Rehab Tech. Exam 2

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  1. what is the number 1 cause for amputations?
    PVD associated with smoking and DM
  2. where would you find a disarticulation amputation?
    at the joint line
  3. where is the disarticulation for the toe?
    MTP joint
  4. what is the resection for a partial foot?
    3rd, 4th, 5th metatarsals
  5. what is symes?
    ankle disarticulation with attachment of heel pad to distal end of tibia
  6. what is a long transtibial?
    • BKA
    • more than 50% of tibial length remains
  7. what is a transtibial?
    between 20-50% of tibial length remain
  8. what is a short transtibial?
    20% or less of tibia remains
  9. what is a knee disarticulation?
    amputation of the knee joint; femur remains intact
  10. what is a long transfemoral?
    • AKA
    • more than 60% of femur remains
  11. what is a transfemoral?
    between 30-60% of femur remains
  12. what is a short transfemoral?
    less than 35% of femur remains
  13. what is a hip disarticulation?
    amputation through the hip joint; pelvis remains intact
  14. what is a hemipelvectomy?
    • resection of the lower half of the pelvis 
    • ischium gone; ilium intact
  15. what is a hemicorporectomy?
    amputation of both lower limbs and pelvis below L4-5
  16. what three things must be considered before the type of amputation is chosen?
    • optimal healing
    • optimal prostesis fit and function
    • stabilization of major muscles
  17. the skin flap on a residual limb must have what three qualitities?
    • nonadherent
    • pliable
    • painless
  18. what is a major concern after an amputation?
    sepsis; infection
  19. what are some of the factors that can influence healing after an amputation?
    • premorbid conditions: DM, cardiac disease, renal disease, 
    • smoking
  20. what are the two phases of the postoperative program after amputation?
    • phase 1: post surgical; from surgery -> fitting of prosthesis
    • phase 2: prosthetic phase; learning to use the permanent replacement limb
  21. what are some of the goals for the postoperative phase after amputation?
    • I bed mob & t/f
    • I with wc and self care
    • demo proper residual limb positioning, bandaging and care
    • mod-min A short distance gait with walker or crutches
  22. what are the post op dressings used mainly for?
    edema control
  23. how would you instruct a patient to wrap their residual limb?
    start at the top and pull down in a diagnal direction and wrap around the back in a figure 8 shape putting more tension at the bottom. Make sure to cover every inch of skin and that there are no wrinkles in the elastic.
  24. how would a patient typically describe their phantom limb pain?
    tingling, burning, itching, pressure, cramping, squeezing, shooting or burning pain
  25. up to ______% of amputees complain of phantom limb pain
  26. what are some other considerations to have when treating amputees?
    • functional status
    • emotional status
    • financial status
    • family support
  27. your treatment with an amputee would include what kind of activities?
    • residual limb care and wrapping
    • shrinkers
    • positioning
    • management of contractures
    • ther ex
  28. what is the purpose of a partial foot prosthesis?
    • restore as much of the foot function as possible 
    • simulate as much of the shape of the missing foot segment
  29. what do transtibial and symes prosthesis have in common?
    both retain the natural knee, motor and sensory function
  30. what are the basic componets of a transtibial and symes prosthesis?
    • foot-ankle assembly
    • rotators
    • shank
    • socket
  31. what is the difference between an articulated and non-articulated prosthesis?
    • the articulated has an ankle joint
    • there is some movement with the nonarticulated, but there is more with the articulated which makes it better to the younger, more active populatin
  32. why is the nonarticulated prosthesis more popular?
    • lighter, more durable, more attractive
    • some even fit high heel shoes
  33. what are the 3 types foot prosthetics?
    • SACH: solid ankle cushion heel
    • SAFE: stationary attachment flexibe endoskeleton
    • carbon copy II: funny skis
  34. which type is the most popular foot prosthetic?
    • SACH
    • comes in a wide array of sizes
    • allows for minimal medal lateral motions
  35. what is the differences between the SACH and SAFE foot?
    the safe allows for more medial lateral motion, is heavier, and more expensive
  36. the foot assembly is chosen with what three things to consider?
    • patients age and lifestyle/activity level
    • weight
    • length of residual limb
  37. what are the rotators?
    • component placed above the prosthetic foot to absorb shock in the transverse plane
    • protects skin from chafing 
    • mostly used by very active individuals
  38. what is the shank?
    sub for the leg
  39. what are the two types of shanks?
    • exoskeletal (crustacean)
    • endoskeletal (modular)
  40. why do symes prothesis not have a shank?
  41. describe an exoskeltal shank
    • made of wood or rigid plastic
    • simulates the look of a lower leg
    • very durable, water proof
    • dont permit for changes in angulation > less prescribed
  42. describe and endoskeletal shank
    • made of central aluminum pylon
    • cosmetic cover to appear like the natural lower leg
    • angulation abilities, more comfort and easier to walk with
  43. what is the socket?
    receptacle where the amputated limb sits
  44. how the socket designed?
    contact all portions of the amputated limb which allows for maximal load distribution
  45. what is a lined socket?
