OT Practice 2 Midterm

Nasogastric Tube (NG Tube)

- nostril to stomach -May desensitize swallow reflex -May initiate feeding training -Limit neck flexion

biomechanical FOR

-Addresses/what to evaluate: structural stability, endurance, edema, ROM, and strength -Fracture, ammonia, anything that doesn't deal with brain injury -Assumptions: Can use purposeful activity to remediate loss of ROM, strength, and endurance, If ROM, strength, and endurance are regained, the person will automatically use these prerequisite skills to regain functional skills, The body must be rested, then stressed, The person must have an intact brain that can produce isolated, coordinated movements

Neurodevelopmental NDT

-Addresses: axial control, automatic reactions, limb control with a specific focus on the scapula and pelvic mobility and stability, ROM and dissociation of movement, alignment, and patterns of weight bearing, muscle tone, balance, and postural control, coordination -What to evaluate: reflex development, automatic reactions, synergies, muscle tone, ROM, alignment and weight-bearing, balance and postural control, coordination -Remediate foundation skills that make normal skill acquisition possible -Normal movement is learned by experiencing what normal movement feels like: accomplished with handling -Postural control is essential for limb movement: postural stability for distal mobility -Normal movement cannot be imposed on abnormal muscle tone: must normalize tone during the session prior to facililiating functional movement patterns -Brain has plasticity and will grow new connects -Sensorimotor impairments affect the whole individual, so sensory system needs to regain homeostasis -Movement is linked to sensory processing through feedback and feedforward/anticipatory control: therapist must provide measured sensory input to illicit the correct response

Universal Precautions

-Apply for all bodily secretions (blood, fluids, mucinous membrane, etc.) -Gloves, handwashing, protective clothing, proper handling of soiled items, cleaning equipment between patients

Stage 3

-Balance problems with delayed reactions, difficulties in skilled sequential tasks -Environmental modifications in the home, including raised toilet seats, chairs with armrests, removal of throw rugs; use of visual cues and supports for sequential tasks

Stage 2

-Bilateral motor disturbances, mild rigidity reported, difficulties with simultaneous tasks and executive function -Energy conservation techniques related to ADLs; develop daily flexibility exercises focused on trunk rotation; driving assessment and alternatives for community mobility; use of task analysis to structure sequential tasks

Monitors

-Cardiac: monitors EKG, heart rate, BP, respiration -Arterial Line: monitors BP -Intracranial Pressure Monitor: watch for seizures, avoid isometric exercise, avoid neck/hip flexion > 90 and prone position, head lower than 15 degrees below horizontal -Pulmonary Arty Catheter: No elbow flexion/ext and limited shoulder ROM

dependent

-Client requires more than 75% assistance to complete the task. -It is important to stat whether assistance provided is physical or verbal assistance

Stage 5

-Client severely compromised motorically, dependent with ADLs -Use of environmental controls to allow access to the environment

work

-Employment interests and pursuits, employment seeking/acquisition, job performance, retirement preparation/adjustment, volunteer exploration, volunteer participation

Stage 4

-Fine motor control severely compromised, oral motor deficits -Modifications to support participations in self-care tasks, change in food textures

Feeding Tubes

-Gastric/PEG tube: tube inserted through abdomen to stomach -IV Feedings/Total Parental Nutrition (TPN) or hyperalimentation device: catheter passed into subclavian vein and empties directly into heart --Used when a client is unable to eat or absorb nutrition o-- Secure connections before and after intervention o-- Air embolus-precaution

IV therapy

-Peripheral (antecubital, dorsum of hand, dorsum of foot) -Peripherally inserted Central Catheter (PICC) upper arm -Central Line (subclavian, jugular, femoral) -Arterial line (artery access radial or femoral, monitors blood pressure at all times)

Kinetic Bed

-Pressure relief with perpetual slow motion, side to side, mobilization of respiratory secretions -Precaution: skin integrity

Air Mattress

-Pressurized air to even weight distribution -Clients with infected lesion, requiring skin protection and position cannot be changed easily -Percaution: prevent puncturing, bed mobility is more difficult and patient is at risk for sliding off edge of bed

Acute Care

-Pt is less medically stable, acute illness -Treatment Intensity: typically, 10-45 mins once a day -ALOS: 1-3 days -OT focus: functional mobility, BADLs, discharge recommendation, equipment if d/c home

Long Term Care Hospital (LTACH)

-Pt is medically fragile and complex, acute + chronic illness -Treatment intensity: Variable, typically 10-45 mins a day -ALOS: Weeks to Months -OT Focus: functional mobility, BADLs, exercise, discharge recommendations

