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Nur 3370 Revised Exam Question and
Solution
spinal cord injury - Solution -(SCI) Bruising or severing of the spinal cord from a blow to the vertebral column resulting in muscle paralysis and sensory impairment below the injury level. T1 and higher - quadriplegia T1 and lower - paraplegia C1-C3: require ADL support and devices to speak, eat, etc. C4: control over neck and diaphragm, independent breathing. No upper extremity functioning, but likely to be able to operate w/c with sip and puff method. C5: functioning in neck, diaphragm, and some in shoulder. Lack functioning in hand and wrist. Some can use w/c with rim projections and sticky gloves. Can transfer independently but may need ADL assist. C6: elbow, wrists and shoulders can flex and extend. Some movement in fingers w/ weak grasp. Can transfer and move w/c independently. C7-8: bladder mgmt. incorporated in treatment. T1-5: can grasp and release small objects, have some arm movement, ltd trunk stability. May need to wear belt or postural brace T6-9/10-12: trunk stability and can hold self up but may need braces to stand. Complete abdominal control.
L1-5: can flex and extend and have lower hip movement, can walk w/ devices S1-5: bladder, bowel, sexual function MS - Solution -muscular deterioration occurring when the immune system attacks myelin sheath protecting CNS nerves - (demyelination). Affects flow of info b/t brain and body and causes pain, weakness, fatigue, numbness, tremors, slurred speech *heat should be avoided and increases pain and demyelination. CP - Solution -lack of muscle tone, coordination, and muscle control from damage to motor control system of brain. Usually congenital or occurring at birth. Symptoms: spasticity, unsteady gait, balance issues, posture, decreased muscle mass. Aquatic therapy useful. Huntington's Chorea - Solution -Begins in middle-age, gradual onset. (Huntington's Disease) - genetic defect causing nerve cells to degenerate. "Chorea" describes involuntary jerking movements almost like spasms. Progressive impairment affecting memory, mental functions, impulse control, mood and personality. Characterized by choreiform movements and progressive intellectual deterioration. Psychiatric disturbance (manic- depressive sympstoms, schizophreniform illness) may precede onset of movement disorder. Mysenthia Gravis - Solution -autoimmune, progressive neuromuscular disease causing weakness that fluctuates
ALS - Solution -"Lou Gherig's Disease" - progressive neurological disease in which the motor neurons degenerate to the point of total loss of motor function. The intelligence, memory, and personality is unaffected. Osteoarthritis - Solution -A disease in which joints become irritated or inflamed, such as when cartilage in joints is damaged or wears away. RA= rheumatoid A chronic inflammatory diease that causes joint pain, swelling, and stiffness. Most common in women and can occur at any age. Some persons need joint replacement surgery;eventually leading to bone erosion and joint deformity. Very painful swelling. OA=, osteoarthritis most common form,"Degenerative Joint Disease"=chronic progressive disorder onset around middle ages causing deterioration of the articular cartilage(hyaline) at joints "weight-bearing joints" and formation due to excessive normal wear and tear of aging or genetic inheritance(increased risk) that can be treated with aspirin and surgery in severe cases but not cured. often called wear and tear b/c protective cartilage at ends of bones wears down over time. Duchenne - Solution -A human genetic disease caused by a sex-linked recessive allele; characterized by progressive weakening and a loss of muscle tissue.muscular dystrophy - affecting muscle fibers that leads to muscle deterioration.
Duchenne's - type of MD affecting young males, involving "lordosis" - pronounced spinal curvature. Usually in w/c by age 12 with a life expectancy of about 25. Amputations - Solution -congenital or acquired. BKA - below knee BEA - below elbow AKA - above knee AEA -above elbow Osteoporosis - Solution -A condition in which the body's bones become weak and break easily. TBI - Solution -traumatic brain injury, an insult to the brain caused by external physical force that may produce a diminished or altered state of consciousness, which results in impairment of cognitive abilities or physical functioning Alzheimer's - Solution -A progressive and irreversible brain disorder characterized by gradual deterioration of memory, reasoning, language, and finally, physical reasoning Hydrocephalus - Solution -Abnormal accumulation of cerebrospinal fluids in the ventricles of the brain. b/c either over-produced or blocked. This increases pressure in the skull. Onset is at any point, with condition being worse in adults rather than kids due to adult's lack of flexibility in cranial bone structure. Can lead to mild and severe ID.