    • foam liner that cushions the residual limb
    • is removable and insulates heat
  46. how would you make an unlined socket more comfortable?
    liner socks and cushion placed at the bottom  of the socket
  47. what are the 5 different ways of suspending the prosthesis?
    • cuffs
    • rubber sleeve: need strong hands and no excessive adipose
    • brim variants: supracondylar suspension
    • thigh corset: increases frontal plane stability, prone to pistioning
    • sheath with distal metal pin: very secure
  48. what is the most commonly used foot with the transfemoral prosthetic?
  49. what are the 4 main features of the knee joint replacement?
    • axis
    • friction mechanism
    • extension aid
    • mechanical stabilizer

    not all knees have all 4
  50. what is the purpose of the knee joint replacement?
    • allows the patient to bend during sitting and kneeling
    • allows for knee flexion during the later stance phase throughout swing phase
  51. what is the knee axis?
    connects the thigh piece to the shank
  52. what is the most common type of knee axis?
  53. what is the friction mechanism of the knee?
    changes the knee swing by modifying the speed of knee motion during swing phase according to the walking speed
  54. what happens if the knee friction is not modulated?
    excessive knee flexion at the beginning of swing phase and vice versa
  55. what is the extension aid of the knee?
    mechanism to assist knee extension during the latter part of swing phase
  56. Do most knee's have stabilizers?
  57. what do the knees depend on for stabilization mostly?
    hip musculature
  58. what is suction suspension?
    atmospheric pressure causes the socket to remain on the thigh.
  59. what are the two grades of suction suspension?
    • total: maximal control
    • partial: wearer uses socks and an external suspension aid
  60. when might you see the patient for physical therapy due to amputation?
    pre amputation (if available) and post amputation
  61. what do you examine the prosthesis for once the patient receives it?
    fit and function in standing and gait
  62. what does the prosthetic training include?
    • socks and sheaths
    • donning and doffing
    • balance
    • gait 
    • transfers, curbs, ramps
    • pt education & skin inspection
  63. what are the three tunics of the blood vessles?
    • tunica adventitia: outer most
    • tunica media: middle
    • tunica intima: inner most
  64. what are the three types of arteries?
    • large elastic
    • medium muscular 
    • small arteries and arterioles
  65. describe large arteries
    • elastic
    • receive blood from the ventricles and pumps it to the medium arteries 
    • ex: aorta
  66. describe medium arteries
    • distributing arteries
    • walls consist of circular smooth muscle
    • have the ablility to vasocontstrict
    • ex: brachial, femoral
  67. describe small arteries and arterioles
    • have narrow lumnia and thick muscular walls
    • have no name and arterioles can only be seen under a microscope
  68. what is the difference between veins and arteries when it comes to their tunics?
    tunica media is thinner in the companion veins
  69. do veins pulsate or spurt blood when severed?
  70. what are the three types of veins?
    • venules
    • medium
    • large
  71. describe the venules
    smallest veins that drain capillary beds that join similar vessles to form small veins that form venous plexuses
  72. describe medium veins
    • accompany medium arteries (which they are named after) and drain venous plexuses
    •  in the limbs that contain venous valves that pump blood towards the heart
  73. describe a large vein
    wide bundles of longtiduinal smooth muscle and well developed tunica adeventita
  74. T/F: there are more arteries than veins. 

    T/F: the walls of veins are thinner than arteries, but veins are bigger than arteries
    • 1: false
    • 2: true
  75. what are simple endothelial tubes connecting the arterial and venous circulation and are arranged in beds/networks
    blood capillaries
  76. what is the purpose of capillary beds?
    allow for the exchange of materials in the extracellular space
  77. what is an "over flow system" for surplus tissue fluid and leaked plasma proteins in the extracellular space that is responsible for removal of debris form cellular breakdown and infection and is essential for survival?
    lymphoid system
  78. what are the components of the lymphatic system?
    lymph plexuses, vessles, nodes, lymphocytes, lymph fluid, lyphoid organs
  79. what are lymphoid plexus?
    lymphatic capillaries that origninate in extracellular space of most tissues that are formed by endothelium and are lacking a basement membrane
  80. describe the lymph vessels
    body wide network of thin walled vessles that contain valves which give lymph the beaded like appearance and they appear everywhere blood capillaries are found
  81. what is lymph fluid
    "blood plasma of the immune system"
  82. what are the lymph nodes?
    small mases of lymphatic tissue along the course of the lymph vessles that filters lymph on its way to the venous system
  83. what are circulating immune cells?
  84. what are the lymph organs?
    • organs that produce lymphocytes
    • thymus, red bone marrow, spleen, tonsils
  85. what is insulin?
    hormone produced in the pancreas that normally maintains balanced blood glucose level
  86. what is IDDM?
    • insulin dependent DM
    • 10% of pop
    • type 1; juvenile
    • absolute deficiency in insulin
  87. what is NIDDM?
