Geriatrics
Some research suggests that ADL decline can be predicted by this.
What is depression?
(Will also accept nutrition or finances after d/c)
A patient with CAD stage 3 is refusing to get their immunizations. What is the biggest issue you’re concerned with? (Think about the topic of this category)
Patients must be immunized before receiving an organ donation. It is a requirement that is meant to keep the patient safe who is in a weakened state due to failing organs, especially after the transplant due to immunosuppressive prescriptions.
What is the difference between Type 1, Type 2, and gestational diabetes?
Type 1 = “Insulin-dependent” because of a malfunctioning pancreas
Type 2 = “Adult-onset diabetes” because it usually happens later in life as a result of obesity and physical inactivity
Gestational = diabetes that occurs during pregnancy due to the increased stress on the body (usually resolves after birth)
Why does WHR have a better association with all-cause mortality over BMI?
WHR measures body shape → ie fat distribution.
Excess weight in the mid-section leads to a greater risk of developing chronic disease.
Enhancing bone growth during the growing years is vital to reducing fracture risk during adulthood and older ages. This is the best type of exercise to stimulate bone growth.
What is weight bearing?
For a physical activity program for reducing fall risk in older adults name two kinds of exercises you would include. What is the intensity?
Any two:
- balance
- strength
- endurance
- gait training
- functional task practice
At moderate-intensity
Name the four common conditions leading to heart transplant.
End stage heart failure
Dilated cardiomyopathy
Severe coronary artery disease
Congenital heart defects
Name three different screening tools for nutrition and malnutrition.
Any of the three:
Nutrition Screening Protocol
Start the Conversation
Rate Your Plate
Weight, Activity, Variety, Excess (WAVE)
Rapid Eating and Activity Assessment for Patients (REAP)
Malnutrition Screening Tool (MST)
Mini Nutrition Assessment-Short form (MNA-SF)
Nutrition Screening Initiative (NSI)
Patients must exercise aerobically for how long each day to begin to qualify for bariatric surgery?
At least 20 min/day
Your patient has Type 1 DM. At what intensity and duration should they be doing aerobic exercise?
60-75% VO2max
150 min per week
Name three exam recommendations for a patient with Post Intensive Care Syndrome (PICS).
Respiratory system exam
Muscle strength
Exercise Capacity (6MWT)
Gait speed
Balance (BBS, FGA, ABC)
ADLs/FAA
Cognitive/Mental Health (MOCA)
You are mobilizing a patient post heart transplant. Why are you concerned with having a longer warm-up and cool down than other patients?
Because of cardiac denervation. The autonomic nervous system has been cut and cannot help to control HR. Instead, these patients are relying on hormonal control.
Your patient has Type 2 DM that they have only recently started to manage. They complain of being “unsteady” at night when getting up to go to the bathroom. What are two neuropathic considerations you will keep in mind during your session?
You should keep in mind two kinds of neuropathy that can affect balance in patients with diabetes:
Peripheral neuropathy can affect sensorimotor systems of balance
Autonomic neuropathy, specifically retinal neuropathy can affect the visual system. In particular the pupillary light reflex is slowed, resulting in difficulties at night or in the dark.
Name any four common comorbidities associated with excess weight.
Any four:
HTN
Heart disease
Type II DM
CVA
Hyperlipidemia
Renal disease
Sleep apnea
OA
Stress urinary incontinence
Increased CA risk
Name four different factors that can affect weight and state whether they’re genetics, behavioral, environmental, or psychosocial.
Some factors include (but not limited to):
- Poor eating habits (behavioral, environmental, psychosocial)
- Overeating or binging (behavioral, psychosocial, environmental)
- Lack of exercise (behavioral, environmental)
- Medical illness (genetics)
- Stress (environmental, psychosocial)
- Low self-esteem (psychosocial)
- Mental health issues (genetics, psychosocial)
This is an underrecognized epidemic in the hospital.
(Hint: 83.3% of the time is spent in bed)
BONUS 100: What are some possible reasons for this?
What is low mobility during hospitalization?
