Foundations-Exam #2 #2

Front 1

Examination is complete

Assessment

Plan

Back 1

Examination is complete
Subjective – history & interview
Objective – systems review & tests / measures
Assessment
Evaluation / diagnosis / prognosis
Goals
Plan
Plan of care
(Goals / prognosis)

Front 2

Plan of Care

Back 2

Within 30-days of SOC
Recertification every 30-days
Includes all of the following
Diagnosis
Relevant PMH
MD orders if applicable
PT goals & prognosis
Contraindications / precautions
Patient’s awareness and understanding of diagnoses, prognosis and goals
Summary of treatment & achievements thus far if applicable

Front 3

ICD-9 codes

Back 3

International Classification of Disease

Front 4

CPT codes

Back 4

Current Procedural Terminology
Time codes vs. untimed codes

Front 5

Documenting Interventions

Back 5

Matches CPT code
Reproducible based on documentation
Shows progress

Front 6

Visit / encounter

Back 6

Changes in status
Patient report / update
Response to last Rx
Symptoms
Follow through with HEP / recommendations
Brief / limited re-examination*
Interventions provided
Specific; frequency, duration, intensity, etc.
Communications
Response to treatment session*
Progress toward goals
Plan for next visit

Front 7

Re-Examination

Back 7

Frequency depends on setting
Should include:
Update on Subjective Status
Diagnoses
Focus of interventions
Re-examine tests & measures and outcome measures relevant to goals
Progress or lack of progress toward goals
Barriers to progress
Changes / update goals
Changes / update plan

Front 8

Discontinuation / Discharge / Summary of Care

Back 8

Discharge summary from SOC to discharge
Conveys medical necessity for episode of care
Should include
Diagnosis
Reason for discharge
Length of care episode and number of visits
Current status compared to initial status
Extent to which goals achieved
Any complications or barriers to care
Discharge plan & recommendations
Summary of interventions and summary of instructions including HEP, recommendations, equipment, etc.

Front 9

Reasons for Denials of Services

Back 9

1.Poor legibility
2. Incomplete documentation
3. No documentation for date of service
4. Cannot understand abbreviations
5. Documentation does not support billing

6. Does not demonstrate skilled care
7. Does not support medical necessity
8. Does not demonstrate progress
9. Repetitious daily notes showing not change in patient status
10. Interventions with no clarification of time, frequency, duration

Front 10

Utilization Review (UR)

Back 10

UR is a system for reviewing the medical necessity ,appropriateness, and reasonableness of services proposed or provided to a patient or group of patients
Conducted on a prospective, concurrent or retrospective basis to reduce the incidence of unnecessary or inappropriate provision of services
UR is a process that has 2 primary purposes
Improve quality of service & patient outcomes
Ensure the efficient expenditure of money

Front 11

Posture and Body Control…Why?

Back 11

Chronic overuse and misuse injuries
Certain cervical & lumbar complaints may have epidemiological factors that stem from faulty posture.
Postural assessment is in our systems review (all clients)
If impaired, intervene especially if managing an individual with cervical &/or lumbar complaints
Ergonomics is the science of fitting workplace conditions and job demands to the capabilities of the working population (OSHA.org

Front 12

COG- Center of Gravity

Back 12

The point at which the mass of a body or object is centered.
Located at approximately the level of the second sacral segment (in standing)

Front 13

BOS- Base of Support

Back 13

The area on which an object rests and that provides support for the object

Front 14

VGL- Vertical Gravity Line

Back 14

An imaginary vertical line that passes through the COG of an object

Front 15

Stability-

Back 15

The stability of an object is indirectly proportional to the height of its center of mass above its base.
Lower the COG and greater BOS, the greater the stability

Front 16

“Ideal” posture during a postural examination with a plumb line:

Back 16

Plumb slightly anterior to lat. malleolus
Slight ant. through knee
Through greater trochanter
Through shoulder
Through ear

Front 17

What are body mechanics?

Back 17

The use of one’s body to produce motion that is safe, energy conserving, anatomically, and physiologically efficient and maintains body balance and control.”

Front 18

Postural muscles are used to

Back 18

Postural muscles are used to stabilize the joints and are more resistant to fatigue

Front 19

Appenditure muscles

Back 19

Appenditure muscles are made to move the limbs and are stronger

Front 20

Forces:

Back 20

Forces: Gravity & friction act on all objects with/without movement.