    • non insulin dependent DM
    • 90% of pop (80% overweight)
    • type 2; adult
    • resistance to insulin action
  88. DM is the leading cause for what two pathologies?
    blindness and renal failure
  89. DM can cause what other pathologies?
    • heart disease
    • stroke
    • kidney disease
    • blindness
    • amputation
  90. what type of neuropathies can a DM patient develop?
    • sensory
    • motor
    • autonomic
  91. what are the cardinal signs of type 1 DM?
    • excessive urination
    • excessive thirst
    • excessive hunger
    • weight loss
    • fatigue
  92. what are the cardinal signs for type 2 DM?
    • everything the same as type 1 but also with
    • blurred vision
    • cuts and bruises that heal slowly
    • tingling, numbness in and and feet
    • or NO s/s
  93. what are some of the long term effects of DM?
    • vascular problems, retinopathy, kidney disease, peripheral neuropathy
    • atherosclerosis
    • impaired resistance to infection
    • neuropathies
    • osteoporosis
    • ulcers
  94. what does the medical management of DM include?
    • insulin administration
    • dietary management 
    • planned exercises
  95. what are some of the safety concerns for DM patients?
    • higher incidence of injuries
    • heal slower
    • poor vision
    • ulcers due to neuopathy
    • hypo/hyper-glycemia
  96. what is insulin shock or too much insulin?
  97. what would a patient that was hypoglycemic present like?
    • c/o feeling "faint"
    • shaky
    • confused
    • clammy skin
  98. what would you do for a patient who was hypoglcemic?
    provide carb snack like fruit juice, honey, hard candy
  99. what also might cause hypoglycemia?
    • overdoes of insulin
    • late or skipped meal
    • over exercise
  100. what is hyperglycemia?
    too little insulin; diabetic comea
  101. what might also cause hyperglycemia?
    skipped or delayed insulin injection or too much food
  102. how would a hyperglycemic patient present?
    dehydrated, intense thirst, abdominal pain, nausea and vomiting, lethargy, deep and slow breathing, fruity breath, red and dry skin
  103. what are some of the precautions for working with a diabetic patient?
    • obeserve for s/s of problems
    • be aware of food intake and insulin adminstration prior to treatment
    • at least one hour after meal
    • replace fluid loss adequately 
    • take glucose q 30min
  104. how would instruct a DM patient on foot self care?
    • daily inspection
    • proper footwear
    • minimize trauma (no barefoot, flip flops or hot cement)
    • maintain strength (pen pennies)
  105. what are some other things you would want to educate your DM patient on?
    • burn precautions with local heat
    • any heat accelerates the rate of insulin absorption; no heat before 15 min after insulin
  106. what is young-old?
  107. what is middle old?
  108. what is oldest old?
  109. the branch of medicine that treats all problems perculiar to old age and the aging, including the problems of senescence and senility
  110. the scientific study of the problems of aging in all their aspects; clinical, biological, historical, and sociological
  111. the gradual changes in the structure of any organism that occur with the passage of time that do not result form disease or other gross accidents and eventually lead to the increased probability of death
  112. older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or tother other infirmity; those who require help
    frail elders
  113. prejudice or discrimination against people of a particular age and especially older adults
  114. the observed age at death of an indvidual
    life span
  115. the highest documented age was ______ and her name was?
    • 122
    • Mme. Jeanne Calment of Aries France
  116. the number of years based on stastical averages that a given person of a secific age or class may reasonably expect to continue living; the average number of years from birth that an individual can expect to live
    life expectancy
  117. a diseased condition or state; the incidence or prevelance of disease or of all diseases in a population, the relative incidence of disease
  118. the quality or state of being mortal; death the number of deaths in a given time or place; the proportion of deaths to population
  119. the presence of coexisting or additional diseases with reference to an additional diagnosis with reference to the index condition that is the subject of study.
  120. what theory believes that aging follows a biological timetable, perhaps a continuation of the one that regulates childhood growth and development
    programmed theories
  121. what theory believes that environmental assaults to our systems gradually cause things to go wrong.
    damage or error theories
  122. aging causes the body to respond differently to what?
    • disease
    • medications
    • changes in the environment
  123. what are some of the concerns with aging?
    • co-morbidities
    • polypharmacy
    • living longer with cardiac disease, DM or other chronic disease
    • cognitive changes
  124. on average, a 75 y/o has ____ chronic medical conditions and take ____ Rx.
    • 3
    • 5
  125. what are some of the age related changes that can affect the nurtiritinal status of your patient?
    • decreased saliva
    • poor dentation
    • decrements of taste and olfaction
    • gastromucosal atrophy
    • reduced intestional mobility
  126. what is sarcopenia?
    age related loss of lean muscle mass
  127. why is obesity common in the older adult?
    • decreased activity, medication, poor diet
    • can also be impacted by arthritis, HTN, heart disease, and DM
  128. what type of diet should the older adult consume?
    nutrient rich, higher quality diet
  129. how can medications affect the nutritional status of the older adult?
