Patient Exam 1 Study Guide PDF
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Uploaded by ThrilledCaesura6974
University of St. Augustine for Health Sciences
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Summary
This document is a study guide for a patient exam. It covers a range of topics including lifting mechanics, patient handling, systems review, Range of Motion (ROM), and joint integrity. The exam is a practice exam and includes important points and explanations.
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The exam is 30 questions, with a 40-minute time limit extra minutes are given because the timer includes environmental scan/setup time. 5 You will have the same amount of time to complete the exam regardless of what time the exam is opened. The exam is Thursday 2/13 at 7:30pm The e...
The exam is 30 questions, with a 40-minute time limit extra minutes are given because the timer includes environmental scan/setup time. 5 You will have the same amount of time to complete the exam regardless of what time the exam is opened. The exam is Thursday 2/13 at 7:30pm The exam is available to download now The download window will close at 7 pm on Thursday 2/13 so please download the exam as soon as possible. All unopened exams will be deleted from your device at 8:15 pm. The password will be posted via a blackboard announcement at 7:15 pm. You can begin the exam as soon as the password is posted. The upload deadline is 9:30pm on Thursday 2/13. If you have an issue with any of these times please email me as soon as possible. No requests will be considered after Sunday. xam Breakdown E Lifting Mechanics: 25-30% General lifting mechanics Concepts related to center of mass, base of support, joint positions, etc Knowledge and application when it comes to the types of lifts Positioning / Patient Handling: 10-15% Including ergonomics and workplace considerations Patient position considerations in various positions (bed, wheelchair, etc). Gait belt application/use Systems Review: 15-25% ROM and Joint Integ: 20-30% Must know everything! End feels, normative values, stabilization, general concepts etc. ICF/Pt Client Model: 10-15% General Study outline 1. Lifting techniques 2. Posture mechanics (staggered stance, arms at 90) 3. ICF Model 4. Difference between activity limitation and participation restriction (STS vs Playing basketball) 5. Purpose of Review of Systems 6. What is included in systems review 7. What part of systems review would BP go? (Cardio) a. Where would strength testing go? (Musculoskeletal) b. Where would reflexes go? (Neuro) 8. Planes of movement (Sagittal, Transverse, Frontal) 9. End feels (Hard, firm, soft) 10.What would indicate an empty end feel? (pain) Unit 1 Patient Posture & Positioning Importance of positioning Safety Comfort Precautions ○ Maintain head/neck in neutral ○ Extremities supported ○ Follow diagnosis specific precautions Avoid Spinal/thoracic rotation, bending, forward head, and chest compression Scapular abduction Adduction and IR of GH joint Knee hyperextension and prolonged flexion Hip adduction or IR/ER Patient positions Supine: on spine/back Prone: on stomach Sidelying: pillow between knees Semi-fowler’s: head of bed elevated around 30 deg Fowler’s: head of bed elevated around 60 deg Sims’: lateral recumbent, torso is prone, upper leg bent Trendelenberg: head is lower than feet Safe Patient Handling U se gait belts with teeth Belts go around narrowest part of patient Use underhand grip, usually behind patient Body Mechanics C onserve energy, reduce injury risk, reduce stress and strain Abdominal bracing (tightening of abdominals) provides better muscle activation for spine stability vs hollowing Valsalva = potentially harmful - rise in BP Close center of gravity and wide base of support Short lever arms Normal lumbar lordosis, avoid trunk rotation and flexion Position feet in staggered stance in direction of the motion Carry loads on waist or back When in hands, alternate hands when possible Shoulder carry for heavy or bulky items Review of Systems P art of history taking (subjective) Screening major body systems Directs the systems review Systems Review oing something to test the system (objective) D Directs further tests and measures Cardiovascular: vital signs Integumentary: observation and testing Musculoskeletal: observation and testing Neurological: observation and testing communication/cognition: ability, affect. Language, consciousness, orientation Movement: observation in context with function and performance Gross Neuromuscular Observation ssess function of CNS/PNS A Guide for more in depth testing Patient specific Observation of motor function, fluidity of motion, and balance Do not need to test all 12 cranial nerves if not needed Coordination screening ○ Dysdiadokinesia: Unable to perform rapid movement (supination and pronation in lab) ○ Heel-to-shin Reflex screening ○ Absent, present, exaggerated Integumentary Observation Rashes, lesions, nodules, edema, incisions, wounds nusual hair loss or breakage U Increases hair growth (hirsutism) Change in nail beds Itching (pruritus) Screen for color, moisture, palpation characteristics, symmetry, and shape Volumetric measurement/ displacement ○ Used for edema ○ Patient dips extremity into volumeter ○ Water displaced = objective measure for charting Palpate for texture, firmness, turgor (elasticity), mobility, temperature Capillary refill test ○ Used for discoloration and/or numbness and tingling in extremities ○ Press on nailbed to turn white and see how long to refill ○ >3 sec = blood flow compromised ○ Cannot test with nail polish on Gross Musculoskeletal Observation ony alignment, contours, symmetry B Posture Hypertrophy, atrophy UE and LE ROM screening ○ AROM across all cardinal planes against gravity ○ Goal = to determine ROM limitations that could limit function ○ If pain free, therapist provides overpressure to feel quality and quantity of tissue resistance (end feel) Muscle strength screening ○ Quick assessment of general strength ○ Test major muscle groups ○ Not trying to break them ○ Will change based on acute care vs orthopaedic Cardiovascular Observation Vitals ○ R H ○ RR ○ BP ○ SpO2 Unit 2 Range of Motion rthrokinematics:movement of joint surfaces (roll,glide, spin) A Osteokinematics:movement of bones AROM:patient moves a joint through available ROMwithout assistance from therapist AAROM:active motion is assisted by therapist P ROM:therapist moves the patient’s joint through available ROM without assistance from patient Gravity resisted ROM:patient is working against gravityto move body part Gravity assisted ROM:gravity assists patient in movingbody part Gravity eliminated ROM:movement happens in planeperpendicular to gravity, neither assisting or resisting End feel:resistance encountered at end of normalPROM ○ Hard:bony and abrupt, no further motion can occur(elbow ext) ○ Firm:slight give due to joint capsule and surroundingnon-contractile tissue limitations at end range (shoulder flexion) ○ Soft:mushy due to soft tissue compression (elbowand knee flexion) Reliability:overall consistency of a measurement,repeatability Validity:accuracy of measurement, measuring whatis intended to be measured Factors affecting ROM ○ Gender ○ Age ○ Build ○ Ligament and joint capsule laxity ○ Extensibility of skin and subcutaneous tissue ○ Culture, occupation, recreation Joint Integrity Arthrokinematics ○ Roll:multiple points contact multiple points (tireon road) ○ Spin:single point rotates on single point (top rotatingin 1 spot) ○ Slide/Glide:single point contacts multiple points (tire skidding on ice) ○ Distraction:separation of joint surfaces Used in combo with joint mobilizations to increase stretch of the capsule ○ Compression:approximation of joint surfaces Improves stability, occurs with muscle contraction ○ Concave on convex:roll and slide occur in SAME direction ○ Convex on concave:roll and slide occur in OPPOSITEdirections Open packed:joint surfaces are in the least contactand ligaments/capsules are on the most slack, allowing for greatest joint mobility Closed packed:joint surfaces are in most contactand ligaments/capsules are on least amount of slack, allowing for least joint mobility R1:the 1st resistance met from joint capsule R2:pushing into the 1st resistance, a 2nd level of resistance will be felt as tissue elasticity is taken up, where end feel is assessed Patient Exam 1 Study Guide Exam 1 Lifting Mechanics: 25-30% General lifting mechanics BB DP’s - Proper body mechanics conserve energy, reduce risk for injury, reduce stress and strain on body parts, and help prevent burnout & fatigue. - Bracing: tightening of the abdominals rather than drawing in the abs in case of hollowing. Should be used whenever loads are lifted or moved. Provides stability to spine. - Load is easier to lift when closer to body. Before attempting to move a load, COG should be as close to object’s COG as possible, and widen BOS to ensure stability and balance. - Stabilize trunk, maintain normal posture and back alignment, avoid trunk rotation with flex or rot’n - Warm up body before lifting Pierson & Fairchild - Before attempting to reach, pull, lift, or carry an object - 2 actions are required to use proper body mechanics: - 1. Position yourself so COG and object’s COG are as close as possible - 2. Increase your BOS - Position UE close to your trunk so you can use them in a shortened position as short lever arms. Muscles will function more effectively require lower torque when object is held close to your body. - VGL vertical gravity line - bisects body in sagittal plane indicates vertical positioning of COG. must be within BOS for optimal balance and stability - Lumbar spine should be maintained in its normal or neutral position of lordosis when lifting is performed. - Flexion of hips and knees allows lifter to lower COG and provides effective position for muscles of LE to perform. - Avoid Valsalva maneuver when contracting abs. Concepts related to center of mass, base of support, joint positions, etc BB DP’s and Piersons & Fairchild - Reaching & Carrying - Move object from high space to lower before reaching to carry them or raise yourself to object to