KEY TERM ASSESSMENT
1. D
9. L
2. G
10. N
3. C
11. E
4. F
12. O
5. I
13. J
6. A
14. B
7. H
15. K
8. M
EVALUATION OF LEARNING
1. State whether the following is an example of dry heat, moist heat, dry cold, or moist
cold.
a. Hot compress Moist heat.
b. Ice bag Dry cold.
c. Heating pad Dry heat.
d. Chemical hot pack Dry heat.
e. Cold compress Moist cold.
2. List three factors that must be taken into consideration when applying heat or cold.
The age of the patient, the location of the application, circulation and sensation
impairments, and individual tolerance to change in temperature.
3. How does the local application of heat to an affected area for a short time influence
the following?
a. The diameter of the blood vessels in the affected area Dilates the blood vessels.
b. The blood supply to the affected area Increases the blood supply.
c. Tissue metabolism in the affected area Increases tissue metabolism.
4. What happens to diameter of the blood vessels if heat is applied for a prolonged
period (more than 1 hour)?
The blood vessels constrict, and the blood supply to the area decreases.
5. List three reasons for applying heat locally.
To relieve pain, congestion, muscle spasms, and inflammation; and to reduce swelling
already present in the tissues.
6. How does the local application of cold for a short period time to an affected area
influence the following?
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a. The diameter of the blood vessels in the affected area Constricts the blood vessels.
b. The blood supply to the affected area Decreases it.
c. Tissue metabolism in the affected area Decreases it.
7. List two reasons for applying cold locally.
To prevent edema or swelling, to control bleeding, to relieve pain, and to reduce
suppuration and inflammation.
8. What are three reasons for applying a cast?
To immobilize a body part, to support and stabilize weak or dislocated joints, to
promote healing after a surgical correction, and to aid in the nonsurgical correction
of deformities.
9. What causes a pressure area?
When the cast presses or rubs against the patient’s skin.
10. What are the symptoms of a pressure area?
Painful rubbing, burning, or stinging sensation under a cast.
11. What are the complications of a pressure ulcer?
Erosion into the subcutaneous tissue, muscle, and bone that can become infected and
develop gangrene.
12. What are the advantages and disadvantages of a synthetic cast compared with a
plaster cast?
Advantages: Sets and dries more quickly, is less likely to become indented, weighs
less and is less restrictive, is less bulky, and the cast material is moisture resistant.
Disadvantages: Cannot be molded to the body part as easily, is more expensive, and
the surface of the cast is rougher.
13. What is the purpose of covering the body part with a stockinette before applying a
cast?
To provide for patient comfort and to cover the rough edges at the ends of the cast.
14. What is the purpose of applying cast padding during cast application?
To prevent pressure areas and to shield the patient’s skin when the cast is removed.
15. Why should each of the following precautions be taken when applying a synthetic
cast?
a. Not covering a wet cast with plastic Covers prevent heat from escaping, which
could burn the patient’s skin.
b. Removing synthetic casting particles using an alcohol swab If particles are not
removed, they may get under the cast and cause irritation.
c. Checking the circulation, sensation, and movement of the extremity To ensure the
cast is not too tight.
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16. Why is it important to dry a synthetic cast as soon as possible after it gets wet?
To prevent softening and breakdown of the skin, which can lead to infection.
17. What symptoms may indicate that a cast is too tight or an infection is developing?
Increased pain or swelling that does not go away with application of an ice bag,
medication, elevation, or rest; a feeling that the cast is too tight; tingling, numbness,
or loss of movement of the fingers or toes; coldness, paleness, or blueness of the
fingers or toes, painful rubbing, burning, or stinging under the cast; foul odor
or drainage coming from the cast; sore areas around the edge of the cast; and chills,
fever, nausea, or vomiting.
18. How is a cast removed?
By cutting it in half using a cast cutter. The cast is pried apart with a cast spreader.
Bandage scissors are used next to cut through the cast padding and stockinette.
19. What will the affected extremity look like after a cast has been removed?
The skin is yellow and scaly, the extremity is thinner, and the muscles are flabby.