    • impact on appetite
    • absorption
    • metabolism
    • excretion of nutrients
  130. what are some of the cognitive changes the older adult may have to face?
    • problem solving declines with age, may be due to educational level and fluid intelligence
    • encoding and retrieval problems cause memory difficulties 
    • short term memory stores seem to have a limited capacity whereas long term memory stores have unlimited capacity
  131. what are the major risk factors for cognitive changes in the older adult?
    • age
    • genetics
    • family history
    • lifestyle
  132. how can we slow down the cognitive decline in older adults?
    • nutrition and supplemntation
    • -15-20% fat diet
    • vitamin E, DHA, ginkgo,
    • Stress management 
  133. how can we maintain cognitive abilites in the older adult?
    • exercise:ncreases blood flow and releases endorphins
    • perscriptions 
    • brain exercise: neuorplasticity
  134. what can we do to improve the cognitive performance of a older patient?
    • orderly environment
    • simple, concrete instructions 
    • appropriate rate
    • meaningful tasks 
    • ample time for practice and repetition
  135. T/F: sudden loss of mental acuity may be due to acute illness, infection, MI, or CVA
  136. what are some of the condtions that can cause reversible dementia?
    • drug reactions
    • dehydration
    • depression
    • infections
    • malnutrition 
    • post trauma/surgery
  137. what are some of the things you would see if your patient was experenceing a congnitive decline?
    • changes in sensory perception
    • loss of memory
    • ADL's performed more slowly
    • learning of new skills is slower
  138. what are some of the psychosocial aspects of aging?
    • depression in many forms 
    • social isolation
  139. what are some of the age related musculoskeletal changes?
    • joint capsules, ligaments, tendons lose elasticity 
    • joint cartilage loses water, wears down
    • joints lose ROM, flexors particulary shorten 
    • pain may hamper mobility 
    • osteoporosis risks
  140. what are balance issues due to with the older adult?
    • decreased vision, proprioception, ROM and strength
    • longer reaction time
    • disease related impairments
  141. what are some of the tests you might do to access the patients balance?
    • berg
    • tug
    • tinetti
  142. what is a major cause for accidental deaths among the elderly?
  143. T/F: not all falls are preventable
  144. what are some of the risk factors for falls among the elderly?
    • balance problems, vestibular dysfuntion
    • decreased hearing and vision
    • proprioceptive loss
    • depression
    • neurological (dementia, CVA)
    • foot problems; shoe problems 
    • medications 
    • anxiety due to previous falls 
    • inactivity 
    • UI
  145. what is a metabolic disease that results in decreased bone mass causing weakened bone and increased susceptibility to fracture
  146. what are the 2 types of osteoporosis?
    • primary: idopathic, post-menopausal, senile
    • secondary: underlying disease (CA, alcoholoism) or medication use (long term corticosteroid use; autoimmune)
  147. what are some of the risk factors for osteoporois?
    • age
    • menopause
    • genetic
    • little white women
    • inactivity
    • tobacco or alcohol use
    • depression
  148. what are some of the dietary risk factors for osteoporosis?
    • deficient Ca, vitamind D, magnesium 
    • high fat diets
    • high sugar intake
    • high intake of Ca deficient beverages (soda, coffee)
    • eating disorders
    • crash diets
  149. what are some of the comorbidities that would increase the risk of osteoporosis?
    • renal disease
    • cancer
    • diabetes
    • endocrine
  150. waht is bone mineral density testing done for?
  151. what are some of the treatment options for osteoporosis?
    meds, hormone replacement, calcitonins, fall prevention and education, exercise and proper nutrition
  152. nonadherance to prescriptions among the elderly is most commonly due to what?
    • convenience 
    • desire to reduce adverse affects
    • cost of meds
  153. what are the most common adverse affects of medications?
    • postural hypotension
    • fatigue
    • weakness
    • depression
    • confusion
    • movement disorders
    • incontinence
    • dizziness
    • depressed appetite
    • nausea and vomiting
    • diarrhea
    • interference with metabolism of nutrients
  154. what is the use of more than one medication to achieve a therapeutic goal, use or administration of more drugs that clinically indicated?
  155. what are some risks for polypharmacy?
    • decreased vision
    • memory decline
    • altered function-arthritic hands
    • altered absorption, distribution, clearance of drugs in older body
    • comorbidities
    • chronic illness
    • multiple healthcare providers
    • number of Rx drugs, doeses per day
    • self medication
    • adverse drug reactions may mimic typical image of aging-dizziness, confusion, falls, fatigue, incontince
  156. what are some of the outcomes of polypharmacy?
    • adverse drug reactions
    • drug-drug reactions
    • unnecessary cost
  157. how can you be proactive in reducing the chances for polypharmacy?
    • ask patient to ID all meds and to bring them in a brown bag to their visit. 
    • always ask your patient if they have been to the doctor and had a change in Rx regimen
    • coordinate care among health care teams
  158. what is the most common adult psychiatric disorder?
