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Acute Care Flashcards

1
Q

What is unique about the patient population in Acute Care?

A
  • Patients potentially medically fragile
  • May have gone through a life changing event
  • High stress for patient and for family
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2
Q

What is different about an Acute Care environment?

A
  • Variety of Acute Care settings
  • Patient may be connected to equipment or monitoring
  • Interdisciplinary approach
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3
Q

How might the exam be different than an outpatient setting?

A
  • Need to know medical status at that moment (lab values, precautions, etc)
  • Consideration for high stress situations for patient and care givers
  • Rapid changes in status
  • Discharge often takes place prior to full recovery
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4
Q

How might the exam be the same?

A
  • ICF model- patient centered
  • Past medical history
  • Thorough systems review
  • Prioritize impairments
  • Assess – Treat– Reassess
  • Address Fear
  • Deciding when it is appropriate to treat and when to refer
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5
Q

Health Care Continuum (Most Intensive to Least Intensive)

A

Most Intensive
- ICU Medical/Surgical
- Rehab Unit (hospital), Subacute Unit (SNF)
- Home Care, Assistive Living
- Outpatient Clinic, Urgent Care
- Independent HEP
Least Intensive

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6
Q

Intensive Care Units =

A

Highest Risk Settings
(Intensive Monitoring – medically fragile
Cognitive & behavioral assessment
Treatment is bedside)

Ex: NICU, CCU, Transplant ICU

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7
Q

NICU stands for (2)

A

Neurological ICU
Neonatal ICU

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8
Q

CCU stands for

A

Coronary Care Unit

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9
Q

Surgical Acute Care

A

Step down from ICU

More medically stable / less fragile

Rehab progression functionally oriented

Treatment at bedside or in the PT inpatient gym setting

Ex: Total knee surgery. Looking at what they need to do next to be able to function.

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10
Q

Who would assess Dysphagia?

A

Speech Language Pathologist

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11
Q

Who would assess CN and DTR?

A

PT, Physician, OT

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12
Q

Who would assess cognitive and perceptual functions?

A

PT, Psychologist, OT, Neurologist

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13
Q

Who would assess safety in locomotion for DC to home

A

PT

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14
Q

Who would assess capacity to bathe and dress self

A

OT

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15
Q

Who would assess BP and Hr at regular intervals?

A

Nurse

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16
Q

How should you prepare to see a patient in an Acute Care setting?

A
  • Chart review (Current lab values, why they are here, family factors)
  • Informed consent/Advanced directives
  • Consultation with IDT(interdisciplinary team)/ nurse
  • Mental review of considerations for or contraindications to treatment
  • Develop a flexible plan
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17
Q

Contraindications for Treatment - Acute Care

A

Priorities for PTs and GUIDELINES for Tx:
Hgb: < 8 no exercise
8-10 light exercise for essential ADLs
> 10 no restrictions/ exercise to tolerance
Na+: hypernatremia associated with dehydration and changes in mental status
Glucose: 250 – caution
> 300 danger for ketoacidosis
< 70 hypoglycemia / dizzy, faint, pale
INR and PTT: Prothrombin time: high = risk for bleeding
Vital signs
O2 Saturation: check expectation based on pt. hx

18
Q

Ketoacidosis

A

Body cannot process the blood glucose that is there

19
Q

When coming into a room what should you be observing?

A

Patient: Are they in pain, are they comfortable, how do they interact with environment
Family: How they interact with patient, what is the mood
Lines and Tubes: Are any under sheets?
Equipment: Walker?
Clues: Tell you how they have been up to this point

20
Q

Informally assess environment while you:

A
  • Introduce self
  • Mutually determine treatment goals for today/ get informed consent
  • Engage in small talk
21
Q

What is a phrase you can say so as to not rush too fast into things without properly assessing your environment?

A

“Thanks for your patience while I safely organize everything before we start to work.”

22
Q

What do we need to consider with medical restrictions/precautions?

A

Is aware of medical precautions
E.g., fractures and soft tissue injury from trauma

Notices any braces or restraints

Notices & ensures safety of tubes and lines
Draining out of patient? (positioned below)
Infusing into the patient? (positioned above)
Requires patient in head-up position?

