Tennessee Regulations
What is 2 years?
The "Assessment" section of the SOAP note must describe the patient's respose and how the response impacts _____________.
What is occupation?
You have applied a hot pack to a patient's shoulder for the first time, due to stiffness due to limited use (injury 2 months ago). After about 5 minutes, the patient complains of itching.
This is the correct course of action.
What is immediately stop the treatment?
(Then, allow the tissue to cool. Ask the patient about history of heat intolerance. If the patient is motivated to try again in a future session, you may do so with more layers and CAREFUL monitoring. If still intolerant or complains of itching or any other adverse effects, discontinue modality in plan of care).
These 2 types of superficial thermal modalities use conduction to heat tissues to a depth of 1 cm.
What are paraffin and hot packs?
(Conduction - transfer of heat by direct molecular collision).
This is the term for the body's physiologic response to cooling, which reduce inflammation and edema
What is vasoconstriction?
You are working with a client who has stiffness around the scapula limiting glide.
This is the best modality and duration of treatment to decrease stiffness in preparation for range of motion and functional activity.
What is a hot pack, and 10-20 min. (20 min MAX!)
In order to become certified in thermal PAMS, you must have this many supervised treatment applications on patients.
What is TEN (10)?
All PAMs documentation should include enough detail ____ ____ _______________, in order to maintain consistency of treatment in future sessions/by future treating therapists.
What is "to be replicated"?
These are 2 potential adverse effects of heating, particularly when not used following recommended protocols/following appropriate precautions.
What are burns?
What is bleeding?
What is fainting?
This is the term for the body's physiological response to heat, specifically as it relates to blood flow.
Name the term and describe it.
Relaxation of smooth muscle widens blood vessels, increasing blood flow.
These are 3 primary reasons that you may utilize superficial COLD modalities.
What are 1. to reduce pain 2. to reduce acute inflammation 3. to decrease spasticity for improved functional activity during short window of cooled temperatures.
You are working with a softball player who has acute soreness in her right shoulder after a game.
This is the most appropriate modality.
What is Cryocompression (Game Ready)?
Number of TOTAL (thermal and electrical) DIDACTIC hours required in preparation for PAMS certification in Tennessee.
What is 45 hours?
(20 thermal & 25 electrical)
The "Plan" section of the SOAP note should include these points. Name at least 2.
What is recommendations for next session including continuing or changing modality and parameters, frequency of recommended modality, grading the task?
These are 3 conditions in which using heat should be done with extreme caution? (Precautions).
What are: Recent injury/inflammation
Pregnancy
Impaired circulation or cardiac function
Edema
Implants and metal in the area
Over open wound (if hemorrhaging or at-risk for hemorrhage, then heat is contraindicated)
Over topical counterirritants
Demyelinated nerves
This is the recommended technique for paraffin, including preparation of patient, number of dips, and insulation.
What is
1. Remove jewelry 2. Wash and dry hands. 3. Dip 6-10x (differs between books), letting drip and dry between each layer, and ensuring no layers go higher/more proximal than first layer. 4. Wrap in plastic. 5. Wrap in towel.
This is the number of layers and duration of application appropriate for cold packs.
What is 1 layer (pillowcase or towel), and 10-20 min (checking skin after 3-5 min)?
You are working with a patient in outpatient occupational therapy due to decreased hand ROM after a sprain a 5 weeks ago. The patient struggles with chronic edema as a comorbidity.
This is the most appropriate modality that may assist in increasing flexibility/ROM while avoiding increase in edema
What are contrast baths?
Alternate between hot and cold at 3:1 or 4:1 ratio.
What is 5 treatments must be ultrasound.
These 2 effects of PAMS must be included in all PAMS documentation.
These are 5 (HARD STOP) contraindications in which you would not use heat.
What is acute injury (less than 3 days post injury/surgery)?
What is infection in the area needing treatment?
What is recent hemmorage?
What is malignancy?
What is DVT/blood clot/thrombosis?
What is significantly impaired circulation?
What is absent sensation?
What is inability to communicate?
Terry cloth covers for hot packs count as this many layers.
What is 3 layers?
This is a direct method of cold application in which the modality is applied until numbness is reached in a targeted area.
What is ice massage?
You are working with a patient who has acute pain along the radial aspect of forearm, in a small appx 1 square inch area.
This is the most appropriate modality and duration of application to manage acute pain at this location.
What is ice cup massage for 3-10 min (stop at numbness)?
In order to become certified in electrical modalities, you must complete _____ (#) treatments on patients, which must include 1 treatment from these three categories.
5 treatments, including 1 treatment of:
1. Neuromuscular e-stim
2. E-stim for pain control
3. E-stim for edema management
The Objective section of the SOAP note MUST include these 6 points of the treatment.
1. Area being treated
2. Patient's position
3. Type of device used
4. Goals of treatment
5. Targeted or desired response
6. Specific parameters (time, intensity, etc.)
7. Treatment results
These are 4 (HARD STOP) contraindications for use of cold modalities.
What is cold intolerance?
What is Raynaud's disease?
What are regenerating peripheral nerves?
What is significantly impaired circulation (such as in PVD)?
What is absent sensation?
What is inability to communicate?
This is the number of layers that must be between skin and heat when applying hot packs.
What is 6-8 layers?
This cold modality uses evaporation to change the temperature of skin.
You are working with a client whose hand had been immobilized in a cast for 8 weeks. The cast has now been removed, the client cleared for full mobility, no edema present. The client is very stiff and you would like to increase soft tissue extensibility at the beginning of therapy session.
This is the most appropriate modality and treatment time.
Two best choices -
What is paraffin and 20 min?
What is fluidotherapy for 15-20 minutes?