20. List two examples of conditions for which a splint may be applied.
To support and immobilize a displaced or fractured part of the body and to protect
areas that are sprained or strained.
21. List one example of a condition for which a brace may be applied.
A stable fracture of the lower leg, such as a stress fracture.
22. What factors does the physician take into consideration when prescribing an
ambulatory assistive device?
The type and severity of the disability, the amount of support required, the patient’s
age, and the degree of muscular coordination.
23. Describe one advantage of the forearm crutch.
The individual can release the handgrip, enabling use of the hand.
24. What may occur if axillary crutches are not fitted properly?
Increases the patient’s risk of developing back pain, nerve damage, and injuries to the
axilla and palms of the hands.
25. List eight guidelines that must be followed during crutch use to ensure safety.
Well-fitting flat shoes with firm, nonskid soles should be worn to provide good
traction and stability.
The patient should use correct posture.
The weight of the body should be supported by the hands on the handgrips.
The patient should look ahead when walking.
The surface that the patient is walking on must be clean, flat, dry, and well lit.
The crutches should be kept 4 to 6 inches out from the side of the feet when walking.
Each step taken with crutches should be at a safe and comfortable distance.
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Tingling or numbness in the upper body should be reported to the physician.
Extra padding can be added to the shoulder rests of your crutches to make them more
comfortable.
Keep the crutch tips dry.
Inspect the crutch tips regularly.
For wooden crutches, periodically check the wing nuts that hold the central strut and
handgrips in place to ensure that they are tight.
26. List one use of each of the following crutch gaits:
a. Four-point gait For patients who have leg muscle weakness or spasticity, poor
muscular coordination or balance, or degenerative leg joint disease.
b. Three-point gait For amputees without a prosthesis, patients with musculoskeletal
or soft tissue trauma to a lower extremity, patients with acute leg inflammation, or
patients who have had recent leg surgery.
c. Swing-to gait For patients with paralysis of the lower extremities and for patients
wearing supportive braces on their legs.
27. List and describe the three types of canes.
A standard cane has one leg, a tripod cane has three legs, and a quad cane has four
legs.
28. List two reasons for prescribing a cane.
For patients with hemiparesis, joint disabilities, and defects of the neuromuscular
system.
29. List two reasons for prescribing a walker.
For geriatric patients with weakness or balance problems and during the recovery
process from knee and hip-joint replacement surgery.
CRITICAL THINKING ACTIVITIES
A. Dear Gabby
Gabby was called out of town unexpectedly and wants you to fill in for her. In the space
provided, respond to the following letter.
Dear Gabby:
I am 15 years old and in the 10th grade. I need your help. I have a backpack; my dad
weighed it and he said it was 40 pounds. I only weigh 105 pounds. My back and neck
hurt from lugging it around. I have to walk almost one-half a mile to the bus stop. I do
not have time to use my locker between classes because it is down a flight of stairs and at
the end of the hall. Once, when I started using my locker, my science teacher got mad at
me because I was late getting to class. Gabby, what should I do?
Signed, Pain in the Neck
c TO THE INSTRUCTOR: Before answering this letter, encourage students to do an
Internet search using the search words: heavy backpack. This will help them learn more
about a problem that is becoming more frequent among school-age children and
adolescents. Ask students to read their responses in a classroom setting.
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B. Fractures and Sprains
Complete an interactive tutorial on fractures and sprains by following these directions:
Go to www.nlm.nih.gov/medlineplus/fractures.html. Under Start Here, click on Fractures
and Sprains Interactive Tutorial. To start the tutorial, click on Go to Module. Answer the
following questions related to the tutorial:
1. What are the names of the bones in the lower leg? Tibia and fibula
2. What are the names of the bones that join the wrist to the fingers? Metacarpal bones
3. What are the names of the bones that join the ankle to the toes? Metatarsal bones
4. How many phalanges does each finger have? Three. How many does the thumb have?
Two
5. What holds bones together? Ligaments
6. What is a pneumatic brace? Uses air to keep the limb in place
7. How can itching be relieved when wearing a cast? By using a hair dryer set on cool
8. What is atrophy and how does it occur? The muscles become smaller because of lack
of exercise.
