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Clin Skills Final

Wichita Sate PT dougs Final

QuestionAnswer
How often must you change a catheter at least once a month
what are drain lines used for reomove excess fluid from surgery/wound site (compressed to create (-) pressure)/ w/ eception of some subdural drain w/ neurosurgery
with drain how often can blood volue be returned through IV only once
when to use rectal drain pt with chronic diarrhea that are at risk for skin brakdown
how are rectal drain held in place inflattable cuff is filled with saline
what could cause dry mucous membranes and skin irritation O2 lines
uses small perforations in pad combined with air pressure to raise pt off surface, much like air hockey table Bariatric transfer pads
what is key when tx bariatric pt early mobilization
how much strength can you lose in the 1 st wk of being bed bound 25%
when bariatric pts are moving they use _______ to move thier body momentum
with obese pt we must always check skin integrity including under folds
protects the confidentiality of pt medical records as they are conveyed between health care providers and/or insurance providers Helath insurance portability and Acccountability Act (HIPPA)
when are facilities required to provide this information to the pt about HIPPA upon admission
Examination consist of chart review interview test and measures eval diagnosis prognosis POC documentation
iwhen should chart review occur prior to interviewing the pt
what falls under chart review demographics current condition PMH general health status social and family hx social health habits prior and present fxn status midication if pt is minor parental consent required
what falls under interview pt safe and comfortablemaintain professional eye contact and body language address pt by formal name (HIPPA requires names & DOB) open/closed ended questions summarize what the pt is telling you to clarify Always conclude by is there anything else
Test & measures ROM MMT sensation fxn mobility (bed mobility, gait, transfers, balance) safety cognition
evaluation analysis of everything observed or heard
diagnosis fxn diagnosis(gait abnormalities gait dysfxn LE weakness impaired ROM, jt contracture, jt effusion or swellin)
Prognosis what fxn or specific progess we expect to make based on the above info
Plan of care include: frequency (#of visits) duration(length of time you seept) goal setting (always involve pt) interventions planned (exercise, ROM, jt mobs, modalities, gait, transfer training, pt family staff education)
Documentation SOAP noted forms computerized only state facts, DO NOt include personal judgement keppt notes concise use only approved abbreviations
vital signs used to monitor pt before, during and after tx
changes in vital signs indicate physiolocal reponse to tx
vital signs consist of HR BP respiration and temp
pulse measure BPM
normal range for heart rate adult 60-100 if in shape can be 40-60 moderate sedentary 60-85
a resting heart rate over 85 bpm is an indication of deconditioning or medical condition although infants and young children have a faster heart rate 80-100
Bradycardia resting heart rate less than 60
tachycardia resting heart rate greater than 100
max heart rate highest one should achieve during exercise upon max exertion with respect to age and medical condition subtract one age from 220
target heart rate heart rate one should achieve during exercise for cardio conditioning with respect to age and medical condtion contraindication it should fall between 60 and 80 percent of max heart rate
basal heart rate resting heart indicator of cardiovascular fxn in the abscence of physical activity
heart rate measured during activity indication of cardovascular system capacity to provide blood flow during physiological or physical stress
heart rate measure after activity indication of the CV system ability to recover
what can be used to determine patency heart rate
patency openness of the peripheral portion of the CV bydeterming the presence or absensce of a pulse at a chosen site
absense of a pulse without underlying diagnosis this is a red flag: report no tx should be given till looked at evaluated adn cleared
trophic changes physiologic sequealae to decreased circulation such as loss of hair dry skin or muscle atrophy
makes assessing patency difficult edema
loss of skin color resulting from decreased circulation blanching
the worse the circulation the more pronunce and rapid blanching becomes
to reproduce blanching raise the extremity above the level of the heart or apply pressure to the skin occlude circulaiton in that area
regularity refers to the eveness of the heart rate
0 absent
1+ thready weak
2= normal
3= strong
4= full bounding
methods of measuring heart rate auscultation doppler pulse oximeter manual palpaation
doppler measure frequency changes during blood flow to examine patency (check for DVT
ausculation stethoscope
pulse oximeter does pulse and o2 and is digital
manual pads of fingers
most common site to palpate pule radial a carotid artery
common site to palpate patency brachial a femoral a popliteal a pos tib a dorsal pedis a
measure of cascular resistance to blood flow and the effectiveness of cardiac mm in pumping blood to overcome reistance blood pressure
measures pressure exerted when heart is contracting systolic pressure
measures pressure exerted when heart is relaxed diastolic
blood pressure sounds to recorded are called korotkoof sounds
normal blood pressure values 120mmHg/80mmHg
what arm is bp usually take in left
to determine if a person has orthostatic hypotension you would take bp in supine sitting then standing
red flags a faulure of systolic pressure to rise in proportion with increased activity a decrease in systolic pressure > 10mmHG w/ activity a systolic pressue > 240 increase of diastolic pressure > 29 during activity
respiration cycle one inhalation and one exhalation
resting respiration rate 12 breathes per minute for adults 20 for children (anything below 10 or above 20 is considered abnormal)
following exercise the rate of respiration can increase to 40-45 breathes per minute and gradually go down
body temp provides info concerning bmr, potential presence of infection and metabolic response to exercise
skin temp provides information concerning circulatory status potential peripheral neve injury and local inflammation responses
normal temp 98.6 degrees F 37 degress C
Afebrile those with temp below 100 degress F
febrile temp exceeds 100 F
hypothermia rectal temp below 94 degress F
hyperthermia rectal temp greater than 106 degrees F
pain subjective desciption descibed by pt
pain is rated on a visual analog scale (0-10)0 being no pain 5 tolerable 10 take me to the emergency room
body machanics the application of kinesiology to the use of the body in activites and to the prevention and correction of problems related to posture
correct lifting maintina spine as erect as possible flex your knees into a squat close to the pt grasp gait belt firmly bring pt in COG close to your body into your COG lift with you leg not your back
general principles of lifting avoid twisting turn with short steps, turn with your whole body as a unit use leverage whenever possible avoid reaching provide the minimal amount of resistance to allo pt to gain independent transfer get help with transfer don't hold on neck
stability maintain COG and base of support
cneter of gravity low center of gravity is more stable pt with LE atrophy have higher COG
Base of support wider BOS is more stable feet in stride position in the direction of the desired movement can plave ft at 90 degree agle to increase BOS applies to all mobility not just trasfers
mobility momentum can be you friend and enemy always instruct pt clearly to improve desired outcome pvot vs twisting
efficiency use the shortest lever arm possible with lifting use the longest lever arm possible when resisting pulling is easier than pushing never lift when you can pull ensure you and pt are brething ( use abdominal bracing not diaphragm)
two person tranfer stongest and or most skilled should control COG unless training
never use a pt arms to lift gh is one of the least stable jt lifting can stretch the capsule, impinge or tear the RC, or sublux or dislocate the jt
during a tranfer do NOT allow pt to reach around neck or grab it they will over power your COG
expect pt to fall or lose their balnce during a transfer being prepared you have control over the movement
what are the exceptions for not using a gait belt during draw sheet bed to bed trasfer
Bed postioning
Created by: klkoester