PTA 101 Exam 1
Pain Assessment - visual analog scale - assessment of pain Ch 3 pg. 64-69
Visual Analog Scale - a visual assessment tool used to assess an individuals pain. *10cm baseline is recommended if used as a graphic rating scale Assessment of Pain (determine and document the following) - pain onset - pattern of pain - exact location of pain - results of pain questionnaire - radiates? or spreads? - description of pain - work; daily life affected by pain? - rate pain from 1 to 10, 1 being the least and 10 being the worst
Pictures of pressure ulcers on exam, written as well - know different stages
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201 KAR 22:053 Section 4 (e) and (h) - (e) supervising PTA; PT much be reachable by? - (h) PTA student clinical rotations what percentage by PTA? (KY State Practice Act)
(e) = telecommunications (h) = 80% supervision by PTA ; 20% supervision by PT on clinical rotations for PTA students (e) Supervising the physical therapist assistant by being available and accessible by telecommunications during the working hours of the physical therapist assistant; (h) Ensuring that a physical therapist assistant student fulfilling clinical education requirements shall receive on-site supervision of which eighty (80) percent may be by a credentialed physical therapist assistant;
327.010 (4) - define referral (KY State Practice Act)
"Referral" means the procedure by which a licensed doctor of medicine, osteopathy, dentistry, chiropractic or podiatry designates the initiation of physical therapy treatment by a licensed physical therapist.
Clinical Scenario Questions - 16 total - pt. scenario; what should you do?
idk examples;
201 KAR 22:053 Section 4 (1) - ratio of PT:PTA; how many supervise? (KY State Practice Act)
1 PT : 4 PTA (1)(a) At all times, including all work locations in all jurisdictions, be limited to supervising not more than four (4) physical therapist assistants or supportive personnel;
Pulse Pulse Normal Values - newborn - child - adult - tachycardia - bradycardia Pulse Sites - 3 locations we need to know and be able to locate Pulse Grading - know that normal = 2+ Pulse Descriptions - 4 descriptions total Documentation - example Target HR - what percentage of MAX HR? (Vital Signs handout)
***normal = 60-100 bpm Normal Values - - newborn = 100-130 bpm - child = 80-120 bpm - adult = 60-100 bpm Other Values - - tachycardia = >100 bpm - bradycardia = <60 bpm Pulse Sites - - carotid artery - radial artery - dorsal pedal artery *use two fingers to take pulse/do not use thumb Pulse Grading - - 0 = absent - 1+ = thready, weak; diminished - 2+ = NORMAL - 3+ = strong, moderately increased - 4+ = full bounding; markedly increased Pulse Descriptions - - Strong and Regular (good force and even beats) - Weak and Regular (poor force and even beats) - Irregular (both strong and weak beats detected) - Thready (weak force and uneven beats) Documentation of Pulse - - pulse site assessed and side of body - rate of pulse (bpm) - any variations from normal - position of patient during recording - time of treatment pulse was assessed *example = L radial pulse taken with patient seated prior to exercise; 84 beats/min regular - Target HR = usually 50-85% of MAX HR *220 - age = Max HR
201 KAR 22:053 Section 5 (d) Standards of Documentation - documentation written by student; what is title? (KY State Practice Act)
- "Physical Therapist Assistant Student" or "PTA Student" (d) If written by a student: "Physical Therapist Student" or "PT Student"; "Physical Therapist Assistant Student" or "PTA Student".
201 KAR 22:135 Fees Section 2 (1) - how much does initial credentialing by application cost? (KY State Practice Act)
- $200 (recently went up to $225) Section 2. Licensure fees shall be: (1) $200 for initial credentialing by application;
201 KAR 22:045 Section 2 (1) b - PTA contact hours? - Jurisprudence Examination - Category 1 - Category 2 (KY State Practice Act)
- 20 hours for PTA Jurisprudence Exam = 2 hours Category 1 = at least 10 hours Category 2 = no more than 8 hours (b) For a physical therapist assistant, the board shall require twenty (20) contact hours as a condition of renewal. These hours shall be obtained as established in subparagraphs 1. through 3. of this paragraph. 1. Two (2) hours shall be awarded for the successful completion of the Jurisprudence Examination per biennium. 2. At least ten (10) hours shall be earned from Category 1 as established in subsection (2) of this section. 3. Hours may be earned from Category 2. If hours are earned from Category 2, hours shall be as established in subsection (3) of this section. Hours earned from Category 2 over eight (8) hours shall not be awarded. (c) A participant shall not be awarded contact hours for a course that is repeated more than once in the same biennium.
