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Cardio, Burns, PAMS
Eval and treatment of Cardio, Burns, PAMS
34
Medical
Graduate
10/02/2013

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Cards

Term
Evaluation and intervention: When can an activity program be initiated?
Definition
Pain free
No arrhythmia
Pulse 100<
Term
When should vital signs be monitored during an activity?
Definition
Prior to activity
At peak of activity
Upon cessation
4-5 min post activity
Term
When should exertion scales be monitored?
Definition
Prior
At activity peak
30 secs before cessation
Upon cessation
3-5 min post activity
Term
What are contraindications/precautions post cardiac/pulmonary event?
Definition
SOB, chest pain, nausea, vomiting, dizziness, fatigue
Decrease in systolic BP > than 20 mm/Hg
Changes in facial expression
Term
Contraindications/precautions (continued): Vital signs
Definition
Risk: HR 100 during very light activity; 120 light activity (less than 6 weeks post surgery), 130 recent bypass.
Term
Contraindications/precautions (continued): What is the blood pressure precaution?
Definition
120/200 mm/Hg
Term
Contraindications/precautions (continued): O2 Saturation
What is the precaution for pulmonary patients?
Precaution for cardiac patients?
Definition
pulm: 86%
card: 90%
Term
What exercises and body positions should be avoided during inpatient rehab stage? (4)
Definition
Overhead exercise or holding UE over head
Lateral arm movements
Exercises that stretch chest and pull incision
Valsalva (isometrics, straining, breath holding
Term
What is a risk for elevation of UEs with a burn patient?
Definition
Brachial plexus strain
Term

Anti-contracture/antideformity position for Dorsal Hand Burns:

Definition

Antideformity/Intrinsic Plus: Wrist, 30-40˚ extension MCPs @ 70-90˚, IPs fully extended, Thumb 40-45 degrees of palmar abduction/opposition. This positions places collateral ligaments of MP and IPs at length to prevent ligamentous contracture.

Term

Anti contracture position for burns to the axilla

Definition

Preventi via 120˚ abduction with slight external rotation- watch for signs of brachial plexus strain

Term
What are the parameters for a functional (mid-joint) resting hand splint?
Definition
Wrist: 20-30˚ extension
MCPs: 35- 45˚ flexion
IPs: slight flexion
Thumb: 45˚ palmar abduction
Term
Postburn, when is the emergent phase? What is the role of the OT during this phase?
Definition
immediately after injury to 72 hours
Edema places joints in deformity position. Static splinting initiated to support hand and maintain length of tissues
Term
How long does the Acute Phase last and what are the goals of the OT?
Definition
72 hours until wound closure. Monitor direction of deforming forces, maintain joint alignment, scar management, increase ROM
Term
An OT should initially evaluate subjective pain prior to any hands-on evaluation or intervention. Name 4 specific pain assessments:
Definition
Visual Analog Scale
McGill Pain Questionnaire (semantic differentiation)
Numerical Rating
Spatial distribution- drawings are used to plot location and type of stimuli
Term
If an individual is experiencing pain, the eval and intervention should target:
Definition
relieving pain
Term
CRPS involves the blood vessels in the affected limb, which may dilate (open wider) or leak fluid into the surrounding tissue, causing red, swollen skin. The underlying muscles and deeper tissues can become starved of oxygen and nutrients, causing muscle and joint pain and damage. At times, the blood vessels may over-constrict (clamp down), causing cold, white, or bluish skin. The dilation and constriction of small blood vessels is controlled by small nerve fiber axons as well as chemical messengers in the blood.
Definition
Complex regional pain syndrome (CRPS) is a chronic pain condition most often affecting one of the limbs (arms, legs, hands, or feet), usually after an injury or trauma to that limb. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems.
Term
CRPS I
Definition
Abnormal burning, hypersensitivity, sympathetic reaction (hot, cold, sweating). Individuals without confirmed Nerve Damage
Term
Contraindications fo Superficial Thermal Agents (9)
Definition
IMPAIRED sensation due to skin graft or scar
Tumors, cancer
Advanced cardiac disease
ACUTE inflammation/edema
DVT
Primary repair of tendon or ligament
RA
Impaired cognitive status
Infection
Term
The most common use for ____ is in the treatment of acute injury and inflammation
Definition
Cryotherapy
Term
Arthritic exacerbation, acute bursitis or tendinitis, and acute or chronic pain secondary to muscle spasm indicates use of _____
Definition
Cryotherapy
Term
Contraindications for ultrasound (4)
Definition
Over pacemaker or adjacent tissues
Reduced sensation
Pregnancy
Epiphyses of growing bone
Term
Precautions for Ultrasound (4)
Definition
Unhealed fracture sites
Primary repair of tendon or ligament
Osteoporosis
Plastic/metal implants
Term
This type of electrotherapy is used primarily for pain relief
Definition
TENS
Term
This neuromuscular electrical stimulation activates targeted muscle groups for orthotic substitutions of functional activiiteis of movements. Often used with shoulder sublux or foot drop post stroke
Definition
FES
Term
This stimulation is used for wound healing
Definition
ESTR/HVPC
Term
This electrical stimulation targets denervated muscles to prevent atrophy, degeneration, and bibrosis. Nerve regeneration and muscle Reinnervation.
Definition
EMS
Term
This type of electrical stimulation used alternating currents to activate muscles of intact peripheral nerveous system to cause a motor response. Stimulating the nerve decreases muscle spasms, strengthens muscles and causes muscle to pump. Reeducation and atrophy prevention
Definition
NMES
Term
Contraindications for Electrotherapy (4)
Definition
Pacemaker
Over carotid sinus
DVT
Mid section during pregnancy (duh)
Term
What is the antideformity positioning for the neck?
Definition
Neutral
Term
Cardiac patients are discharged from an inpatient program when they are able to carry out activities at a_______.
Definition
3.5-4 MET level
Term
Anti-contracture positioning for dorsal wrist burn
Definition
Neutral
Term
Anti-contracture position for volar wrist burn
Definition
Wrist cockup splint in 5-10 degrees of flexion
Term
Anti-contracture position for dorsal hand burn
Definition
Intrinstic plus: MP @ 90, IPs extended, thumb opposed
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