Front 21

Lifting an object shifts the COG________

Back 21

Lifting an object shifts the COG towards the object

Front 22

Proper body mechanics reduce

Back 22

Proper body mechanics reduce stress/strain

Front 23

Principles of Proper Body Mechanics

Back 23

Get closer to the object/patient
Get the object/patient closer to you
Your COG & the object/patient COG as close as possible
Use larger muscles
Don’t twist
Avoid prolonged forward bending
Alternate sides/ weight shift
Prevention programs are ideal (Back schools, ACL prevention, Ergonomic assessments)

Front 24

Lifting Principles and Techniques

Back 24

Engagement of the transverse abdominis has been demonstrated to increase intra-abdominal pressure.
This may help support the spinal structures during a lift.

Front 25

lever arm when lifting

Back 25

COG moves forward with lifting increasing stress
Decreasing the lever arm will decrease the resultant torque experienced in your body.

Front 26

The rationale for positioning is:

Back 26

Patient comfort
Therapist ergonomics
Prevent potential injury (patient and therapist)
Support to patient’s body
Improve access for interventions
Prevent the risk of development or progression of a contracture
Relieves pressure to tissue
Can aide in optimal system function
Can assist in eating/swallowing
Educating the patient/caregiver/staff

Front 27

Integumentary (skin) examination should be performed pre AND post positioning to evaluate any possible beneficial or deleterious effects including but not limited to:

Back 27

Non-blanchable erythema: http://www.puclas.ugent.be/puclas/e/page3575.html
Ischemia- a restriction in blood supply to tissues causing a shortage of oxygen and glucose needed for cellular metabolism
Edema: excess accumulation of serous fluid in connective tissue
Effusion: fluid in a joint
Ecchymosis: escape of blood into tissue

Front 28

Ischemia

Back 28

Ischemia- a restriction in blood supply to tissues causing a shortage of oxygen and glucose needed for cellular metabolism

Front 29

Edema:

Back 29

Edema: excess accumulation of serous fluid in connective tissue

Front 30

Effusion:

Back 30

Effusion: fluid in a joint

Front 31

Ecchymosis:

Back 31

Ecchymosis: escape of blood into tissue

Front 32

Positioning: Restraint Rules

organizations who facilitate rules

Back 32

Dept of Public Health (DPH)
Centers for Medicare and Medicaid Services (CMS)
Joint Commission
American Osteopathic Association

Front 33

Positioning: Restraint Rules

Back 33

guidelines from federal, state agencies instruct and oversee the appropriate use of these interventions


All restraints must be ordered by a physician every 24 hours of use and recommended for short term use only


Orders vary for time by patient age (ie. 4 hrs for adults, 1 hr for children <9yrs)

Orders are communicated to the family along with rationale.


Rules vary by state.

Front 34

Contracture Sites

Back 34

Common soft-tissue contracture sites correlated with prolonged position.

Front 35

Positioning: Guidelines

Back 35

Repositioning needed every 30 minutes to 120 minutes, ultimately per patient/client needs.
Dependent patient: at least every 2 hrs
Precautions:
Dependent pts
Decreased sensation
Minimal soft-tissue protection
Unable to communicate
Avoid folds of clothing/linens under body
Safety
E.g. Side rail, pillows
Assure that you use safe mechanics

Front 36

Trans-femoral Amputation
avoid

Back 36

Avoid:
Prolonged hip flex
Prolonged elevation of residual limb
Prolonged hip ABD of residual limb
Sitting for > 40 minutes

Front 37

Trans-tibial Amputation
avoid

Back 37

Avoid:
Prolonged hip and knee flexion
Elevation of residual limb on pillow
Knee flexion if limb elevated

Front 38

Hemiplegia

Back 38

Frequent changes in position of affected extremity are important to avoid contractures and/or swelling.
Prolonged use of slings for UE should also be avoided secondary to potential contractures.
Consider resting splints
Affected limb should be exercised/moved multiples times daily.

Front 39

Rheumatoid Arthritis (RA)

Back 39

Prolonged immobilization should be avoided unless in an acute inflammatory state.
Regular, careful exercise/mobility may be helpful
Goal is often to minimize deformity in RA

Front 40

Split-Thickness Burns and Grafted Burn Areas

Back 40

Burns typically develop scar tissue, so regular movement and prescribed exercise may help to reduce contractures.
Prolonged positions of comfort should be AVOIDED.
DO NOT place stress on regenerating tissue.

Front 41

Ortho Surgical Conditions

Back 41

TKA uses continuous passive motion (CPM) which needs proper positioning
Roll towel under ankle position promotes terminal extension
THA (posterior approaches) have total hip precautions which require proper positioning (abduction pillows)

Front 42

Splinting
caution with application of new brace/splint

Back 42

Caution with application of new brace/splint
Pressure points
Straps too tight
Patient/caregiver education is key
Mole skin, heat gun for modifications when able (orthotist)

Front 43

Why is draping important?