Focus Charting - Solution -focus on problems, events and factual occurrences such as self-care, adls, etc. Each note includes data, actions, and patient response. Charting by exception - Solution -System in which documentation is limited to exceptions from pre- established norms or significant findings Flow sheets with boxes and you check off what they did. Incident orders are one time orders. -often used in LTC settings DARP - Solution -DA(R)P stands for Data, Assessment (and Response), and Plan. Data, in this format, includes both subjective and objective data about the client as well as the therapist's observations and all content and process notes from the session. The Assessment and Response includes your clinical impressions, hunches, hypotheses, and rationale for your professional judgment. Progress is also noted here. Plan refers to your original treatment plan and any response / revisions needed based on your most recent interactions with your client. SOAPIER notes - Solution -Subjective-This is what the patient is saying about how they're feeling.
Objective-This is what you are observing is happening. Assessment-This is your assessment-usually all the head to toe stuff in addition to your observations of the patient's problem. Plan-This is what you plan to do for that patient r/t the problem and overall care, and the goals for the patient. Implement-This is what you've done. Evaluation-This is whether the care so far has been effective in helping the patient reach the goals BIRP notes - Solution -B Behavior. The pts behavior including subjective and objective data, mood and affect. I Intervention. The nurses intervention to the behavior. R Response. The pts response to the intervention. Include progress of lack of tward care plan goals. P Plan. What is the plan to assist pt in progressing tward goals in the care plan. Narrative charting - Solution -Traditional system of charting in which nurse documents in story from all pertinent patient observations, care, and responses in the nurses notes section FACT charting - Solution -this documentation includes only exceptions the norm or significant information about the patient. It eliminates the need to chart normal findings.
Vital Signs - Solution -Determinations that provide information about body conditions; include temperature, pulse, respirations, and blood pressure PERRLA - Solution -PUPILS EQUAL, ROUND, REACTIVE TO LIGHT AND ACCOMMODATION "wnl" within normal limits possible problems: neurological damage, eye infection, glaucoma, drugs EDEMA - Solution -Abnormal accumulation of fluid in interstitial spaces of tissues. Structures of scales - Solution -... Scales - Solution -... AIS - Solution -AIS: American Spinal Injury Association Impairment Scale -measures severity of SCI w/ 5 levels of completeness. 28 locations of sensation and 10 locations for motor function Braden Scale - Solution -A scale which evaluates a person for pressure ulcer risk; Range of pts from 6-23. Lower score means increase risk for pressure ulcer developmen BCRS - Solution -The Brief Cognitive Rating Scale (BCRS; Reisberg & Ferris, 1988) is used to assess
functional and cognitive abilities in both normal aging and progressive dementia. CNPI - Solution -Checklist of Nonverbal Pain Indicators The Checklist of Nonverbal Pain Indicators is an observational assessment tool designed to document pain behaviors in cognitively impaired elders. FACES - Solution -What pain scale operates on a scale of 0-5 and uses faces that a patient may interpret represent how they feel? FIMS score - Solution -The Functional Independence Measure (FIM) The FIM™ score ranges from 1 to 7, with 1 (Total Assistance) being the lowest possible score and 7 (Complete Independence) being the best possible score. GCS & CCS - Solution -is a tool that caregivers use to measure a person's level of consciousness. (usually in ER) -GCS - used for older children and adults -CCS- age 3 or younger -3 sections - EMV - eye, motor, verbal -severity: 3-8 (severe); 9-12 (moderate); 13-15 (mild to absent) GAF score - Solution -would be classified on Axis V (5) ranges from 1 (death) to 100 (total absence of mental and physical issues) combines psychological, social and occupational elements to assess total well being
measurement, so you can demonstrate worsening or improvement of cognition over time with treatment Multiaxial Assessment - Solution -five category reporting system used by psychiatrists and clinical psychologists. DSM IV falls into first 2 axes. First 3 describe biological and behavioral processes. Axis 1 - clinical disorders Axis 2 - personality disorders Axis 3 - general medical conditions Axis 4 - psychological and environmental problems Axis 5 - GAF Muscle Strength - Solution -The ability of a muscle or group of muscles to produce a maximal force during a single contraction. Orientation X3 - Solution -awareness of time, person and place- person with this deficit will not Solution his own name, not know day and time or season and will get lost easily. OX3 - you know the time, who you are, and where you are OX2 - know who you are, where you are, but don't know time OX3 - know one of them Rancho los Amigos - Solution -In TBI what describes the level of cognitive function to determine treatment intervention; determines how we do treatment?,