201 KAR 22:045 Section 2 (4) - documentation of compliance; audited how long do you have to get documents to the board? (KY State Practice Act)
- 30 days of written request from the board (b) The licensee shall, within thirty (30) days of a written request from the board, provide evidence of continued competency activities to the board.
201 KAR 22:020 (3) - how many failed attempts are allowed? (KY State Practice Act)
- 6 failed attempts and then cannot be licensed Effective July 1, 2012, after six (6) failed attempts at either the physical therapist or physical therapist assistant examination, or combination thereof, in any jurisdiction, an applicant for licensure or certification shall not be eligible to register for any additional examinations.
201 KAR 22:020 Section 7 (3) b - score to pass? (KY State Practice Act)
- 600 (b) After July 1, 1993, a passing score shall be the criterion referenced passing point recommended by the FSBPT set equal to a scaled score of 600;
Medical Terminology Question (off of cardiovascular quiz) - What is ischemia? [from wikipedia]
- Ischemia = is a restriction of blood supply to tissues, causing a shortage of oxygen that is needed to keep the tissues alive. [wikipedia] Ischemia is generally caused by problems with blood vessels, with resultant damage to or dysfunction of tissue. It also means local anemia in a given part of a body sometimes resulting from constriction (such as vasoconstriction, thrombosis or embolism). Ischemia comprises not only insufficiency of oxygen, but also reduced availability of nutrients and inadequate removal of metabolic wastes. Ischemia can be partial (poor perfusion) or total.
Measles - what should you be wearing? - isolation type - common clinical syndromes - room assignment - mask - gown - gloves - patient transport/discontinuing isolation table in book Ch. 2 pg. 35
- Isolation type = airborne - Common clinical syndromes = measles (pulmonary) - Room assignment = private room w/ negative airflow; keep door closed (N-95 respirator) - Mask = Yes (dust/mist mask) - Gown = No - Gloves = No - Patient transport/discontinuing isolation = minimize transport of patient; and ask patient when transport is necessary
201 KAR 22:053 Section 2 (4) - reassessment times for inpatient and school system? (KY State Practice Act)
- Reassessment times: Inpatient = 14 days School System = 90 days (4) Reassess each patient in accordance with the following: (a) Reassessing inpatients in either a hospital or comprehensive rehabilitation facility every fourteen (14) days; (b) Reassessing every ninety (90) days, with the physical therapist assistant present, patients in: 1. A facility defined in 902 KAR 20:086 as an intermediate care facility (ICF) for the mentally retarded (MR) and developmentally disabled (DD); or 2. A school system. (a) A forty-five (45) day grace period shall be allowed upon transfer from another school district or from the start of the school year; (b) During this grace period treatment may continue based upon the previous reassessment or evaluation; (c) Reassessing each patient not otherwise noted every thirty (30) days following the last evaluation or subsequent reassessment; (d) Reassessing a patient whose medical condition has changed;
201 KAR 22:020 Section 4 (2) - supervisory agreement; temporary permit (KY State Practice Act)
- know what a supervisory agreement is; PT signs Section 4. To be eligible for a temporary permit, the candidate shall: (1) Meet the qualifications of Section 2 or 3 of this administrative regulation, except for the retake provisions in Section 2(3) of this administrative regulation; (2) Complete a Supervisory Agreement for Applicant with Temporary Permit with one (1) or more physical therapists; and (3) Have not failed either the physical therapist or physical therapist assistant examination in any jurisdiction.