BONUS: Possible barriers to mobility in the hospital include staffing issues, complex medical conditions that contraindicate OOB activities, lines/tubes, medication schedule, etc.) Award points for any viable reason even if not listed here.
What is the reason patients are given inhaled NO after lung transplant?
To facilitate pulmonary vasodilation and help effectively reduce the stress on the R-side of the heart. This helps to reduce the risk of heart transplant right after lung transplant.
Your patient has kidney failure due to chronically unmanaged diabetes. They are on HD three times a week. What are four side effects or social impacts of HD?
Some physical side effects to consider:
Vascular access is blocked
Muscle cramps
Hypotension
Weakness/dizziness/nausea
Blood loss
Infections (skin or fluids)
Fatigue
Pruritus
Some social considerations:
Time consuming procedure can affect daily routine
Costs
Discomfort
Decreased QoL
Your patient whose ultimate goal is to manage their Type 2 DM and HTN is upset because despite adhering to their prescribed exercise program for the past 6 weeks (with objective improvements in muscular strength and endurance) they have not lost any weight. What would you say to them?
You should reiterate for them that physical activity and a healthy diet is what is associated with improvements in metabolic risk factors - independent to weight loss.
Their adherence to these healthy lifestyle behaviors is what will help them achieve their goal of medical management, not the number on the scale.
You are asked to evaluate a patient post heart transplant and are asked for a discharge recommendation. Where would you most likely NOT recommend for the patient and why?
Most likely, a SNF is not a good d/c disposition due to the high risk of infection.
OP PT with cardiac rehab, HHPT, or ARU would be better choices.
Your 74yo patient with HTN, osteoporosis, would like to improve their strength and endurance to continue walking with their grandkids. Describe one type of exercise you would prescribe (aerobic, mobility, etc.) and the dosage. Explain your reasoning.
Multiple possibilities, but one example:
Combined aerobic and resisted training to reduce fall risk and therefore risk of fx since this patient has osteoporosis. Walking for aerobic exercise is also weight bearing and good for stimulating/maintaining bone growth. The resisted training should focus on strengthening first to build the muscles needed for progressing to endurance training.
Aerobic - start at threshold, then gradually build up to 30min/day 3-5x/week
Strengthening - 10-15 x 2-3 sets at mod intensity, 1x/day 2-3/week
You are seeing a patient post double lung transplant. They seem a little nervous about getting up to the eob and you want to help them calm down. Would you or would you not educate them on diaphragmatic breathing? Why or why not?
Although diaphragmatic breathing as part of an active cycle of breathing would be a good retraining exercise. It is not the best choice if the intent is to calm down the patient. This is due to the impaired mechanoreceptor sensitivity, so the vagal nerve is not as stimulated during deep breathing as before.
Your patient has Type 1 DM, but is managing it very well. They have come to you asking about the possibility of running in a 10k with their partner. What are some things you would educate this patient on?
Make sure that they understand that exercise can increase sensitivity to insulin, causing a risk of hypoglycemia post exercise. The patient should be informed that they must check the glucose before, during and after exercise.
If their blood glucose is low they should definitely eat a snack, but it might be good to have a snack even if it isn’t low given the amount of exercise they plan on doing.
If their blood glucose is higher than 240, they should check their ketone levels. If they do have ketones in their bloodstream, they should not exercise to avoid DKA.
Finally, they should frequently check glucose after exercise since the effects of exercise can last up to 24hr.
Your patient with chronic COPD is in your clinic for knee OA. Due to their dyspnea, they have not been as physically active as they were before, resulting in excess weight over the years. Their chart also indicates HTN and hyperlipidemia. They have passed their Par-Q and are ready to begin their exercise program. What is an appropriate outcome measure for this patient?
It would be most beneficial to pick an outcome measure that measures cardiovascular endurance given their CV hx. So the 6MWT would be an appropriate outcome measure for this patient.
Other appropriate measures are:
30s STS
5xSTS
TUG
10mWT
…and any others for muscular endurance, functional strength, or QoL
What blood glucose levels contraindicate exercise?
(This is from TherapyEd, NOT the lecture! I thought this is an important piece of info we should know for boards)
< 70 mg/dL OR
>300 mg/dL