206 terms

Definitions & misc

A hodgepodge of definitions relating to CRRN
Program Evaluation
monitor patient satisfaction and outcomes data to evaluate the effectiveness and efficiency of care
in this tool, a score of 4 means the patient requires min assistance and is able to do 75% of the work
Quality improvement
assess processes, target areas for improvement, and evaluate options
these stds address management issues
mission is to improve the quality of life of persons served
Inpatient Rehab Facility tool to collect data for Medicare: IRF-____
this process begins with an initial conference with organizational leaders
Plan, Do, Check, Act. A process of quality improvement.
CARF emphasizes more than JC?
accessibility and safety of those with disabilities
compare data against the best, oneself, or another standard
A CARF guideline for quality improvement.
Principles of TQM
Doing the right thing, right the first time, on
time, all the time, and continuously looking for
ways to improve
Affinity diagram
grouping method for large amounts of input
Affinity diagram
used to organize ideas and data
Check sheet
simple tool used to collect data in real time
Check sheet
identifies trends
Control chart
quality-measurement tool with control limits
Control chart
shows if a process is within expected parameters
Fishbone diagram
visual cause-and-effect diagramming tool
Fishbone diagram
defines relationship between results and possible causes
visual representation of a process
process design and coumentation tool
a diagram showing the distribution of data points
determines amount of variation in a process
Pareto chart
descending bar graph
Pareto chart
identifies most important problems
Run chart
a method of visually displaying time-sequenced data
Run chart
identified data anomalies that may indicate problems in a process
Scatter diagram
display of data in a collection of points
Scatter diagram
shows correlation or cause-and-effect between variables
Outcomes data collection
measures efficiency and effectiveness of care
incorporated into the IRF-PAI to measure function and burden of care
problem-solving approach to integrate critical appraisal of the evidence concerning a clinical problem with clinical experiene and patient needs, values, and preferences
A patient-care strategy with a moderate degree of certainty reflecting Level II evidence, expert opinion, or a consensus of caregivers.
A patient-care strategy that reflects
inconclusive or confusing evidence or conflicting expert opinion.
Evidence or Standard
Well-conducted research studies support
the action of a generally accepted patient-care strategy. Levels of Evidence range from I, which is a thorough, repeatable study, to V, a case series (less valid).
Addresses the relearning of acquired skills or adapting to a different method for achieving an outcome than previously was used
Refers to teaching a person a skill they have not previously accomplished (thus it is new to him or her)
Acquired disability
results from trauma, infection, or other conditions generally occurring after birth
Congenital disability
the result of a genetic disorder (even if symptoms don't show up for months or years) or is present from the time of birth and not r/t external environmental factors during birth or post-birth periods
an increase in body size or change in structure or function, progressing to some point of optimal maturity
Patterned and orderly life-long changes in structure, thought, behavior which evolve as a result of the maturation of physical and mental capacity, experience and learning, leading to a new level of maturity and integration of skills
Head to toe
trunk to extremities
the process of gaining specific skills and acquiring habits and attitudes as a result of experience, training and behavioral changes
Developmental task
a growth responsibility that arises at a certain time in the course of development
Deviant development
Disruption in the normal developmental sequence secondary to unevenly-developed or neurologically-impaired processes
Delayed development
Advancement through the normal sequence of milestones at a rate slower than that of peers at the same chronological age
Interdisciplinary Team
Coordination, collaboration, and communication are critical to the success of my team. Patients/families are active participants in goal setting and discharge planning. While membership is the same as in multidisciplinary teams, the way the team works together is different as members work beyond their own turf boundaries.
Multidisciplinary Team
In practice I see each discipline complete their assessments and establish discipline-specific goals. Disciplines work within their own boundaries for goal achievement. The team's outcomes are the sum of these parts. I am not a holistic approach to care, but all team members know very specifically what they are supposed to work on.
Transdisciplinary Team
which is considered to be a strategy for reducing costs while achieving goals without compromising on quality. I minimize duplication of effort through the selection of a primary therapist who then consults with other therapists to achieve the goals of the patient. There is much boundary-blurring, flexibility, and cross-training required in this team model.
