Acute Eval

Question 1

Medical Dx

Answer 1

Medical condition, the chief complaint is sometimes a medical Dx, sometimes not.

Question 2

PT Dx

Answer 2

Impairments and functional limitations. & what are they associated with. May have nothing to do with Med Dx.

Question 3

What do you include from the PMH?

Answer 3

Only pertinent information. About their mobility, or how they will tolerate activity.

Question 4

What do you need to know about the current hospital course?

Answer 4

Pertinent tests, labs, orders. Depends on condition. Like H/H after ortho surg, 1st CXR, Negative LE duplex (no clots)

Question 5

What do you need to know about orders?

Answer 5

PT eval and treat, Activity level, WB restrictions, Mobility precautions. Don’t take “orders” from a nurse.

Question 6

What order should you read the pt notes?

Answer 6

Admission note is important. Start at the beginning and move forward. most recent note also really important. The middle ones, less so but we still don’t skip them.

Question 7

What info do we want from the interview?

Answer 7

Orientation, Cognition/Behavior, PLOF, pre-admission environment. Read the H&P from the doc.

Question 8

What are the 4 components of orientation?

Answer 8

Person, place, time, orientation.

Question 9

What does behavior speak to?

Answer 9

Rehab potential.

Question 10

What constitues cognition?

Answer 10

command following (% of commands followed - how many how well), problem solving (can they identify dangerous situations), insight (person with broken leg thinks they can go home even though they cant, decreased insight into deficits).

Question 11

Why is PLOF important?

Answer 11

Establishes a baseline level of mobility.

Question 12

What do you want to know about hte pre-admission environment?

Answer 12

Structure (stairs, elevator, etc), assistance at home, surface of floor (hardwood/carpet), type of shower

Question 13

Systems review: Cardiopulm

Answer 13

Vitals: RR, HR, BP, O2
Heart Rhythm
Keep in mind S/S dec CO.

Question 14

What should BP do during exercise?

Answer 14

Systolic should increase, diastolic should dip a little at first but should not continue to dip (no more than 10 mmHg)

Question 15

Where are the most important integumentary areas to check?

Answer 15

FEET!!
Gait belt location
Ischial tub/sacrum

Question 16

What NM things do you want to check?

Answer 16

coordination on everyone.
& coordination with gait (document this the most)
Tone, Sensation, Pain

Question 17

What MSK things are you looking at with review?

Answer 17

ROM, MMT (more gross function) - esp knee ext, hip flexion, just the big ones. Functional mobility, balance are other categories.

Question 18

Whats in our assessment?

Answer 18

PT Dx (what is wrong with the pt), How well did they participate, how well did they tolerate what we did

Question 19

Impairments

Answer 19

How did the pt move before (interview), PLOF/mobility PTA vs. How does the patient move now? Gap between those = impairment list.

Question 20

What should you keep in mind when determining rehab potential?

Answer 20

Judgement call. Behavior/command following, act. tol, PLOF, motivation, pain, prognosis. (Excellent, good, poor)

Question 21

What should goals relate to?

Answer 21

Directly to: impairments, PLOF (safe return to, not better than they were)
Patient goal!
Functional mobility (type of mobility and assist), gait (distance, assist, device), pain (functional), HEP

Question 22

Discharge planning

Answer 22

What D/C location is safe for the pt?
What level of therapy is appropriate?
What equipment does pt need?
How will we get process started?

Question 23

Inpatient rehab facility

Answer 23

15 hrs/wk minimum. (5x/week 3 hrs combined therapy)
LOS: at least 7 days. determined by Dx. Avg = 16 days
Goal: D/C to home (any other location don’t get full reimbursement)
24 hr nursing, MD followup, limited by diagnosis.

Question 24

SNF

Answer 24

15-72 min per discipline per day.
PT based on RUG (ultra high 72 min per disc. per day)
Tx 5-6 days/week (LOS 7-100 days medicare max)
Medicare A: 100% for first 20 days (avg stay 20 days)
24 hour nursing

Question 25

Home health

Answer 25

30-45 min/visit (1-5 visit/week, typically 2)
PRN for up to 60 days per certification
Primary goal is prep pt for house. (secondary goal = family training)
Pt. MUST be homebound

Question 26

outpatient

Answer 26

30-60 min per visit. PRN up to 30 days per certification. Primary goal is rehab.

Question 27

Long Term Acute Care

Answer 27

Acute care needs.
Wound care/ventilator weaning.
Avg LOS = 25 days, PT prn. Pts may not really be candidates for therapy. Same level as acute care but need to be there > 25 days

Question 28

Extended care facility

Answer 28

Assisted living (assistance prn), nursing home (24 hour assistance), Intermediate care (short term). Hard to D/C from hospital to here usually SNF in between. Long process.