question

HIPAA

answer

Health insurance portability and accountability act

question

SBAR

answer

Situation, background, assessment, recommendation

question

Heart rate 1. normal 2. low 3. high

answer

1. normal 60-100 bpm 2. bradycardia 100 bpm

question

Respiration 1. normal 2. low 3. high

answer

1. normal 12-20 breaths/min. 2. bradypnea 20 breaths/min.

question

blood pressure (systolic / diastolic) 1. normal 2. low 3. high

answer

1. normal < 120/80 mmHg 2. hypotension (< 90 mmHg) / ( 160) / (> 100)

question

Oxygen Saturation (02 sats) 1. normal 2. low medicare levels for home? collapsed alveoli / lung lobe is termed?

answer

1.normal SpO2 >95% in room air 2. hypoxia < 93% medicare levels for home < 88% atelectasis - collapsed alveoli / lung lobe

question

CBC (Stands for, includes (6))

answer

1. Complete Blood Cell Count 2. RBC's, WBC's, WBC differential, hemoglobin, hematocrit, and platelet count

question

Hematocrit/hemoglobin 1. normal values (male v. female) 2. patients with ahemoglobin value < (?) should not be treated (PT contraindication)

answer

1. Hematocrit - Male - 42-52% Female - 37-47% Hemoglobin - Male- 14-17 g/100mL Female - 12-16 g/100mL 2. 7 g/100mL

question

Platelets (normal value, low, contraindication for PT when...?)

answer

1. normal values : 150,000 - 450,000 2. thrombocytopenia less than 150,000. 3. platelets < 10000 = DO NOT TREAT! Spontaneous bleeding can occur if plt count < 20K

question

Exercise guidelines (Samuelson 2010) - Most current guidelines for thrombocytopenia

answer

- Platelets 100.5degrees • No therapeutic exercise/hold therapy - Platelets 10 - 20 K • Therapeutic exercise, bike without resistance - Platelets > 20K • Therapeutic exercises, bike with or without resistance

question

Bradycardia 1. signs/symptoms (4) 2. causes (3)

answer

1. lethargy, fatigue, Dyspnea (shortness of breath), and syncope (passing out). 2. beta blockers, being a well trained athlete, or heart conduction pathology

question

Tachycardia 1. signs/symptoms(6) 2. causes (7)

answer

1. dyspnea (shortness of breath), dizziness, diaphoresis (sweating), syncope, chest pain, palpitations. 2. anxiety, caffeine, fever, anemia, arrhythmias, breathing treatments, respiratory distress

question

Bradypnea 1. causes (5)

answer

sedatives, narcotics, alcohol, and neurologic and metabolic disorders.

question

Tachypnea 1. causes (5)

answer

1. acute respiratory distress, fever, pain, emotions, and anemia.

question

Orthopnea

answer

often refers to number of pillows needed below a patient because if this patient lays down flat they will have shortness of breath (dyspnea)

question

Signs of HTN (4)

answer

difficult to detect, referred to as "silent killer" headache, blurred vision, numbness, and ringing in the ears.

question

Hypotension symtoms (3)

answer

lightheadedness, syncope, fatigue

question

signs of hypoxia (4)

answer

tachypnea, tachycardia, restlessness, altered mental status.

question

Anemia 1. defined 2. causes (6), symptoms (9)

answer

1.Decrease in quantity or quality or red blood cells. (hemoglobin < 14 Men less than 12 women) 2. caused by B12/iron deficiency, RA, blood loss, lupus, AIDS, sickle cell. 3. Mild fatigue until hemoglobin falls to less than half of normal. Weakness, dyspnea; pallor of fingernails, mucosa, conjunctiva, tachycardia, angina in patients with CHD, palpitations. Lupus = a chronic, autoimmune disease that can damage any part of the body ( skin, joints, and/or organs inside the body). pallor = an unhealthy pale appearance. Angina = chest discomfort due to poor blood flow through the blood vessels in the heart

question

WBC count 1. Normal values

answer

Normal values - 4500-11000

question

Neutropenia 1. definition 2. cause

answer

1. Decrease in neutrophils less than 2000/ml. 2. Caused by bone marrow suppression (chemo/radiation), aplastic anemia, prolonged infections. Aplastic anemia = a condition in which the bone marrow does not make enough new blood cells. Bone marrow is the soft, fatty tissue in the center of bones.

