PT Care 1 – Exam 1 Review

Definition: Indicates: Contributing Factors: Elements: Pulse Sites:

Pulse Indirect Indicates a Temperature Rate (bpm) Rate (bpm) Tachycardia: fast Temporal
measure of rate at Infection Rhythm Bradycardia: slow Carotid
contraction which the Age Volume Braachial
of the left heart is Sex Rhythm Normal rhythm: same time Radial
ventricle of beating and Physical Activity interval between the beats Femoral
the heart. is reported Emotional Status Abnormal rhythm Popliteal
in beats per Medications (arrhythmia/dysrhythmia): heart Posterior
minute Physical Conditioning beats may be too slow, too rapid, Tibial
(bpm) Cardiopulmonary disease too irregular, or too early Dorsalis
Volume Documenting Pulse Volume Pedis
(Strength/Amplitude)
0 Absent; not detectable
1+ Thready or weak; difficult to
feel
2+ Normal; detected readily,
obliterated by strong pressure 3+
Strong
4+ Bounding; difficult to obliterate

Definition: Elements: Scale: Documentation Tools

Style: Needed:
Blood Force exerted Systolic 120/80 Blood pressure
Pressure by the blood Pressure: Systolic Diastolic cuff
against the contraction of Normal Less than 120 Less than 80 Stethoscope
arterial walls left ventricle mmHg mmHg
Pre-Hypertensive 120-139 80-89
Diastolic Stage 1 Hypertension 140-159 90-99
pressure: rest
Stage 2 Hypertension At or greater than At or greater
period of the
160 than 100
heart
Hypotension Under 90 Under 60
 PT Care 1 – Exam 1 Review

Guidelines for Positioning and Draping:

 Introduce yourself to the patient – Ex: Name, SPT
 Inform the patient of the planned treatment, apply the principles of informed consent, and obtain consent for treatment
 Describe how the patient is to be positioned and provide assistance if needed
 If the patient is wearing clothing covering the treatment area, request permission to expose the area and request assistance if
necessary
 Make sure to drape area if it does not need to be exposed with linen
 Ensure that linens, pillows, and equipment needed for treatment are available in treatment area
 Provide safe and secure storage for patient’s personal belongings
 Describe how you want the patient to apply linen items, a gown, a robe, or exercise clothing to cover (drape) the body and
provide privacy while the patient disrobes
 Instruct the patient to inform you when they are positioned and draped or confirm they are covered before entering the space
 At the end of treatment,
o instruct patient on how to remove draping items and put on their clothing
 make sure they have privacy
o Provide linen so the patient can remove perspiration, massage lotion, electrotherapy gels, water, or other substances
o Return personal items to them
o Dispose of used linens in proper container
o Prepare the treatment area for the next patient

Precautions for Patient Positioning:

 Avoid clothing or linen folds beneath the patient
 Observe skin color over bony prominences before, during and after treatment
 Protect bony prominences from excessive and prolonged pressure
 Avoid positioning the patient’s extremities beyond the support surface
 Avoid excessive, prolonged pressure on soft tissue, circulatory, and neurologic structures
 Use additional caution when positioning patients who are cognitively challenger or confused, comatose, very young or elderly,
paralyzed, or lacking normal circulation or sensation

Rationale for Proper Positioning: Rationale for Patient Draping:

 It prevents soft tissue injury, pressure and joint contracture
 It provides patient comfort
 It provides support and stability for the trunk and extremities
 It provides access and exposure to areas to be treated
 It promotes efficient function of the patient’s body systems
 It relieves excessive, prolonged pressure on soft tissue, bony
prominences, and circulatory and neurologic structures
 It provides modesty for the patient
 It helps the patient maintain an appropriate body
temperature
 It provides access and exposure to areas to be
treated while protecting order areas
 It protects the patient’s skin or clothing from
being soiled or damaged
 PT Care 1 – Exam 1 Review

ASSISTIVE DEVICES:

Purpose of Using Assistive Device: Checklist:

