MidTerm

Question 1

Airborne Precautions - MTV

Answer 1

M - measles

T - TB

V - varicella (private room)

Question 2

Body Mechanics Guidelines

Answer 2

• Plan ahead
• Position yourself close to the load
• Test the load before lifting!
• Maintain a wide BoS
• Maintain normal spine curvature whenever possible
• Bend the hips and knees
• Exhale during exertion
• Avoid twisting at the trunk, particularly when the trunk is flexed
• Push rather than pull when possible
• Get help if needed!

Question 3

How often should we change a dependent patient’s position?

Answer 3

Every 2 hours

Question 4

Symptoms of Aneurysm

Answer 4

Question 5

Max A

Answer 5

Maximum Assistance - Patient doing 25% of the work, PT doing 75%

Should be in front of patient for Max A

Question 6

Nervous System Division

Answer 6

Question 7

What is thermanalgesia?

Answer 7

Loss of the temperature sense or of the ability to distinguish between heat and cold; insensibility to heat or to temperature changes.

Question 8

Long-Term Positioning Checklist

Answer 8

• Clear airway
• Good spinal alignment
• Minimize pressure over bony prominences
• Minimize gravity creating shearing forces
• Cushioned support surfaces to minimize pressure
• Immobile extremities elevated
• Positioned to prevent joint and soft tissue contractures
• Support and stability provided for trunk extremities
• Positioned to allow patient maximum long-term function
• Positioned to optimize interaction with the environment
• Special needs accommodated

Question 9

Mod A

Answer 9

Moderate Assistance - Patient doing 50% of the work, PT doing 50%

Question 10

Contact Precautions - Mrs. Wee

Answer 10

M - multidrug resistant organism

R - respiratory infection

S - skin infections

W - wound infections

E - enteric (c. diff)

E - eye infection - conjunctivitis

Question 11

Brachial Pulse

Answer 11

In the antebrachial fossa, just medial to the biceps brachii tendon

<1 year: Upper extremity musculature is not sufficiently developed to interfere with brachial artery palpation. During emergencies, direct auscultation is a faster and more accurate method than palpation.

Question 12

Signs and Symptoms of Myocardial Infarction

Answer 12

Question 13

Airborne Precautions

Answer 13

• Chickenpox
• Disseminated herpes zoster (shingles)
• Measles

N-95 Mask:

• Tuberculosis
• SARS
• Avian influenza

Question 14

DT Grading

Answer 14

4+ Very brisk

3+ Brisker than average

2+ Average, normal

1+ Diminished, low normal

0 No response

Question 15

If lateral assessment shows forward head and rounded shoulders, what would you expect on posterior assessment?

Answer 15

Question 16

Portals of Entry

Answer 16

• Penetration: a foreign body allowing bacteria entry into internal body cavities. eg. Medical: Catheterization, surgical drains, or Trauma: wooden sliver or metal spike breaks the skin
• Direct contact: transmission via touch, person-person (person with contaminated hands touching another person) or person-contaminated contact surface (doorknob, tap etc.)
• Ingestion: consumption of contaminated, toxin-laden foods (Salmonella), poisonous plants or chemicals
• Inhalation: air-borne contaminants are inhaled into the lungs and respiratory tract. pathogens such as fungal spores or microbes, toxins, aerosol droplets of contaminated bodily fluids (sputum from a cough).

Question 17

Host Reservoir

Answer 17

The reservoir of an infectious agent is the habitat in which the agent normally lives, grows, and multiplies. Reservoirs include humans, animals, and the environment.

Question 18

Orthostatic Hypotension

Answer 18

• AKA Postural hypotension
• Occurs when there is a decrease in BP of at least 20 mmHg systolic and 10 mmHg diastolic within 3 min of standing up (or from supine to sit)
• Failure of the systolic pressure to increase with increasing workload
• All should result in immediate cessation of activity!!
• Can be associated with:
  
  • Cardiac abnormalities
  • Decreases in cardiac blood volume (venous pooling)
  • Use of certain pharmacological drugs (ie. HTN drugs)
  • Central, peripheral, autonomic nervous system disorders (TBI, DM, SCI)

Question 19

Pressure Ulcers - Predisposing Factors

Answer 19

• Inability to move independently
• History of skin breakdown
• Bladder and/or bowel incontinence
• Absent or impaired sensation
• Fragile or friable skin
• Impaired circulation
• Cachexia - a condition of severe weight loss including muscle wasting
• Muscle atrophy
• Postural impairments
• Nutritional deficits
• Impaired cognitive ability
• Medication use that affects mobility or awareness
• Friction and shear (consider when moving/transferring patients! - avoid bed elevation > 30º)

Question 20

Calculate Max HR and Percentage for target HR during exercise

Answer 20

• Maximal HR: the maximum recommended physiological intensity for a given individual during exercise
• Estimated Maximum HR = 220 - the person’s age
• Target HR: specific range of HR intensity to achieve aerobic training effect
• Target HR = Maximum HR * Desired intensity (%)

Question 21

Dorsalis Pedis Pulse

Answer 21

Question 22

Carotid Pulse

Answer 22

Place the fingers just to the side of the larynx (Adam’s apple) and medial to the SCM

Question 23

Where would a patient receive a nosocomial infection?