question

Neutropenic precautions

answer

-Generally if WBC < 1000/mm3 or neutrophil < 500 mm3 -Markedly immune-compromised. Do not treat if you are sick -Therapists will wear mask in room vs. patient wears mask in hallway -Strict hand washing. Clean equipment before entering room -Do not bring flowers or fruit into room (parasites, fungus, etc)

question

INR 1. purpose 2. normal 3. Reasons for elevated values 4. contraindications

answer

1. Assesses adequacy of Warfarin/Coumadin therapy. (takes tissue factor issue out of the equation) 2. Healthy person has an INR 0.9 - 1.3 if not on anti-coagulants 3. pt. on anti-coagulation medicine, if vitamin K deficiency, or liver disease 4. INR > 4 = increased risk of bleeding, >5 do defer PT, >6 bed rest / chance of spontaneous bleeding

question

BMP 1. What it stands for 2. What lab values are included (do not have to memorize values).

answer

1. BMP: Basic Metabolic Panel. 2. Glucose, Potassium, Sodium, bun, creatinine, calcium, carbon dioxide/bicarbonate, and chloride. BUN = blood urea nitrogen; used, along with the creatinine test, to evaluate kidney function

question

Glucose: normal values, pre-diabetic, DM

answer

1. Normal 126 mg/dl fasting on two separate days.

question

Hemoglobin A1C (HgA1C) 1. use 2. normal val. 3. diabetic goals 4. 1% drop of HgA1C = (?%) decrease in diabetic complications

answer

1. 4.0 - 6.4 % 2. Reflects average glucose levels for the last 120 days. 3. Diabetic goals (ADA) is a HgA1C of < 7.0% 4. 25 % decrease in diabetic complications for every 1.0% drop in HgA1C

question

Hypoglycemia signs

answer

Symptoms include tachycardia, HTN, hunger, tremor, irritability, sweating, headache, mental status changes, paresthesias, seizures, visual changes, dizziness, LOC (loss of consciousness). Coordinate insulin, meals, exercise to reduce risk of hypoglycemia. < 100 mg/dl limit exercise. paresthesia = a sensation of tingling, tickling, prickling, pricking, or burning of a person's skin with no apparent long-term physical effect

question

hyperglycemia

answer

hyperuria, polydypsia (thirst) weight loss, blurred vision, effects on wound healing. (> 250 mg/dl limit exercise.)

question

Diabetic foot care

answer

avoid bare feet, wear proper shoes and socks, check feet daily, don't soak feet, keep feet dry, tell physician if blisters/ cuts/ wounds, keep toe nails trimmed correctly

question

Potassium: normal value physical therapy precautionary values

answer

3.5-5 mEq/L use caution, get medical clearance generally if 6.0mEq/liter, especially if history arrhythmias/CHD

question

Hypokalemia causes clinical signs

answer

Hypokalemia < 3.5 mEq/liter. o Causes- vomiting, renal disease, gastric suctioning, polyuria (excessive urination), diuretics o Clinical signs - Fatigue, muscle weakness, slow/weak pulse, v-fib, paresthesias, leg cramps, hypotension, EKG changes

question

hyperkalemia causes clinical signs

answer

Hyperkalemia > 5.0 mEq/liter. o Causes - Renal failure, burns, Addison's disease, chronic heparin use o Clinical signs - Muscle weakness, nausea, tachycardia followed by bradycardia, dysrhythmia, flaccid paralysis, irritability, anxiety, EKG changes Addison's disease: A rare, chronic endocrine system disorder in which the adrenal glands do not produce sufficient steroid hormones. This includes aldosterone, which regulates potassium secretion among other things. Burns: Potassium is prevalent within cells, when cells are damaged, this increases extracellular potassium levels, thus hyperkalemia heparin blocks an enzymatic step in the synthesis of aldosterone, and reduced aldosterone levels may be evident as early as four days after initiation of therapy. Although all patients who receive heparin may have reduced aldosterone levels, most are able to compensate through increased renin production and therefore remain asymptomatic. However, patients on prolonged heparin therapy or those unable to adequately increase renin production (e.g., patients with diabetes or renal insufficiency) may exhibit signs of hypoaldosteronism, such as hyperkalemia.