  159. what is depression?
    morbid sadness, dejection or melancholy
  160. depression is associated with what?
    numerous physical condtions, drugs, and somatic symptoms
  161. what are some s/s of clinical depression?
    • depressed mood, loss of interest daily for >2 weeks
    • persistence of s/s for >2 months following loss
    • sleep disturbances, restlessness, fatigue
    • feelings of worthlessness, guilt
    • decreased concentration and decision making ability
    • recurrent thoughts of suicide
  162. what are some of the risk factors for clinical depression?
    • previous history
    • family history
    • medical history
    • medications
    • age (most common in the elderly)
  163. when worried about suicide, what are the most important things to look for?
    • "i dont know how much longer i can take this" statements
    • plan
    • resources
    • abrupt improvement in mood (thats when they decide today is the day)
  164. what is the M0590 from Oasis?
    depressive feelings reported or observed in patient and they mark (or you) that apply
  165. what is the geriatric depression scale?
    short form with 15 questions that are answered with yes/no. A score above 5 indicated referral for proable depression
  166. chronic pain disorders are often associated with what?
    depressive disorders
  167. what are some chronic pain disorder?
    • arthritis
    • persistent neck/back pain
    • neuralgias
    • peripheral neuropathies
    • myofascial pain syndrome
    • fibromyalgia
    • CA 
    • spinal stenosis
  168. what are the 3 D's?
    • depression
    • dementia
    • delirium
  169. what is progressive failure of many cerebral functions that is characteried by decrease in cognitive functions?
  170. what is the difference btw delirum and dementia?
    dementia has an isidious onset that is progressive. delirium is a temporary, abrupt onset.
  171. what is the clinical significance of delirium?
    • often accompanies changes in medical status and hopsitilzations 
    • is reversible
    • is associated with severe adverse outcome if not reversed
  172. what are the ways in which the elderly are most commonly abused?
    physical, sexual, psychological
  173. what if fragility of multiple body systems as their customary reserves diminish with age and disease; difficulty in maintaining homeostasis. A fatal chronic condition in which all of the body systems have littel reserve and small upsets cause cascading health problems?
  174. when you have a frail patient what are some things you need to consider?
    • anorexia/weight loss
    • fatigue
    • weakness
    • slow gait
    • low physical activity
    • social factors; low education, low income, lack of family, lack of support
  175. what are some of the effects being frail can have on your patient?
    • loss of mobility
    • decreased social activity
    • tendency to become incontinent
    • falls
    • overall decreased fucntion
    • tendency to be hopsitalized, institutionalized
  176. how can we prevent our patients from becoming frail
    • maintain food intake
    • stay active; walk, resistance exercise
    • avoid isolation
    • limit pain
    • be proactive
  177. what are some of the considerations with rehab for the elderly?
    • minimize loss of function
    • keep disabilty from becoming a source for social decline
    • help elderly maintain I and preferred lifestyle
  178. what are some of the obstacles to rehab with the elderly?
    • more difficulty learning (sensory changes, cognitive, etc)
    • loss of stamina, endurance required with increaed activity 
    • overall loss of reserves(frail)
  179. T/F: the elderly respond the exercise the same way the younger population does.
  180. what are the body systems that need to be assessed before rehab begins?
    • cognitive
    • musculoseltal
    • cardiopulm
    • neurlogic
    • disease specific
  181. what are some of the cardiovascular considerations with the elderly with regards to exercise?
    • target heart rate is less (220-age) 
    • upper limit of 02 available decreases
    • should have an MD approval prior 
    • rehab activities should be slower, shorter periods, adequate rest
  182. what are some of the goals for rehab with an elderly patient?
    • set the goals with the patient; your goal may not be their goal
    • previous level of activity
    • support available
    • focus on function; make it meaningful to them
  183. what condition affects the circulatory system including arteries, veins, and lymph vessels and primarily affects LE > UE?
    peripheral vascular disease
  184. what is a inflammatory PVD pathology?
  185. what does atherosclerosis cause?
    damage to endothelial lining of vessels and leaves fatty deposits
  186. what s/s are intermittent calaudication, rest pain, and is most likely to lead to ulceration?
    arteriosclerosis obilterans
  187. what PVD pathology is an inflammatory proess due to reduced blood flow that affects male smokers younger than 40?
    thromboangitis obliterans (buergers dz)
  188. pain
    intermittent claudication
    thin, shiny, hairless skin

    these are s/s related to what PVD pathology?
    thromboangitits obliterans
  189. homans sign
    capillary refill test
    rubor of dependency

    these are tests and measures for what?
    vascular pathologies
  190. what is the ABI?
    • ankle brachial index
    • examine vascular system to identify loss of perfusion in LE
    • ankle systolic - brachial systolic / 2
  191. what is the homans sign?
    pain with gentle forced DF with knee extension
  192. what is inadequate circulation of oxygenated blood?
    arterial insufficiency
  193. what is chronic arterial insuffiencey?
  194. what is an acute arterial insufficiency?
    thrombus, trauma
  195. what are the risk factors for arterial insufficiency?