reach and carry it. Stand on ladder to bring center of body closer to object. Avoid twisting. - Carry at level of waist or in a pack on back with both straps. - Alternate hands or balance load between two hands when carrying - Heavy, bulky objects should be carried on shoulders. - Lower object or raise your position to reach for objects - Object at arm length should be brought closer to body before lifting to reduce torque - When carrying, hold object close to you, use arms as short levers, maintain object’s COG to your COG. - Pushing v. Pulling - Ensure arms and legs are partially flexed to avoid strain at maximum end ROM. - Use crouched or semisquat position to push or pull - lowers COG to objects COG, increasing stability & reducing energy expenditure. - Force should be applied parallel to surface over which object is to be moved and in line of desired movement. - reduces friction Knowledge and application when it comes to the types of lifts Type of Lifts - Pierson & Fairchild - Deep squat: used for objects that are low to ground and heavy or awkwardly shaped. Positionhips below level of knees. Lifter’s feet straddle the object with elbows extended and upper extremities parallel to each other. Lifter grasps opposite sides, handles, or underside of object. Trunk maintained in vertical position and lumbar spine remains in lordosis. - Power lift: used for heavy or awkward objects that are low to ground but do not require lifter to bend all the way down. Only a half squat is performed sohips remain above level of knees. ½ squat position puts legs in better mechanical advantage compared to deep squat. Feet parallel to each other and remain behind object, UE parallel. Grasp object on opposite sides or handles. Trunk is more vertical than horizontal and lumbar spine remains in lordosis. - Straight leg lift: knees are only slightly flexed or may be fully extended. LE parallel and straddle object, UE parallel to grasp opposite sides of object. Trunk may be vertical or horizontal and lumbar spine in lordosis. Used for objects that are positioned at waist or hip level, like unloading something from trunk of car. Bring object close to body before lifting. - One-leg stance lift (Golfer’s lift): used for light objects that can be easily lifted with one UE. lifter faces object with body weight shifted onto forward LE. weight-bearing LE is partially flexed at hip and knee, non-weight bearing LE is extended to counterbalance forward movement of trunk. Pick up object similar to golfer picking up ball and return to upright position. Similar to SL RDL. - Half-kneeling lift: align body by kneeling on one knee positioned behind object with opposite LE foot flat and hip and knee flexed approximately 90 degrees. Object is grasped and lifted by UE, placed on thigh of flexed LE and moved close to body before flexed LE begins rising to standing. Opposite LE assists with raising body as person continues to stand. Lumbar spine is maintained in normal lordosis. This lift allows person to secure object close to body before standing. Useful for small people with limited UE strength and overall good balance. Pt with knee conditions should avoid this lift. - Traditional lift: perform deep squat to provide low COG and wide BOS. grab handles of object and bring closer to body by using UE flexors. LE used to raise body and object to an upright position. Lumbar spine remains in normal lordosis. This lift provides stability and makes use of large extensor muscles of LE to raise body to full standing. LE must perform the lift NOT the back. Avoid elevating hips and pelvis before LE raise body. - Stoop lift: when object rests below level of waist but can be reached without squatting. Partially flex hips and knees, maintain lumbar lordosis. Grasp object and use LE to raise body and object. Feet positioned at shoulder width and slight anterior-posterior to each other (staggered) to improve stability and balance. Can lift object with one UE. other UE is used for support or balance. Requires less energy expenditure than using deep or full squat. Positioning / Patient Handling: 10-15% Including ergonomics and workplace considerations Patient position considerations in various positions (bed, wheelchair, etc). BB DP’s and Piersons & Fairchild Supine- head supported with bed flat, pillow underneath knees (if no contraindications are present). Avoid excessive neck and upper back flexion or rounded shoulders. Prone- head supported with bed flat, pelvis supported with pillow. Rolled towel under each anterior shoulder area to adduct scapulae and protect head of humerus. Side-lying- head supported, bed flat, pillow placed between knees and one pillow under upper arm. Semi-fowler’s- head supported, head of bed elevated about30 degrees.Pelvis is close to transition point or bend in bed as possible. Elevating head of bed may be more comfortable for those with GERD (Gastroesophageal Reflux Disease) or experience dizziness while lying flat. Fowler’s- The patient is supine, and the head of the bed is placed at a45-degree angle. A pillow is placed under the head and, if needed, pillow