question

Sodium: normal values Hyponatremia Hypernatremia

answer

• Normal ranges 135 - 145 mEq/liter • Hyponatremia 145 mEq/liter

question

Order of increased O2 support

answer

1. Nasal Cannula: Most common method of delivering supplemental 02 2. Open face mask / face shield: Used if nasal cavity is obstructed (i.e. mouth breathers) 3. Closed Face Mask: Closed mask provides 02 to both mouth and nose 4. Partial Non-Rebreather: Closed face mask with reservoir bag, allows some rebreathing of air 5. Non-Rebreather Face Mask: Provides highest concentration of supplemental 02 via a face mask (one way valve) 6. BiPAP (Bi-level positive airway pressure: Provides positive pressure to keep airway open. Provides varying inspiration/expiration support (can be programmed). Can be the step before intubation. Can be loud, claustrophobic. Need to remove to eat. 7. CPAP (Continuous Positive Airway Pressure ): Used to treat sleep apnea. Push air through trachea at pressure high enough to prevent sleep apnea. 8. ETT = endotracheal tube: When patient has ETT inserted, it is referred to as intubation (aka as oral intubation & tracheal intubation). When patient has ETT removed, it is referred to as extubation. 9. Tracheostomy: Surgical incision in trachea below vocal cords. Allows weaning to RA by decreasing the size of the trach (Decannulation = trach completely removed). Also used with Head/neck surgery due to swelling and potential for airway impairment

question

Reasons for intubation

answer

1. patients 02 sats are not maintained by other means (ie nasal cannula, face shield, bi-pap) 2. pt's work of breathing is excessively high, and pt's respiratory muscles will fatigue (respiratory distress) 3. pt's respiratory drive is too low (apneic) or respiratory muscles are too weak (Guillain Barre) 4. Can be used when patient is combative and needs to be sedated (level of sedation suppresses respiratory drive) 5. If pt's mental status is impaired (i.e, pt cannot cough, clear secretions - "protect their airway") 6. Used if pt needs to be sedated after brain injury or surgery in order to recover, and level of sedation will suppress respiratory drive 7. Intubation allows suctioning of secretions to clear airways 8. Used during surgery to allow paralytics/sedatives , which would then stop respiration 9. Upper airway obstructions (including burns), tracheal injuries, which can prevent appropriate respirations

question

What does ETT/mechanical respiration control?

answer

1. Respiration rate, depth, and pressure (to inflate lungs) 2. O2 and CO2 levels 3. pH

question

Passy Muir Valve

answer

A valve that allows patients to speak with a tracheostomy. Stays closed until patient exhales, then opens. Lets air reach vocal chords for speech. Make sure balloon is deflated on trach or patient will not be able to breath.

question

Pt's sometimes "self extubate", pull their ETT out. What are the implications of this?

answer

If ok, will simply leave extubated.

question

PCA vs. Nerve Blocks vs. Epidural

answer

1. Patient controlled anesthesia: Pt must press button to deliver dose of meds (has hourly limit). Pt must press button themselves. We cannot press button for pt. Has immediate effect, but effects are relatively short lived. 2. Nerve Blocks: Used postoperatively to locally control pain. In the OR a surgically inserted catheter administers an anesthetic that bathes specific nerves. Used for 1-2 days after surgery. 3. Epidural: Catheter placed in epidural space in spine Opioid/anesthetic mix infused into epidural space Motor and sensory deficits are side effects. Foley catheter kept in place for duration of epidural to avoid urinary retention.

question

Oral vs. IV pain meds

answer

IV pain meds works in 0-20 minutes; fast acting, but shorter duration (1-2 hrs). Takes 20-40 min (max 45 - 60 min) to work, however lasts longer (4-6 hrs). Pt.'s are discharged with oral meds, but not always with IV meds. Example: Should not be receiving IV morphine on day of discharge, as patient will not have access to IV morphine at home

question

Pain control ladder

answer

1. Level One NSAIDS (non steroidal anti inflammatory drugs), acetaminophen, dexamethasone 2. Level Two Mild opioids - codeine, hydrocodone, propoxyphene 3. Level Three Stronger opioids - morphine, oxycodone, hydromorphone, fentanyl, methadone, demerol

question

What are the signs of narcotics overdose, and what drug is used to counteract said overdose?

answer

Signs include decreased mental status/sedation decreased 02 sats decreased respiratory rate pupillary constriction (pinpoint pupils) Narcan

question

Heparin v. coumadin/warfarin v. Lovenox

answer

1. Heparin - Intravenous. Fast acting, with immediate onset. Short lived effects measured w/ PTT. Used for DVT, MI, pulmonary embolism. 2. Coumadin (warfarin)- Given orally, with therapeutic onset 12 hrs - 3 days. Heparin is given initially in combination with coumadin until PT/INR is in therapeutic range for the INR, at which time heparin is discontinued. Used for PE, DVT, MI, rheumatic heart disease with valvular damage, prosthetic heart valves, chronic A-fib. • Can be neutralized by vitamin K infusion • Frequent checks of INR/PT needed, even as outpatient. • Patients are told not to change diet to include foods high in vitamin K. 3. Lovenox - Derivative of heparin, given subcutaneously, used to prevent /treat pulmonary embolism and DVT. Can combined with coumadin.