Medical Asepsis vs. Surgical Asepsis - when would you need to put a gown on? (random question from "Approaches to Infection Control" PP) Ch 2 pg 27
- medical asepsis = practices that help reduce the number and spread of microorganisms - surgical asepsis = practices that render and keep objects free of all microorganisms Medical Asepsis = techniques designed to keep pathogens confined to a specific area, object, or person. Includes isolation of a pt. (private room). Includes the use of PPE when treating a pt. in a private room. "Clean Approach" use of extreme care when removing PPE after treating a pt. in isolation to reduce cross contamination. *Body's natural barriers = primary (intact skin) and cilia in respiratory tract Surgical Asepsis = techniques used to exclude all microorganisms before they can enter a surgical wound or contaminate a sterile field before or during surgery. Techniques include sterilizing all inert objects (instruments, drapes, etc.), and all personnel (hand scrub, don sterile gloves). - When would you need to put a gown on during patient care? Airborne of fluid - Wash hands after working with someone with C-dif vs using alcohol-based rub
Hand Washing - basic principles - procedure Ch. 2 pg. 28-33
- most common method of transmission is by direct contact, habitual use of proper hand hygiene techniques is the most effective way to protect the pt. and caregiver. - hand-washing for 40-60 seconds w/ ordinary soap and water removes transient bacteria from the hands as a result of the mechanical action of the friction while rubbing and scrubbing during the wash. Basic Principles - remove jewelry, artificial or chipped nail polish; may harbor pathogens - trim nails (less than one-quarter inch) to reduce collection of pathogens; nails should not be seen when palm is in front of face - wear gloves when breaks in the skin are present; at greater risk for infection - use warm water; comfort; promote lather; carry pathogens away - apply soap and rub briskly after hands are wet; use friction to loosen dirt, dead skin, and pathogens from skin Procedure (Medical Asepsis) - remove jewelry - turn on water; adjust temperature; - wet wrists and hands directed downward - apply soap - wash for 40 to 60; lather and scrub palms together; interlace fingers scrub between/around; wash web spaces; scrub dorsum of each hand; scrub fingertips and dorsal finger creases; encircle each thumb and wrist with opposite palm and scrub - rinse hands throughly; proximal to distal; - discard towel used for drying hands; get new towel to turn off the faucet; discard all used towels; avoid touching container
O2 stats - normal levels - Hypoxemia - pulse oximetry Ch 3 pg 57
- normal blood oxygen saturation reading at or near sea level is = 95% - 100% - Hypoxemia = O2 levels below 90% - pulse oximetry = measures the level of blood oxygen saturation, monitors pulse rate, and calculates HR.
#63 on the exam is A (apparently) 63. HIPAA main focus... (from test review notes)
- privacy and confidentiality
201 KAR 22:053 Section 3 (2) - PT request unlawful treatment... what do you do? (KY State Practice Act)
- refuse to carry out procedures (2) Refuse to carry out procedures that the assistant believes are not in the best interest of the patient or that the assistant is not competent to provide by training or skill level;
KRS 327.050 (8) - when to renew license and certificates; on what day (KY State Practice Act)
- renewed biennially - on or before March 31 - uneven-numbered year All licenses and certificates shall be renewed biennially (every two years), upon payment on or before March 31 of each uneven-numbered year of a renewal fee in an amount to be promulgated by the board by administrative regulations.
Blood Pressure - systemic arterial BP - systolic pressure (systole) - diastolic pressure (diastole) - sphygmomanometer - normal ranges for BP - hypertension - hypertensive crisis - hypotension - factors associated with hypertension Ch. 3 pg. 57-
- systemic arterial BP = a physiologic variable that reflects the effects of cardiac output, peripheral vascular resistance, and other hemodynamic factors Systolic pressure = is the BP at the time of contraction of the left ventricle (systole) Diastolic pressure = is the BP at the time of the rest period of the heart (diastole) - sphygmomanometer = (BP cuff) measures BP; is an indirect measurement of the pressure inside an artery caused by blood flow through the artery Acceptable Normal Ranges For BP - hypotension = <100 systolic value - normal ranges for BP = <120/80 mm Hg - Prehypertension = 120-139/80-89 - Stage 1 hypertensive = (consistent reading) >140/90 mm Hg - Stage 2 hypertensive - 160-179/100-109 - hypertensive crisis (EMS needed) = >180/110 mm Hg Factors Associated with Hypertension - obesity; physical inactivity; excessive use of nicotine, alcohol, salt; arteriosclerosis; diabetes mellitus; oral contraceptives (in women); advanced age; kidney disease; race (>african americans); and diet. *People with high BP are more succeptable to coronary artery disease, cerebrovascular accident, peripheral vascular disease, and congestive heart failure.