9. What complications can occur from a cast or splint? The cast or splint may be too
tight and press on the blood vessels and nerves of the arm or leg; this can result in
nerve damage, paralysis, and a permanent decrease in sensation.
10. What may cause a cast to become loose? What should the patient do if this occurs?
The underlying muscles become smaller, or the cast has gotten wet or has otherwise
been damaged; inform the physician in case the cast needs to be replaced.
11. What symptoms are present when a blood clot occurs in the leg? It causes the leg to
swell and hurt.
12. What complication can occur if a blood clot in the leg dislodges? The blood clot can
dislodge from the leg and go to the lungs where it causes shortness of breath, chest
pain, and possibly death.
C. Cast Care
1. You are employed by a pediatric orthopedic surgeon. She is concerned because many
of her school-age patients do not follow proper guidelines for the care of their
fiberglass casts, even with their parent’s constant reminders. She asks you to develop
a creative and colorful instruction sheet in the shape of a cast that presents cast care
instructions at a level that can be understood by this age group (6 to 12 years old).
Use the illustration of the cast on the following page to design your instruction sheet.
2. After developing your instruction sheet, get into a group or three to four students and
share your sheets. Have the group decide whether the instructions on each sheet are
appropriate for a school-age child and whether the sheet would be visually appealing
to this age group.
c TO THE INSTRUCTOR: This activity provides students with an opportunity to
develop a patient education document. It also helps them learn and retain cast care
guidelines.
D. Crutch Guidelines
Each of the following patients is wearing a long leg cast because of a broken tibia and is
using wooden axillary crutches to ambulate. Evaluate the crutch technique being
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practiced by each patient. Write C if the technique is correct and I if the technique is
incorrect. If the technique is correct, explain why it should be performed this way. If
incorrect, indicate what might happen from performing the technique in this manner.
1. Andy Morris wears Nike sports shoes when ambulating with his crutches. C: Provides
for good traction and stability
2. Juliet Wright does not stand up straight when using her crutches. I: Will not have
proper body balance
3. Miguel Saldivia puts his weight on the axilla when getting around on his crutches. I:
Pressure on the axilla may cause crutch palsy.
4. Lindy Campbell has a lot of decorative throw rugs in her house and she does not want
to remove them. I: May cause her to fall
5. Andrew Spence likes to move quickly on his crutches so he advances them forward
about 20 inches with each step when using the swing-through gait. I: May cause the
crutches to slide forward and he might lose his balance
6. Hanna Romes has tingling in her hands but thinks it is just part of what happens when
one uses crutches. I: She may be using the crutches incorrectly, or they may be the
wrong size, which could lead to crutch palsy.
7. Tamra Hetrick pads the shoulder rests and the handgrips of her crutches. C: This
provides her with more comfort when using the crutches.
8. Erica Anderson’s crutch tips get wet but she does not take the time to dry them before
going into a shopping mall. I: Surface tension will not be maintained, which could
cause the crutches to slip.
E. Accessibility for Physical Disabilities
Next to each of the following facilities, list the features you have observed that facilitate
accessibility of individuals with a physical disability.
Answers vary based on individual student responses. Examples of responses are listed.
1. Schools Wheel chair ramps, handicap parking, handicap bathroom stalls, and lower
water fountain
2. Grocery stores Motorized grocery carts, handicap parking, and handicap bathroom
stalls
3. Shopping malls Automatic door, motorized carts, wheelchair rentals, handicap
parking, handicap bathroom stalls, lower water fountains, and ramps next to stairs
4. Movie theaters Aisle for handicap seating, handicap parking, ramp sidewalk, handicap
bathroom stalls, and lower water fountains
5. Restaurants Handicap parking, ramp sidewalk, tables instead of booths, and handicap
bathroom stalls
6. Doctors offices Ramp sidewalks, wheelchairs, extra wide doors and rooms, and
handicap parking
7. Community parks Ramp sidewalks, handicap parking, handicap bathroom stalls, and
low water fountains
F. Crossword Puzzle: Physical Agents to Promote Tissue Healing
Directions: Complete the crossword puzzle using the clues presented.
