CRRN Exam 281 Questions with Verified Answers
Rehabilitation and Goals - CORRECT ANSWER Rehab is the philosophy of practice and an attitude toward
... [Show More] caring for people with disabilities and chronic health problems. Goals are to improve quality of life and help people who have disabilities and chronic health problems.
Rehabilitation act of 1973- section 501& 505 - CORRECT ANSWER prohibit against qualified people who work in federal government
ARN standards and scope of rehabilitation nursing practice - CORRECT ANSWER 1976
Capped Medicare Part B - CORRECT ANSWER *Rehab therapy for post acute delivery has a limit
*combine outpatient PT and ST share same cap
*OT has its own cap
*Treatment must be medically necessary
Impairment - CORRECT ANSWER a loss or abnormality of a psychological, physiological, or anatomical structures and function
*Occurs at the organ level DIABETES
Disability - CORRECT ANSWER A restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being
*Occurs at the level of the person NEUROPATHY
Handicap - CORRECT ANSWER a disadvantage for a given individual resulting from impairment or disability that limits or prevents fulfillment of a role that is normal for that individual
*Occurs at the societal level AMPUTATION
Effective teams have a thorough understanding of - CORRECT ANSWER -collaborative practice
-Group dynamics
-conflict resolution
-Team functioning
Interdisciplinary model - CORRECT ANSWER HS-OT,PT,ST,NSG (team conference)
Most important member of rehab team - CORRECT ANSWER patient and family
Provision of services - CORRECT ANSWER -client centered care
-setting centered care
-provider centered care
Rehab defintion - CORRECT ANSWER a process of helping a person to reach the fullest physical, psychological, social, vocational, vocational and educational potential consistent with his or her physiological or anatomic impairment, environment limitations and desires and life plans
Perkins institute and the sheltered workshop - CORRECT ANSWER 1829
Disabled were the first to be killed in the Holocaust because they were flawed - CORRECT ANSWER WW2
Head of American air force convalescent training program was a leader in organizing rehab program - CORRECT ANSWER Dr. Howard Rusk
Goal of rehab - CORRECT ANSWER improve quality of life
Education of all Handicapped children - CORRECT ANSWER 1975
Self determination act (part of Omnibus Budget) 1990 - CORRECT ANSWER -advanced directives copy should be on charts
-facilities must educate patients on their patients rights
Balanced Budget act 1997 - CORRECT ANSWER -called for Medicare spending cuts that affected rehab
-required a prospective payment system PPS
-required the use of resource utilization groups
Americans with Disability Act of 1990 - CORRECT ANSWER *increased accessibility
*increased opportunity for employment, education, health care
-people with disabilities have equal opportunity, access, and accommodation
-litigation to define its implementation
-reinforced advocate role of rehab nurse
1990 ADA- Title I & Title IV - CORRECT ANSWER prohibit employment discrimination against qualified people with disabilities in the private sector and in state & local government
Title I-V - CORRECT ANSWER -address private employers, state, and local governments
-providers civil rights for qualified people with disability
-addresses the public sector and defines which private entity must meet ADA
-telecommunication
-provisions to cover legal fees and prohibit retaliation
Legislation ADA Title I-V - CORRECT ANSWER -protects the 54 million americans with disabilities (physical or mental impairments)
-Title I- employment
-Title II- Public services
-Title III- public accommodations & services operated by private entities
-Title IV- Telecommunications
-Title V- Misc provision
75% Rule to 60% Rule - CORRECT ANSWER -initiated in 1984 by CMS
-established 10 categories for admission to rehab which were later increased to 13 diagnoses in 2003
-enforcement began in 2004
Medical model - CORRECT ANSWER Doctors
Multidisciplinary model - CORRECT ANSWER OT, PT
Most important person on the rehab team - CORRECT ANSWER the patient and their family
Definition of Rehab - CORRECT ANSWER "...a process of helping a person to reach the fullest physical, psychological, social, vocational, avocational and educational potential consistent with his or her physiological or anatomic impairment, environmental (home evals) limitations and desires and life plans"
Definition of Rehab - CORRECT ANSWER "...the diagnosis and treatment of human responses of individuals and groups to actual or potential health problems relative to altered functional ability and lifestyle"
Goal of rehabilitation - CORRECT ANSWER improvement in the quality of life
1829 - CORRECT ANSWER Perkins institute and the sheltered workshop
1965 - CORRECT ANSWER -Medicare an Medicaid established
-workers compensation and rehabilitation law
-1966-CARF (Commission on Accreditation Rehab Facilities)
CARF vs Joint Commission (TJC) - CORRECT ANSWER TJC CARF
-Deemed status -every 3 years
-every 3 yrs -six divisions
-random 5% -rehab specific requirements
-complaint investigation -scheduled surveys
-unannounced -submit quality improvement & annual plan
-mimics COP -no direct payment benefit in most states
-more stringent in some areas
-prevents annual CMS survery
**Voluntary Agencies (fee paid for survey & application)
WWII - CORRECT ANSWER disabled were the first to be killed in the holocaust because they were flawed
Dr. Howard Rusk - CORRECT ANSWER head of the American air force convalescent training program was a leader in organizing rehab programs.
Frank granger - CORRECT ANSWER trained physical reconstruction aids and sent them to france to help casualties of war
Lydia Hall Model - CORRECT ANSWER Nurturing and teaching
-Person(care):rehab greater significance
-Disease(cure):acute care highest priority
-Body(care)
Imogene King: Open systems Model - CORRECT ANSWER Personal system (individual)
Interpersonal system (two or more personal systems)
Social systems ( social forces)
Goal oriented and stressers
-role congruence-goal attainment
Dorothea E. Orem: self-care deficit theory - CORRECT ANSWER OT
Martha Rogers: Science of Unitary Human Being Theory - CORRECT ANSWER Hippy, coaches and guide
intergrality
Gordon's functional health patterns - CORRECT ANSWER delivery of holistic care when all components are used
Ethics - CORRECT ANSWER the study of nature and justification of general principles that apply to special areas where there are moral problems. Is a science of duty with a balance of either side of a dilemma.
