1
Q
What is Physical activity?
A
Any form of body movement generated by skeletal muscle
contraction that results in an increase in caloric requirements over resting energy expenditure.
2
Q
What is Exercise?
A
A type of PA consisting of planned, structured, repetitive and purposeful bodily movement done to improve or maintain one or more components of physical fitness.
3
Q
What is Sedentary behaviour?
A
Any behaviour characterized by an energy expenditure of ≤1.5 METs while in sitting, reclining or lying posture.
4
Q
What is Physical fitness?
A
A set of attributes or characteristics that individuals have or
achieve that relates to their ability to perform physical activity.
5
Q
What are Current PA Guidelines?
A
- At least 150 minutes to 300 minutes a week of moderate intensity
- OR 75 minutes to 150 minutes a week of vigorous intensity aerobic physical activity, or an equivalent combination of moderate and vigorous intensity aerobic activity.
- Muscle-strengthening activities on 2 or more days a week.
6
Q
What are PA Guidelines for Older adults?
A
Older adults should do multicomponent physical activity that includes BALANCE training as well as AEROBIC and MUSCLE-STRENGTHENING activities.
7
Q
What are the Canadian 24-Hour Movement Guidelines for Children and Youth?
A
- Sweat: Accumulation of at least 60 min/day moderate to vigorous PA involving variety of aerobic activities. Vigorous PA, muscle and bone strengthening activities should each be incorporated at least 3x/week.
- Step: Several hours of a variety of structured and unstructured light PA.
- Sleep: Uninterrupted 9 to 11 hours sleep per night for 5-13 years and 8-10 hours for 14-17 years with consistent bed and wake-up times.
- Sit: No more than 2 hour/day of recreational screen time. Limited sitting for extended periods.
8
Q
What are the sleep and sedentary behaviour guidelines for Canadian adults?
A
- 7-9 hours of good-quality sleep on a regular basis, with consistent bed and wake-up times.
- Limited sedentary time to 8 hours, with no more than 3 hours of recreational screen time.
9
Q
What are the sleep and sedentary behaviour guidelines for Canadian Older adults?
A
- 7-8 hours of good-quality sleep on a regular basis, with consistent bed and wake-up times.
- Limited sedentary time to 8 hours, with no more than 3 hours of recreational screen time
10
Q
What are the difference between the 24-hour movement guidelines for adults vs. older adults?
A
- Older adults require PA that challenge balance.
- They need 7-8 hours of sleep where as adults need 7-9 hours.
11
Q
What is the role of PT in PA promotion?
A
- Promoting optimal mobility, PA and overall health and wellness.
- Improving and maintaining optimal functional independence and physical performance.
12
Q
What are some screening tools used for aerobic exercise participation?
A
- Self-guided methods: PAR-Q or AHA/ACSM Health/Fitness Facility Pre-participation Screening Questionnaire
- Specific forms for professionals: CVD Risk Assessment and Classification
- Medical evaluation: physical exam + stress test by qualified health care provider.
13
Q
What is being asked in the 2020 PAR-Q+?
A
- Asking patient about things that are indicative of cardiovascular/medical issues.
- If any box is checked, patient requires medical clearance to participate.
14
Q
What are the flow of questions on the ACSM approach for clinician screening?
A
- Participating in Regular Exercise?
- CV, Metabolic or Renal Disease
- Signs or Symptoms suggestive of CV, metabolic or Renal Disease
15
Q
When is Medical Clearance NOT necessary?
A
If the individual does NOT have any CV, metabolic or Renal disease and NO signs or symptoms.
16
Q
Where are the 3 places you can find pulse?
A
- Radial
- Carotid
- Brachial
17
Q
How long are you counting pulse for?
A
10, 15, 30 or 60 seconds
18
Q
How do you measure radial pulse?
A
- Wrist well supported
- In a neutral position
- Palpate radial styloid
- Move medial (between radial styloid and flexor tendons)
- If trouble, extend wrist slightly
19
Q
How do you measure carotid pulse?
A
- Head in neutral
- Best measure with hands lateral to trachea
- Do NOT press too hard! - External pressure against the carotid artery sometimes slows HR
20
Q
How do you measure brachial pulse?
A
- Place index and middle finger just above elbow joint
- Draw finger laterally
- Artery can be palpated against brachial tendon
- Not typical to take HR here, but need to landmark for BP
21
Q
What is normal HR in adults?
A
- 60-80 bpm
- May be as low as 40 bpm in well trained individuals and true resting conditions.
22
Q
What HR is considered bradycardic?
A
Below 55-60 bpm
23
Q
What HR is considered tachycardic?
