Specialty Program Review

Orthopedics

100

Name 2 ways patients can prevent blood clots? 

- Wear compression socks 

- Elevate feet 

- perform ankle pumps

- Take anticoagulant as prescribed 

- walk every hour

200

What do you do if the DC instructions the patient has, is different than the protocol? 

Follow the DC instructions for that visit as they take precedence over the protocol.  Notify RPD of discrepancy after the visit. 

300

What are 2 things that must be documented every visit with a patient following a Total Knee Arthroplasty? +

- Knee extension 

- Knee flexion 

400

Name 2 things on the patients Post Op "To do list" post operatively

1. manage meds as directed 

2. manage my pain 

3. prevent constipation 

4. prevent infection 

5. Manage Swelling 

6. Prevent blood clots 

7. Schedule and keep MD appointments 

8. Keep moving

9. Avoid Falls 

10. Do my exercises 

500

A patient's TKA is covered with a bandage, but looks to be red surrounding the incision, swollen, with increased pain.  What should your next steps be? 

- Either send RPD a picture to send to MD, and assess together.  

- (if MD cell is listed and notes okay to send pictures) send photo to surgeon directly. 

- Call surgeon's office. 

-DO NOT remove bandage unless indicated in orders or protocol. 

Heart Failure

100

Name 2 signs or symptoms that demonstrate a patient is having worsening heart failure? 

- weight gain 2-3 lbs in a day or 5 in a week 

- frequent need to urinate 

- palpitations or irregular pulse

- Vague feeling of being confused 

- difficulty sleeping in a flat position 

- loss of appetite, indigestion, nausea or vomiting. 

- swelling in feet, legs, or stomach

200

Name 2 things that you can educate the patient on to manage their heart failure? (also found in the "to do list")

1. Weigh yourself daily

2. Take medications as directed 

3. Keep MD appointments4. 

4. Eat well 

5. Keep moving

6. Stop smoking 

7. Plan for the future 

8. know their BP

300

If a patient is on a protocol with a cardiologist, and is currently in the yellow zone, what would be your next step? 

- refer to protocol, and if it indicates, it is okay to give the patient an extra dose of prescribed diuretic. 

- call MD if symptoms do not improve

400

What score on the heart failure index is an "adequate" self-management score?

70+

pg 13 of heart failure book. 

500

What's the difference between diastolic heart failure, and systolic heart failure?

Job security?

100

After having a stroke what is the reoccurrence rate of having another stroke in 5 years?

+/- 5%

25% 

1. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation. 2023;147:e93–e621.

200

What percentage of people will have cardiovascular disease by 2050? 

+/-  5%

61%!!!!

Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050—Prevalence of Risk Factors and Disease: A Presidential Advisory From the American Heart Association | Circulation (ahajournals.org)

300

What percentage of patients with heart failure are readmitted to the hospital within 90 days?

+/- 5%

35% (in 2017 and rising)

Trends in 30- and 90-Day Readmission Rates for Heart Failure | Circulation: Heart Failure (ahajournals.org)

400

What percentage will the group of 50 year + grow between 2020 and 2050? 

 +/- 5%

 The number of people in the United States aged 50 years and older will increase by 61.11% from 137.25 million in 2020 to 221.13 million in 2050.

Ansah JP, Chiu CT. Projecting the chronic disease burden among the adult population in the United States using a multi-state population model. Front Public Health. 2023 Jan 13;10:1082183. doi: 10.3389/fpubh.2022.1082183. PMID: 36711415; PMCID: PMC9881650.

500

What is the annual median cost of managing 1 patient with heart failure in the US?

+/- $5,000

The annual median total medical costs for heart failure care were estimated at $24,383 per patient, with heart failure-specific hospitalizations driving costs (median $15,879 per patient). 

A Systematic Review of Medical Costs Associated with Heart Failure in the USA (2014–2020) - PMC (nih.gov)

Lung Disease

100

Name 2 things a patient can perform to slow breathing when feeling anxious? 

1. pursed lip breathing 

2. Belly Breathing 

3. Visualization 

4. Guided Imagery

5. Progressive muscle relaxation 

6. Music

7. Mindfulness 

200

Name 2 things that would indicate your patient is in the yellow zone for breathing management?

1. Phlegm increase, color change, or thickening 

2. Coughing or wheezing increase after taking medications 

3. Meds are not helping 

4. More trouble breathing or coughing with activity

5. Need extra pillow to sleep

6. Reduced appetite

7. Temperature 98.6-100.4

300

Name 2 oxygen equipment precautions.

1. No smoking or open flames near oxygen

2. Keep oil and petroleum products or other flammable objects away from O2. 

3. Keep all electrical equipment at least 10 ft away

4. Dust the o2 cylinder with cotton cloth to prevent static electricity or sparks 

5. Have a backup portable O2 in case of power outage

6. Store O2 in well ventilated area away from heat or extreme cold. 

7. Test smoke detectors 

400

On the Modified Borg scale, when should a patient stop activity and sit down to allow for better breathing?

5+

Modified Borg is 0-10, 5 is severe (unable to speak during activity or exercise) 

500

Your patient is on a protocol that notes that you can titrate O2 from 1-4L, but they are currently on 4L and your patient is still at 85% O2 saturation seated. What is your next step?

- Work on deep breathing techniques in the meantime while you contact MD office to see if you can titrate O2 higher. 

Stroke

100

Name 1 type of stroke and what it means? 

Ischemic - Most common form of stroke, due to a clot. The artery becomes narrow or clogged, cutting off blood flow to brain cells.

Hemorrhagic - Least common, and occur when a blood vessel ruptures in the brain. Ruptured vessels keep the surrounding areas of the brain from getting oxygen. 

Transient ischemic attack (TIA): "mini" stroke. Produce symptoms just like a stroke, but typically last a shorter amount of time.  While they don't cause lasting damage, they are major predictors of future strokes and should be taken seriously. 

200

What are 2 signs a patient is having a stroke?

1. Face drooping

2. Arm drop / weakness 

3. Slurring speech/ speech difficulty 

300

Name 2 controllable risk factors that increase your risk of a stroke?

1. High BP 

2. Smoking 

3. High cholesterol 

4. physical inactivity

5. Coronary artery disease 

6. Afib/heart disease

7. Excessive alcohol intake 

8. Illegal drug use

9. Sleep apnea

400

Name 2 things a person can do "on my to do list" to take control after having a stroke? 

1. Take BP and HR daily 

2. Take medications as directed 

3. Keep MD appointments 

4. Follow my nutritional recommendations 

5. Get moving 

6. Stop smoking 

7. Plan my future 

500

Your patient is on services for a recent stroke, and you take his BP.  It is 188/128, and you notice him slurring.  What are your next steps? 

Call 911. Patient is in a hypertensive crisis (180/120 or higher) and is possibly experiencing another stroke.  Getting him seen timely may help save his life.