Back 43

Maintains privacy/modesty at all times
Will likely differ significantly across cultures. Additional communication may be needed during these instances.
Informs patient/client of your actions and attention to their privacy/modesty
Allows access to body part for procedural intervention/management.
Protects patient’s garments
If consent is given, remove garments to prevent soiling with body fluids and/or lotions/gels.
Protect patient/client skin from body fluid or drainage.
Maintain comfortable environment (temperature)
Blankets/ blank warmers

Front 44

For successful draping:

Back 44

Assistance from additional health care providers of similar gender to patient/client may be helpful
Always explain what you are doing and why
Use clean linen/garments
Give an extra gown to be worn as a robe (watch for an “open backside”)

Use universal precautions
If possible, access private/semiprivate Rx area.
Tell them specifically what you want them to remove
Announce entrance/exit from treatment area
Knock first and ask… “All set?”
“Need any help?”

Front 45

systolic and diastolic

Back 45

systolic (pressure of left ventricular contraction) and diastolic (continual pressure in the arteries/resting heart pressure) BP = systolic/diastolic

Front 46

normal adult under what for bp

Back 46

120/80

Front 47

Pre-Hypertension

Back 47

120-139 mmHg systolic
80-89 mmHg diastolic

Front 48

Hypertension
Stage 1:
and stage 2

Back 48

Hypertension
Stage 1:
140-159 mmHg systolic
90-99 mmHg diastolic
Stage 2:
≥160 mmHg systolic
≥ 100 mmHg diastolic

Front 49

Hypotension

Back 49

If you have a consistent reading of <100 systolic, you are considered hypotensive
Symptomatic

Front 50

normal HR

Back 50

Adults: 60-100 beats per minute

Newborns: 100-130 beats per minute

Children Ages (1-7): 80-120 beats per minute

Front 51

Bradycardia

Back 51

Less than 60 beats per minute

Sinoatrial (SA) node fires too slowly or not at all

Could be due to a damaged SA node, heart disease, aging, medications, and/or inherited or congenital defects

Front 52

Tachycardia

Back 52

Abnormally fast heart rate: greater than 100 beats per minute

They are classified by their location:
Supraventricular tachycardia

Ventricular tachycardia

Sinus Tachycardia

Front 53

Irregular Rhythm and/or Abnormal Quality (Patency)

Back 53

Change in the normal sequence of electrical impulses

Atrial Fibrillation:
Upper chambers of the heart beat irregularly (quiver)

Ventricular Fibrillation
Ventricles flutter rather than beat

Front 54

Resp RAte. normal

Back 54

Normal Respiratory Rate (Eupnea)

Normal range:
12-18 breaths/min for adults
2 breathing patterns:
Upper chest (thoracic) breathing
Abdominal breathing
With labored breathing, both breathing patterns may be present
With normal respiration, no sounds should be heard

Front 55

AROM<PROM

Back 55

AROM<PROM indicates strength impairments

Front 56

AROM = PROM

Back 56

AROM = PROM for Normal for joints

Front 57

PRoM > AROM

Back 57

passive stretching to end range may be greater than AROM ...

Front 58

Results of Resisted isometric testing

Strong and painless

Back 58

Strong and painless
No lesion or neurological deficit involving the tested muscle and tendon

Front 59

Results of Resisted isometric testing

Strong and painful

Back 59

Strong and painful
Minor lesion of the tested muscle or tendon

Front 60

Results of Resisted isometric testing


Weak and painless

Back 60

Weak and painless
There is a disorder of the nervous system, neuromuscular junction, complete rupture of the tested muscle or tendon, disuse or atrophy.

Front 61

Results of Resisted isometric testing


Weak and painful

Back 61

Weak and painful
There is a serious, painful pathology such as a fracture or neoplasm. Other possibilities:
Acute inflammation that may inhibit muscle contraction, or a partial rupture of muscle or tendon.

Front 62

Coordination:

Back 62

Coordination: related to a muscle contraction, joint movement, and sensory perception, allows the human body to move in the environment, safely and efficiently

Front 63

balance

Back 63

Balance assessment is used to evaluate the patients ability to maintain appropriate posture during functional activities.

Front 64

Kinetic

Back 64

Used to determine the forces involved in gait

Front 65

Kinematic

Back 65

Describes movement patterns without regard to forces involved in producing those movements
Description of the body as a whole or body segments in relation to each other during gait
Can be qualitative or quantitative