A
Above 100 bpm
24
Q
What is normal HR for children?
A
80-100 bpm
25
What does a pulse oxymeter measure?
Measures saturation of hemoglobin in arterial
blood (SaO2), i.e., oxygen carried in red blood cells.
26
How does a pulse oxymeter work?
Works by passing light through the nail/skin, tissue and blood, sensor on other side detects amount of light passing through without getting absorbed.
27
What are some important values regarding SaO2?
- Normal values = 95-100% at sea level
- <92% = potential need for intervention
28
How do you measure respiratory rate?
- Number of breaths/minute
- Count how many times the CHEST or ABDOMEN rises in 1 minute (in supine)
- Count how many times the shoulder raises.
- Can be combined with pulse check so the patient is not as acutely aware what you are measuring
29
What is the Normal respiratory rate for adults?
14-18 breaths/min
30
What is the Normal respiratory rate for children?
20-25 breaths/min
31
What is considered abnormal respiratory rate for adults?
<10 or >20
32
T/F:
Earpiece should be inserted to point anterior superiorly (towards the bridge of the nose)
True
33
T/F:
- The tension of the headset to your ears should make a good seal– not too loose or too tight.
True
34
T/F:
Apply the diaphragm or bell directly to the skin (not over clothing).
True
35
T/F:
For the diaphragm, apply enough pressure to slightly defect the surface.
True
36
T/F:
The diaphragm is used for higher frequency sounds e.g., breath sounds
True
37
T/F:
The bell side is used for lower frequency sounds e.g., heart sounds
True
38
What is Blood Pressure?
Blood pressure represents the force exerted by blood against the arterial walls during a cardiac cycle.
39
What is Systolic BP?
Provides an estimate of the work of the heart and force that blood exerts against the arterial walls during ventricular systole.
40
What is diastolic BP?
Indicates peripheral resistance or the ease that blood flowing from the arterioles into the capillaries.
41
What are the sounds we are listening for in measure BP?
- Systolic – at least 2 consecutive beats (Korotkoff’s sounds)
- Diastolic – cessation of sound
42
What are the best practices for measuring BP?
- Test with arm at HEART height
- Test LEFT arm (but in clinical setting this may not be possible)
- Use good TECHNIQUE, including the proper cuff size (there are different sizes)
- Test in a QUIET place
- Pump cuff up at least 20 mmHg above systolic if known; if not start at 160-200 mmHg
43
What is included in patient preparation for BP measurement?
- Ideally no caffeine, exercise or smoking for at least 30 minutes prior -ASK THE PATIENT
- Secure a quiet and warm environment
- Patient should sit quietly for at least 5 minutes in a chair
- Feet should be flat on the floor
- Crossing the legs should also be AVOIDED (elevates both SBP and DBP)
44
What is the ideal arm position for BP measurement?
- The arm should be supported at heart level (increased when the arm is below heart level and vice versa)
- Standard position is sitting (other positions should be noted if used for consistency).
- The arm should be supported by PT - not held actively by the patient (increases BP)
45
What is the ideal patient position for measuring BP?
- Back supported
- Legs supported
- Feet uncrossed
- Cuff about 2 cm above elbow crease
- Arm supported by clinician or pillows
- Cuff on arm at heart level
46
What are the 11 steps in measuring BP well?
1. Subject is seated and arm is supported ~ 10° of elbow flexion; shoulder is relaxed.
2. Locate the brachial artery at the inner side of the upper arm, approximately 1 inch above the bend in the elbow.
3. Align the arrows on the BP cuff with the brachial artery.
4. Wrap BP cuff around the upper arm; should be snug.
5. Relocate brachial artery and place the stethoscope bell below the antecubital space over the brachial artery
6. Before inflating the cuff, ensure that the air-release switch remains closed (turn the knob
clockwise).
7. Ensure the dial is positioned so you can read it.
8. Inflate the cuff to at least 20 mm Hg than usual systolic BP (~160/180-200 mm Hg)
9. Gradually release cuff pressure (2-3 mm per second) by slowly opening the air-release knob (counterclockwise turn).
10. Note the pressure when you hear the first sound (this represents SBP).
11.Continue to reduce cuff pressure, noting when the sound muffles and when it disappears (which is when clinicians usually record DBP); then release all the air from the cuff.
47
What are the 8 Vertical lines of thorax?
1. Midsternal Line: A vertical line down to middle of sternum
2. Parasternal/ Lateral Sternal Line: A vertical line along lateral edge of sternum
3. Mid-clavicular Line: A vertical line from middle of clavicle.
4. Anterior axillary line: A vertical line along anterior axillary fold.
5. Mid-axillary line: drops vertically from the APEX of the axilla.
6. Posterior axillary line: drops vertically from the posterior axillary fold.
7. Scapular line: drops from the inferior angle of the scapula
8. Vertebral line: overlies the spinous process in the midline
48
Where is the superior border of lungs?