Sub-Acute Rehab (SNF: Short Term Rehab)

-Pt is medically stable -Treatment intensity: 30-75 mins daily, 5x or more per week -ALOS: 1 week minimum, weeks to months -OT Focus: ADL, IADL, strengthening/endurance building, functional mobility, caregiver training, equipment ordering, d/c plan w/ team, home evals)

Inpatient (Acute) Rehab

-Pt is medically stable -Treatment intensity: 60-90 mins daily, 5x or more per week -ALOS: 7-14 days -OT Focus: ADL, IADL, functional mobility, caregiver training, specialized training (vision, cognition, etc.), community outings, home eval, equipment ordering, d/c plan w/team

Home Health

-Pt is medically stable -Treatment intensity: 45-60 mins, 2-3x week -ALOS: variable, weeks-months -OT Focus: ADL, IADL, functional mobility, caregiver training, HEP training, equipment ordering/set up/training

Outpatient Rehab

-Pt is medically stable, living at home, receiving OT at a clinic -Treatment intensity: variable, typically 45-60 mins 2-3x a week -OT focus: rehabilitation of UE function (pain management, strength, sensation re-education), modalities, activity modification, IADL/work functions

Long Term Care (Nursing home)

-Pt is medically stable, usually several comorbidities -Cannot live at home alone safely (needs 24-hour care/supervision) -Treatment intensity: 30-60 mins 3x a week -ALOC: usually remain in LTC rest of life; treatment generally 2-4 weeks depending on needs -OT focus: specific ADL (self-feeding, transfers, toileting), fall prevention, dementia staging, leisure skill/social participation development, w/c positioning and mobility

Assisted or Independent Living Facility (ALF; ILF)

-Pt is medically stable; higher functioning than those in a LTC -Cannot live at home safely but do NOT need 24-hour care/supervision -Seen for outpatient or home health therapy, depending on the facility, insurance, etc. -Generally, pay for their living/care out of pocket

Trach

-Surgical procedure to create an opening through the neck into the trachea (windpipe) to provide an airway and to remove secretions from the lungs

Suprapubic catheter

-Urinary bag should not be placed above the level of the bladder for more than a few minutes; do not place in patients lap during transport -Tube should not be pulled and empty bag when full -Report urine that is dark, cloudy, bloody -Leg bag when appropriate for improved mobility and client independce in emptying bag

transmission-based precautions

-Used with clients who are known to be infected -Require additional control measures -Client is typically isolated -Contact, droplet, airborne precautions -Protective clothing: gown, mask, cap, gloves, booties -Common conditions: C.diff, MRSA, VRE)

ventilator

-Utilized to maintain adequate air exchange -Endotracheal Tube (ET tube)- catheter inserted into nose or mouth into trachea -Difficulty talking: head nods or other nonverbal -Can treat in sitting or standing -Percuations: Watch length of tube and signs of respiratory distress (change in respiratory patterns, fainting, blue lips)

safety measures in preparation for mobility

-eliminate clutter, ensure tubes/lines are free and won't interfere with movement, footwear: non-ski slippers or supportive shoes, gait belt worn during functional mobility, check patient mentation-alert, memory, safety awareness, communicate with nurse prior to treatment

wheelchair cushions

-solid seat insert to reduce the effect of the "sling" and create a solid seating surface -wedge cushion (fall prevention) -pommel cushion (fall prevention; hip adduction prevention) -coccyx cushion (the opening goes in the back, below coccyx - people have them backward all the time!) -combination gel and foam cushion -High profile Roho and Low profile Roho - pressure relieving cushions - $$$ - pump them full of air -Contour cushion (mostly comfort) -Wedge contour cushion (comfort and fall prevention) -Pressure reducing cushion

It is recommended that wheelchair footplates clear the floor by a minimum distance of: 1" 2" 3" 4"

2''

During the initial stage of PD, clients should perform an exercise program for : a) 5-10 minutes/day b) 60 minutes 3x/week c) 30 minutes 5x/week d) None of the above

5-10 minutes

All of the following are true regarding depression in the older adult, EXCEPT: A) Older adults are likely to seek intervention for depressive symptoms. B) Depression can have a major influence on occupational performance. C) Depression may increase the degree of disability and negatively affect rehab potential. D) OTs working with older adults should screen for depressive symptoms and help clients manage depression.

A) Older adults are likely to seek intervention for depressive symptoms.

Correct measurement of a client for determining appropriate wheelchair seat width involves measuring which of the following? Across the hips or thighs (whichever is widest) and adding ½" to 1" Across the hips or thighs (whichever is widest) and subtracting 1" - 2" Across the hips or thighs (whichever is widest) and adding 1" - 2" From the back of the knee to the rear of the buttocks and adding 1" - 2"

Across the hips or thighs (whichever is widest) and adding ½" to 1"

Rehabilitation FOR:

Addresses: activities of daily living, work, and leisure activities What to evaluate:,Ability to perform ADLs in a timely manner,Ability to safely perform home management tasks in a timely manner, Work behaviors, work tolerance, general work traits, and/or specific work skills, Ability to participate in meaningful leisure activities , Clinical observations and interviews are used to evaluate these areas of occupational performance Possibilities for treatment:IF the therapist uses adaptive devices, orthotics, environmental modifications, wheelchair modifications, ambulatory aids, adapted procedures, and/or safety education, THEN independent in ADLs, home management, work, and leisure will be maximized

IADLs

Care of others (including selecting and supervising caregivers), care of pets, child rearing, communication management, driving/community mobility, financial management, health management/maintenance, home establishment/management, meal prep/cleanup, religious/spiritual activities/expression, safety and emergency maintenance, shopping

modified independence

Client is completely independent with task, but may require additional time or adaptive equipment.

independent

Client is completely independent. No physical or verbal assistance is required to complete the task safely. No verbal cues required

maximal assistance

Client required 51% to 75% physical or verbal assistance from one person to safely complete the task

Moderate Assistance

Client requires 26% to 50% physical or verbal assistance from one person to safely complete the task

supervised

Client requires supervision to safely complete task. Verbal cue may be required for safety

social participation

Community, family, peer/friend

Which of the following has been found to be a benefit for continued completion of activities of daily living (ADLs) for the older adult? A) avoid disability B) Increase life expectancy C) Decreased self-efficacy D) Both A and B

D) Both A and B

education

Formal education participation, informal personal educational needs or interest's exploration (beyond formal education), informal personal education participation

Contact Guard/Standby Assistance

Hands on contact guard assistance is necessary for the client to safely complete the tasks, or the caregiver must be within arms-length for safety

leisure

Leisure exploration, leisure participation

As PD progresses, exercises should be added to improve gait. All of the the following have been found to improve gait patterns with PD, EXCEPT: a) Dancing b) rhythmic auditory stimulation with an accentuated initial beat c) PENS electrical stimulation for improved quad strength d) Using a rocking motion to initiate movement activities

PENS electrical stimulation for improved quad strengt

play

Play exploration, play participation

rest & sleep

Rest, sleep preparation, sleep participation,

What are the three classic clinical symptoms of Parkinson's disease? a) Resting tremor, spasticity, rigidity b) Resting tremor, impaired voluntary movement, rigidity c) Spasticity, impaired postural reflexes, decorticate posture d) Spasticity, choreiform movements, impaired postural reflexes

Resting tremor, impaired voluntary movement, rigidity

The leg rests of a client's wheelchair are adjusted too short. This increases the client's risk for which of the following? Skin breakdown of the popliteal fossa Skin breakdown of the ischial tuberosity Skin breakdown of the heel of the foot Skin breakdown at the scapula

Skin breakdown of the ischial tuberosity

This phrase, commonly used in healthcare and advocacy groups, refers to the idea of an older adult continuing to live in the community and maintain some degree of independence, as opposed to moving into an institution: A) Productive aging B) Aging in place C) Wellness aging D) Community-dwelling

aging in place

Older adults affected by hearing loss may be limited in: A) Safety B) Participation C) Socialization D) All of the above

all of the above

Which area of occupation should an OT assess when a client has had significant weight loss to determine potential causes? A) swallowing or feeding B) meal preparation and grocery shopping C) positioning and posture while seated for eating D) all of the above

all of the above

The progression of Parkinson's disease has been described in stages. Which description best fits Stage IV of the disease progression? a) Client is able to complete all activities of daily living (ADLs) but has difficulties with balance reactions. b) The client experiences marked impairment and is bedridden. c) The client has mild asymmetrical involvement but no problem with ADLs. d) Although still ambulatory, the client needs assistance with ADLs.

although still ambulatory, client needs assistance with ADLs

ADLs

bathing/toileting, toileting/toilet hygiene, dressing, swallowing/eating, feeding, functional mobility, personal device care, personal hygiene and grooming, sexual activity

Which of the following is NOT a sign of respiratory distress that you must monitor for when working with a client who requires a ventilator? a) Fainting b) Choking c) Change in respiration pattern d) Blue lips

choking

Minimum Assistance:

client requires up to 25% physical or verbal assistance from one person to safely complete the task