- three common means of transmission What is a nosocomial infection? - HAI (healthcare-associated infection) What is VRE?
- three common means of transmission = - contact (direct and indirect); - droplet (cough, sneeze, talking) - airborne (measles, varicella) Nosocomial Infections - (aka HAI - healthcare-associated infections) are infections acquired while in a hospital of clinical setting VRE = vancomycin-resistant Enterocococcus
Joe Savage - define tort - two types of torts - best defense against intentional torts joe savage video and packet test question about negligence, torts, and assault vs battery
- tort = a wrongful act or an infringement of a right (other than under contract) leading to civil legal liability *a civil wrong / as apposed to a criminal wrong. For example, Jon Doe vs. Joe Savage / Commonwealth of KY vs. Joe Savage Two Types of Torts: - 1. Intentional = assault (putting someone in fear of an action) and battery (performing and following through with the harmful or upsetting action) - 2. Unintentional = negligence (failure to take proper care of something/failure to use reasonable care, resulting in damage or injury to another) Defense against assault and battery? - Consent Consent - 1. Expressed - oral or written - 2. "dentist office" implied consent by conduct Which consent is better? - written consent form Next best? - oral consent Worst type of consent? - implied consent Negligence = failure to take proper care of someone resulting in injury Four Fundamental Concepts of Negligence - 1. Duty = acting carefully, (reasonable man standard = law imposes a reasonable conduct that someone must follow to not breach duty) - 2. Breech = proof that someone did something wrong - 3. Cause = the bad result - 4. Injury = injured (medical bills both passed and future, future impairment, pain and suffering/ future p@s, loss of consortion for spouse) and death (funeral expenses, destruction of ability to earn money)
Hazards of Immobility - 3 major changes in CV system resulting from immobility - 3 major complications
3 Major Changes in CV System resulting from immobility - - 1. Orthostatic hypotension (combat OH = elevate head) - 2. Increased workload of the heart (heart works harder in supine) - 3. Thrombus formation (venous stasis and hyper-coagulability of blood) *10-15% of strength lost per week w/ immobility *w/o muscle activation blood pools in LE (stasis) (pt. should do ankle pumps/heel slides) *pallor = loss of color *hyper-coagulability of blood = back of calf is #1 place for blood clot formation; immobility leads to an increase in the proteins in blood responsible for formation of blood clots; dehydration causing blood to thicken 3 Major Complications - - 1. Osteoporosis (decreased bone density; osteoblasts build bone/osteoclasts eat bone; w/o weight bearing osteoblasts stop production while osteoclasts continue; bones become demineralized; easily fracture) - 2. Contractures (decreased length of muscular tissue or other soft tissue around joint; musculotendonous components; muscles do not activate to maintain integrity; muscle spasms happen to prevent osteoporosis leads to contracture) - 3. Decubitus ulcers ("Pressure Sores") (caused by prolonged pressure; decreased nerve impulses; decreased blood supply; ischemia; cellular level dies)
Lift Techniques - Name the 7 different lifting techniques discussed in the text Ch 4 pg. 75-79
7 Different Types of Lifting Techniques - 1. Deep Squat Lift = hips are positioned below the level of the knees; trunk is in a vertical position; lumbar spine remain in lordosis with an anterior pelvic tilt (inclination) - 2. Power Lift = "half squat"; hips are kept above knees; trunk in vertical position; lumbar spine remains in lordosis with an anterior pelvic tilt - 3. Straight Leg Lift = knees only slightly flexed/or fully extended; LE parallel or straddle object; trunk may be vertical or horizontal; lumbar spine remains in lordosis. - 4. One-Leg Stance Lift ("Golfer's Lift") = used for light objects; weight shifted onto one LE; hip and knee slightly flexed while non-weight bearing extremity is extended for counterbalance; similar to golfer lifting golf ball from hole - 5. Half-Kneeling Lift = get on one knee positioned behind the