    • smoking
    • dm
    • htn
    • hypercholesterolemia
    • hypertriglyceridemia
    • hyperlipidema
    • trauma
  196. what are some arterial insufficiency characterisitics?
    • lower 1/3 of leg, toes, web spaces
    • wounds with cliff edge, "punched out"
    • dry, lack granulation, necrotic
    • painful especially with elevation and exercise
    • pulses weak or absent
    • decreased skin temp
    • no edema present
    • hair loss, yellow nails, skin is shiny and thin
  197. what are some things you would educate patients on with arterial insufficiency?
    • wash and dry feet thoroughly
    • avoid unnecessary LE elevation
    • inspect feet daily with appropriate foot and shoe wear
    • avoid heat to LE's, scratching and direct contact
  198. what kind of agents would you use on an arterial wound?
    • alginates
    • hydrogels
    • foams
  199. would you remove necrotic tissue from an arterial wound?
  200. will skin grafts adhere to an arterial wound? why or why not?
    • nope! 
    • no blood supply probably
  201. what would you advise your patient with an arterial wound to do?
    stop smoking and exercise
  202. which veins do venous insufficiency affect?
    deep and superficial
  203. what does DVT cause?
    damage of valves
  204. what is an obstruction in the venous system?
    tumor, injury or inflammation
  205. what is varicosity?
    • damaged vessles
    • varicose veins
  206. what are some risk factors for venous HTN?
    • CHF
    • muscle weakness
    • obesity
    • preggo
    • DVT
    • trauma
    • family history
    • age
    • valve dysfunction
  207. How does a venous wound present?
    • shallow with irregular edges
    • flaky, dry and brownish discoloration
    • less painful, decreased with elevation
    • pulses normal and present
    • normal skin temp
    • edema present
    • hair loss, yellow nails, skin is shiny and thin
  208. What kind of care instructions would you give to a patient with venous insufficiency?
    • proper care/washing of ulcer; wash and dry feet thoroughly
    • active exercise with increased ROM
    • elevate legs when resting
    • inspect daily with proper foot wear
    • avoid scratching and direct contact
  209. what types of agents would you use on a venous wound?
    • alginates
    • hydocolloids
    • hydrogels
    • foams
  210. How do ulcer's affect the nerves?
    • neuropathic ulcers; peripheral neuorpathy
    • sensory: loss of protective sensation (stepping on tack)
    • autonomic: skin changes, dry, non-pliable
    • motor: degeneration of muscles
  211. What are the major risk factors for neuropathic ulcers?
    • DM
    • tri-neuropathy s/s present
    • increased trouble regulating insulin leads to increased risk of ulceration
  212. what are the neuropathic ulcer characteristics?
    • usually on the WB surfaces of foot
    • ischemia
    • impaired healing time
    • impaired 02, antibiotic and nutrient transport
  213. What types of interventions would you include with a patient with neuropathic ulcers?
    • pt. education on foot care, shoe wear and inspection
    • decrease WB stress with appropriate AD depending on area of ulcer
    • wound care
    • orthotics
    • exercise
    • modalities
  214. what do lymph nodes do?
    filter to remove unwanted substances from body and produce lymphocytes
  215. what are the characteristics of dry and wet gangrene?
    • dry: no drainage or odor
    • wet: drainage and odor
  216. how would you treat wet and dry gangrene?
    • wet: call MD for surgical amputation
    • dry: leave and protect area, watch for conversion to wet, and watch for auto amputation
  217. what is a chronic disorder of abnormal accumulation of lymph fluid in tissues of one or more body regions that is usually caused by mechanical insufficiency of lymphatic system and is primarily congenital or can be secondary to injury of the lymphatic system?
  218. what are the risk factors for lymphedema?
    • Hx of CA
    • Hx of radiation
    • lymph node disrupiton- genetic or traumatic
    • onset of swelling at birth or puberity
    • chronic inflammation
    • onset may be immediate or >30 years later
  219. swelling distal to impairment
    edema not relieved by elevation
    pitting edema early on, non-pitting later and fibrotic much later
    fatigue, heavyness, pressure or tightness
    numbness & tingling
    decreased wound healing
    fibrotic changes to dermis
    increased risk to infection
    loss of mobility and ROM

    these are characteristics of what?
  220. What are some of the interventions included in treating a patient with lymphedema?
    • skin care
    • manual lymphatic drainage
    • bandaging
    • compression therapy
    • exercise and AROM
    • garment fitting
  221. what is manual lymphatic drainage contraindicated for?
    CHF and/or pulmonary edema
  222. what indicated if compression therapy if appropriate?
  223. what is the scale for the ABI and when is it contraindicated?
    • 0-1.1
    • contraindicated at <0.8
  224. what is the unna boot?
    compression + venous wound with zinc paste impregnated gauze
  225. what are the different types of paste that be used in the unna boot?
    medicopaste, unna-flex, gelo-cast
  226. what types of wounds are an unna boot not appropriate for?
    arterial or A/V mixed
  227. What is a 4 layer bandage? How long can it be left in place?
    • several layers of compression used for LE ulcer closure
    • 1 week
  228. what are long and short bandages used for? what provides the long and short stretch?