Level 1 -I- no response Level 2 -II- generalized response - may open eyes or move arms and legs but it is slow and involuntary Level 3 -III-localized - can follow direction, can follow movements of people, may respond to familiar faces Level 4 - IV-confused/agitated - increased awareness and responsiveness, memory better for past events, easily agitated and aggressive Level 5 - V-confused/inappropriate/nonagitated - decreased agitation, increased attention and ability to follow commands, poor short term memory, may have inappropriate responses and bx Level 6 -VI -confused appropriate - can initiate some activities, attention span limited, can retain more info and may have unrealistic goals Level 7 -VII- automatic appropriate - little to no confusion, impaired ability to problem solve, may appear to be bored/depressed/irritable because supervision. Robot-like Level 8 -VIII- purposeful appropriate - can plan realistically for future, slow processing, may have difficulty managing time and planning ROM range of motion - Solution -movement of each joint and muscle through its availabe arc of motion Sedation Scale - Solution -used to assess the level of sedation of a hospitalized patient used as part of FACES pain scale S- sleeping easily aroused 1 - awake/alert
Criterion-related - Solution -how well the test scores compare to what is being measured Construct validity - Solution -how well we have operationalized (described) the different elements of our content so that they can be measured accurately Clinical - Solution -base line functional level Types of reliability - Solution -... Test-Retest - Solution -test's consistency over time most common two test with a gap of time in the middle Interrater - Solution -two therapist get the same findings when they observe the same situation retrained every 6-12 months Equivalent Forms - Solution -two forms of the test to the same group Reliability scores - Solution -... Reasons to do assessments - Solution --identify person's strengths and needs -opportunities available - whats in their home or community? -Identify person's barriers to leisure/recreation: (structural, interpersonal, intrapersonal)
-build and establish rapport Considerations - Solution --stability of client - how in touch are they with reality? -location of work will change window of time allotted and how you perform assessment -scope of your practice - only do what you are trained to -staffing level - staff to participant ratio -governing bodies - certification bodies governing the facility may have time requirements -determine the baseline function of clients at admission Parts of the assessment -3 - Solution -...1.standardized tools - valid, reliable, numeric systems
- non-standardized tools - TR can make this up. You may be trying to identify individual's interests, so you can create programs that are individualized. These tools meet needs but are not tested for validity and reliability. 5 components of non-standardized tools: -nominal data - category, age gender, etc. -attitudinal data - info about client's attitudes, feelings, opinions, etc. -functional data - how well they function -treatment direction - our plan -summary of findings - other relevant details + summary
- clinical impression Criterion for admission - Solution -Acuity: how long person has had issues
physical involvement. Helps therapist identify participants' needs and baseline. IALB - Solution -Idyll Arbor Leisure Battery: For: clients w/ moderate to no cognitive impairment Purpose: give therapist idea of client's leisure aptitudes About: Includes 4 assessments: -leisure attitude -leisure interest -leisure motivation -leisure satisfaction LDB - Solution -leisure diagnostic battery: For: Purpose: to assess leisure functioning, determine where improvement is needed, determine impact of services, gain better understand of purpose and impacts of leisure About: various sections that measure perceived leisure competence, perceived leisure control, leisure needs, depth of involvement in leisure, and playfulness. Leisurescope Plus - Solution -For: adolescents and adults in a wide variety of settings Purpose: identify areas of high leisure interest, identify emotional motivation, identify individuals with a high need for arousal experiences About: 2 different instruments, one for adults and one for adolescents. Measures the degree of interest an individual has in 10 areas of leisure. LSS - Solution -life satisfaction scale:
For: clients with moderate to no impairment - good when you want to establish a baseline or compare change over time Purpose: measure client's perceived satisfaction Descriptions: list of statements client agrees or disagrees with SET - Solution -Measurement of Social Empowerment and Trust: For: adolescents and adults w/ no cognitive impairment Purpose: measure changes in an individuals perception of his/her social attitudes and skills as a result of involvement in a treatment program or adventure class. Specific skills measured include: bonding/cohesion, empowerment, self- awareness, affirmations, awareness of others Description: 5 subscales on a test sheet BUS - Solution -bus utilization skills assessment For: created for individuals with I.D., useful for anyone with socially inappropriate behaviors Purpose: determines the breadth and depth of skills a client has related to the use of public transportation and how well a person can use public transportation independently. Description: checklist with section 1 evaluating the cognitive and social skills and section 2 checking for maladaptive behaviors that may be interfering. CERT Psych/R - Solution -comprehensive evaluation in recreational therapy For: used in acute care settings as an intake assessment.