object; other opposite side w/ foot flat on floor 90 degrees; grasp and lift object; place on thigh of flexed LE; lumbar spine in normal lordosis throughout lift; useful in persons of small stature, limited UE strength, and overall balance. CAUTION: persons with knee conditions; exacerbated - 6. Traditional Lift = feet parallel; LE deep squat; low COG; wide BOS; UE flex first to lift object off of the ground; LE then raise body and object into upright position; object held close to body. CAUTION: LE should perform lift, not the back - 7. Stoop Lift = "picking up briefcase" ; used when object can be reached without squatting; lifter can stoop to lift; partially flexes at hips and knees; lumbar spine in normal lordosis; grasps object; uses LE to raise body and object; feet positioned shoulder width apart and slightly anteroposterior to each other; less energy expenditure than deep squat
Regions of the Spine - cervical vertebra - thoracic vertebra - lumbar vertebra - sacrum - coccyx test question regions of the spine
7 cervical (8 cervical nerves pairs) 12 thoracic (12 thoracic nerve pairs) 5 lumbar (5 lumbar nerve pairs) 5 sacral 1 coccygeal
327.020 (3) - physical therapist title (KY State Practice Act)
A licensed physical therapist may hold himself or herself out as a "physical therapist" or "licensed physical therapist" and may use the abbreviations "P.T." or "L.P.T." as a part of or immediately following the physical therapist's name, in connection with his or her profession.
Changes in HR and BP w/ activity - changes in HR - changes in BP - abnormal changes in HR - abnormal changes in BP Ch 3 pg 59
Changes in HR w/ activity - - normal = pulse rate should rapidly increase in response to vigorous physical activity; plateau or stabilize as the intensity or severity of exercise plateaus; and then decline as the intensity of exercise declines; *after exercise the pulse rates should revert to the person's resting pulse rate within 3-5 minutes after cessation of exercise *a conditioned athlete will probably show less change in pulse rate, and pulse will return to normal levels faster. Changes in BP w/ activity - - systolic pressure = should gradually increase w/ exercise; plateau as exercise intensity plateaus; and then gradually decline as exercise intensity declines; *following exercise systolic BP should return to normal resting value within 3-5 minutes after termination of exercise - diastolic pressure = should remain essentially unchanged throughout exercise period, although an increase of approximately 10-15 mm Hg is usually not considered abnormal; an increase of >15vmm Hg is considered abnormal Abnormal Changes in HR w/ Activity - - slow or no increase w/ exercise activity - increases/decreases whenever exercise intensity plateaus - slow or no decline as intensity declines - rhythm becomes irregular during or after exercise Abnormal Changes in BP w/ Activity - - systolic pressure = rapid increase; no increase; or a decline of systolic pressure before exercise intensity declines - diastolic pressure = an increase greater than 10-15 mmHg Abnormal Changes in BP after Activity - - systolic pressure = continues increase after plateau; rapid decrease; no decrease; significant decline (below resting value)
201 KAR 22:020 - define CAPTE (KY State Practice Act)
Commission on Accreditation in Physical Therapy Education -possibly know - (2) To be eligible for the examination, the applicant for certification as a physical therapist assistant shall: (a) Have successfully completed the academic and clinical requirements of a physical therapy or physical therapist assistant program accredited by CAPTE;
KRS 327.990 Penalties (1) - violation; penalty (KY State Practice Act)
Each violation of KRS 327.020 shall constitute a misdemeanor and be punished by a fine of not less than fifty dollars ($50) nor more than five hundred dollars ($500) or by imprisonment for not less than ten (10) days nor more than thirty (30) days, or both, for the first offense. Each subsequent violation thereof shall be punished by a fine of not less than one hundred dollars ($100) nor more than one thousand dollars ($1,000) or by imprisonment for not less than thirty (30) days nor more than ninety (90) days or both.