23
Q

What are some requirements for Ethical and legal use for restraints?

A
  • deemed medically essential
  • use least restrictive option
  • re-ordered every 24 hours
  • 1-pull release
24
Q

Tubes for draining out fluids

A
  • Suction – NG/ secretions
  • Chest tubes
  • Wound drains
  • Catheters
  • Shunts
25
Tubes for infusing fluids
* IVs * Tube feedings * Blood transfusions
26
Monitoring devices:
* Arterial line/ Swan- Ganz line * Central venous lines – CVP and PICC lines * Pulse oximeter * Intracranial pressure line
27
Breathing devices:
* Oxygen masks/ nebulizer * Ventilator/ respirator
28
Patient Energy is Precious. What is important as a PT to do?
Do NOT repeat tests if other’s results are clear & re-testing… - Would not provide additional info or help clarify current status - Would be detrimental to patient status DO perform tests needed for PT specific goals - focus on components to reach goals
29
Systems Review and Screening
Mental status:  Alert and Oriented x 4?  CV/P:  BP, HR, Respirations, vascular flow, edema;  Status: at rest / with position change/ with activity?  Integument:  Skin intact? Color? Post-surgery or post-injury:      Status of wound and healing? Sensation intact? Musculoskeletal:   A or PROM limits?  Weakness? Strength screen?  Neurological:  Weakness? Incoordination? Imbalance? Cranial nerve deficits? Sensory loss?
30
How should you select tests?
Completed systems review - Observation and chart review Prioritize testing What tests will give you the most information needed at that moment? Minimize position changes for patients with pain or low endurance - Preplan your examination
31
Functional Assessment - Acute
Method used, level of success, assist needed, indicators of safety Bed mobility Transfers (All in reverse as well) Sit to Supine Sit to Stand Bed to Chair Gait
32
In acute care what is your intervention?
**FUNCTIONAL MOBILITY**
33
Levels of Physical Assistance
Stand By Assistance (SBA)- PT does not touch or provide assistance but is close in proximity for safety Contact Guard Assistance (CGA): PT needs to have 1-2 hands lightly touching pt to help steady pt; no other physical assistance Min-Max assist chart | Need to know
34
Considerations for total/max assistance
Integumentary Skin breakdown from pressure Consider a different mattress or assistance with changing positions Cardiopulmonary Pulmonary function in supine Consider raising the head of the bed Musculoskeletal 3-4% strength loss per day in the first week Consider PROM or AAROM to maintain motion Neuromuscular Cognition, mental status ALWAYS! ALWAYS! ALWAYS! Treat your patient with respect and explain what you are doing and why. You can not judge someone’s intelligence or comprehension based on verbal communication or a diagnosis.
35
Determining Discharge Destination
Very short lengths of stay in acute care May be asked to make a judgment with limited info **“What’s the next safe step?”** **Outcome measures help us determine functional outcomes. Helps determine discharge.**
36
Options at Discharge
* Discharge directly to home * Transitional Options - Going Home Shortly * Inpatient Rehabilitation * Inpatient care facilities
37
Discharge directly to home
Independent (with or without equipment or changes to the home) With support: physical assist of family/ in-home care providers May include home-based therapy services if patient is “homebound”
38
Transitional options - going home shortly
Transitional care unit “Swing bed” at regional facility Short term placement in skilled nursing facility (SNF) Inpatient rehab unit ->
39
Inpatient Rehabilitation
Dedicated IP Rehab Unit Commission on Accreditation of Rehab Facilities (CARF) Must have functional goals that require intensive rehab Must tolerate 3 hours of PT, OT or SLP (combined) per day DC plan established…to home or other community residential setting
40
Inpatient Care Facilities
Assisted Living Mostly independent with some assist Ex: Bathroom safety Skilled Nursing Facility Slower pace than inpatient rehabilitation Potential for improvement Monitor levels, make medical decisions Extended Care Facility Higher level of assistance required Not expected to return home
41
When assessing discharge decision making what do we look for?
- Medically stable - Is patient safe to function at home safely - Expected to gain safety from home with prescribed adjustment - Expected to gain safety for home within days

PT Screening (21 decks)

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