardiac glycosides) =
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product from plant that impacts the heart. Poisons sodium potassium pump ATPase and slows down action potential in muscle cell because repolarization takes longer.
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Valve Dysfunction types
acquired one is usually due to |
endocardium
congential and acquired inflammatory process like RAor infective endocarditis |
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Valve Dysfunction problems =
in both cases the heart has to |
regurgitation
stenosis (narrow) both of these are called diastole murmer. work harder to maintain the cardiac output. |
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Most commonly damaged valvue =
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MITRAL
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etiology of hypertrophic cardiomyopathy-
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hypertension or valvular disease
- mediated by angiotension II |
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hallmark of hypertrophic cardiomyopathy-
Whats usually used first to treat this? |
disproportionate thickening of the septum
- do an ultra sound beta-blockers |
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hypercontractile musculature-
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anything that increases contractility also increases the obstruction!!
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diving reflex-
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put your face in ICE and dec your heart rate!
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mitral stenosis with some kinda orbit has been known to look like-
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fish mouth valvue
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In general Valvular dysfucntion stimulates chamber dilation and myocardial are all...
but eventually... |
compensatory mechanisms intended to increase the pumping ability of the heart.
a decrease in myocardial contractility developes - EF dec - diastolic pressure inc - ventrical fails from overwork |
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causes of aortic stenosis-
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- inflammatory damage from RA
- congential malformation - degeneration with thickening and calcification |
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So literally... aortic stenosis ---->
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aortic orifice narrows, and outflow resistnace increaess pressure in the left ventricle
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Aortic stenosis tends to develope....
signs.. |
gradually
- decreased pulse pressure, SV - LV hypertrophy - systolic murmer |
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LUb ch DUB =
Lub dub CH = |
stenosis
incompetant- regurgitation |
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Causes of Mitral valvue Stenosis =
Mitral Valcue stenosis results in .. |
acute rheumatic fever or bacterial endocarditis or congenital
- increased LA pressure, this causes dialtation and hypertrophy - increased risk of fibrillation - dec co in exercsion- eventually leads to right ventricular failure |
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Ace inhibitors work with volume- they adjust-
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venous return to the heart
-STOPS RAAS system so we PEE more!!!! |
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inotrops work on actual
post ino- CA blockers |
contraction- since beta is a receptor on the CA muscle.
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aoritc regurgitation is by things that..
Seen with what diseases= |
the valvue cusps and aortic root.
RA HTN syphillis marfan |
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During exercise, what does EDV depend on?
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positive inotropic agents - NOT starlings LAw!
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mitral regurgitation is common in ____% people
- causes... - leads t0.... |
19%
- MVprolapse - RHD LV hypertrophy, dilation, and eventually heart failure THEN pulmonary hypertension, right failure THEN this is usually well tolerated |
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Mitral Valve Prolapse Syndrome =
prevalent in - |
may result in regurgitation
tall thin ladies (get a chest xray and need a valvue replacement) |
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FYI BETA BLOCKERS =
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The antiarrhythmic effects of beta blockers arise from sympathetic nervous system blockade – resulting in depression of sinus node function and atrioventricular node conduction, and prolonged atrial refractory periods.
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FYI CALCIUM CHANNEL BLOCKERS =
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Most calcium channel blockers decrease the force of contraction of the myocardium (muscle of the heart). This is known as the negative inotropic effect of calcium channel blockers. It is because of the negative inotropic effects of most calcium channel blockers that they are avoided (or used with caution) in individuals with cardiomyopathy.
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rheumatic fever begins with
the mechanism - affecting.... |
strep throat from streococal infection.
delayed autoimmune response. its an inflammatory deisease and can affect many connective tissues. heart, joints, brain, skin |
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Rheumatic fever usually happens in what ages-
therapy- |
children 5-15 (white spots in throat)
this can last for LIFE antibiotics within 9 days can sometimes prevent fever but this does tend to run in families |
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10% of Rheumatic Fever restults in
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RHD
and now you are more likely to get more infections |
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Major manafestations of Rheumatic Heart Disease
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1. carditis
(friction rub and chest pain) 2. Polarthritis (migrates to major joints) 3. Chorea ( self limiting CNS disorder) 4. Erthema marginatum (trunkm but not hands or face) IN ORDER |
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Infective endocarditis is inflammation of endocardium,
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espeically valvues. results from a bunch of different conditions. maybe acute, sub acute or chronic
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Risk facotors for infective endocartidis
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- male
- IV drugs - recent heart surgery - mvp - turbulent blood flow |
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Signs and symptoms of infective endocarditis =
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fever
anorexia weight loss back pain night sweats abnormatiltes of urine |
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Valvue replacement Shnitix
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biological pig - but you'll have to be immuned for the rest of your life - problem with scar tissue
mechanical - Must be anticoagulated all the time so cant get hurt, but you dont have to immuno supressed. |
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the systolic phase of the pulmonary artery pressure reflects
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right ventricular contraction
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fyi
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heart failure is a garbage can term
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final common pathway for heart failure
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disease of the heart that interferes with the ability of the heart to pump
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weak vs stiff heart
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weak= systolic failure
stiff = diastolic failure |
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Heart failure is a syndrome in which
Old term for heart failure |
cardiac abnormatilies couse: exercise intolerance, SOB, fluid retention and ultimatly end organ dysfuction
Congestive heart failure |
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"Scope" of the problem of heart failure
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prevalance> 5mil
ini > 500 thou morta > 287 thou, 50% 5 year Cost > 23 bill most common DC diagnosis in patients > 65 years old. |
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68% of the causes for heart failure are -
32% are - |
CAD, Hx, MI
nonischemic reasons: - HTN - valve disease - toxins - myocarditis - other |
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Most common cause of left sided failure-
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ichemia/MI/CAD
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coarctation =
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narrowing of aorta
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Causes of right sided failure
(cor pulminal) |
- pulmonary stensois
- hypertension PE |
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Neurohormonal model of pathophysiology of heart failure-
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1. initial cardiac insult initiates (RAAS, SNS)
2., intiial compensation is appropriate but continued activiation promotes cardiac dysfunction and circultaor abnormailitues progression |
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2 ways to increase ejection fraction-
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inotrophy and EDV
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ventricular remodeling is a poathalogic process...