lengthwise under the calves to alleviate pressure on the heels. The hips may or may not be flexed Trendelenberg- The patient is supine with a 15-30 degree decline. The head of the bed is lowered so the feet are elevated above the head. Originally, the position was used in treatment of shock or hypotension, some neuro and vascular surgeries, as well as postural drainage. There is a question as to whether this procedure should be used due to intracranial and intraocular pressure increase.There isn't enough evidence to reach a consensus on if the Trendelenburg position impacts pressures. Sims- The patient lies between the supine and prone position with the upper leg flexed beside the patient, a pillow is placed under this LE; arms should be at the patient’s side (not underneath) in a comfortable position; a pillow can be placed under the arm to protect the elbow and a small bolster or pillow under the lower leg to protect the lateral malleolus Sitting- the trunk should be upright and midline, with the head in neutral alignment over the shoulders. Upper extremities should be supported on armrests, pillows, or a lap tray to reduce strain. The hips and knees should be positioned at approximately 90-degree angles, with feet resting flat on the floor or a footrest to promote stability and prevent excessive pressure on the posterior thighs. Gait belt application/use Applying the Gait Belt - Communicate with your patient - Put the belt around the patient around waist level (depending on surgical site/stitches) - “Teeth” first - Snug not tight Gripping a Gait Belt - Underhand grip - Usually behind the patient Systems Review: 15-25% The physical exam begins with the Systems Review - Cardiovascular: Vital signs - Integumentary and Surface Anatomy: Observation & Testing - Musculoskeletal System: Observation & Testing - Neurological System: Observation & Testing - Communication and Cognition: Ability, affect, language, consciousness, orientation - Movement: Observation in context with function and performance ICF/Pt Client Model: 10-15% ROM and Joint Integ: 20-30% Must know everything! End feels, normative values, stabilization, general concepts etc. 1. How would you document the following ROM measurements? “Right Shoulder abduction to 140 degrees, able to go into extension” - R shoulder abduction 0-140 degrees 2. How would you document the following ROM measurements? “Left Elbow extension to 3 degrees past neutral, able to go into flexion to 150 degrees” - L elbow ROM 3-0-150 degrees End Feel- The resistance felt by the therapist atthe end of a passive movement Soft- soft tissue approximation, ie muscle compressingmuscle Hard- bony approximation Firm- firm tissue resistance from contractile structures,joint capsule, ligaments and surrounding connective tis Joint integrity is assessed by considering several factors during the patient examination: - AROM - PROM - Joint mobility Why do we test joint integrity? - Information on capsule and joint: quantity of motion present, quality of motion, symptom reproduction, and end feel - Help determine causes for impairments Why do we test joint mobility? - Full joint mobility is necessary for full ROM - To assess for joint-specific causes of pain - To help determine causes for impairments Accessory motion: the motion occurring at the jointsurfaces Component motion:the joint surface motions that aresuspected to occur with osteokinematic motions Passive Intervertebral Motion (PIVM): a specific mobilitytest for segmental spinal mobility Open-packed position of the joint:the anatomical position where the joint surfaces are in the least contact and ligaments/capsule are on the most slack, allowing for the greatest joint mobility Closed-packed position: the anatomical position wherethe joint surfaces are in the most contact and/or ligaments/capsule are on the least amount of slack, allowing for the least joint mobility What is joint mobility testing? - While holding one side of the joint stable, moving the other bone at the joint surface What data is being gathered? - Symptom provocation. To determine if joint anatomy is causing the patient's symptoms. - The quantity of motion. Within the joint, using gliding of the joint surfaces on one another and moving into the capsular resistance to determine how much joint motion is present. - The quality of motion. Normal is smooth movement; abnormal might be crepitus, clicking grinding, popping. - The end feel. The expected to be firm resistance and with mild give due to creep of the joint capsule tissue. Exception – some joints have other tissues that limit motion. Joint Hypermobility: excessive motion as comparedto what is expected for a given joint or as compared bilaterally Joint Hypomobility:limited joint motion as comparedto what is expected for a given joint or as compared bilaterally Normal End-Feels Soft– gradual increase in resistance as tissues arecompressed between body parts Firm– abrupt increase in resistance with varying amounts of creep (or give), depending on the barrier being stretched Hard– abrupt and immediate stop as bone contactsanother bone
