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Integ Final > Acute Care Considerations > Flashcards

Acute Care Considerations Flashcards

1
Q

Competencies for Practice in Acute Care
for Physical Therapists

A

Clinical decision making

Patient Management

Communication

Safety

Discharge planning

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2
Q

Elements to collect and synthesize

A

Determine patients level of support- physical, social,
emotional

Previous PT

Baseline and Prior Level of Function- endurance, assistance,
fall history, activity level, airway

Risk analysis of possible abuse

Equipment

Discharge plans

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3
Q

Systems Screen

A

Monitor vitals

Exam based on medical record

Multisystem exam for more complex patient
 MSK
 Integ
 Cardiopulm
 Neuro

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4
Q

Cardiopulmonary:

A

edema
respiratory rate
heart rate
heart rhythm
blood pressure
oxygen saturation

jugular venous distension

ECG
observations/telemetry

dyspnea

posture/chest shape
cough
sputum/hemoptysis
nail appearance
auscultation

supplemental O2/ respiratory
equipment

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5
Q

Musculoskeletal:

A

strength/myotomes, ROM, posture

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6
Q

Neurologic:

A

balance
gait quality
cranial nerves
vision
tone
coordination
reflexes
sensation
tremor
vestibular testing

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7
Q

Integumentary:

A

edema
skin integrity
burns/wounds
sensation
capillary refil

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8
Q

Acute Care Interventions

A

 Therapeutic Exercise

 Functional mobility training

 Locomotor training, as indicated

 Neuromuscular re-education

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9
Q

Therapeutic Exercise =

A

 Strength

 Aerobic/ endurance/cardiac/
pulmonary

 Flexibility

 ROM

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10
Q

Functional mobility training =

A

 Rolling
 Scooting
 Supine to/from sit
 Sit to/from stand

 Transfers between surfaces

 bed to chair, wheelchair to commode

 Pressure relief

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11
Q

Locomotor training, as indicated =

A

 Gait training, with or without assistive devices

 Stair training

 Wheelchair mobility & management

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12
Q

Neuromuscular re-education =

A

 Balance

 Coordination

 Vestibular interventions & exercises

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13
Q

Other Interventions =

A

Manual Therapy

Posture Training

Orthotic/prosthetic fitting/training

Functional activity training

Airway clearance, pelvic floor, respiratory muscle training

Biophysical Agent

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14
Q

Select and perform appropriate education intervention for patient, family or other caregiver:

A

Role of therapy

Impairments/ limitations

Barrier modification

Health/injury risk factor modifications

Adaptive equipment

Energy conservation

Pain management

Relaxation techniques

Safety

Precautions

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15
Q

Fall prevention =

A

Functional mobility training

Caregiver training

Home exercise program

Positioning/pressure relief

Discharge recommendations

Plan of care

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16
Q

Acute Care Examination

A

Pain

Functional mobility

Cognition

Speech and language ability

Appearance

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17
Q

Pain:

A

at rest; with activity; with recovery; quality of pain; interventions to address pain

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18
Q

Functional mobility:

A

rolling; supine to/from sit; sit to/from stand; transfers;
ambulation; stairs; curb; wheelchair mobility

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19
Q

Cognition:

A

arousal; orientation; attention; memory; calculation; language;
construction; abstraction; speed of processing; problem-solving; motor
planning; command following; delirium; and Confusion Assessment Method (CAM) positive

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20
Q

Speech and language ability:

A

aphasia, word finding, apraxia, dysarthria

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21
Q

Appearance:

A

skin color; muscle wasting/temporal atrophy; positioning upon
entering room

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22
Q

Safety Planning:

A

Consider and anticipate
compromised medical stability

Use appropriate PPE

Screen for safety with mobility
* Gait belt, slipper socks, scan room
environment, lines and tubes

Integrate and interpret information
from multiple sources
* Chart, vitals, patient response, labs, , meds

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23
Q

Safety Equipment:

A

Ask for assistance and use safe handling equipment when needed

Respond to emergent needs

Basic understanding of equipment
*Vent, IV, bed alarms, WC, call bells

24
Q

Select communication style based on:

A

age, learning style, cognition, communication needs

25
Q

Collaborate with team:

A

Situation Background Assessment Recommendation:
SBAR

26
Q

Documentation and Electronic Medical Record

A

Official record of the patient’s past and current status along with a documentation of all procedures the patient has experienced

One of the primary sources of patient information for the PT to gain information about the patient as well as to share pertinent details of the
patient’s therapy session

Maintain confidentiality of protected health information based on ethical and
regulatory guidelines, including HIPAA and the APTA Guide from Professional
Conduct and Code of Ethics

27
Q

Medical Record Review

A

Confirm PT orders

Admission note: H&P from other providers

Patient demographic: Age, Gender, Height/weight

Admission date and reason for admit

Past medical history

Reason for PT consult

Information pertaining to discharge (ex: prior level of function, home setting)

Social history, including home set up

Consult/specialist notes

Lab values
Vital signs

28
Q

Retrieve =

A

Gather and analyze medical information to determine an image
of the patient to determine prognostic and management
strategies

Gather data on timing to see patient, if mobilization is
indicated

29
Q

Document =

A

Clear documentation that reflects decision making

All relevant aspects of patient encounter to be understood by
team

Immediately following care

Use judgement if oral and written communication is necessary

30
Q

Levels of Care

A

IIntensive Care Unit (ICU)

Acute Care Unit (ACU) = Hospital, Medical Center

Acute Rehabilitation Facility (ARF)

Inpatient Rehabilitation Facility (IRF)

Sub-Acute Rehabilitation Facility (Sub-acute)

Skilled Nursing Facility (SNF)

Long-Term Acute Care (LTACH)
Home with Home Health

Home with Outpatient

Home

31
Q

Acute Care =

A

Short LOS

PT value added service

Hospitalist and Interventionist

Wide variety of patient conditions, team

Complex patient population

Set goals to prepare for DC and educate

Bedside Care

Levels of Care- Critical Access, Trauma Center, Academic Medical Center

32
Q

Patient Treatment Sessions:

A

Acute Care: Patients receive minutes per day of treatment, often focused on stabilizing immediate medical concerns.

Subacute Care/Inpatient Rehab: In contrast, hours per day of therapy are provided, especially in inpatient rehabilitation, where patients engage in more intensive therapy sessions.

33
Q

Length of Stay:

A

Acute Care: Patients typically have a short stay of a few days due to the high acuity of their conditions, and the focus is on stabilizing them before discharge or transfer.

Inpatient Rehab: Patients stay for a few weeks, as the goal is more focused on recovery and rehabilitation, often post-acute care or surgery.

34
Q

Patient Acuity:

A

Acute Care: Patients in this setting are typically very ill or post-surgical with immediate, critical medical needs.

Subacute Care/Inpatient Rehab: Patient acuity decreases as they improve, requiring less intensive medical care but more rehabilitation support.

35
Q

Number of Patients:

A

Acute Care: The environment is high-volume, fast-paced, and unpredictable, as many patients are seen for urgent or emergent conditions.

Inpatient Rehab: The patient volume is lower, and treatment is more scheduled and coordinated to meet the rehabilitation needs of each patient, often with structured sessions.

36
Q

Intensive Care Unit =

A

Life-threatening injuries and illnesses

Team of specially-trained health care providers -> 24 hour care

Function and Mobility in the ICU

37
Q

Acute Rehabilitation & Inpatient Rehabilitation =

A

patient requires and is able to tolerate and participate in a comprehensive
level of rehabilitation services

(3 hours minimum of rehab)

requires close rehabilitation medical supervision and available 24- hour daily
medical attention

Necessary services cannot be provided in an alternative, less costly, setting

Cannot access necessary care outside a comprehensive rehabilitation setting.

38
Q

ARF & IRF

A

Interdisciplinary specialized care

Physiatrist or equivalent > 3days/week, available 24/7 for emergencies

24 hour rehabilitation nursing care

Need for > 2 disciplines PT/OT/SLP

Must also have SW, psychology, rec tx, access to voc rehab,
prosthetics/orthotics

39
Q

ARF Therapy Requirements

A

Tolerate > 3 hours PT/OT/SLP 5 days/week or 15 hours/week

Need at least 2 disciplines

Benefit from > 3hours of therapy (active participation)

Measurable improvement

40
Q

ARF D/C

A

Intended as a relatively brief start to rehab

LOS typically 5-30 days

Expected discharge: SNF or Home

41
Q

IRF D/C

A

Intended as a longer stay then ARF

LOS typically 2 weeks - 2 months

Expected DC: SNF or Home

42
Q

ARF & IRF - Advantages

A

Inter-disciplinary team

Specialized care

Focus on community re-entry

Availability of hospital services

Capitated reimbursement
encourages short LOS

43
Q

ARF & IRF - Disadvantages

A

Cost $$$$$

Too fast-paced for many patients

Hospital-based (not home)

44
Q

Long Term Acute Care Hospital
(LTACH)

A

Chronic Hospital

Patients need acute care services long-term

> 28 days average length of stay

Often used for ventilator care, wound care, TBI (esp. coma stim)

45
Q

Subacute rehab

A

Can be in a hospital transitional care unit (TCU) or in a skilled nursing facility
(SNF)

Need skilled nursing or therapy

Covered for 100 days maximum Medicare

Paid per diem—incentive to keep patients longer

Typically 1-2 hours PT/OT/SLP daily

Often 1-2 RN/shift + CNAs

Limited nursing care, infrequent physician visits

46
Q

Subacute rehab - Advantages

A

Cost ¢¢

Can stay longer if needed

Option for residence post-discharge

47
Q

Subacute rehab

A

Long LOS

Less therapy

Limited RN

Limited physician visits

Away from hospital services (unless
TCU)

NH environment

High rehospitalization rates

48
Q

Skilled Nursing Facility
(SNF)

A

Not skilled care

Considered resident’s “home”

Rules accordingly

Typically after SAR stay (after 100 days exhausted in SNF)

NO PT/OT/SLP paid for

Residential

Disabled or elderly patients with limited family support

49
Q

Home care

A

Must be unable to leave home for rehab services -> strict criteria

Medicare pays capitated rate

Typically 2-3 x/week visits

Limited home health aide coverage(typically 5-10 hours/week)

50
Q

Home care - Advantages

A

Cost ¢

Convenience

Adaptation to home setting

Slow paced

“No place like home”

51
Q

Home care - Disadvantages

A

More expensive than OP tx

Limited equipment

Less aggressive

Limited goals

Need for family support

Nursing care primarily for teaching
family to do care

52
Q

Outpatient care

A

Mobile patients

Varied settings—hospitals, free-standing

Can be sub-specialized — e.g., sports, neuro, cancer, male/female health issues

Can be up to 5 days/week

53
Q

Outpatient care - Advantages

A

Cost ¢¢

Community level goals

Equipment

54
Q

Outpatient care - Disadvantages

A

Time limits set by insurance(#
visits capped)

Transportation needed

Limited physician supervision

Not typically inter-disciplinary

55
Q

Comprehensive Outpatient Rehabilitation Facility
(CORF)

A

Can be specifically licensed and CORF accredited

Inter-disciplinary

“Day hospital programs”—may have RN

Typically 4 hrs 3-5 days/week

Often sub-specialized—e.g., TBI or Cancer rehab

56
Q

Assisted Living Facilities

A

Private pay and little regulation

Support provided by CAN and LPN

On site nursing supervisor

Meals

Medications

Rooms, cottages may be attached to other services

Integ Final (16 decks)

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