 Support  Protection  Shoes on
 Reduce joint compression forces  Gait belt on
 Joint instability: Reduce stress on connective tissues   Lock wheelchair
 Weight bearing   Pain  Slide forward in wheelchair
 Stability/Balance  Move caster wheels out of the way
 Compensation for weakness
 Improved function and independence Things to Remember:
 Demonstrate assistive device
Precautions:  Close guard patient, on the strong leg preferably
 Patient needs anti-slip footwear when walking  Measure the assistive device to fit the patient correctly
 Watch vital signs, general appearance, and mental  Pivot towards uninvolved leg
alertness – diverted attention/sixth sense  With bilateral crutches, you can use patient preference
 Use safety belt to control patient but don’t manhandle for which side to have crutches in their hand when
the patient getting up out of the wheelchair
 Never ever leave patient unattended o Use the other arm on wheelchair to get up
 Clear area of obstacles  For one cane, always use it on the opposite side of the
 Be careful of appliances (tubes, catheter) involved leg
o Unless going upstairs and patient has railing on
Common Errors that occur in Fitting Assistive Devices: involved side only, then use the cane and
 Patient elevates or hunches shoulders during railings for extra stability
measurement  For wheelchair going up or down ramp:
o Results: too long o On multiple steps, the patient should always
 Patient depresses/ drops shoulders or looks face down the stairs and patient can grab onto
down/slumps during msmt the big wheels and help
o Results: too short o You can slide back of wheelchair up or down
 Measured without shoes on your thigh to control it better
o Result: too short o Put patients COM over the big back axel
 For Crutches: when patient is not in tripod position  For Stairs:
o Result: too short o Foot placement:
 Going up: patient should be about 2
inches away from the stairs
 Going down: patient should have toes
off the edge of the stairs
 PT Care 1 – Exam 1 Review

Walker Cane Crutches

Types: Standard Rollator Reciprocating Quad Tripod Standard Traditional or Forearm (Lofstrand, Gutter or Platform
Walker Walker Walker Cane Cane /Straight Axillary Canadian)
Cane
Fitting:  Stand with midfoot in line with  Standing: Arm relaxed at  Crutch tips 2” lateral and 4-6” anterior to the feet
rear legs of walker side, wearing shoes, top  2-3 fingers between axilla and top pad
 Erect posture with arms at sides curve of cane should come  20-25° of elbow flexion with hands on pads
 Grip to wrist level to proximal wrist crease,  Lofstrand:
 Check 20-25-degree bend in ulnar styloid, or gr. o Height: 1-1.5 inches distal to olecranon process
elbow trochanter
 Advantages: very stable  Supine: With hip/knee
 Disadvantages: straight, distance from gr.
trochanter to bottom of heal
 Hand on cane 2” lateral and
parallel to leg: 20 to 25
degrees elbow flex. Elbow
flexion allows shock
absorption, and different
range during gait
When Used when maximal patient stability Used to compensate for Used for persons Used when stability Used for patients who
to Use and support are required impaired balance or to improve who need less and support of an are unable to bear
this stability and are more functional stability or support axillary crutch are NOT weight through their
Assisti on stairs and in narrow, than is provided by required, but when wrist and ahnds, have
ve confined areas parallel bars or a more stability and severe deformities of
Device walker, they allow support than can be wrists or fingers that
: greater selection provided by a cane are make it difficult to grasp
of gait patterns needed the handpiece of a
and ambulation They are more regular crutch, have a
speed and provide functional on stairs and below-elbow
stability and in narrow, confined amputation, or are
support spaces and do not unable to extend one or
injury axillary vessels. both elbows
Disadv  May be difficult to store or  Provides very limited  Less stable  Provide less  Patients loses use
antage transport support because of its small than a walker stability and of the triceps to
s:  Difficult to use on stairs base of support (BOS) support than elevate and
 PT Care 1 – Exam 1 Review