3 month old child
hold head up, begins to coo, reaches for familiar objects/people, holds hand open at rest
6 month old child
babbles, recognizes strangers, reach with either hand and transfers objects from hand to hand
12 month old child
walks with one hand being held, throws objects, comes when called, follows one-step commands with gestures
18 month old child
runs, turns two to three pages at a time, knows one body part, builds a tower of 3-4 blocks, fills spoon and feeds self
24 month old child
walks up & down steps w/ rail, turns pages one at a time, removes shoes and pants
3 year old child
alternates feet on stairs, uses plurals and past tense, dresses & undresses partially, plays in group and shares toys
4 year old child
hops on one foot, knows colors, catches ball (trapping against body), buttons clothing
5 year old child
skips alternating feet, ties shoes, spreads using knife, prints first name
Erikson's Trust vs Mistrust
trust that basic needs will be provided for. Infant to 18 months
Erikson's Autonomy vs Shame & Doubt
2-3 years. learns self-control and will power. Consistent application of discipline help to form this stage. B&B control established.
Erikson's Initiative vs Guilt
3-5 years. Learns the ability to control body (self-regulation), environment, and self (identity). Physical & social skills are developed and child develops internal values and reward systems.
Erikson's Industry vs Inferiority
5-12 years. Develops conscience, imagination and entrepreneurial skills. Inherent reward in completing tasks that are of interest.
Erikson's Identity vs Role Confusion
12+. Develops sense of who he is and what he wants to be. Physical, cognitive and hormonal changes drives changes in social roles.
Paiget's Sensorimotor
Birth-18 months. Responds to environment by trial & error, uses senses to explore and learn cause/effect. Eventually able to anticipate results of actions. Bx becomes intentional w/ active experimenting
Piaget's Preoperational Thought Toddler
2-3 years. Egocentric thinking predominates. Symbols, words and objects are used to represent things not physically present. Immature logic forms.
Piaget's Preoperational Thought Preschool
3-5 years. Use symbols to recall past events, represent the present and anticipate the future. Intuitive thought develops. Egocentrism decreases (thru age 7)
Piaget's Concrete Operations
5-12 years. Systematic thinking about familiar situations; begins to solve concrete problems thru perceptions (abstract thinking hasn't developed). Concepts of causation and processes of change begin to be understood.
Piaget's Formal Operations
12+. Develops workable philosophy of life, abstract & analytical thinking, and the ability to solve contradictions. Able to solve hypothetical & concrete problems. Logic develops.
Piaget's Four Operational Stages
Sensorimotor, Preoperational, Concrete Operations, Formal Operations
Disability in infancy
can disrupt parental boding; parents feel guilt/anger; must deal with sorrow & mourning. Support parental bonding, limit use of restraints. Place toys in visual field.
Disability in toddlerhood
frustration may increase if toddler is unable to do what they want to do or are placed in unfamiliar environments; team needs to recognize the significance of ritualistic bxs. Keep safe. Adapt toys to encourage play.
Disability in early childhood
Children have very active fantasies & fears, play involves pretend. Loss of interactive play may limit child's social development. Maintain daily routines. Focus on abilities.
Disability in middle childhood
Children are developing an ego and eager to be responsible. Peer relationships become important. Will be very conscious of how they differ from peers. Provide opportunities for child to demonstrate responsibility. Provide honest, complete explanations.
Disability in adolescence
Independence & identity at risk, including sexual identity. Encourage independence & decision-making. Respect privacy. Provide information. Support social relationships.
Erikson's Intimacy vs Isolation
Young adult, looking for life partner
Erikson's Generativity vs Stagnation
Middle adult, passing values and beliefs on to future generations
Erikson's Ego Integrity vs Despair
Older adult, reflecting, content and satisfied with life's choices
Aging & cerebral circulation
Decreased cerebral blood flow increases the risk of stroke
Aging & vision
Night vision, peripheral, and depth perception decrease. About 3 x as much light is needed to see.
Aging & taste
Decreased sense of taste may result in decreased appetite, and increased intake of sweet and spicy food.
Aging & pulmonary function
Decreased d/t muscular degeneration & atrophy, and decreased elastic recoil capability of lung tissue. Alveolar surface diminishes and pulm circulation declines, reducing ability to oxygenate the blood.
Aging & GI tract
Caloric needs decrease. Enzyme activity & gastric secretion diminish decreasing the absorption of nutrients. GI motility decreases.
Aging & bladder
Bladder muscles relax, incomplete emptying & chronic retention.
Aging & activity level
inactivity leads to increased loss of calcium & nitrogen. Bones become more brittle and osteoporosis may develop.
Aging & skin
SubQ fat is lost with dermal thinning and decreasing collagen & elastin. Cell replacement declines by 50%. Wounds heal more slowly.
Aging & kidneys
Renal function diminishes at age 40. Increases risk of dehydration & development of renal calculi. Renal clearance of drugs may be affected.
What determines team membership (i.e., those disciplines providing care) for an individual patient?