    • control edema and suppl compression for venous and lymphatic systems
    • long: ace bandage
    • short: comprilan and rosidal
  229. what assist in venous blood flow, manage surgical scars and burns, and prevent accumulation of lymph fluid?
    compression garments
  230. T/F: compression are not a treatment, they are used after the condition is managed.
  231. what is intermittent pressure to increase venous/lymphatic flow?
    pneumatic pump
  232. what BP is inappropriate for a pneumatic pump and when should you take vitals?
    • >140/90
    • before and after treatment
  233. acute inflammation
    cardiac/kidney dysfunction
    obstructed lymph channels
    impaired cognitive function

    these are contraindications to what?
    pneumatic pump
  234. Pressure and position use _____ and ________ ___________ for ulcerative support.
    • beds
    • turning schedule
  235. what is the name of the pressure relieving bed that is used for ulcerative support?
  236. what is total contact casting?
    plaster cast for neuropathic ulcers on plantar surface of foot is worn for 7-10 days
  237. how do cast shoes help with temporary wound care to the foot?
    off loading or extra depth shoes for cushion or support
  238. what is the second most common cause of death?
  239. what is the single most significant risk factor for cancer?
  240. in order to be "cured" of cancer, how long must one be in remission
    5 years
  241. what is a term that refers to a large group of diseased characterized by unctonrolled growht and spread of abnormal cells?
  242. what is abnormal growth of new tissue that serves o useful purpose, does not respod to normal body controls and may harm the host organism by competing for blood and nurtrients.
  243. what is either an "over growth" or neoplasm?
  244. what are the two types of tumors? describe them.
    • benign: good prognosis; not caner
    • malignant: bad prognosis; cancer
  245. what are the two types of malignant tumors?
    • carcinoma: epithelial cells involved
    • sarcoma: connective tissue, muscles, nerves are involved
  246. what is the process of describing the extent of disease at the time of diagnosis?
  247. what is the purpose in staging cancer?
    • aids in Tx planning
    • prognosis
    • compairing outcomes
  248. staging reflects what?
    • rate of growth
    • extent of neoplasm
    • prognosis
  249. what are the most important predictors for recurrent CA?
    • the stage at initial diagnosis
    • histological findings
  250. what are the stages of cancer?
    • stage O: carcinoma in situ (abnormal cells present)
    • stage I: early stage; local CA
    • stage II: increased risk of spread due to tumor size
    • stage III: local cancer that has spread but may not be spread to distant mets
    • stage IV: metastasis: has spread and disseminated to distant sites
  251. what is the TNM staging system?
    • T: primary Tumor
    • N: regional lymph Nodes
    • M: distant Metastasis
  252. What are the potential carcinogens that can cause cancer?
    • viruses: HPV
    • chemical: tar, soot, asphalt, asbestos, radiation exposure/sun
    • drugs: steroids, chemo
    • excessive alcohol consumption: liver cancer
  253. what is the progression of carcinogensis?
    • dysplaisa: alteration and disorganization of adult cells with variations in size and shape that may reverse or progress to cancer
    • anaplasia: loss of cellular differenation and function, only characteristic of malignant cells
    • neoplastic hyperplasia: occurs after anaplasia, formation of a tumor
    • carcinoma in situ: presence of abnormal cells
    • invasive carcinoma: stage III
    • metastatic carcinoma: tumor that orginated else where, traveled and attached to another body organ. Can occur as late as 15-20 years after treatment
  254. how does cancer metasize?
    cells break off from original location and travel in the blood and lymph and reattach themselves to other organs
  255. what are the 5 most common sites for mets?
    liver, bone, lung, brain, lymph nodes
  256. what is tumor angiogensis?
    blood vessels from the surrounding tissues begin to grow into the solid tumor. Only a few of the cancerous cells survive being attacked by the immune system in the blood stream.
  257. what percent of all cancer patient have occult mets?
  258. T/F: pain is usually an early sign of cancer.
    false! pain usually occurs when cancer is well developed.
  259. superfical oncologic pain usually elicits a ______ nervous system response with what s/s?
    • sympathetic
    • HPT, tachycardia, tachypnea
  260. severe or visceral oncologic pain elicits what type of nervous system response with what type of s/s?
    • parasympathetic
    • hypotension, bradycardia, nausea & vomiting, tachypnea, weakness, fainting
  261. why is oncologic pain felt?
    • bone destruction
    • obstruction of hollow visceral organs and ducts
    • infiltration or compression of peripheral nerves, arteries and veins
    • infiltration or distention of skin or tissue causing pain due to tissue stretching
    • inflammation , infection, and necrosis of tissue causes sensitivity and tenderness and excruciating pain
  262. what are the 5 cancer treatments?
    • surgery
    • chemo
    • radiation
    • hormone
    • biotherapy or biologial response modifiers (BRM)
  263. what is pallitive treatment and what does it include?
    • symptom reliefe
    • radiation, chemo, meds
    • physical therapy
    • acupuncture
    • homeopathy
    • hospice
  264. what are some of the side effects of cancer treatment?
    • mouth sores
    • nausea and vomiting
    • fluid retention
    • headach
    • malaise
    • fatigue
    • hair loss
  265. how is the nutritional status of a cancer patient affected by treatment?
    • affect how the body digests, absorbs and uses food
    • altered appetite, weight loss and malnutrition
    • alters need for adequate nutritional intake
  266. what are the numbers you need to monitor when working with cancer patients?
    • platelet count: <50,000
    • hemoglobin: <10
    • WBC: 3,000 or >10,000 with fever
    • absolute granulocytes: <500
  267. what are somethings you always want to check prior to treating a cancer patient?
    • MD orders: clearance for mobility or WB status changes
    • blood values
    • chemo patients: levels of toxicity and risk levels for contact with other patients and staff
  268. what are some things that you need to keep in mind when working with cancer patients?
    • fall prevention: increased risk due to the local and secondary treatment affects of cancer
    • patients are often weak, tired, in pain, peripheral neuropathy, decreased flexibility and mobility
    • may possibly need the appropriate AD based on their physical and cognitive status
    • may be appropriate candidate for modalities
  269. what heart rate range do you want to exercise a cancer patient?
    • 40-65%
    • no more than 12 on borg
  270. what vitals do you monitor when working with a cancer patient?
    • 02
    • heart rate
    • pulse rate
    • breathing frequency
    • blood pressure
  271. when working with a cancer patient, what do you want to watch for when working a aerobically?
  272. what must you never allow a cancer patient to do while exercising?
    go anaerobic
  273. what things must you notify the nurse/PT/MD of when working with a cancer patient?
    • fever
    • extreme or unusual tiredness or fatigue
    • unusual muscular weakness
    • irregular heartbeat, chest palpitation, or chest pain
    • sudden onset of dyspnea
    • leg pain or cramps
    • unusual joint pain
    • disorientation, confusion, dizziness, lightheadedness,blurred vision, or other visual disurbances
    • recent onset of back, neck, or bone pain
    • unusual brusing, nose bleeds, or other bleeds
  274. in order to conserve you cancer patients energy, what are some things you can do?
    • schedule at times of peak energy, co-treat when possible
    • plan frequent rest periods
    • sitting exercises when possible
    • minimize climbing stairs and cluster activites
  275. What are some of the advantages of TENS over narcotics with cancer patients?
    • cheaper, few side effects
    • controlled by the patient
    • can control nausea and vomiting while on chemo
    • can help with post-op and chronic pain
  276. what is superior vena cava syndrome?
    lung cancer; distended neck veins, facial and arm lymphadema
  277. mets from lung, breast, prostate, colon and multiple myeloma that present with back pain, muscle weakness or gait changes indicate what?
    spinal cord compression
  278. what is tumor lysis syndrome?
    • leukemias and lymphomas
    • chemo can cause acute renal failure most pronounced 6-72 hours after chemo.
    • Presents with muscle weakness & cramping, tachycardia, decreased BP or arrhythmias during activity
  279. what are the C's to superficial heat with cancer patients?
    • over irradiated areas
    • over a tumor
    • over inflammation
    • over bleeding areas
  280. what are the C's to deep heat with cancer patients?
    • over acute hemmorhage, inflammation, or irradiated areas
    • over a tumor
    • over growing epihyses
  281. what are the C's to cryotherapy with cancer patients?
    • over dysvascular/irradiated tissue
    • over areas with impaired sensation or nerve injury induced by chemo or radiation
    • delayed wound healing
    • when chemo has exacerbated raynauds or PVD
  282. what are the C's to electrotherapy with cancer patients?
    • potential pathological fracture
    • cariopulm insuffienciency
    • deep bone pain
  283. what 4 cardiopulm s/s do you monitor closely for with patients that have cancer?
    • dyspnea
    • pallor
    • sweating
    • fatigue
  284. T/F: cardiac dysfunction can occur months-years after chemo treatment and can result in L vent. failure, cardiomyopathy, and/or CHF
  285. What are some precautions you should take when working with cancer patients?
    • pathological fractures: bone metastasis; WB restrictions
    • massage: may encourage metastasis through lymph and blood
    • deep heat may increase tumor growth or pain
  286. T/F: You don't have to tell the nurse or MD that your patient vomited during the treatment. Just documenting is enough.
    • false!
    • especially inform the nurse/MD if the patients is on meds to keep them from vomiting
  287. what is the CARING outcome measure?
    helps determine end of life care
  288. what is hospice?
    • care for terminally ill
    • must have 6 months or less to live
    • patient must be aware of Dx and have primary care giver and not undergoing any curative treatments
  289. T/F: hospice care is free.
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Rehab Tech. Exam 2
exam 2
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