 Reduce speed of ambulation  Can cause axillary crutches, a maintain the body
 May be difficult to perform a injury to walker, or parallel during swing phase
normal gait pattern axillary vessels bars  Another person may
 Can be difficult to use in narrow and nerves if  Require functional need to apply or
or crowded areas used or standing balance remove them
measured and functional UE  Less effective on
improperly and body strength stairs
 Require good for many gait
standing patterns
balance  Forearm cuff can
 Elderly make it difficult to
patients may remove the crutch
feel insecure  Elderly patients
with them may feel insecure
 Functional with them
strength of UE
and trunk
muscles are
required
Degree NWB FWB WBAT to FWB NWB WBAT to FWB WBAT to FWB
of WB- PWB PWB FWB PWB WBAT
ing WBAT PWB
FWB
Gait 3-point 3-1- Two point One cane: One crutch: Bilateral: Bilateral:
Pattern 3-1-point point Four point Modified 2-point (more Modified 2-pt 2-point 2-point
common) Modified 4-pt 4-point 4-point
Modified 4-point
Two crutches:
Two canes: 2-point
2-point 4-point
4-point 3-1-point
3-1-point
Stairs Ascending: lead up with the unaffected leg (“good goes to heaven”)
Descending: lead down with the affected leg and cane at the same time (“bad goes to hell”)
Caution: whenever a fixed handrail is available, the patient should use it for security and stability.
 PT Care 1 – Exam 1 Review

TRANSFERS:

Transfer Terms Before Transfer:

Dependent Patient unable to help with transfer  Check the patient’s chart for precautions: such as weight-
Assisted Patient requires physical assistance bearing status, postsurgical procedure orders, joint disease,
pain levels, or osteoporosis
from PT or other HCP
 Plan the transfer across the shortest distance
 Minimal assist 25%  Plan to move the patient toward his or her strongest side and
 Moderate assist 26-50% assist on the weaker side
 Maximum assist 51-75%  Obtain necessary equipment or assistance before initiating
the transfer – GAIT BELT and/or other people
Guarding In close proximity or actually in contact  Ensure the patient is properly dressed for the transfer
(close/contact) with the patient/safety belt  Wash your hands
Standby Assist Verbal and/or tactile cuing for PT who  Introduce yourself to the patient
is in close proximity  Explain the transfer procedure to the patient and
Modified Adaptive devices or assistive demonstrate
Independent Assist equipment  Obtain the patient’s consent after you explained the transfer
Independent No additional physical assistance or
verbal cuing needed During Transfer:
 Lock the wheelchair, bed, or gurney
 Be alert of your surroundings
Checklist for all transfers:  Use gait belt and/or other equipment
 Adjust the bed height if possible  Remain close to the patient and guard them
 USE PROPER BODY MECHANICS
 Angle wheelchair
o Lift with your legs and avoid twisting
 Lock wheelchair o Avoid trunk flexion or rotation
 Remove footrests and clear area o Position your COG close to the patient’s COG
o Put footrests back on after the transfer is complete (center of gravity)
 Move patient forward in wheelchair (or if they can do it o Increase your base of support (BOS)
themselves, allow them too)  Lower your COG and maintain your vertical
 Use GAIT BELT gravity line within your BOS
 Instruct the patient and any assistances with the transfers by
 Tell the patient what you are going to do and make sure
using short statements
they understand their role in the transfer
 Make sure the patient has shoes on After Transfer:
 Use proper body mechanics  Position the patient for comfort, stability, and safety
 PT Care 1 – Exam 1 Review

Type of Things to Remember: When to use it: When NOT to use it:
Transfers:

Dependent –  Block patient’s LE  Used for a patient who is unable  An alternative