The apex of each lung rises approximately 2 to 4 cm above the inner 1/3 of the clavicle.
49
Where is the medial border of lungs?
Along the parasternal line
50
Where is the inferior border of lungs?
Crosses the 6th rib at the mid-clavicular line.
51
Where is the lateral border of lungs?
Crosses the 8th rib at the mid-axillary line.
52
Where is the posterior border of lungs?
At the 10th rib/T10 spinous process.
53
Which fissure is present in both lungs and divides the lung into an upper and lower lobes?
Oblique fissure
54
What fissure is only present in the right lung?
Horizontal fissure
55
What is the pathway of the oblique fissure?
1. From T3 spinous process
2. Obliquely down and around chest
3. To the 6th rib at the mid-clavicular line
56
What is the pathway of the horizontal fissure?
1. From the 4th rib
2. Meets oblique fissure in the mid-axillary line at 5th rib.
57
How many lobes do lungs have?
- Right Lung has 3 lobes.
- Left lung has 2 lobes.
58
What does IPPA stand for?
- Inspection
- Percussion
- Palpation
- Auscultation
59
What is included in the Inspection step of IPPA?
1. Patient is comfortable and alert
2. Skin is pink and healthy - no scars, bruises or swelling
3. Check for cyanosis of lips
4. No digital clubbing
5. Check for accessory muscles of respiration (neck) being recruited or prominent
6. Chest wall configuration
60
What is a normal chest wall configuration?
Anteroposterior (AP) to lateral diameter is 1:2
61
What is a barrel chest?
The ribs become more horizontal & the AP diameter increases.
62
What is kyphosis?
A curving of the spine that causes a bowing or rounding of the back and forwardly tilted head.
63
What is Pectus excavatum?
Depressed lower sternum
64
What is Pectus carinatum?
Prominent upper sternum
65
What is included in Palpation step of IPPA?
- Tenderness
- Abnormalities
- Chest wall excursion ***
- Edema
- Tactile Fremitis ***
- Tracheal deviation
66
What hand positions are used in chest wall excursion?
1. Hands are placed over the anterior chest. The heel of the hand is at about the level of the 4th rib and the fingertips reach toward the upper traps. The thumbs are on the sternal angle in the mid-line. (Upper lobe)
2. Hands placed with the palms distal to the nipple line and thumbs meeting in the midline. The fingers lie in the posterior axillary fold. (R middle & L lingular lobe)
3. Hands are placed flat on the posterior chest wall at the level of 10th rib. Thumbs meet at the midline, fingers reaching toward the anterior axillary fold. (Lower lobe)
67
What is Tactile Fremitus?
- Spoken words produce vibration over the chest wall ("99")
- PT can feel this using hands on the clients chest.
- Presence or absence provides information about density of underlying lungs and thoracic cavity.
68
How do you manage breast tissue during lung assessments?
- Adequately inform client about goal of assessment and what it entails.
- Clearly explain what you are planning to do & ask for permission.
- Ask person to gently displace their breast tissue upwards or laterally to allow for proper placement of the stethoscope diaphragm on the chest wall.
- You may also demonstrate on yourself or mime the motion to show the client what you would like then to do.
69
What locations is used for tactile fremitus?
- 3 locations on anterior/lateral chest.
- 3 locations on the posterior chest.
70
What is Auscultation?
The ability to listen to lung sounds using a Stethoscope.
71
What is the diaphragm of the stethoscope used for?
- Works by listening to vibrating BODY sounds
- Picks up HIGH Frequency sounds better (LUNG sounds)
72
What is the bell of the stethoscope used for?
- Works by listening to vibrating SKIN sounds
- Picks up LOW Frequency sounds better (used more for HEART sounds)
73
What are General Practices for Auscultation?
- Direct access to skin is required, firm pressure on the chest wall
- Quiet environment if possible
- Upright position if possible
- Instruct patient to take a ‘deep’ (larger breath than normal) inspiration/ expiration
- Open Mouth breathing
- Allow patient to take a rest in between breaths as needed.
- Make sure patient does not get light-headed or dizzy
- Deep breath can be in/out through nose/ mouth or in/out through mouth.
74
Where do you listen for auscultation?