201 KAR 22:020 Section 5 (4) - when does the temporary permit expire? (KY State Practice Act)
Expires after 6 months; or notice of exam results (4) The temporary permit shall expire the earlier of: (a) Six (6) months from the date of issuance; or (b) Notice of exam results by the board. A temporary permit holder who is registered for the examination in another jurisdiction shall register with the FSBPT Score Transfer Service to have results submitted to Kentucky within forty-eight (48) hours of the release of the exam results.
Fraud vs Abuse - fraud - abuse - waste APTA lecture on preventing fraud, abuse, & waste: a primer for physical therapists test question on fraud vs abuse
Fraud = intentional deception or misrepresentation that a person makes to gain a benefit to which they are not entitled. + Examples of fraud = knowingly billing for services not furnished; knowingly altering claims forms to receive more payment; falsifying documentation Abuse = payment for items or services that the provider is not entitled to and for which the provider has intentionally misrepresented facts to obtain payment + Examples of abuse = billing for services that are not medically necessary; unbundling services and billing; billing services that do not meet professionally recognized standards Waste = incurring unnecessary costs as a result of deficient management practices, systems, or controls + Examples of waste = duplication of services already provided elsewhere; spending money on services that lack evidence of producing better outcomes compared with less-expensive alternatives
327.020 (4) - False; only physical therapy can use PT title for services (chiropractors cannot) (KY State Practice Act)
It shall be unlawful for any person, or for any business entity, its employees, agents, or representatives to use in connection with the person's or entity's name or business activity the words "physical therapy," "physical therapist," "physiotherapy," "physiotherapist," "registered physical therapist," the letters "P.T.," "L.P.T.," or any other words, letters, abbreviations, or insignia indicating or implying directly or indirectly that physical therapy is provided or supplied or to bill for physical therapy unless that physical therapy is provided by or under the supervision of a physical therapist licensed and practicing in accordance with this chapter.
Blood Pressure - key points - procedure (summarized) - mean arterial pressure (MAP) - documentation (Vital Signs - Procedure) Ch. 3 pg. 60
Key Points: - applying the deflated cuff (approx. 2.5 cm above the antecubital space); make sure needle is visible - deflating the cuff; needle should drop at a rate of 2 to 3 mm Hg per second - brachial artery; (femoral artery used in patients w/ known or suspected LE peripheral vascular disease - the width of the bladder should be 40% of the circumference of the midpoint of the limb - the length of the bladder should be approx. twice the width of the bladder, 80% of the arm circumference - retaking BP; allow pt. to sit quietly for 1 to 2 minutes before measurements are retaken - Kortkoff sounds I and V most important - arm must be supported; fully relaxed or flexed will cause erroneous measurements; healthy individual will have no difference in measurement w/ position (sit, stand, laying) Procedure (summarized) - wash hands, get equipment (stethoscope; sphygmomanometer), - introduce self to pt./obtain permission; explain procedure - *if pt. has exercised/stressed, have them rest for 15-30 minutes - clean the earpieces and diaphragm; insert earpieces of stethoscope pointed forward into ears; apply firm but light pressure on the diaphragm to maintain contact with the skin - position forearm resting at same level as the heart (if standing support arm between your arm and lateral area of chest - expose the antecubital space of the arm; palpate brachial pulse - apply the deflated cuff (approx. 