1 person o Feet and knees outside of the patient’s feet and knees to stand or is unable to perform method can be
 Use momentum to lift the patient any type of assisted transfer using the sliding
 Don’t lose contact with the patient until they are stable onto the  Used when the caregiver is board to
surface (after transfer) sufficiently strong and skilled to incrementally slide
perform the lift or lift a dependent
Caution: do not leave the patient sitting unattended on the edge of the patient
bed, mat, chair, or plinth. If you have returned the patient into the
wheelchair, be certain that the patient’s hips are positioned back on
the seat so that the trunk will be supported by the back of the chair
Dependent –  Instruct assistant on hand placement on the patient and how to  Used when a patient is unable to  If an assistant is
2 persons lift stand unavailable
o Make sure your assistance knows on your count (the leader)  Used when the transfer is  If the strength of
when to lift performed from two surfaces of leader is weak
o Ask for permission to go under the patient’s legs unequal height
 Used when the patient is unable
Caution: this can cause back strain for the leader and should be used to assist the transfer
only in an emergency or when mechanical equipment is unavailable  In case of emergency
Standing,  Tell the patient that they can grab onto your shoulder, NOT your  Used for a patient who has  If the patient has
assisted pivot neck greater strength in one upper and two weak LE, then
 Do not pull on the patient’s gait belt lower extremity than the C/L use a dependent
o Could cause them to lose their balance, resulting in both of extremities transfer
you falling  If the patient stands
o Let the patient do as much of this transfer as possible and get dizzy
 Transfer towards the patient’s stronger leg/side
 Stabilize the weaker extremity by lifting/holding
o If the patient is PWB, then lifting the LE is not necessary
 Instruct patient to use the armrest when going from sit to stand
 After getting the patient to the desired location:
o Tell the patient to look back at their surface before sitting
o Tell the patient to bend at their knees and waist to sit
 PT Care 1 – Exam 1 Review

Slideboard  Bring patient forward in wheelchair  Used for patients who are unable  If the patient
o You can ask the patient to move forward in the wheelchair to stand, but have functional UE doesn’t have good
 Hand placement  Patient has good core/trunk trunk stability or
o Place hands on top of the board about 4 to 6 inches away strength weak UE strength
from their thigh in the direction they are moving to  Patient has good UE strength  If the patient has
o Make sure they don’t put their fingers under the board conditions with their
 Tell the patient to think of this like a “seesaw” hands that prohibits
o How weight will be distributed them from being
 Close guard patient if first time doing the transfer stable using them
Hoyer Lift  Make sure to count and have the same number of hooks for all  Can be used when the  If the mechanical
four sides, so the patient is level on the Hoyer lift mechanical equipment is equipment is not
 Make sure to have enough space and clear surface for the available, instead of a dependent available or not
transfer lift working properly
 Position wheelchair appropriately, locked, caster wheels out of
the way and without footrests in the way
 PT Care 1 – Exam 1 Review

MEDICAL COMMUNICATION AND THE INTERVIEW

Communication: b. Transfer information to other health care

1. Obtain information professionals
a. Gather data to understand the patient’s problem Interview:
i. Non-verbal skills: eye contact, judicious 1. Preparation: review background, identify red flags,
use of space, attentive body posture, prepare questions, and prepare the environment
being an active listener 2. Body of the interview: define the purpose and be aware
ii. Asking questions: open vs. closed of non-verbal behaviors
ended questions, facilitation (encourage 3. Middle: exchange questions and answers
the patient to keep talking in an open- 4. End/Closing: restate your findings during the interview
ended manner), clarification and and indicate what will happen next or where we go
direction, checking the accuracy of your from here
information
iii. Surveying the problem: learning of other Note: The tone, volume, and inflection of your voice can
concerns detract from or add to your message.
2. Establish Rapport
a. Developing rapport and responding to patient’s Barriers for Effective Possible Solution:
emotions Communication:
i. Empathy: your appreciation, Excessive distance sit closer together
understanding, and acceptance of between the patient and
someone else’s emotional situation therapist
ii. Reflection: reflect to the patient what Noise be in a quiet space
you see Patient may be unable to If the patient has a communication
iii. Legitimation: communicate acceptance comprehend the disability, then have the caregiver
of the patient’s emotional experience message present. The caregiver must be aware
iv. Personal support: let the patient know of their responsibility to communicate
you’re there to help appropriately with a person with an
v. Partnership: biopsychosocial model impairment.
vi. Respect Patient may be unable to use non-medical terminology
3. Instruction interpret or understand
a. Patient and family education: Educate the technical, medical, and
patient, develop treatment plan with the patient, professional terms,
and check for adherence to the treatment plan language, or
abbreviations
Different interpretations ask the patient to repeat back what you
said to check their understanding
Cultural, gender, or age understand cultural, gender, or age
differences between the differences
patient and therapist
Illegible writing practice writing better or take your time
 PT Care 1 – Exam 1 Review

