Acute Care

Question 1

the utmost importance in acute care

Answer 1

Reduce risk of further decline
Improve functional independence
Assist the team with discharge planning

Question 2

care giver education - discharge rehab-therapy recommendations
3 types of recommendations
what type of handout?

Answer 2

Are you recommending outpatient therapy, sub-acute (in-patient?)rehab, or home care OT services post-discharge?
home exercise program handouts you can administer and demo?

Question 3

care giver education - ADL skills
(5)
assistance/ safety/ management

Answer 3

• going to need assistance with meal preparation, doing the dishes and/or laundry, cleaning the house?
  -discuss safe reaching strategies and easy meal prep ideas. I also address medication management at this time.
  -Money management, bill paying, and other more technical activities may need to be addressed depending on the patient’s cognitive level.

Question 4

care giver education - ADL skills what are the 5 areas?
teaching what?
remind them?

Answer 4

• How is your patient dressing, grooming, eating, bathing, and toileting? What techniques are they using - demonstrate and have family practice & let the patient do as much as they can upon going home to continue to increase their independence.

Question 5

Care giver education - 6. Functional Mobility
list precautions / recommendations / safety suggestions

Answer 5

Will your patient require fall precautions, supervision recommendations, or home set-up? Are there any clutter, cords, throw rugs that could be hazardous? Would a non-skid bath mat be helpful?
night lamp next to the bed to decrease falls at night
eliminating access to keys to the car if there is a cognitive impairment.

Question 6

ADL Retraining
build up strength and sitting balance by doing?

Answer 6

Grooming or dressing sitting edge of bed can mean a world of difference to a patient who hasn’t done oral hygiene in days and needs to build up strength and sitting balance.

Question 7

The biggest concern in the acute setting is to:

Answer 7

Safety
Acute care patients are the least medically stable, and may have ever-changing orders and precautions.

Question 8

the utmost importance in acute care

Answer 8

Reduce risk of further decline
Improve functional independence
Assist the team with discharge planning

Question 9

care giver education - diagnosis knowledge approach?

Answer 9

• ask if they’re familiar with the diagnosis, then go into more detail

Question 10

care giver education - 8. Caregiver Body Mechanics

Answer 10

Observing how the caregivers are completing the transfers is hugely important since many people lift incorrectly and risk major injury. Having copies of body mechanics handouts is also helpful along with visual demonstration.

Question 11

care giver education - 9. Emotional Support & Resources
suggestions and what handout?

Answer 11

support groups for the patient and family members.
caregiver burnout away from the patient if possible

Question 12

Care giver education - functional mobility - list different mobility options consider 2 things.

Answer 12

How is your patient going to be moving around in the home and community? Wheelchair, walker, cane, no assistive device but contact guard assist when walking? Be sure to practice this briefly as well.

Question 13

Care giver education - transfers (5 )

Answer 13

How is your patient transferring to the toilet, bed, wheelchair, bedside commode, or tub/shower bench?
You’ll want your patient’s caregivers to complete these transfers hands-on after you’ve given them a proper demonstration.

Question 14

10 family education topics

Answer 14

1. Diagnosis
2. ADL skills
3. I-ADL skills
4. Equipment
5. Transfers
6. Functional Mobility
7. Safety Education
8. Caregiver Body Mechanics
9. Emotional Support & Resources
10. Follow-up Recommendations

Question 15

medical equipment

Answer 15

what are you recommending? Remember to inform the patient’s family on how they can order it?

Question 16

Before Treating, Always Check With whom?

Answer 16

check with the patient’s nurse beforehand to confirm they are okay to treat.
make friends with the nurses, and the techs
you’ll be relying on the nurses to make sure you aren’t accidentally disconnecting anything during treatment.

Question 17

Before you begin treating your patient, you’ll want to do a thorough chart review that includes 7 items:

Answer 17

This includes (but is not limited to):
Therapy orders
Lab values
Vital signs
Test results
Weight bearing precautions
Diet changes
Code status

Question 18

ADL Retraining to address standing tolerance and balance functionally

Answer 18

Bedside commode transfers and toilet transfers are also a personal favorite, along with grooming or bathing at the sink to address standing tolerance and balance functionally.

Question 19

main goal with any ADL treatments is to incorporate?

Answer 19

incorporate mobility when possible, since oftentimes patients may only get edge of bed or out of bed with OT or PT.

Question 20

Equipment Recommendations for Discharge to Home may include:

Answer 20

tub bench, bedside commode, or hip kit

Question 21

Hand Splinting To avoid the following:

Answer 21

contractures, maintain joint integrity and prevent skin breakdown

Question 22

Exercise Programs: get creative with upper body exercises by using what you have on hand for example? lower body?

Answer 22

rolling up a towel for a dowel or using water bottles for upper extremity ROM exercises since there usually aren’t many other types of equipment handy.
Chair or wall push-ups and sit to stands from the toilet are also great if the patient can tolerate it.

Question 23

Addressing the Patient’s Deficits through function such as:

Answer 23

bed mobility, bedside commode transfers, or even standing with support of a walker to work up to gaining independence in dressing and toileting tasks

Question 24

acute care is vastly different than other settings; Instead of doing a full hour-long ADL retraining session like you’d do in rehab, you’ll be more focused on?

Answer 24

quick, functional interventions.

Question 25

Time management in the acute setting, your morning may look like?

Answer 25

-look at our scheduling board and write down all of my evaluations and treatments for the day.
-I chart review each evaluation (and some treatments if I have time) for the first 45 minutes to an hour in preparation for seeing them in the morning.
-I check in with the nurse treating each patient to make sure there isn’t anything else going on with them that isn’t yet in the chart. Once given the all-clear, I try my best to see as many evaluations as I can before lunch.

Question 26

Evaluations are due? approx how soon after perscribed? how long should evals take?

Answer 26

Evaluations have to be completed (or attempted) within 24 hours of receiving the order, which is often from the afternoon before.
Evals can take between 15-30 minutes in general

Question 27

When and how long do you chart/ document and write up eval / treatments?

Answer 27

document and chart 1 hour before lunch always getting morning notes done before doing the afternoon evals. Post-lunch I try to get all of my evals and treatments written up.

Question 28

Post- lunch after charting and write-ups, what is done?

Answer 28

a repeat of the morning
review charts for my afternoon treatments and other evals I may have left. I used to review all the charts first thing in the morning, but I found that a lot can change from 7:30 am to 2:00 pm.
nursing again
hour and a half to two hours seeing any evals I have left as well as my prioritized treatments (patients that have already been evaluated and are on our caseload).

Question 29

what things should be brought with you to save time / prepare

Answer 29

look up the patients’ goals and needs beforehand, and bring the essentials that they may need, such as a hip kit or home exercise program. I also try to keep these must-haves with me to stay prepared.

Question 30

Treatment might be as low level as? or high level as?

Answer 30

Depending on the patients’ needs (and wants), a treatment could be as low level as sitting edge of bed with max assist for a few minutes in preparation for ADLs, or it could be as high level as ambulating to the linen cart or bathroom and completing multiple toilet sit to stands or full bathing in standing.

Question 31

also try to include brushing teeth in what way?

Answer 31

(in standing at the sink when possible) since patients hardly ever get set up for this with nursing.

Question 32

Once I have about an hour of the day left, I try to?

Answer 32

focus on wrapping up my last treatments so I can have time to get my notes done without staying late.

Question 33

get nurses names and numbers for that day to ask questions if need in the moment

Question 34

communicate to nurses etc when heart rate rise when up and moving around. paint the picture if they’re stable, what they need to do, O2 drop when walking to bathroom

Question 35

where do you think that patient is ready to know next?
current level of fxn supports and barriers
provide safe transition
study your qulaifies ppl for different settings, and what kind of care can come in does this allow them to go home then?
always ask do you have a pet at home- to walk dog- strength endurance balance- do they need help with that, trouble managing medications

Question 36

assessment - not a lot of time, can be fast paced
insurance companies for standardized testing
there are some appropriate - boston 6 clicks: help w discarge planning, where do they need to go based on that. Mocha, slumms, MMSE
for balance: Functional Reach, tenetti, Berg, Timed up and Go

Question 37

the Occupational Therapy Took Kit - book full of printable handouts