question

Function of anticoagulants

answer

Drug that helps prevent blood clotting. Tend to prevent new clot from forming or existing clot from enlarging. Does not dissolve blood clots that already exist.

question

NPO

answer

(Latin, nothing by mouth): Used if patient is scheduled for surgery (can also see "NPO after midnight if patient is scheduled for procedure/surgery next day) Also used after GI surgery, or if patient has Ileus (paralysis of intestinal tract)

question

Venous dopplers

answer

Ultrasound test to assess presence of DVT's. Do not treat patient until results are documented.

question

Transfer PRBC

answer

In transfusion medicine, packed red blood cells are red blood cells (RBC, also called erythrocytes) that have been collected, processed, and stored in bags as blood product units available for blood transfusion purposes. An order for a blood transfusion that is given for low hgb values. Need to check hgb before starting PT hgb <7 do not perform PT

question

Cardiac enzymes

answer

After/during an MI, myocardial cell death causes the release of specific enzymes into the blood. These enzymes can be used to determine the level of myocardial death, and are used in the clinical diagnosis of an MI, especially if EKG changes are not clear. If MD is concerned enough to order cardiac enzymes, do not perform physical therapy until first TWO sets are negative. examples: Troponin I (cTnI) and Creatine Kinase /Creatine Phosphokinase (CK or CPK)

question

CT scans

answer

(for abdominal abscesses, head bleeds)-> used to assess strokes, brain hemorrhage, tumors, or brain injuries, abdominal/lung tumors, bone fx in detail

question

The role of neurontin/lyrica for neuropathic pain, valium /flexeril for muscle spasms

answer

...

question

AV fistula precautions

answer

Do not take BP (blood pressure) on arm with AV fistula With an arteriovenous fistula, blood flows directly from an artery into a vein, bypassing some capillaries. When this happens, tissues below the bypassed capillaries receive less blood supply. Arteriovenous fistulas usually occur in the legs, but can develop anywhere in the body. Arteriovenous fistulas are often surgically created for use in dialysis in people with severe kidney disease.

question

Sternotomy precautions

answer

• Avoid repetitive overhead motions. • Avoid lifting/pushing/pulling anything > 10 lbs. • Non weight bearing (B) UE • No driving until sternum heals • Use heart pillow to chest during coughing and sneezing.

question

Hip dislocation precautions (posterior)

answer

No hip flexion past 90 degrees No hip adduction No hip internal rotation

question

paralysis of intestinal tract

answer

Ileus

question

Lumbar Punctures

answer

Used to obtain cerebral spinal fluid (CSF) samples. Check with nurse to see if patient needs to remain supine after procedure. Normally on bedrest after (from one to six hours). Be aware of headaches 24 - 36 hours after test (spinal headaches - severe headache upon sitting that resolves with return to supine).

question

Angiogram

answer

An angiogram is an X-ray test that uses a special dye and camera (fluoroscopy) to take pictures of the blood flow in an artery (such as the aorta) or a vein (such as the vena cava). An angiogram can be used to look at the arteries or veins in the head, arms, legs, chest, back, or belly. • Bed rest for up to 8 hours after procedure. • Know your facility guidelines. Also contact MD regarding results - is patient safe for PT based on test results, or should PT be deferred until intervention (ie angioplasty or CABG) performed?

question

Weight bearing statuses

answer

WBAT or FWB PWB TDWB NWB

question

Non-Weight bearing x 2 (UE)

answer

Non-Weight bearing x 2 (UE) Can only ambulate with CGA

question

can NWB 1 LE use cane

answer

nope

question

Knee scooter-

answer

If distal tibial or foot injury, with MD permission

question

w/ TDWB/TTWB, how much force can you apply through affected extremity? Where should you apply weight

answer

the pressure that wouldn't break an egg." Mid-foot TDWB places less stress on hips.

question

TDWB/TTWB difference from NWB

answer

Really doesn't change functional status from NWB

question

If (B) PWB, can you do gait training

answer

no, you need 1 LE WBAT for gait training

question

Non -weight bearing x 1 UE, LE Can only do what transfers...?

answer

bed to wc (wheelchair) or bsc (bedside commode) transfers (Use a stand pivot or squat pivot transfer using uninjured limbs)

question

w/ PWB make sure to

answer

requires additional documentation of % or # to clarify. Don't assume certain amt.