2.5 cm above the antecubital space); make sure needle is visible - determining how high to inflate cuff = palpate brachial artery; inflate cuff; wait until pulse can no longer be felt; record number; wait 30 to 60 seconds and reinflate cuff 15 to 20 mm Hg above the pressure recorded to ensure artery is occluded - deflate the cuff; needle should drop at a rate of 2 to 3 mm Hg per second. Listen for normal Kortkoff sounds and note when first sound is heard. continue deflation, listening for the absence of pulse sound. - remove equipment - record the values, including the patient position and extremity used (e.g., 130/70 right upper extremity, sitting) - clean equipment Mean Arterial Pressure - - definition = the average pressure that occurs during a single cardiac cycle (contraction/relaxation) - formula = [Systolic Pressure + (Diastolic pressure x2)] /3 = MAP Example BP of 130/80: [130 + (80 x 2) ] / 3 = 96.7 - a MAP of >60 is necessary to perfuse the body's major organs and vessels to maintain them. Documentation - extremity / artery assessed - patient position - at what point in treatment session - value expressed in mmHg *example = BP taken in Left UE with patient seated prior to treatment 120/80 mmHg
Different Types of Learning Styles - 5 total (Becoming a Successful PTA Student - handout)
Learning Styles: - Visual - Auditory - Kinesthetic (learning by carrying out physical activity) - Analytic (concepts) - Spatial (a person's ability to perceive, analyze, and understand visual information in the world around them)
Respiration Rate Normal Values - infant - adult Other Values - tachypnea - bradypnea Factors Affecting RR Documentation - example Respiration Abnormal Responses (Vital Signs hangout)
Normal Values - - infant = 30-50 RR - adult = 12-18 RR Other Values - tachypnea = >20 RR - bradypnea = <12 RR Factors Affecting RR - - age (greater in very young and old) - activity - emotional status - air quality & altitude - disease Documentation - - at what point in the treatment rate was assessed - patient position - rate *example = respiration rate measured prior to exercise patient sitting; 20 breaths/min or RR Abnormal Responses - - slow / no increase with activity - continues to increase with activity plateau - slow / no decrease as activity intensity declines
KRS 327.030 (1) - may/may not be on test (KY State Practice Act)
One (1) board member shall be a resident of Kentucky and who is not affiliated with or does not have more than five percent (5%) financial interest in any health care profession or business.
Vital Signs Red Flags - orthostatic hypotension - blood pressure, RR, pulse - general symptoms (Vital Signs handout)
Orthostatic Hypotension - - low BP upon standing from a seated or recumbent position - dizziness, lightheadedness, loss of balance, loss of consciousness Blood Pressure, RR, Pulse - - any significant changes from normal of baseline values - anoxia / hypoxia General Symptoms - - cognitive change - decreased breathing - shortness of breath (dyspnea) - diaphoresis (profuse sweating) - severe headache - bloody stools
Bony Prominences That May Cause Pressure Injuries - Supine Position - Prone Position - Side-Lying Position (lower-most extremity) - Side-Lying Position (upper-most extremity) - Sitting Position Ch 5 pg 89 table 5.1
Supine Position - head and trunk = occipital tuberosity (another name Steve uses); spine of scapula; inferior angle of scapula; vertebral processes; sacrum - UE = medial epicondyle of humerus; olecranon process - LE = posterior calcaneus; greater trochanter, head of fibula, and lateral malleolus with excessive external rotation of hip Prone Position - head and trunk = forehead; lateral ear; tip of acromion process; sternum; ASIS - UE = anterior head of the humerus; clavicle - LE = patella; ridge of tibia; dorsum of foot Side-Lying Position (lower-most extremity) - head and trunk = lateral ear; lateral ribs; lateral acromion process - UE = lateral head of the humerus; medial or lateral epicondyle of humerus - LE = greater trochanter of femur; medial and lateral condyles of femur; malleolus of fibula and tibia; fifth metatarsal Side-Lying Position (lower-most extremity) - head and trunk = none - UE = medial epicondyle of humerus (if resting on a hard surface) - LE = medial condyle of femur; malleolus of tibia Sitting Position - head and trunk = ischial tuberosities; scapular and vertebral spinous processes (if leaning against back of chair); sacrum (if patient if slouched) - UE = medial epicondyle of humerus; olecranon process (if resting on a hard surface) - LE = greater trochanter; popliteal fossa; posterior calcaneus (if resting on a hard surface)
Cycle of Cross-Contamination and Infection - test question about host and reservoir - what is the goal? Ch. 2 pg 26