- Anterior - 6 segments per side (4 mid-line, 2 lateral to nipple, highest above the clavicle, lowest at level of xiphoid)
- Posterior - 7 segments per side (5 mid-line, 2 lateral, highest on traps, lowest at level of T10)
75
T/F:
With Auscultation, compare symmetric pulmonary segments between lungs in a “Ladder-Like” pattern.
True
76
What is a normal breath sound called?
Vesicular
77
What is a Bronchial sound?
- Harsh, hollow, high pitched
- Heard over trachea or manubrium (NORMAL), heard anywhere else in the lungs is ABNORMAL
- Expiration sounds lasts longer and louder than inspiration sound
- Distinct pause between inspiration and expiration.
78
What is a Vesicular sound?
- Soft, low pitched
- Heard over most of lung fields (where alveoli are present)
- Typically heard during inspiration and first 1/3 of expiration
- No distinct pause between inspiration and expiration
- Might be softer in people with more muscle or adipose tissue
79
What is the Percussion step in IPPA?
- Striking the chest wall produces vibrations in
underlying structures that in turn give rise to sound waves or percussion tones.
- Allows PT to access the density of underlying organs.
80
What is the percussion technique?
- Middle finger, non-dominant hand, placed firmly on chest wall
- Intercostal space, parallel to ribs
- Strikes distal phalanx of stationary hand
- Use middle finger (or two fingers), dominant hand
- Use finger tips
- Quick, sharp motion
- From the wrist (rather than the elbow)
- Follow SAME sequence as auscultation
- Main aim is to compare side to side
81
What are Resonant sounds?
- Loud
- Low pitch
- Longer duration
- Heard over air-filled organs (such as the lungs)
82
What are Dull sounds?
- Low amplitude
- Medium to high pitch
- Short duration
- Heard over solid organs (such as the liver)
83
What are Tympanic sounds?
- High pitch
- Medium duration
- Heard over hallow structures (such as stomach)
84
What are Flat sounds?
- High pitch
- Short duration
- Heard over muscle mass (such as thigh)
85
What are the 7 questions of 2020 PAR-Q+?
1. Diagnosis of heart condition or high BP?
2. Chest pain at rest, ADL or PA
3. Loss of balance due to dizziness or loss of consciousness in the last 12 months?
4. Diagnosis of other chronic medical condition?
5. Taking prescription medication for chronic medical condition?
6. Any bone, joint or soft tissue problem (in last 12 months) that could become worse with PA?
7. Ever been told to only do MEDICALLY SUPERVISED PA?
86
When does a patient who does NOT participate in regular exercise require medical clearance to participate in PA?
- Has known CV, metabolic or renal disease AND asymptomatic
- Has any signs or symptoms suggestive of CV, metabolic or renal disease (regardless of disease status)
87
What is the protocol if a patient participates in regular activity and has an asymptomatic known CV, metabolic or renal disease?
- Medical clearance for MODERATE intensity exercise is NOT necessary.
- Medical clearance (within last 12 month if no change in sign/symptoms) recommended before engaging in VIGOROUS exercise.
88
What is the protocol if a patient who participates in regular exercise is having signs and symptoms suggestive of CV, metabolic or renal disease?
- Discontinue exercise and seek medical clearance
89
T/F:
Adult Trachea is approximately 12 cm
long and a diameter of 1.8 cm.
True
90
Which side is the trachea slanted towards?
Right
91
Where does the trachea start from?
Crocoid process
92
Where does the trachea end posteriorly?
T4 spinous process
93
What are the characteristics of Right bronchus?
- Shorter, wider & more vertical
- Branches off from trachea at an angle of 20-30 degrees.
94
What are the characteristics of Left bronchus?
- Longer & more horizontal (due to position of the heart)
- Branches off from trachea at an angle of 45-55 degrees.
95
What is the outline of the diaphragm?
1) Anteriorly: xiphoid process and 7-10th costal margin
2) Laterally: 11th and 12th ribs
3) Posteriorly: bodies of L1-3
96
What are the 3 accessory muscles of inspiration?
1. SCM
2. Scalenes
3. External intercostals
97
What is the normal chest wall excursion in young adults between 20-30 years old?
approximately 8.5 cm
98
T/F:
Chest wall excursion decreases with age.
True
99
PHTH 514 - Core Skills
flashcards
Decks in class (12)
# Cards
-
The Therapist, Environment & Client40
-
Massage & Soft Tissue Techniques31
-
Cardiorespiratory99
-
Mobility65
-
Mobility and Care for People Living with Obesity42
-
Wheelchair & Seating37
-
Ambulation Aids90
-
Range of Motion56
-
Range of Motion Measurement25
-
Manual Muscle Testing (MMT)58
-
Exercise Prescription I60
-
Exercise Prescription II36