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Instructor’s Resource Manual
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1 Transfers weight from legs to arms
4 Cold blood vessels do this
6 Removable immobilizer
9 Popular synthetic cast
10 Warm blood vessels do this
11 Prevents pressure areas
16 Examples: standard, tripod, or quad
17 Takes 4 to 6 weeks for fracture to do this
20 Discharge
21 Purpose of a cast
23 Needed after knee replacement
24 Bone doctor
25 Cuts cast in half
7-7
Down
2 “Too long” crutches may cause this
3 Soft and broken down skin
5 Maximum minutes for heat
application
6 Elevate cast to prevent this
7 Do not bend here to lift!
8 Prevents LBP
12 Cast is rubbing against the skin
13 Red skin
14 Pus formation
15 Located between skin and cast
padding
18 Walking
19 Blow-dry a cast on this setting
22 Holds body part in correct
position
G. Bone and Joint Conditions
1. It is National Bone and Joint Week. The mayor has asked you and your classmates to
develop informative, creative, and colorful brochures for the community about bone
and joint conditions. Choose a condition below and design a brochure using the blank
Frequently Asked Questions (FAQ) brochure provided on the following pages. Each
student in the class should select a different topic. On a separate sheet of paper, write
three true-or-false questions relating to the information in your brochure.
2. Present your brochure to the class. After all the brochures have been presented, each
student should ask the questions to the entire class to see how well the class
understands bone and joint conditions. (Note: You can take notes during the
presentations and refer to them when answering the questions.)
1. Bursitis
2. Congenital hip dysplasia
3. Epicondylitis
4. Fibromyalgia
5. Gout
6. Hammer toe
7. Herniated disk
8. Juvenile rheumatoid arthritis
9. Knee-replacement surgery
10. Kyphosis
11. Osteoarthritis
12. Osteomyelitis
13. Osteoporosis
14. Paget’s disease
15. Rheumatoid arthritis
16. Scoliosis
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17. Sprain
18. Strain
19. Tendonitis
c TO THE INSTRUCTOR: This activity is a fun way for students to become familiar
with conditions that affect the bones and joints. A suggestion for assigning topics is to
write each condition on a piece of paper and have each student draw one from a “hat.”
APPLY YOUR KNOWLEDGE
Choose the best answer to each of the following questions.
1. Savannah Uriz recently played in a golf tournament; since then, she has been having
low back pain. Dr. Walker recommended that she use a heating pad for 30 minutes
every 2 hours for the next 3 days. Marlyne Cooper, CMA (AAMA), is explaining the
use of a heating pad to Savannah. Marlyne instructs Savannah to:
A. Place a protective covering over the heating pad before using it
B. Place a wet towel between her back and the heating pad.
C. Lie down flat with her back on the pad.
D. Turn the setting higher if the pad no longer feels warm enough.
2. Savannah wants to know why she cannot apply the heating pad for more than 30
minutes at a time. Marlyne’s response should include the following information
A. The muscles of the lower back may go into a spasm.
B. It may cause erythema of the skin.
C. Applying heat for too long a time period works against the healing process.
D. The wires in the heating pad may overheat.
3. Brody Adams fell on the playground and has a large “goose egg” on his forehead. Dr.
Walker directs Marlyne Cooper, CMA (AAMA), to apply an ice bag. Marlyne uses
small pieces of ice to fill the ice bag. Why does she do this?
A. To prevent Brody’s forehead from becoming too cold
B. So that the ice bag molds better to Brody’s forehead
C. To prevent the goose egg from hatching
D. To prevent irritation to the affected skin
4. Michael Kasey broke his left wrist while playing football. He had a short arm
fiberglass cast applied 3 hours after the accident. Marlyne Cooper, CMA (AAMA), is
instructing Michael on what to do to minimize swelling. Marlyne’s explanation would
include all of the following except
A. Elevate the cast above heart level for the first 24 to 48 hours.
B. Cover the cast with a plastic bag.
C. Apply an ice bag at the level of the injury.
D. Gently move your fingers as often as possible.
5. Marlyne continues to instruct Michael on how to care for his cast. All of the following
would be included in Marlyne’s instructions except
A. Do not insert anything down into the cast.
B. If the cast gets wet, dry it with a blow-dryer on the high setting.
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C. Do not trim the cast or break off rough edges.