CONFIDENTIALITY

TERMS: DEFINITIONS:
CONFIDENTIALITY An ethical responsibility and a professional duty that demands that information learned in private
interaction with a client not be revealed to others
PRIVILEGED A legal protection granted by state laws to the clients of specified professionals that information arising
COMMUNICATION from the relationship may not be divulged in certain court proceedings without client consent
INFORMED CONSENT The right to be told about the nature and consequences of procedures such that clients are enabled to
make informed choices

APTA Code of Ethics:

Principle 1: A physical therapist shall respect the rights and dignity of all individuals and shall provide compassionate care.

Principle 2: A physical therapist shall act in a trustworthy manner towards patients/clients, and in all other aspects of physical
therapy practice.

HIPAA: federal regulation that ensures the privacy and security of Protected Health Information (PHI)
 Includes:
o Name
o Address
o Telephone and fax numbers
o Email addresses
o Social security number
o Account numbers
o Medical record numbers
o Health plan beneficiary numbers
o Biometric identifies: Finger or voice prints
o Full face photographs
 Overseen by Medicare and Medicaid Services
 PT Care 1 – Exam 1 Review

PAIN

TERMS: DEFINITION:
PAIN Is an unpleasant sensory and emotional experience associated with actual or potential tissue damage
Note: Pain is a subjective experience
TENDERNESS Sensitivity to pain upon pressure
Note: Tenderness is an objective finding
REBOUND Production or intensification of pain when pressure is released
TENDERNESS
THRESHOLD The lowest intensity of stimulation at which pain is perceived as noxious
TOLERANCE Amount of pain that a person can withstand before breaking down emotionally and/or physically
NOCICEPTION Pain pathways (peripheral pain pathway vs. central pain pathway)
PLACEBO A harmless pill, medicine, or procedure prescribed more for the psychological benefit to the patient that for any
physiological effect
NOCEBO A detrimental effect on health produced by psychological or psychosomatic factors such as negative
expectations of treatment or prognosis

Types of Pain

Acute Pain Results from an injury and/or disease causing potential or real tissue damage
Lasts as long as the noxious stimulus persists: seconds, minutes, hours, few days
Note: acute pain is more localized than chronic
Subacute Pain The stage between acute injury and healing or chronic pain
Lasts a few days to several weeks
Chronic Pain Pain persisting beyond the normal tissue healing time even after noxious stimulus is removed or tissue “heals”
Lasts greater than 3 or 6 months
Referred Pain Convergence of various nociceptors on spinal nerve root that come from a remote source (organs)

Radiating Pain Neural pain from a stretched or impinged nerve root

 PT Care 1 – Exam 1 Review

Factors that Assessment Verbal cues indicating:

Influence Pain
 Words expressing discomfort or pain: “ouch or “that hurts”
 Age  Pain onset  Cursing during movement
 Time of onset  Pattern of pain  Exclamations of protest: “stop”
 Previous pain  Exact location of pain
experience  Results of a pain questionnaire
 Type of injury  Whether pain radiates or spread to other parts Non-verbal cues indicating pain:
 Pain perception of the body
influenced by  Description of pain  Nonverbal signs: sighs, gasping, moans, groans, cries
anxiety, o When is it best and worst?  Facial grimaces/winces: furrowed brow, narrowed eyes,
attention, o Is the pain constant or intermittent? clenched teeth, tightened lips, jaw drop, distorted expressions
depression, and o What activities make pain better and  Bracing: clutching or holding onto furniture, equipment, or
cultural worse? affected area during movement
influences o Time of day when pain is better or worse?  Restlessness: constant or intermitter shifting of position,
 What work or social activity is affected by pain? rocking, intermittent or constant hand motions, inability to keep
 Rate pain from 1 to 10, with 1 being the least still
and 10 being the worst  Rubbing: massaging affected area

PAIN SCALES:

Simple descriptive pain distress scale:

Visual analog scale (VAS):

0-10 numerical pain distress scale: