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What information about a patient needs to be confidential?
all information is important
What is negligence by omission?
when a person fails to respond to any given situation when a response is necessary to limit or reduce harm
What is negligence by commission?
when an individual acts on a situation but doesn't perform at the level that a RPP would
What are the safety factors that should be considered when using a whirlpool?
- (1) must be connected to a ground fault breaker
- (2) don't turn it on or off while patient is in it
- (3) PTA should be in view of their pt's at all times
- (4) treatments can be started at a comfortable yet cool tempature
- (5) increased circulation/placement of extremity in gravity dependant position tends to increase edema
- (6) don't run whirlpool turbine dry
- (7) flowing water can nauseate some pt's
- (8) pts under influence of drugs/alcohol, seizure disorders, or heart disease have to be careful when warm water is used
- (9) pts with respiratory disease are prone b/c of pressure with full body immersion
When using a whirlpool, which patients are most likely to become nauseated?
those prone to motion sickness
Failure to provide informed consent can bring up what legal issue?
battery or professional negligence/malpractice
What is the definition of ischemia?
local and temporary deficiency of blood supply caused by an obstruction of circulation to a part.
Where can you find what is within your scope of practice as a PTA in NC?
APTA guide to physical therapy practice
What are the Cardinal signs of inflammation?
Heat, Redness, Pain Swelling, Loss of Function
In what phase of would healing does wound contracture occur?
in the proliferation phase following revascularization
What is phantom pain?
although the limb isn't there, the nerve endings at the site of the amputation continue to send pain signals to the brain that make the brain think the limb is still there
When dealing with phantom pain, is it true that sometimes the brain memory of pain is retained and interpreted as pain regardless of signals from injured nerves?
Where does the pain originate when dealing with phantom pain?
in the cut ends of the primary afferent fibers near the surface of the stump
What is referred pain?
pain originating from a site on/in the body but felt in other areas
What might patients who are suffining from unknown origin be suffering from?
What is chronic pain?
- pain that persists after a wound has healed
- pain that extends beyond the normal course of injury or illness or amount of pain perceived is much greater
In what can chronic pain be produced?
- (1) the PNS at the site of the injured nerves
- (2) the CNS by neural patholgies that are largely unknown
In chronic pain is the pain experienced by the patient related to underlying tissue trauma?
In chronic pain is the location of the pain associated with the area of tissue trauma?
What tissue heals the fastest?
What tissue heals the slowest?
What tissues don't regrow new tissue cells but rather scar tissue?
What does pain free ROM do during early healing?
can increase the tensile strength of healing ligaments and may increase the level of phagocytic activity
What are CPT codes?
codes used to describe the care provided for the patient and used for billing purposes
CPT codes were established by the AMA department of crediting and noenclature to define what?
those treatments rendered by health care providers who are licensed by the atea to perform their services therapeutic models
What are ICD-9 codes?
a 5 digit string that describes the pathology and structures involved
What do the 1st 3 digits of an ICD-9 do?
describe the body area
What do the last 2 digits of an ICD-9 do?
describe the pathology
What are the sequential responses to trauma?
acute inflammation, proliferation, maturation
What substance does Aspirin block, thus reducing pain and swelling?
What are prostaglandins responsible for?
vasodilation and increased vascular permeability
What do the prostaglandins influence?
the duration and intensity of the inflammatory process
What is the Ia A-Alpha?
sensory fibers from mm spindles afferent
What is the Ib-A-Alpha-Golgi?
tendon afferent which keeps the mm from tearing
What is the 11 A-beta?
What is the 111 A-delta?
- smaller slower temperature
- sharp pain afferent
What is IV (C)?
- dull pain a lot slower
- diffused location
- slow onset
What are the efferents?
- A-Alpha skeletal mm efferent
- A-gamma mm spindle efferent
- A-beta mm and mm spindle efferent - slow
What is a pain threshold?
the level of noxious stimulus required to alert an individual to a potential threat to tissue
What are trigger points?
pathological localized areas of pain that are hypersensitive to stimulation
Where can trigger points be found?
- other soft tissue such as ligament, tendon, & fascia
What are dermatones?
a segmental skin area supplied by a single nerve root
What is a placebo effect?
pain reduction obtained thru mechanisms other than those related to the physiological effects of the treatment
if the pt thinks the treatment is beneficial than a degree of pain reduction occurs
How might a PTA use the placebo effect for the good of their pt?
- mind over matter
- PTA can use thise with theraputic modalities by changing modalities and new approaches in the treatment of an injury
- can have a positive influence on the pt's perception and result in decreased pain
Why do gender differences in regard to pain preception matter to the PTA?
extroverts will quickly tell you how much pain they are in but introverts won't
Do male or female patients describe more pain and are more vocal about it?
Do women or men receive more and stronger pain medications?
Are men or women less likely to receive no medication for their pain?
How do you know if a nerve tract is an efferent or afferent tract?
afferent not strong enough to produce sufficient stimulus to open the gatemotor response
Do efferent or afferent pathways lead to the cortex receiving sensory information at 4 different levels all the way up?
Do efferent or afferent pathways lead away with actions occuring at the highest level?
Which nerve tract controls the sensory flight or fight limbic?
What is an ecchomosis?
blue/black discoloration of the skin caused by movement of blood into the tissues
In the later stages of ecchomosis, what colors may appear?
greenish brown or yellow
What is a hematoma?
a mass of blood confined to a limited area resulting from the subcutaneous leakage of blood
What is neuropathy?
destruction, trauma, or inhibition of a nerve
How long does the early phase of inflammation generally last?
- a few seconds to a few months
- Martha - 0-14 days
What is General Adaptation Syndrome?
a theory stating that the body has a common mechanism for adapting to stress
What happens in the alarm phase of GAS?
vessels constrict in extremities to supply more blood to the heart (fight or flight) to prevent any change in homeostasis
What happens in the resistive phase of GAS?
- individual achieves physiological resistance or physical fitness working to maintain homeostasis plateau in the body's adaptation to stress
- works to maintain homeostasis chornic inflammation
How long does the restrictive phase of GAS last?
many months to years
What happens in the exhaustion phase of GAS?
- the body can no longer withstand the applied stresses
- at this point 1 or more body systems can't tolderate the stress and therefore fails
- point of distress-negative effect
- traumatic or overuse injuries - no longer tolerant of stresses
- elimination of homeostasis
What are the endogenous opiates?
- pain inhibiting substances produced in the brain
What are the nuerotransmitters that effect tissue healing?
- substance P
What are the first order neurons and where are they found?
- connect seonsry receptor in PNS to neurons in CNS cell bodies
- found in the dorsal root ganglia or cranial nerve ganglia
What are the second order neurons and where are they found?
- receives sensory input from 1st order n and projects to neurons at higher levels of the CNS cell bodies
- found in dorsal horn of spinal cordoe trigeminal nuclie of the brain stem
What are the third order neurons and where are they found?
- receive sensory input from 2nd order n and projects to still higher levels of the CNS, possibly the cerebral cortex
- found primarily in the thalamus
What are the fourth order neurons and where are they found?
What are the chemotaxic substances released during inflammation?
- (1) Heparine
- (2) Histimine
- (3) Kinins
- (4) Neutrophils
- (5) Prostaglandins
- (6) Seratonin
- (7) Leukotrienes
What is the function of heparine?
inhibits clotting by preventing conversion of prothrombin to thrombin
What is the function of Histamine?
vasodilation of arterioles and increased vascular permeability in venules
What is the function of kinins?
- produce pain
- sharper pain at the early stages of inflammation
What is the function of Neutrophils and where is it formed?
- formed in the bone marrow
- relased in the bloodstream
- aggressive phagocytes
- damage good and bad cells
What is the function of Prostaglandins?
- responsible for vasodilation
- influences the duration and intensity of inflammatory process
What does PGE1 deal with?
What does PGE2 do?
What are 2 types of prostaglandins?
What is the function of seratonin?
causes local vasoconstriction
What is the function of leukotrienes?
- cause smooth mm contraction
- increase vascular permeability
- attact neutrophils (WBC)
- slows down anaphylaxis
What is the difference b/t slow twitch and fast twitch muscles?
- slow twitch - aerobic; long duration low intensity contraction
- fast twitch - anaerobic; short duration high intensity
What is the Gate Pain Theory?
suggests that the spinal cord contains a neurological gate that either blocks pain signals or allows them to continue on to the brain
How does the gate in the spinal cord operate according to the Gate Pain Theory?
by differentiating b/t the types of fibers carrying pain signals
According to the Gate Pain Theory, pain signals travelling along what are allowed to pass through the "gate"?
small nerve fibers
According to the Gate Pain Theory, pain signals travelling via what are blocked by the "gate"?
large nerve fibers
What are GTOs?
- autogenic inhibition
- monitor the amount of strain placed on the tendon to prevent damage resulting from too much strain placed on the tendon and to prevent damage resulting from too much tension
If the rate becomes too great what do the GTOs do?
generates a great nerve impluse that inhibits mm contraction
What are MM Spindles?
- reciprocol inhibition
- monitor the amount and rate of tension on a mm
How can GTOs and MM Spindles produce muscle weakness if mm spasms are allowed to continue?
atrophy will occur if continuous inhibitory influence is placed on the mm
What is the most common leukocyte during the early inflammation phase?
Chronic pain can take a serious toll on the lives of its sufferers and lead to what?
- medication abuse
- difficulty sleeping
- manipulative behavior
- somatic preoccupation
How long do the symptoms of chronic pain last?
longer than 6 months
What is the definition of pain?
body's final line of defense