The patient's needs
Which type of team is likely to deliver care in a potentially complex system that involves a variety of disciplines working together to pursue a common set of patient goals?
Which setting provides 24-hour care for patients but does not require this to be skilled care?
Transitional Living Centers
Who requires that IRF settings have a person coordinating the patient's care and ensuring achievement of outcomes?
Which team member has responsibility for mgmt of health, facilitation of return to work or school, coordination of timely and effective care, as well as mgmt of financial resources?
External case manager
What is one of the more important reasons for d/c planning?
To coordinate timing and access to resources in a timely manner.
Does manifest conflict result in negative behaviors?
No, actions that result from conflict can be either + or -. Manifest conflict leads to overt action.
Lewin's Classical Change Theory
Livneh's Unified Model
*Initial Impact (shock, anxiety, confusion)
*Defense Mobilization (resisting therapy activities, refusing help, requesting increased contact with staff, bargaining)
*Initial Realization (fatigue, dependent, grief, sleep disturbances)
*Retaliation (blaming, critical, unhappy, active resistance)
*Reintegration (new self-concept, confidence, goals, acceptance)
Warning signs of burnout
Difficulty getting organized, feeling they cannot do anything right, crying for no reason, being short tempered, feeling numb & emotionless, everyday tasks become harder, feeling constantly pressed for time, feeling that there is not time for self.
A person's capacity to positively cope with stress and catastrophe.
Impact of anxiety on cognitive functioning
difficulty concentrating; decreased awareness of environment; forgetfulness; rumination; focus on past; hypervigilance; blockage of thoughts
Primary prevention
health-promotion activities directed at preventing a problem or complication, or improving a situation already present
Secondary prevention
early diagnosis and treatment in an effort to limit the consequences of a disease or injury
Tertiary prevention
activities that promote recovery, restoration and rehabilitation following a disabling event.
Affective component to teaching
addresses attitudes and desire to comply with medication regimens
Cognitive component to teaching
Include understanding reason for medications, mgmt strategies, and potential risks.
Psychomotor component to teaching
Include actually setting up and administering medications
Left brain or right brain: speech and language
Left brain or right brain: left/right discrimination
Left brain or right brain: constructional skills
Left brain or right brain: analytical reasoning
Left brain or right brain: proprioception
Left brain or right brain: spatial perception
Which lobe: executive functioning
Which lobe: recognition of objects
Which lobe: body awareness
Which lobe: reception of sensory impulses
Which lobe: screening out unnecessary stimuli
Which lobe: interpretation of the sensations of touch, pressure, temp & pain
Which lobe: location of memorized patterns of movement
Which lobe:initiates voluntary movement
Which lobe: seat of personality
Which lobe: spatial relationships
Which lobe: speech motor area in left hemisphere
Which lobe: interpretation of balance
Which lobe: control of the amt of muscle tone
Which lobe: concentration
Which lobe: complex problem solving
Which lobe: logical thinking
Which lobe: abstract thinking
Which lobe: future planning
Which lobe: voluntary muscle coordination
Which lobe: interpretation of visual information
Which lobe: complicated math problems
Which lobe: recognition of the meaning of written words
Which lobe: recognition of tones, loudness, and qualities of sound
Which lobe: interpretation of the meanings of spoken words
Which lobe: modifies speed, force, and accuracy of movement
Which lobe: storage of short term memory
Basal ganglia
collection of nerve cell bodies deep in cortex that smooths out movement
Initial recognition of pain & temp; Reticular Activating System controls level of excitability & helps maintain waking state; relays sensory info; differentiates pleasant from unpleasant feelings
Limbic system
Contains the amygdala and hippocampus; important role in memory; has a role in fight/flight; interprets importance of sensory messages
Recognition of thirst and hunger; contains centers which directly influence the pituitary gland; regulation of vegetative functions; influential in the release of several hormones; contains satiety center; controls concentration of electrolytes thru ADH
Brain stem
Contains respiratory control center; majority of cranial nerves arise from here; motors tracts pass through
I Olfactory
II Optic
III Occulomotor
Motor control of the eye (except superior oblique and external rectus), iris, and ciliary muscle
IV Trochlear
Motor control of superior oblique muscle of eye
V Trigeminal
Motor control of muscles for chewing, sensory fibers for eye, face, sinuses, and teeth
VI Abducens
Motor control of external rectus muscle of eye
VII Facial
Motor control of facial muscles, submaxillary and sublingual salivery glands
VIII Vestibulocochlear
Hearing and vestibular sensations
IX Glossopharyngeal
Motor control of the pharyngeal muscles and the parotid gland
X Vagus
Motor to heart, lungs, bronchi, digestive tract.