Morality - CORRECT ANSWER traditions or beliefs about right and wrong moral conduct :should we keep them alive or not
*these are common to most human beings
Bioethics - CORRECT ANSWER Ethics applied to health care including moral rules, principles, and values that guide healthcare professionals in relationships with clients and families.
-the study of the relationships between biology, medicine, technology as related to ethics, social changes affect issues
*we can keep them alive but should we
Professional ethics, codes and standards - CORRECT ANSWER -ANA code for nurses with interpretive statements (1985)
-ARN standards of rehab nursing practice (1994)
-ANA position statements regarding ethics (1996)
Values or Moral Principles - CORRECT ANSWER -Morals are specific beliefs, behaviors and ways of being
-Values are beliefs that one considers meaningful and good
Rehabilitation nursing ethics - CORRECT ANSWER judgments about decisions to act and subsequent actions based on the rules of conduct or precepts of rehabilitation nursing practices
Autonomy - CORRECT ANSWER right to choose
Nonmaleficience - CORRECT ANSWER do no harm
Beneficence - CORRECT ANSWER doing good
advocacy - CORRECT ANSWER standing for patient
veracity - CORRECT ANSWER truth telling
fiduciary responsibility - CORRECT ANSWER recognize costs to patients when provided
ethics of care - CORRECT ANSWER compassion, equilty, fairness, ect
reciprocity - CORRECT ANSWER integrity, impartiality
fidelity - CORRECT ANSWER always keep promises
sanction of life - CORRECT ANSWER maintaining life
Quality of life - CORRECT ANSWER condition of ones life
Consent - CORRECT ANSWER voluntary agreement with a procedure, process or treatment
confidentiality - CORRECT ANSWER responsibility to keep private
competence - CORRECT ANSWER ability or legal right to make appropriate decisions
values - CORRECT ANSWER worthwhile or positive qualities
Case management - CORRECT ANSWER The ARN: the process of assessing, planning, organizing, coordinating, implementing, monitioring and evaluating the services and resources needed to respond to a persons healthcare needs. (ARN 2010)
1980 - CORRECT ANSWER Department of Veterans Affairs and TRICARE (Military)
Maslow Hierarchy Of individual needs as compared to community needs - CORRECT ANSWER Inidividual Needs Community Needs
-self actualization -Community actualization
-esteem -community pride
-belongingness -educational preparation
-safety -security
-physiological needs -life sustaining activities
Benefits of client education - CORRECT ANSWER -better outcome for client and family
-improved client and family satisfaction
-improved staff satisfaction
-continuitity of care
-cost containment
Cranial Nerves Involved in Swallowing & Nutrition - CORRECT ANSWER I-Olfactory, sensory, transmits smell to olfactory area of cerebral cortex
Cranial Nerves Involved in Swallowing & Nutrition - CORRECT ANSWER V-Trigeminal, motor, innervates muscles of mastication & facial expressions
Sensory, sensory impulses from teeth, gum, and lips
Cranial Nerves Involved in Swallowing & Nutrition - CORRECT ANSWER VII-Facial, sensory, receives sense of tasts from anterior 2/3 of tongue, sensatation of oropharynx
Cranial Nerves Involved in Swallowing & Nutrition - CORRECT ANSWER IX-Glossopharyngeal, motor, motor impulses to muscles of pharynx for swallowing
Sensory, impulses from taste buds of posterior 1/3 of tongue
Cranial Nerves Involved in Swallowing & Nutrition - CORRECT ANSWER X-Vagus, motor, muscle contraction of pharynx (swallowing) & larynx (Phonation)
Cranial Nerves Involved in Swallowing & Nutrition - CORRECT ANSWER XI, Spinal accessory, skeletal muscle of soft palate, pharynx, & larynx which contract reflexively during swallowing.
Cranial Nerves Involved in Swallowing & Nutrition - CORRECT ANSWER Hypoglossal, innervations of tongue muscles, allowing for coordinated contraction of the tongue muscles necessary for food manipulation, swallowing & Speech
Phases of Swallowing- Oral preparatory Phase - CORRECT ANSWER *food formed, chewed, mixed saliva, forms ball (bolus)
-drooling on weak side
-asymmetry of face
-pocketing of food
-altered lip closure & inability to close lips
-weak or absent gag reflex
-extended periods of time required to finish eating
-chewing problems
*At what stage does_______occur?
Phases of Swallowing- Oral propulsive phase - CORRECT ANSWER *food move back, squeezing action mainly by tongue
**At what stage does_______occur?
Phases of Swallowing- Pharyngeal phase - CORRECT ANSWER *food enters throat, above voice box, soft palate elevates, epiglottis closes, tongue moves backward pharyngeal wall moves forward
-delayed or absent swallowing
-coughing
-history of aspiration pneumonia
-weight loss
-fear of eating/drinking
-wet-sounding voice while eating or drinking
-frequent clearing of throat
-complaints of something sticking or burning the back of throat
*At what stage does_______occur?
Phases of Swallowing- Esophageal phase - CORRECT ANSWER *Bolus moved to stomach by squeezing action by throat muscles.
-burping
-indigestion
-substernal pain from esophageal reflux
-complaints of bad taste in mouth, bad breath
-coughing, wheezing
-high incidence of dental cavities
*At what stage does_______occur?
Pressure Ulcers - CORRECT ANSWER Stage 1-red non-blanchable
Stage 2-open
Stage 3-slough, granulated tissue and has depth
Stage 4- Bone or muscle poss. showing
Unstageable- suspected deep tissue injury
Bowel and bladder management - CORRECT ANSWER Goals BEST achieved through interdisciplinary team
-cog. ability, communication ability, hand function, level of independence with ADL, transfers
Detrusor muscle - CORRECT ANSWER the bladder: made of thick muscle walls that can expand 2-3 times it size
Sacral cord reflex center - CORRECT ANSWER s2,s3,s4
UMN - CORRECT ANSWER T12 and above- anal wink tetra
-spastic paralysis, reflexive muscles
-Rare sudden incontinence (urgency, frequency, noturia) due to full rectal vault
**tight as a drum
LMN - CORRECT ANSWER t12 and below- no anal wink para
-Flaccid paralysis, no reflexes, flaccid sphincters
-Overflow incontinence (weak sensation of fullness), stool leakage, impactions
**Loose as a goose
Saddle sensation - CORRECT ANSWER qtip,anal wink
Bulbocavernosus (motor) - CORRECT ANSWER clap foley
Urodynamics give a more detailed neurologic function of the bladder - CORRECT ANSWER pull pubic hair, see wink
Reflex Neurogenic - CORRECT ANSWER -disruption of central nervous system above conus medullaris
-damage to UMN above T12
-trauma, tumors, infection, infarct, MS
-absent saddle sensation
-hyperactive bulbocavernosus
-rare sudden incontinence due to full rectal vault
TREATMENT
-suppository
-Circular dig. stim.
-sit on commode-may need anesthetic ointment if prone to dysreflexia
Areflexic Neurogenic - CORRECT ANSWER -loss of sphincter control-flaccid
-damage to sensoy/motor sacral nerve reflex arc
-injury to LMN, trauma@ or below T12, spina bifida, herniated intervertevral disc
-absent saddle and bulbocavernosus senstation
-overflow incontinence, weak sensation of fullness
-stool leakage/impactions
TREATMENT: bulk, fiber, maintain intake to 2000ml/day, some pts get ostomy to resolve problems
Uninhibited Neurogenic UMN - CORRECT ANSWER -impaired cortical awareness of urge
-damage to UMN, stroke,TBI,MS
-sudden incontinence, hard stool with smearing
TREATMENT
-bulk fiber, avoid gas producing foods, check medications, time regulate 2-3x day up to toilet
Conus medullaris syndrome - CORRECT ANSWER areflexic lower extremities-flaccid
Anterior cord syndrome - CORRECT ANSWER most common, damage to anterior spinal artery affecting anterior 2/3 cord
Elimination SCI - CORRECT ANSWER Lower motor neuron T12-S5 muscules of bowel & bladder are flaccid *loose as a goose
Rancho levels - CORRECT ANSWER used for TBI neruologoical function
Rancho levels - CORRECT ANSWER I-III: toatal
IV-V: max
VI: mod
VII: min
VII-X: supervison
Rancho levels - CORRECT ANSWER I-no response
II-generalized response
III-localized response
IV-confused, agitated
V-confused, inappropriate/ nonagitated
VI-confused, appropriate, robot-like
VII-automatic, appropriate, robot-like
VIII-abstract, purposeful, appropriate
IX-purposeful, appropriate, standby assist on request
X-purposeful, appropriate, modified independent
Rancho III - CORRECT ANSWER sleeps 75% of the time
*incontinent
Rancho IV - CORRECT ANSWER confused, agitated, no awareness, no cooperation
*avoid constipation
*sleeps only 1-2 hours at a time
*sexual inapporiat/ feels as they are being abused (example: giving a suppository could trigger that they are being abused, why is best to avoid constipation
*Avoid foley, schedule toileting
Rancho V - CORRECT ANSWER confused, inappropriate /nonagitated
*largest age group in this population are teenagers/young adults
Masters & Johnson - CORRECT ANSWER during the 1960s & 1970s lead the way in sexual research by conducted many studies on human sexuality
Where are the nerve centers used for sexual response? - CORRECT ANSWER *Sympathetic: T10-L2
*Parasympathetic: S2-S4
*Somatic control: pudendal nerves
Reflexogenic erection - CORRECT ANSWER -UMN
-initiated by internal/external tactile stimulation mediated by the reflex arc at S2-S4
-triggered by genital stimulation
Psychogenic erection - CORRECT ANSWER -LMN
-requires intact neurological pathways to brain
-initiated by cortical input from visual/tactile sensory input to the brain that stimulates the sympathetic ganglion chain found at T10-L2 to stimulates an erection
Spinal cord injury - CORRECT ANSWER -paralysis
-loss of sensation
-spasticity
-autonomic dysreflexia
-decreased self esteem
INTERVENTION
-identify reflexive/ psychogenic dysfunction
-educate client on mechanical/pharmacological treatments for erectile dysfunction-medicals, penile injections, vacuum tumescence, penile implants, vibratory stimulation, transrectal electro-stimulation, LUBRICATION
-explore altered surfaces (warerbed/hard surfaces) POSITIONING
-discuss with partner in taking an active role
Heart disease, hypertension, peripheral vascular disease
*sex and intimacy problems - CORRECT ANSWER sex best when pt can walk a flight of steps
Diabetes
*sex and intimacy problems - CORRECT ANSWER Keeping A1c below 7
Chronic lung disease
*sex and intimacy problems - CORRECT ANSWER Wear O2 during sex, sit up, adapt to positions that prevent SOB
Arthritis
*sex and intimacy problems - CORRECT ANSWER sex at mid-am when meds are at peak level
Stroke
*sex and intimacy problems - CORRECT ANSWER affected side down for sex
P L I S S I T Model - CORRECT ANSWER Permission giving
Limited
Information
Specific
Suggestions
Intensive
Therapy
Peripheral Nervous system- LMN - CORRECT ANSWER Upper
*11 cranial nerves (exception CN II)
*peripheral nervs
*connect CNS to organs & muscles
*no protective covering
Divided into:
Somatic NS-lower
Autonomic NS-lower
Subarachnoid space - CORRECT ANSWER Pia mater
space filled with CS fluid
Arachnoid mater
Subdural space - CORRECT ANSWER dura mater
Epidural space - CORRECT ANSWER Bone/skull
Neuron - CORRECT ANSWER Axon-away
Dendrites-toward
Cerebrum left side - CORRECT ANSWER details- Language and Logic
Frontal lobe - CORRECT ANSWER -emotions, personality, complex intelligence, problem solving, judgment, orientation, voluntary motor movements
Broca's area- on left, speech motor part
Broca aphasia - CORRECT ANSWER trouble speaking fluently but their comprehension can be relatively preserved (left frontal lobe)
Occipital Lobe - CORRECT ANSWER -receives & interprets visual stimuli, depth perception
Temporal lobe - CORRECT ANSWER -controls hearing, taste, smell, sequencing, memory
Processing area, Wernicke's area-aphasic "word salad"
Receptive aphasia also known as Wernicke aphasia - CORRECT ANSWER individual is unable to understand language in its written or spoken form, receptive, fluent (left temporal lobe)
Aphasia - CORRECT ANSWER communication
Limbic system - CORRECT ANSWER -emotions, motivation, and memory
-deep inside brain
-associated w/hypothalamus
-primitive emotions
-runs on serotonin
-Fight or Flight responses
-Affects motivation, attention, biological rhythm
Reticular activation system - CORRECT ANSWER tells brain when to rest
Thalamic syndrome - CORRECT ANSWER intolerable pain, vascular disorder
Medulla oblongata - CORRECT ANSWER Swallowing & vomiting centers originate here (aspiration pneumonia)
Injury-flaccid muscle tone
Reticular formation - CORRECT ANSWER Injury to Coma
I-Olfactory - CORRECT ANSWER sense of smell
II-Optic - CORRECT ANSWER sense of light
III- Oculomotor - CORRECT ANSWER movement of the eyeball; pupil contriction in bright light or near vision
IV-Trochlear - CORRECT ANSWER movement of eyeball
V- Trigeminal - CORRECT ANSWER sensation in face, scalp, and teeth; contraction of chewing muscles
VI- Abducens - CORRECT ANSWER movement of the eyeball
VII- Facial - CORRECT ANSWER sense of taste, contraction of facial muscle, secretion of saliva
VIII- Acoustic (vestibular) - CORRECT ANSWER sense of hearing; sense of equilibrium
IX- Glossopharyngeal - CORRECT ANSWER sense of taste; sensory of cardiac, respiratory, and blood pressure reflexes; contraction of pharynx; secretion of saliva
X- Vagus - CORRECT ANSWER sensory of cardiac, respiratory, and blood pressure reflexes; sensory and motor laynx (speaking); decreasing heart rate; peristalsis; increases digestive secretions
XI- Accessory - CORRECT ANSWER contraction of neck and shoulder muscles; motor to larynx (speaking)
XII- Hypoglossal - CORRECT ANSWER movement of tongue
Cranial Nerves - CORRECT ANSWER On Old Olympus Towering Top A Fin And German Viewed Some Hops
Some Say Marry Money But My Brother Says Bad Business Mary Money
If two nerves are injured in the face can you still chew and smile? - CORRECT ANSWER Yes different nerves control different things
Middle cerebral artery - CORRECT ANSWER Most strokes happen here
The circle of Willis - CORRECT ANSWER supplies blood to sub-acaroid
Cervical vertebra - CORRECT ANSWER C1- shake head yes
C2-shake head no
C3-maybe
C4-Idk shrugs shoulders; diaphragm
C5-wrist; lateral side of antecubital fossa
C6-wrist & thumb; thumb
C7-2 fingers (index&middle) & thumb; pincher
C8-Ring & little finger
C4 &C5 keep diapragm alive
Lumbar spine - CORRECT ANSWER Spine ends at L1
White mater contains: Major Afferent, Ascending (sensory) tracts - CORRECT ANSWER *will start with spino
-posterior spinocerebellar tract & posterior column
-lateral spinothalamic tract
-anterior spinothalamic tract
White mater contains: major efferent, descending (motor) tracts - CORRECT ANSWER *ends with spina
-lateral corticospinal tract
-anterior (ventral) corticospinal
Spinal Nerves - CORRECT ANSWER 31 pairs of nerves
*8 cervical
*12 thoracic
*5 lumbar
*5 sacral
*1 coccygeal
C4 - CORRECT ANSWER diaphragm starts to work
C5 - CORRECT ANSWER Deltoid & biceps-lateral side of antercubital fossa
C6 - CORRECT ANSWER wrist extensors-thumb
C7 - CORRECT ANSWER Triceps & hand-index middle finger
C1-T1 - CORRECT ANSWER person is a quadriplegia (tetraplegia)
T2-down - CORRECT ANSWER person is paraplegia
T4 - CORRECT ANSWER nipple line
T6 - CORRECT ANSWER risk of autonomic dysreflexia
T6 - CORRECT ANSWER Make you sick
T10 - CORRECT ANSWER umbilicus; belly button
T12-L1 - CORRECT ANSWER End of cord; line between UMN & LMn
L1-L5 - CORRECT ANSWER leg muscles
L2-S - CORRECT ANSWER peripheral nerves
S2-S4 - CORRECT ANSWER Bowel, bladder & sexual fuction
*S2,3,& 4 keep pee & poop off the floor
Spinal shock - CORRECT ANSWER last 4-6 weeks up to 8 weeks
Incomplete spinal injury - CORRECT ANSWER anal wink present; SENSORY preserved but NO motor function below injury ("B" ee you will feel it)
*s4-s5
Complete spinal injury - CORRECT ANSWER anal wink not present; No motor & sensory function ("A" for absent)
*s4-s5
Spinal reflexes - CORRECT ANSWER reflex activity DOES NOT return at level of injury, brain unable to inhibit/facilitate spinal reflexes-spasticity
--till after shock
Sympathetic - CORRECT ANSWER produces "fight or flight" patter; elevated heart rate & BP, dilatation of pupils of eye
Parasympathetic - CORRECT ANSWER More vegetative, operates in calm, movements; allow body to restore itself
*Rest and Digest
Multiple Sclerosis - CORRECT ANSWER -Remissions& Relapses
-degenerative
-inflammation, demyelization & plaques in white matter of CNS & scarring of myelin sheath in CNS
-primary adults
-Older lesions become sclerotic
-Increased risk with vitamin D deficiency
MS Disease Patters - CORRECT ANSWER -relapsing remitting MS- exacerbation&remissions
-secondary progressive MS- starts as relapsing-remitting followed by progressive that is unpredictable
-primary progressive MS- slow continuous worsening without distinct relapses
Progressive relapsing MS- marked by disease progression from onset with acute relapses
MS Pathology - CORRECT ANSWER Blood-brain barrier protects the brain, the barrier is breached as activated T-Cells migrate into the CNS
MS Symptoms - CORRECT ANSWER -Uhthoff's phenomenon-one of the first symptoms, neurologic symptoms in which the body gets over heated & core temperature elevated
-dysphagia and dysarthria
-Double vision, eye movement changes, optic neuritis, optic nerve (CN II), oculomotor (CN III), decreased visual field, nystagmus, visual clouding, dysphagia, blurred vision, forgetfullness
MS diagnosis - CORRECT ANSWER MS can mimic other diseases
Parkinson - CORRECT ANSWER loss of dopamine causes neurons to fire out of control-marked decreased-initiation & execution of smooth, coordinated voluntary movements & balance
Parkinson Manifestations - CORRECT ANSWER *Propulsion-forward stepping with leaning trunk
-safety issues fall prevention
-gait/balance issues
*Bradykinesia-gradual loss of spontaneous movement of slowness of voluntary movement
*Cognitive losses-memory, problem solving, depression, confusion
***first sign pill rolling
What is ALS - CORRECT ANSWER A-absence of
Myo-muscle
Trophic-nourishment
Lateral-side (of spinal cord)
Sclerosis-hardening of
Guillan Barre Syndrome - CORRECT ANSWER affects the peripheral nervous system, affecting the myelin of the PNS NOT the CNS
-triggered by a viral or bacterial infection
Myastenia Graves - CORRECT ANSWER chronic autoimmune disease
-presence of abnormal thymus gland
Myastenia Graves Crisis - CORRECT ANSWER Myasthenia crisis
-involvement of respiratory & accessory muscles escalates, requiring mechanical ventilation
-causes- infection, fever, adverse reaction to med & insufficient med
Cholinergic crisis
-results from excessive dosage of cholinergic treatment meds
-symptoms-salivation, lacrimation, urinary incontinence, GI upset, emesis, miosis, flaccid paralysis & respiratory failure
Post Polio Syndrome - CORRECT ANSWER -A viral infection of the nervous system
-symptoms: weakness, fatigue, pain in muscles and joints, sleep, breathing & swallowing difficulties
-Interdisciplinary rehab key
Rehabilitation - CORRECT ANSWER is focused NOT on longevity BUT on quality of life
Ischemic Stroke - CORRECT ANSWER a blood clot blocks a blood vessel or artery
Hemorrhagic Stroke - CORRECT ANSWER a blood vessel breaks/bursts, interrupting blood flow
-happens in young people
Transient ischemic attach - CORRECT ANSWER warning stroke or mini-stroke
Systemic Hypoperfusion stroke - CORRECT ANSWER Called "watershed stroke"
Hemispheres - CORRECT ANSWER LEFT
-spoken language
-number/math skills
-written language
-scientific skills
-reasoning/ logic
-reading
-detailed oriented
Hemispheres - CORRECT ANSWER RIGHT
-music awareness
-three dimensional forms
-art awareness-drawing/copying
-insight
-imagination
-aware of senses
-emotions, expression
-facial recognition
-arousal, attention, orientation
Left sided stroke - CORRECT ANSWER affects right side, slow, deliberate and aphasic
Left side (slow) - CORRECT ANSWER -spoken language, number/math skills, written language, scientific skills, reasoning/logic, reading, detailed oriented
Right sided stroke - CORRECT ANSWER affects left side, unilateral neglect, safety impulses, uninhibited & have perceptual deficits
Right side (fast) - CORRECT ANSWER -music awareness, three dimensional forms, art awareness-drawing, copying, insight, imagination, aware of senses, emotions, expression, facial recognition, arousal, attention, orientation
Visual Neglect - CORRECT ANSWER an attention disorder that decreases awareness of part of the field of view. The person has problems from attending to stimuli to their body or environment on the affected side. It occurs when a stroke damages the right hemisphere of the brain. The patient is unable to attend to the left side of the body
Epidemiology of TBI - CORRECT ANSWER Males age 0-4 years, highest rates of TBI related ED visits, hospitalizations and deaths combined
Classification of TBI - CORRECT ANSWER Glasgow scale
-mild brain injury: 1-15
-Moderate brain injury: 9-12
-Severe brain injury: less than 8
-coma (no response)
-vegetative state (nothing)
-Minimally conscious state (behavior signs)
-Locked-in syndrome
-akinetic mutism (inattention)
Glasgow scale - CORRECT ANSWER score of 3 patient can be dead
-Severe brain injury
Coma is 8 & below, length of coma
-vegetative state-no anything
-minimally conscious state-behavior signs
-locked in syndrome
-akinetic mutism- inattention
Autonomic Dysreflexia - CORRECT ANSWER **MEDICAL EMERGENCY
-occurs with injuries at T6 and above, especially cervical injuries
-causes bladder related; overdistended, UTI, kidney stones
-causes bowel impaction
-causes sudden changes in temperate
-C/O headache, increase B/P, congestion, bradycardia, flushing profuse sweating
-vasocongestion symptoms above the level of the injury
-pilorection, nasal congestion
-Below injury-cold, pallor
**Know steps on what to check
Autonomic Dysreflexia treatment - CORRECT ANSWER -monitor BP & pulse
-sit patient up; raise the head of the bed to encourage orthostatic, admin appropriate meds
-remove TEDs & binder
-LOOK for causes & remove stimuli
*empty bladder-good B & B care
*empty bowel
*check skin- prevention of pressure ulcers
-patient/ family education
-prevention
Upper Motor Neurons (spinal cord injury) - CORRECT ANSWER C1-T12
-tone is present in the muscles of the bladder and bowel making them reflexive
*tight as a drum
Lower Motor Neurons (spinal cord injury) - CORRECT ANSWER L1-S5
-muscles of bowel and bladder are flaccid
*loose of a goose
Central Cord Syndrome - CORRECT ANSWER -a lesion in cervical region
-damage to central part of spine
-greater weakness in UE's compared to LE's
-sacral sensory sparing
-hyperextension or flexion in cervical region
-bladder dysfunction
Brown-Sequard syndrome - CORRECT ANSWER -damage to one side of the cord
-ipsilateral paralysis & loss of touch, pressure, vibration & proprioception, on same side as injury
-contralateral loss of sensitivity of pain & temperature on the opposite side
-associated with penetrating injuries
Osteoporosis - CORRECT ANSWER asymptomatic "silent thief"
Rheumatoid Arthritis - CORRECT ANSWER Chronic inflammatory systemic
-can damage muscles, lungs, skin, blood vessels, nerves and eyes
-symmetrical involvement
-symptoms: fatigue and weight loss
RA interventions - CORRECT ANSWER -Medications; anti-inflammatory, glucocorticoids, immunosuppresants, DMARDs
-maintain joint function & prevent deformities
-PT (assistive devices)
-OT (helping with ADLs)
- splinting (support, rest joints, correct deformitites
-psychological support
- cartilage matrix enhancers (glucosamine, cosamin DS)
-vitamins, minerals, herbs
-surgical interventions; relieve pain, stabilize the joint, and correct deformity
Classifications of arthritis - CORRECT ANSWER *inflammatory-rheumatoid arthritis
*Degenerative- osteoarthritis
*Metabolic- Gout
Late stages of RA - CORRECT ANSWER -Boutonniere deformity of thumb
-Ulnar deviation of metacarpophalangeal joints
-Swan neck deformity of fingers
Resulting disabilities of OA late stage - CORRECT ANSWER Heberdens nodes
THR precautions - CORRECT ANSWER -keep hips > a 90 degree angle when sitting; do not lean forward
-have pt sit in a tilt-back or reclining chair, or slouch position; no low chairs
-keep surgical leg forward & knee extended when transferring from or returning bed
-use a raised toilet seat or commode
-no bending to pick objects from floor
-no flexing at hip to don/doff pants, socks, shoes
-avoid reaching forward
Chronic postamputation pain syndromes - CORRECT ANSWER -Residual limb pain: a chronic pain localized in the residual limb that occurs after surgical or traumatic amputation
-Phantom sensation: sensory perceptions that are thought to occur in all people with amputations
-Phantom limb pain: painful sensation that is perceived in a part of the body that is no longer present as the result of surgical or traumatic removal
Blast injuries - CORRECT ANSWER have become more common in rehab settings since the onset of the wars in Iraq and Afghanistan
-occurs in industry and in the private sector
Burn Extent-the Rule of 9's - CORRECT ANSWER
Why are coronary arteries so important? - CORRECT ANSWER *coronary arteries deliver blood to the heart muscle
*Any coronary artery disorder can have serious implications by reducing the flow of oxygen and nutrients the the heart
*this may lead to heart attack and possibly death
Atherosclerosis - CORRECT ANSWER a build up of plaque in the inner lining of an artery, causes it to narrow or become blocked
Coronary Heart disease - CORRECT ANSWER smoking, HTN, serum cholesterol, DM, stress, alcohol, obesity, sedentary lifestyles, heredity, race, gender, and age
Congestive Heart Failure - CORRECT ANSWER swelling of legs, ankles and abdomen due to build up of fluid, SOB, Persistent cough, decreased ability of kidneys to remove sodium and water, fatigue, weight gain, and loss of appetite and nausea
Congenital Heart disease - CORRECT ANSWER structural or functional abnormalities occurring at time of birth
-tetralogoy of fallot
-transposition of great arteries
-coarctation of the aorta
-atrioventricular sepetal defects
-hypoplastic left heart syndrome
-ventricular septal defect
Artherosclerosis - CORRECT ANSWER build up of plaque in the inner lining of an artery, causes it to narrow or become blocked
Management of CHF - CORRECT ANSWER decrease the workload-pace activities!
MI - CORRECT ANSWER women atypical s/s: anxiety, nausea, vomitng
Phase II restoration - CORRECT ANSWER Is the phase that is rehab
C-BABE - CORRECT ANSWER Obstructive
-C: cystic fibrosis
-B: Bronchitis
-A: asthma
-B: bronchiectasis
-E: Emphysema
Obstructive disease complications - CORRECT ANSWER SOB, coughing, sputum production, weight loss (emphysema), obesity (chronic bronchitis), change is chest circumference (leaning over)
Cystic Fibrosis - CORRECT ANSWER Genetic disorder of the exocrine glands
-abnormally thick mucus
-kissing would be a way to taste for salt as a sign of cystic fibrosis (diagnosis by sweet taste measures of salt content in sweat)
-Symptoms; persistent cough, wheezing, frequent pulmonary infections, excess appetite, poor weight gain, stools smell foul, frothy and fatty
Acute and Chronic Pain - CORRECT ANSWER Acute-localized pain, fast A-delta fibers
Visceral- diffuse pain, slow C-fibers
Gate Control Theory - CORRECT ANSWER Pain theories
-gating mechanism in the spinal cord
-nociceptor impulses travel via large A-delta or small C-fibers-spinal cord
-cells of substantia gelatinosa are the gate keeper
-large fast A-delta fibers close the gate
-small slower C-fibers open the gate
-closed gate+ decreased in stimulation of trigger cells decreased in pain impulses an decrease in pain perception
-open gate= increase in trigger cells, pain impulses and pain perception
Rapid Acting insulin therapy - CORRECT ANSWER -Insulin lispro (Humalog)
starts working in 5-15 min
lowers blood glucose most in 45 to 90 min
finishes working in 3-4hrs
-Insulin aspart (Novolog)
starts working in 10-20min
lowers blood glucose most in 1 to 3 hrs
finishes working in 3-5hrs
-Insulin glulisine (Apidra)
starts working in 5-15min
lowers blood glucose most in 45 to 90 min
finishes working in 3-4hrs
Short Acting Insulin - CORRECT ANSWER -regular (R) insulin
starts working in 30min
lowers blood glucose in 2-5hrs
finishes working in 5-8hrs
Intermediate-acting Insulin - CORRECT ANSWER NPH (N) or Lente (L) insulin
starts working in 1-3hrs
lowers blood glucose in 6-8hrs
finishes working in 12-16hrs
Long acting Insulin - CORRECT ANSWER Ultralente (U) insulin
starts working in 4-6hrs
lowers blood glucose in 8-20hrs
finishes working in 24-28hrs
Peakless Insulin - CORRECT ANSWER -Insulin Glargine (Lantus)
starts working in 1hr
lowers blood glucose evenly for 24hrs
finishes working in 24hrs-by the time a new dose "kicks in"
-Insulin Detemir (Levemir)
starts working in 1hr
lowers blood glucose evenly for 24hrs
finishes working in 24hrs-by the time a new dose "kicks in"
HIV: primary infection - CORRECT ANSWER -CD4+Tcell count-declines from 1,000 to 500
HIV: chronic asymptomatic infection - CORRECT ANSWER asymptomatic period
-CD4+Tcell count=200-499
HIV:AIDS - CORRECT ANSWER -CD4+Tcell counts=1-200
Cancer side effects - CORRECT ANSWER fatigue-need to learn self pacing; meds, activities, therapy need to be paced and timed out
Intrapsychic Theories- Freud - CORRECT ANSWER Conflict between an individual's natural instincts and society's restrictions on them experienced in childhood influence an individuals adult personality; children are thought to progress through four stages of psychosexual development
Intrapsychic Theories- Freud Phases - CORRECT ANSWER -Oral phase: 1st year of life, exploring the world
-Anal phase: 18 months-3yrs, buildup and release of tension in the orifices
-Phallic phase: 3-6yrs of age, become aware of gender roles
-Latent & genital phase: 6-12 years of age, learns social rules while experiencing sexual gratification
Interpersonal theories- Sullivan - CORRECT ANSWER Repeated experiences between parents or caretakers and children lead to development of a good self and a bad self, which is the basis for healthy development. Seven states represent processes by which an individuals identity develops in the context of relationships
Seven stages-Sullivan - CORRECT ANSWER -Infancy
-Childhood
-Preadolescence juvenile
-Preadolescence
-Early adolescence
-Late adolescence
-Adulthood
Social learning theories-Erikson - CORRECT ANSWER Interaction between parents of caretakers and the child is essential to healthy psychological growth; each phase of normal development requires the individual to accomplish age appropriate developmental tasks through 8 phases of development from infancy to older adulthood.
Erikson Stages - CORRECT ANSWER -Trust vs mistrust: Birth-1yr
-Autonomy vs shame: 1-2yrs
-Initiative vs guilt: 3-5yrs
-Industry vs inferiority: 6-12yrs
-Identity vs role confusion: 12-18yrs
-Intimacy vs isolation: young adulthood
-Generativity vs stagnation: middle adulthood
-Integrity vs despair: older adulthood
Erickson stages - CORRECT ANSWER What your focus would be a specific age?
Piaget's Stages of Development - CORRECT ANSWER Developmental concerns are important so children are not treated as little adults
- Sensorimotor- up to 2 years; senses guide the child
-Preoperational- 2-7yrs; child and fantasy
-Concrete operations-starts as age 7
-Formal operation-age 12-18; lack of judgment and are egocentric
*Cognitive Theories
Vygotsky's Theoretical Framework - CORRECT ANSWER Four basic principles:
-Children construct their knowledge
-Development cannot be separated from social context
-Learning leads to development
-Language has a major role in mental development
*Cognitive Theories
Maslow's Hierarchy of Individual's - CORRECT ANSWER Individual Needs
-self actualization
-esteem
-belongingness
-safety
-physiological needs
Florence Nightingale's - CORRECT ANSWER work forms the trunk of the tree; infection control
Red cross - CORRECT ANSWER who staged
Principles of growth (size) & development (function) - CORRECT ANSWER children are children first with a disability second- the child needs to focus on WHO they are, NOT WHAT they are
School program: - CORRECT ANSWER the individuals with Disabilities Education Act ensures that all children & youth age 3-21 years receive free, appropriate public education
Laws affecting children with disabilities - CORRECT ANSWER parents should be involved in developing their child's individual education plan. IEP must be evaluated annually & revised each year.
Polypharmacy - CORRECT ANSWER atleast 4 meds
CRASHED (safety risk) - CORRECT ANSWER *C- cords, carpet, cracks
*R-Rx (drugs)
*A-affect (depression)
*S- sickness
*H- hypotension
*E- eyes
*D- dizziness
Child Health Insurance Plan - CORRECT ANSWER "CHIP"
Federal programs - CORRECT ANSWER Medicare
-a federal program for people who are elderly or disabled
-pay into SS through payroll taxes for 10 yrs or 40 months
-Must be 65y/o and eligible for SS or permanently disabled and receiving SS benefits for 24 months
-Parts A,B,C,D
Medicare - CORRECT ANSWER Part A-Hospital insurance plan that covers hospitals, SNFs, Home health, hospice, and nursing homes
Part B-Medical insurance that covers physician's services; voluntary enrollment
Part C-Medicare advantage plans
Part D-Prescription drugs voluntary enrollment
State programs - CORRECT ANSWER *Medicaid
-for certain individuals and families with low income and resources
*Child health insurance plan (CHIP)
*Workers compensation
Military personnel - CORRECT ANSWER Tricare- department for the VA for any veteran honorable discharged
Medicare prospective payment systems - CORRECT ANSWER Home Healthcare -OASIS (payment)
Health care system's response to Health policy - CORRECT ANSWER -Value, assessment, and accountability (1990s and beyond)
CMS - CORRECT ANSWER federal government
Outcome measurement tools - CORRECT ANSWER *Global Adult Services
-FIM
-IRF PAI
*Pediatric tool
-wee FIM
-PEDI
*ADL scale
-Kenny self care (ADL self care scale)
Quality Improvement Tools - CORRECT ANSWER -Brainstorming
-A cause and effect diagram
-Affinity diagram
-Check sheet
-Run chart
-Histogram
-Scatter diagram
-Control chart
-Flow chart
-Force field analysis
-Pareto chart
****just recognize****
Nursing Theories and conceptualizations - CORRECT ANSWER -Metaparadigms: generalized, global perspective
-Philosophies: related to beliefs and values about nursing
-conceptual frameworks: ideas rather than tested concepts
-grand nursing theories: less abstract but broad enough to provide a foundation for middle range theories
-Middle range theories: contain testable variables that have potential to contribute to evidence based nursing practice
REM - CORRECT ANSWER rapid eye movement-lack of muscle movement & vivid dreams
Sexual teaching SCI - CORRECT ANSWER can get pregnant
Sexual teaching hemiplegia - CORRECT ANSWER lady on top
Which med caused drowsiness? - CORRECT ANSWER Anxiolytics
Med for spasticity? - CORRECT ANSWER baclofen
How many functions measured in FIMS? - CORRECT ANSWER 18 but 5 cognitive
Fims - CORRECT ANSWER scores lower on admission & higher at discharge
NCCAM - CORRECT ANSWER Center for Complementary & Alternative Medicine
Locus of control - CORRECT ANSWER believes he/she can influence events & their outcomes
Spirituality - CORRECT ANSWER sense of connection to something bigger than ourselves & typically involves a search for meaning in life
Somatoagnosia - CORRECT ANSWER inability to identify any part of ones own or another's body
American Red cross founded by? - CORRECT ANSWER Clara Barton
What is a woman with SCI most at risk for? - CORRECT ANSWER autonomic dysreflexia
Disabilities that grant you Medicaid right away? - CORRECT ANSWER dialysis & Lou Gehring Disease
Benchmarking - CORRECT ANSWER trends over time, year to year, within an organization, national, regional, industry, best practice
Post Trauma Syndrome or Post traumatic Stress Disorder - CORRECT ANSWER The state in which an individual experiences a painful response for more than 1 month to 1 or more overwhelming traumatic events that have not been assimilated
-anxiety disorder that results from the experience or witnessing of traumatic event
*under recognized by care providers
Assessment of PTSD - CORRECT ANSWER -re-experiencing the traumatic event in one or more of the following ways:
*flashbacks
*repetitive dreams or nightmares
*excessive verbalization of the event
*Survival guilt-felt helpless
*painful emotions, self blame, shame
*fear of repetition
*anger outburst
*reduced interest in significant activities
*rape or assult
*seriously injured
*was a victim or witness to traumatic event
Interventions for PTSD - CORRECT ANSWER -active listening, presence, counseling, anxiety reduction, emotional support, support system enhancement, grief work facilitation, referrals
SCI Peds - CORRECT ANSWER -cervical injuries NOT common, but hard to diagnosis
-higher risk for scoliosis because of growth
-younger children who are "low to ground" may have an easier time leaning to use braces to ambulate than older/taller children
-children who use W/C most of time have higher risk of pathological fractures
-standing frames useful for weight bearing & functional activities
Cerebral Palsy (CP) - CORRECT ANSWER nonprogressice congenital condition resulting from damage tot he brain that control voluntary motor muscles. It is common misconception that children with CP also have mental retardation
*most common childhood disability [Show Less]