D. Inspect the skin around the cast.
6. Michael calls the office to complain of a problem with his cast. Which of the
following would indicate that Michael should be seen immediately?
A. His friends are unable to sign his cast with a ballpoint pen.
B. He accidentally got his cast wet.
C. There is a foul odor and drainage coming out of his cast.
D. He decided he would rather have a purple cast instead of an orange one.
7. Katie Avery severely strained her left ankle. Dr. Walker asks Marlyne Cooper, CMA
(AAMA), to fit her for axillary crutches. What indicates that Katie’s axillary crutches
have been properly fitted?
A. Her shoulders will be bent over the crutches.
B. Two fingers can be inserted between the top of the crutch and her axilla.
C. Her elbows will be flexed at a 45-degree angle.
D. The axillary pads will fit snugly against her axillae.
8. Dr. Walker told Katie not to put weight on her left foot for the next 5 days. What is
the most appropriate crutch gait for Katie?
A. Two-point gait
B. Three-point gait
C. Four-point gait
D. Swing-through gait
9. Marlyne instructs Katie in the proper use of her crutches. Which of the following
guidelines would be included in Marlyne’s explanation?
A. Support your body weight on your hands.
B. Look straight ahead when walking.
C. Keep the crutch tips dry.
D. Report any tingling or numbness of the upper body.
E. All of the above.
10. Marlyne fitted Katie’s crutches correctly. When Katie gets home, she adjusts the
crutches to a longer length. Katie is putting herself at risk for
A. Carpal tunnel syndrome
B. Sciatic nerve damage
C. Crutch palsy
D. Chickenpox
VIDEO EVALUATION FOR CHAPTER 7: PHYSICAL AGENTS TO PROMOTE
TISSUE HEALING
Name:
Directions:
a. Watch the indicated videos.
b. Listed in the following are statements that are true or false. Mark each true statement
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with a T and each false statement with an F. For each false statement, change the
wording of the question so that it becomes a true statement.
Video: Procedure 7-1: Applying a Heating Pad
____T___ 1. Heat may be used to treat low back pain, arthritis, menstrual cramps, and
localized abscesses.
____T___ 2. When heat is applied locally to a body part, the blood vessels in that area
dilate.
____F___ 3. Hypothermia is reddening of the skin caused by dilation of superficial
blood vessels.
____T___ 4. Prolonged heat for longer than 1 hour can reverse the healing process.
____T___ 5. A heating pad is placed in a protective covering to provide comfort for the
patient and absorb perspiration.
____F___ 6. When applying a heating pad, the selector switch is usually set on a high
setting.
____F___ 7. The patient should be instructed to lie on the heating pad.
____T___ 8. The patient should be checked periodically for signs of an increase or
decrease in redness or swelling.
Video: Procedure 7-2: Applying a Hot Soak
____T___ 1. The soaking solution should be warmed to 105° F to 110° F.
____T___ 2. The purpose of a hot soak is to relieve pain and promote healing.
____F___ 3. The patient’s body part should be rapidly immersed into the solution.
____F___ 4. A hot soak should be applied for 45 to 60 minutes.
____T___ 5. After the procedure, completely and gently dry the affected part.
Video: Procedure 7-3: Applying a Hot Compress
____F___ 1. Check the temperature of the solution with the bath thermometer to make
sure it is at room temperature.
____T___ 2. Wring the compress to rid it of excess moisture until it is wet but not
dripping.
____T___ 3. Apply the compress lightly at first to the affected site to allow the patient to
gradually become used to the heat.
____F___ 4.
Repeat the application of the compress every 10 to 12 minutes for the
duration of the time specified by the physician.
____T___ 5. Check the patient’s skin periodically for signs of an increase or decrease in
redness or swelling.
Video: Procedure 7-4: Applying an Ice Bag
____T___ 1. Cold can reduce bleeding, swelling and pain.
____T___ 2. When cold is applied locally to a body part, the blood vessels in that area
constrict.
____T___ 3. A cold application causes the skin to become cool and pale.
____T___ 4. Applying cold directly to the skin can result in a skin burn.
____F___ 5. Applying cold for more than 20 minutes can have a reverse, secondary
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effect.
____F___ 6. The ice bag should be filled completely with small pieces of ice.
____T___ 7. The application of ice is usually uncomfortable, but most patients accept it
if they realize the benefits they can derive from it.
Video: Procedure 7-5: Applying a Cold Compress
____T___ 1. Large pieces of ice are used for a cold compress to prevent them from
sticking to the compress and slowing the rate at which they melt in the
water.
____T___ 2. After applying a cold compress, it can be covered with an ice bag to keep
it cold.
____T___ 3. Repeat the application of the cold compress every 2 to 3 minutes for the
duration of the time specified by the physician.
____T___ 4. Add ice to the basin, if needed, to keep the solution cold.
Video: Procedure 7-6: Applying a Chemical Cold and Hot Pack
____T___ 1. A chemical pack is activated by applying pressure to the pack to break an
inner bag.
____T___ 2. Shake the chemical pack vigorously to mix the contents.
____F___ 3. Chemical packs do not need to be covered with a protective covering.
____F___ 4. Discard the chemical pack in a biohazard waste container.
Video: Procedure 7-7: Measuring for Axillary Crutches
____F___ 1. Crutches remove weight from the arms and transfer it to the legs.
____T___ 2.
Incorrectly fitted crutches increase the patient’s risk of developing back
pain, nerve damage, and injuries to the axilla and palms of the hands.
____F___ 3. The crutches should be adjusted so that the crutch length is approximately
4 to 6 inches below the axilla.
____T___ 4. Tubular aluminum crutches are adjusted by pressing spring-loaded pushbuttons.
____T___ 5. The handgrips on the crutches should be adjusted so that the patient’s
elbow is flexed to an angle of approximately 30 degrees.
____T___ 6. If the crutches are measured correctly, the medical assistant should be able
to insert two fingers between the top of the crutches and the axilla when the
patient is standing erect with the crutches under her arms.
Video: Procedure 7-8: Instructing the Patient in Crutch Gaits
____F___1. The type of gait the patient uses depends on the patient’s height and
weight.
____T___2. Patients can reduce their fatigue by learning more than one crutch gait.
____F___3. A faster gait is useful in crowded spaces.
____T___4. The tripod position provides a wide base of support and enhances stability
and balance.
____T___5. The four-point gait is the most stable and safest of the crutch gaits.
____F___6. The four-point gait is used by patients with a sprained ankle.
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____F___7.
____T___8.
The two-point gait is slower than the four-point gait.
To use the two-point gait, the patient must be capable of partial weight
bearing on each foot and have good muscular coordination.
____T___9. The three-point gait is used by patients who cannot bear weight on one leg
but can support full weight on the unaffected leg.
____T___10. The three-point gait is used by patients with a leg fracture.
____T___11. The patient must have good muscular coordination and strength to use the
three-point gait.
____F___12. The swing gaits are used by patients with severe upper extremity
disabilities.
Video: Procedure 7-9: Applying a Cold Compress
____T___ 1. Canes are used by patients who have weakness on one side of the body.
____T___ 2. Patients with joint disabilities or defects of the neuromuscular system may
require the use of a cane.
____F___ 3. The standard cane provides the most amount of support.
____T___ 4. The tripod cane has three legs and the quad cane has four legs.
____F___ 5. A cane is held on the side of the body that is on the same side that needs
support.
____T___ 6. The cane handle should be approximately level with the greater trochanter.
____T___ 7. The elbow should be flexed at a 25- to 30-degree angle.
____F___ 8. The patient should stand erect and lean on the cane.
Video: Procedure 7-10: Instructing the Patient in the Use of a Walker
____T___ 1. Walkers are most often used by geriatric patients who have weakness or
balance problems.
____T___ 2. Patients who have had knee or hip joint replacement surgery often use a
walker following the surgery.
____T___ 3. Walkers can be difficult to maneuver and limit how fast the patient can
move.
____F___ 4. The walker should extend from the ground to approximately the level of
the patient’s waist.
Notes
Notes
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