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- that results from myocardial injury alters size shap (elliptical and globular shape) and function o the ventricle.
- progress over time. occasionally reverses |
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Markers of ventricular remodeling-
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via- echocardiogram
- EDV - Ef normally 55% |
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Clinial characteristics of ventricular remodeling...
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chronic progressive condition with acute exacerbations
sodium and water retension leading to s/s of congestion so weigh yourself everydays to predict problem |
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fyi
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loss of cardiac reserve
-exercise intolerance - end organ underperfusion. |
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left sided heart symptoms-
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dyspnea
orthopnea cough PND exercise intolerNCE |
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Low cardiac output symptoms-
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fatigue
reduced alertness confusion |
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common right sided symptoms
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anorexia
cacexia right upper quadrant pain edema EPISTAXIS nocturia fatigue |
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EPISTAXIS =
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nose bleed
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ascites =
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fuild biuld up in the abds
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differences in right and left heart failure wil only bve apparent
treatment considerations are based on... |
in the beginning
- degree of left V function - Stage and symptoms - medical therapies - device therapies |
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low output failure vs high output failure =
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low cardiac output vs low systemic vascular resistance
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NYHA scale=
this is used to determine... depends on |
used to gage the progression of CHF in a particular patient
how much CHF limits their lifestyle and sodes noit apply to a particular decompensated episode. symptoms which way you move in the scale (takes prgressive nature of diesase into account) |
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NYHA class I =
Class IV = |
no symptoms
no functional limitations symptoms at rest |
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ACC/AHA scales arent as functional, their stage A =
stage D |
best
- at risk for disease - no known symptoms no hope, eligibale for clinical trials. |
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assessment of functional Capacity=
peak vo2 can be correlated with |
VO2 (oxygen consumption)
NYHA classes and with prognosis - used to determine need for transplant! |
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Mtabolic Syndrome =
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fasting hyperglycemia
HTN central obesity decreased HDL elevated uric acid levels |
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Stage B-
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left venbtricular dysfunction without sigfns or symptoms of HF (maybe add meds)
it sucks to be stage c becuase you get an inplantable defbribulatr and its painful and you become agoraphobic! |
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PRIL =
side effects- |
ace inhibitors
- hypotension - renal insuff - hyperkalemia - angioedema (airways) - cough |
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What kinda of inotrop is digitalis?
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positive
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Suboptimal rate control is associated with
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increased congestion
(so hesart rate may increase more then expected when exercising) - common weight change and get stressed |
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indications of biventricular pacing
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-symptomatic HF
- may result inreverse modeling - helps wiht exericse tolerance - improved srvivial - risky sugery |
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Pacemakers work 2 ways-
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1. chest impedence
2. motion sensitive (vibration and movement) |
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ICD prevents sudden death by...
how od you know if you should get it |
treats dangerous arryhtmias
less than 30% survival- - individual decisision - psychoevaulation |
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Indications for heart transplant-
limited due to remembre that even if you get a new heart... |
one year survivL LESS THAN 80-85%
(refractory disease) donors your still going to have tons of shit to deal with for the rest of your life. |
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LVAD=
improves life? lasts long risks |
left ventricular assistive device
doubles 1 and 2 year survivial rates good for 5 years until you need to replace it infection bleeding device failure |
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Palliative Care-
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continuous infusion positive inotropes via indwelling catherter to decrease symptoms of congestion
- deactive implanted defibs! - hospice |
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Acute Coronary Syndome
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includes ischemic heart disease, unstable angine and acute MI
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how many people in US had an MI, angina pectoris or both
more than ____ go to ER with chest pain |
over 12mil
over 5 mil |
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Smooth muscle function
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capable of susatined, tonic contractions to maintain organ dimensions against loads like blood pressure
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