The cycle of cross-contamination and infection is as follows: - Infectious Agent (bacteria, fungi, protozoa, prion) = pathogens that cause communicable diseases. - Reservoir (humans, contaminated food, water, insects, animals, soil) = a place where microorganisms can grow and reproduce. - Exit (open wound, respiratory tract, intestinal tract, blood and body fluids) = a means by which microorganisms can leave their host; nose; mouth; eye; intestinal tract; wound. - Transmission (soiled dressings, exudate from the wound, soiled linen, ingestion of contaminated food or water, needle stick, insects/animals, respiratory droplet, contaminated dust) = a method by which microorganisms are passed from one person to another to spread the infection. - Entry (a cut, abrasion, cuticle tear, urinary tract, respiratory tract, intestinal tract, mucus membrane) = infection; microorganism entering into a person. - Susceptible Host (a person with low or limited systemic resistance to the organism, children who are not fully immunized, infants, elderly and debilitated) = someone's immune system that cannot destroy, repel, remove, or ward off the microorganisms is a susceptible host. *goal is to break up the cycle
201 KAR 22:070 Section 1 (b) - proof PT can speak english? = True (KY State Practice Act)
True; must show proof of English Language Proficiency (b) Shows proof of English Language Proficiency by: 1. A score of not less than fifty (50) on the Test of Spoken English (TSE); 2. Verification that the applicant has achieved the following minimum scores for each category of the Test of English as a Foreign Language, TOEFLE Internet-based test (TOEFL IBT): (a) Writing, twenty-two (22); (b) Speaking, twenty-four (24); (c) Listening, twenty-one (21); (d) Reading, twenty-two (22); with an overall score of not less than eighty-nine (89); or (e) With an overall score of not less than eighty-nine (89);
Decubitus Ulcers ("Pressure Sores") - Why do the occur? - Stages 1-5
Why do they occur - - compression against bony area - obstruction of blood supply - leads to ischemia - results in necrosis and ulceration Stage 1 - - skin is still intact - nonblanchable (stays red when pressed) ; blanchable (turns white when pressed) Stage 2 - - partial thickness skin loss involving epidermis and/or dermis. - Ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater - worse on inside/died inside out Stage 3 - - full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. - Presents clinically as a deep crater - tunneling... Stage 4 - - full thickness skin loss with extensive destruction, or damage to muscle, bone, or supporting structures (e.g., tendon or joint capsule) - "when you hit bone" = Stage 4 How to stop Decubitus Ulcers? - good nutrition (increased protein) - frequent change in position (every 2 hours) - avoid excessive pressure on bony areas *no doughnuts (causes ischemia) *do not use alcohol over skin (dries skin out) Immobility Effects of Respiratory Function - - basal metabolism decreases (shallow breaths; pneumonia) - decreased respiratory movements (diaphragm rises up; compressing chest components - stasis of secretions (dehydration thickens secretions; good medium for bacterial growth; weak abdominals cannot cough) - oxygen-carbon dioxide imbalance (deficient ventilation; CO2 buildup leading to hypoxia/tissue hypoxia and respiratory acidosis w/ increased CO2; causing respiratory failure or cardiac failure; death) *blood pH = 7.4
What disease is responsible for increasing the demand for the profession of physical therapy? Who is responsible? What year did the PTA profession begin? - History of PT question (from Physical Therapy as a Profession handout)
polio - the disease responsible for increasing the demand for the profession of physical therapy is polio Mary "Mollie" McMillan - credited as being the first PT in U.S.; American Women's Physical Therapeutic Association founded Jan. 15 1921; elected Mary McMillan as the president. PTA was formed in 1967 - (documents were first created for the formation of the position) Polio epidemic in 1916 and outbreak of WWI in 1917 increased demand for PT; women were selected as corrective exercise "nurses"; WWI incorporated wound care; PT started as PA *promotion of optimal health and function/functionally independent as possible