question

PFWB (platform weight bearing) - associated w/

answer

Distal radius fractures, NOT for scapula or clavicle fractures Can attach platform to walker or crutches

question

Levels of Assist

answer

Independent (I) - Perform correctly w/o supervision Supervision (S) - Performed w/o verbal cues Stand by assist (SBA) - Performing task without holding onto pt. Contact guard assist (CGA) - Performing task with light touch on pt Hand hold assist (HHA) - Performing task while holding pt's hand Min Assist (min) - Requires up to 25 % assist to perform task Moderate Assist (mod)-Requires up to 50 % assist to perform task Max Assist (max) - Requires up to 75 % assist to perform task Dependent (D) - Requires > 75 % assist needed to perform task Can indicate, "mod A for (L) LE only"

question

most equipped position to suggest DME for discharge?

answer

PT's are in the best position to suggest DME for discharge

question

Patients are admitted to an acute care hospital for the following reasons

answer

1. Surgery (elective or emergent) 2. Need for admission to find a diagnosis for an illness (can't be handled on an outpatient basis) 3. Treatment of an acute illness (pt is medically unstable and requires 24 hr medical treatment) 4. Injuries that require in patient admission to treat

question

A patient is ready for discharge from the hospital from a medical standpoint when the patient...

answer

1. Is medically stable 2. Blood work is acceptable, vital signs appropriate 3. Patient is eating, urinating and having bowel movements 4. Symptoms are managed 5. The diagnosis has been made and treatment begun 6. Treatment of illness completed 7. Injuries are surgically repaired or medically treated 8. Patient no longer requires physician supervision

question

_____?_____ is considered household ambulation for discharge purposes **

answer

150'

question

3 hr rule

answer

3 hours skilled therapy day Needs > 3 hrs day, at least two therapies Can tolerate 3 hrs day, medically stable, ok if medically complex Willing to participate (cannot refuse PT in acute care)

question

ABI unit

answer

Some in patient rehab facilities have dedicated "ABI Rehab" units, for patients with acquired brain injuries. The ABI units provide a low stimulus environment that is beneficial to ABI patients Unit has posey beds (see picture), which allows a patient to remain safely in bed without the danger of falling out of bed or inappropriately trying to walk in the room not all strokes need ABI

question

coma stim

answer

Some rehab units contain "coma stim" programs, for pts who are too low functioning to be approved for in pt rehab programs. The programs work on targeted stimulation to increase alertness and ability to follow commands. If patients improve, can enter ABI programs.

question

Can get new wc every __?____ years per medicare

answer

5

question

____?____ is the standard adult size

answer

18"

question

Usually ____?_____ weight limit for 18" wc

answer

Usually 250#

question

WC > ___?___ may be difficult for doors

answer

20"

question

renting a wheelchair in the hospital is common, but beyond a certain point

answer

you own it

question

Insurance will pay for a bedside commode every ___?___ years

answer

5

question

bedside commode can be used what 3 places

answer

3 in 1 can be used next to bed, over toilet, shower chair

question

bedside commode Almost mandatory if

answer

THR (unless very short or has raised/handicapped toilet seat)

question

sliding board appropriate pt.'s

answer

For NWB (B) LE Spinal Cord Injuries (SCI) Difficulty weight bearing For safety

question

things medicare doesn't cover

answer

tub transfer bench and shower chair

question

can get a walker every _____?____ yrs

answer

5

question

crutch weight bearing Wooden Metal Bariatric up to

answer

Wooden 350# Metal 250 # Bariatric up to 650 #

question

Know weight limits of your equipment Crutches metal (?), wooden (?) WC 18" (?) # Walkers (?) # Hospital wall mounted commodes (?) #

answer

Know weight limits of your equipment Crutches metal 250 #, wooden 350# WC 18" 250 - 300 # Walkers 300# Hospital wall mounted commodes 250-300# Can add support under commode

question

HHPT v. outpatient

answer

HHPT: 30 to 60 minutes each tx outpatient: 2-3 x week, 45 - 60 minutes each tx May start with HHPT first then progress to outpatient therapy outpatient clinic will have more tools/modalities/options for treatment

question

SNF pt.'s put in how much work?

answer

1 - 2 hours therapy per day (PT/OT/ST combined) five to six days/wk Generally longer stay (3-4 weeks, or longer)

question

Typical rehab facilities only accept patients ____?___ yrs old or greater.

answer

Typical rehab facilities only accept patients 13 yrs old or greater. In NC only Charlotte and Greensville accept children < 13 years old

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