A caregiver should help someone in a w/c up a curb by approaching the curb backward and lifting up the w/c so the large back wheels are in contact with the curb first. True False

false

True or false: Balance is significantly impaired during the early stages of PD. a) True b) False

false

True/False: All cognitive changes in older adults are attributed to either normal aging or dementia. A) True B) False

false

True/False: Transmission-Based Precautions apply to the care of all patients in healthcare settings. Incorrect Response a) True Correct Answer b) False

false

True/false: a catheter is inserted into superficial veins a) True b) False

false

to safely use a standard-weight w/c (over 35#) the user must have intact trunk balance and equilibrium. Incorrect Response True Correct Answer False

false

Which activity is most appropriate when providing an intervention to a client who is ventilator dependent? a) Bathing in a shower seated on a shower chair b) Grooming activities seated edge of bed c) Completing a role task inventory questionnaire requiring patient to talk about their hobbies d) Stair training

grooming activities seated edge of bed

Foley catheter

held in bladder by inflated balloon

You are reviewing the medical record of your next patient, who has Parkinson's disease. The neurologist has indicated that this man has bradykinesia. What does this mean? a) He has no movement available. b) His movements are slow. c) He has oscillations in his movements. d) His movements are very erratic and quick.

his movements are slow

During the last stages of PD, the primary focus of OT should be: a) remediation of postural control b) home/environmental modification c) pain management d) adaptive equipment training for ADLs

home/enviornmental modification

If your client is experiencing a seizure, all of the following steps should be taken EXCEPT: a) place the person in a safe location and away from anything that may cause injury b) loosen clothing around the person's neck c) insert an object into the person's mouth to prevent injury from lip-smacking d) lay the person on their side after the convulsions subside

insert an object into the persons mouth to prevent injury from lip smacking

A sign or symptom of insulin reaction (insulin shock) is: a) Fruity breath odor b) Moist, pale skin c) Vomiting d) Thirst

moist, pale skin

Rehabilitation FOR:

o Assumptions: -A person can regain independence using compensation when underlying deficits cannot be remediated -Motivation for independent cannot be separated from volitional and habitual subsystems -Motivation for independence cannot be separated from environmental contexts -A minimum level of emotional and cognitive prerequisite skill must be present to make independence possible -Clinical reasoning should take a top-down approach. Focus should be on environmental demands and resources. Then, volitional and habitual subsystems should be considered, followed by functional capabilities and then prerequisite skills/deficits

What type of wheelchair should be recommended to maximize independence in mobility in the individual who has good cognitive and perceptual skills but very poor endurance and significant physical impairment of the upper and lower extremities? Hemiplegia-style manual wheelchair Lightweight manual wheelchair Power wheelchair Reclining wheelchair

power wheelchair

Exercise programs during the initial state of PD should include all of the following EXCEPT : a) alternating movements from various planes b) postural flexibility exercises c) relaxation techniques and controlled breathing d) reciprocal movements in a single plane

reciprocal movements in a single plane

Why might a rigid frame chair be preferable for individuals with paraplegia who are manually propelling the wheelchair? They are more lightweight than collapsible chairs They are more easily folded and stored. They are more sturdy and do not need to be replaced as often. They are more energy efficient during propulsion.

they are more energy efficient during propulsion

To push a client up a ramp, the caregiver should move in a normal, forward direction. True False

true

To self-propel a manual w/c by using his/her arms on the rear wheels of the w/c, the user must have sufficient and symmetric grasp, arm strength, and physical endurance. True False

true

True or False : Even in the early stages of Parkinson's Disease, clients have difficulty in executive functioning. a) True b) False

true

True or false: patient and caregiver education is an important element of the OT plan of care for PD because it is a progressive disease. a) True b) False

true

True/false: A precaution when working with older adults is to allow longer rest periods/recovery time during activity. A) True B) False

true

True/false: Changes in cognition often affect the ability to function and perform ADLs safely and independently. A) True B) False

true

True/false: Cognitive capacity greatly affects the client's rehab potential. A) True B) False

true

True/false: Isolation systems are used to prevent infection by transmissible pathogens and include the use of contact, droplet, and airborne precautions. a) True b) False

true

True/false: Signs and symptoms of fainting include slower pulse, paleness, and perspiration. a) True b) False

true

True/false: When working with a client with visual deficits the OT will need to pay close attention to the environment in the treatment setting and home. A) True B) False

true

True/false: an NG tube is a plastic tube inserted through a nostril, terminating in the client's stomach to provide nutrition. a) True b) False

true

stage 1

• Unilateral tremor, micrographia, poor endurance for previous occupations, fatigue o Work eval if the client is employed, work simplification for work/home, develop the habit of taking frequent rest breaks, use of utensils with enlarged handles