Answer 23

From the hospital

Question 24

Detrimental Effects of Bedrest

Answer 24

• Loss of muscle mass
• Poor respiratory function
• Poor cardiac function - orthostatic hypotension
• Pressure ulcers
• Poor swallowing function - aspiration

Question 25

**This is what the** **practical** **will look like...**

Answer 25

* Hand hygiene, PPE if necessary * Introduction: Student Physical Therapist Assistant * Patient Name and DOB * Explanation of testing * Sensation - protective response * Proprioception/Kinesthesia - balance LE's -functional use of arms without looking - UE's * Any questions? * Obtain consent

Question 26

**Lateral Transfer with Transfer Board**

Answer 26

Question 27

**Popliteal Pulse**

Answer 27

Question 28

**Min A**

Answer 28

Minimal Assistance - Patient is doing 75% of work, PT doing 25% ## Footnote **DO NOT let go of the patient!**

Question 29

**Contact Precautions**

Answer 29

* MRSA (mask if respiratory infection) * VRE * Adenovirus * Diarrhea * C. Difficile * Rotavirus * E.Coli 0157 * Enterovirus * Salmonella * Shigella * Hepatitis A * Herpes Zoster (shingles, localized) * Herpes simplex * Parainfluenza (mask if coughing) * RSV (mask if productive cough) * Lice * Scabies * Chickenpox (symptomatic, until all lesions crusted and dried

Question 30

**Long-Term Positioning**

Answer 30

* Used when people are unable to move voluntarily in a way that maintains optimal health * Extended periods of immobility (coma, severe traumatic injury with/without surgical intervention, etc.)

Question 31

**Femoral Pulse**

Answer 31

Question 32

**Factors Affecting Heart Rate**

Answer 32

* Age * Gender * Activity * Autonomic Nervous System * Environment * Drugs

Question 33

**Homunculus**

Answer 33

Question 34

**Pressure Ulcers - Biomechanical Factors**

Answer 34

* Load - patient's body weight * Pressure - surface area over which the body weight is distributed * Time - duration in a particular position

Question 35

**Infectious Agents**

Answer 35

* Bacteria * Virus * Protozoan * Fungus * Helminth

Question 36

**Long-Term Positioning - Objectives**

Answer 36

* Safety * Prevention - prevent negative effects of long-term immobility (ex: wounds, burns) * Promotes cardiovascular function * Promotes pulmonary hygiene * Patient comfort * Pillows, small bolsters, specialized foam supports as appropriate

Question 37

**Susceptible Host**

Answer 37

An organism capable of contracting a specific disease

Question 38

**Standard Precautions**

Answer 38

* CMV * HIV * Hepatitis B and C * Aspergillosis

Question 39

**Repositioning and Skin Inspection**

Answer 39

* Upon repositioning, check the patient's skin color and integrity after the first 5-10 minutes (blanching test) * Pay careful attention to areas of skin covering bony areas/prominences

Question 40

**How to record BP**

Answer 40

Question 41

**Dependent/Total Assist**

Answer 41

Go get a mechanical lift or more people

Question 42

**Squat Pivot Transfers**

Answer 42

Question 43

**Short-Term Positioning Checklist**

Answer 43

* Patient is safe * Good spinal alignment * Accessibility of necessary areas of the body * Trunk and extremities supported for comfort * Positioned to optimize interaction with the environment * Special needs accommodated

Question 44

**Radial Pulse**

Answer 44

Place fingers over the distal artery on the lateral (thumb) side of the anterior surface of the wrist

Question 45

**Droplet Precautions - SPIDERMAN**

Answer 45

**S** - sepsis/scarlet fever/streptococcal pharyngitis **P** - parvovirus B19/pneumonia/pertussis **I** - influenza **D** - diphtheria (pharyngeal) **E** - epiglottitis **R** - Rubella **M** - mumps/meningitis/mycoplasma **An** - adenovirus

Question 46

**Purpose of Draping**

Answer 46

* Protection of patient's modesty & dignity * Warmth & comfort * Protection of vulnerable skin (wounds, surgical sites, scars, neurologically impaired areas) * Protection of patient's clothing

Question 47

**Droplet Precautions**

Answer 47

* Pertussis * Influenza A or B MRSA (respiratory infection) * Neissera meningitides (suspected or confirmed) * Coxsackie * Bacterial meningitis (for 24 hours after effective antibiotic therapy) * RSV (droplet and contact) * Mumps * Rubella

Question 48

**What is a pathogen?**

Answer 48

A specific causative agent (such as a bacterium or virus) of disease​

Question 49

**Positioning Devices**

Answer 49

* Completely alleviate pressure on an area * Prevent certain contraindicated motions or positions (example: s/p THA) * Provide additional cushioning for vulnerable areas such as bony prominences * **Positioning devices DO NOT take the place of proper patient positioning!** * Regardless of whether or not cushions or more custom-made supports are utilized, **patient positioning** is key! * Cushions alone do not allow sufficient pressure distribution to prevent skin breakdown!

Question 50

**Short-Term Positioning**

Answer 50

* Safety * Patient comfort * Therapist access