XI Accessory
Motor to sternomastoid, trapezius, pharynx, larynx, and soft palate
XII Hypoglossal
Motor control of the strap muscles of neck and tongue
What provides collateral circulation to the brain in the event of an interruption in blood flow?
Circle of Willis
Nerve supply to deltoid and biceps allowing shoulder shrug and elbow flexion
Nerve supply to legs
Nerve supply to wrist and extensors allowing pinch
Nerve supply to diaphragm
Nerve supply to hand allowing hand flexion
Nerve supply to bowel/bladder and sexual organs
Nerve supply to chest
Nerve supply to intrinsic muscles of the fingers allowing hand function and thumb opposition
Nerve supply to triceps allowing elbow extension
Nerve supply to abdomen
Upper motor neurons
run from the brain to the segmental level of the spinal cord; central nervous system; above the level of the reflex arc
Lower motor neurons
run from the segmental level of the spinal cord to the muscles they control; peripheral nervous system; below the level of the reflex arc
Damage to upper motor neurons
results in hyperactive, uninhibited reflexes. Spasticity and uncontrolled spasms are common.
Damage to lower motor neurons
results in flaccid muscle tone and hypoactive or absent reflexes
Spinocerebellar tracts
Reflex proprioception
Lateral spinothalamic
Pain, temperature
Ventral spinothalamic
Light touch, pressure
Corticospinal tracts
Voluntary movement
Posterior column
Proprioception, deep touch, vibration
Simple reflex response
1. Sensory receptor stimulated
2. Sensory fibers relay message
3. Interneuron relays message
4. Motor nerve relays message
5. Target muscle contracts
Dermatome: C4
top of shoulder
Dermatome: T1
undersurface of forearm
Dermatome: C6
thumb, top surface of forearm
Dermatome: T10
Dermatome: T4
nipple line
Dermatome: L3
inner thigh
Dermatome: L5
outer calf
Dermatome: S5
Dermatome: S1
bottom of foot
Parasympathetic nervous system
Controls and directs the production and conservation of energy. Its actions are reflexively controlled and carried out below the level of consciousness. Rest & digest, bowel & bladder, tears & saliva
Sympathetic nervous system
Fight or flight system. Works in balance with parasympathetic system. Increased vision, hairs stand up, HR up, increased breathing, adrenaline, no B/B
What nerves innervate the diaphragm?
C3, 4, 5. The phrenic nerve
Pulmonary edema
results when fluid accumulates faster than the lymphatics can remove it
Where are involuntary respiratory centers located?
Medulla and pons
Oral phase of swallowing
Food is manipulated in the mouth and the bolus is centered and moved towards the oropharynx
Pharyngeal phase of swallowing
Bolus passes through the pharynx
Esophageal phase of swallowing
Bolus transported to the stomach on peristaltic waves
Gastrocolic reflex
mass peristalsis of the colon occurring 1-3 times daily and generally initiated by food in the stomach
Defecation reflex
stimulated by the presence of stool in the rectum and resulting in peristalsis of the descending colon and relaxation of the sphincters.
REM sleep
Characterized by rapid eye movements, dreaming and a lack of muscle movement; heightened brain activity is associated with muscle paralysis
Non-REM sleep
Quiet sleep with fully functional brain and movable, but inactive body; contains four stages of progressively deeper sleep
Stage 1 sleep
Brief transitional stage of sleep; person is easily aroused and, if wakened, may deny being asleep
Stage 2 sleep
Deeper level of sleep that lasts 10-25 min; slowed respiration, pulse, metabolism, and decreased body temp with periods of muscle tone mixed with periods of relaxation
Stages 3 & 4 sleep
Deep sleep with full muscle relaxation and slowed GI activity; if awakened, person may be disoriented for a few minutes
Motor nerve tracts
descend the spinal cord; include the lateral corticospinal, the ventral corticospinal, and the extrapyramidal
Sensory nerve tracts
ascend the spinal cord; include the anterolateral (pain, temp, crude touch, tickle, itch, and sexual sensations), and the posterior (dorsal) column (tactile, vibratory and proprioceptive). Anterolateral tract crosses the spinal cord. Posterior column crosses the medulla.
Mean Arterial Pressure =
Cardiac output x total peripheral resistance
Cardiac output =
heart rate x stroke volume
contains no blood vessels; melanosomes, which determine skin color, are located here
A very elastic layer which contains large amts of collagen proteins and elastin
Varies in depth; contains connective tissue, blood, lymph vessels and nerve endings