Acute Eval Flashcards
Medical Dx
Medical condition, the chief complaint is sometimes a medical Dx, sometimes not.
PT Dx
Impairments and functional limitations. & what are they associated with. May have nothing to do with Med Dx.
What do you include from the PMH?
Only pertinent information. About their mobility, or how they will tolerate activity.
What do you need to know about the current hospital course?
Pertinent tests, labs, orders. Depends on condition. Like H/H after ortho surg, 1st CXR, Negative LE duplex (no clots)
What do you need to know about orders?
PT eval and treat, Activity level, WB restrictions, Mobility precautions. Don’t take “orders” from a nurse.
What order should you read the pt notes?
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.
What info do we want from the interview?
Orientation, Cognition/Behavior, PLOF, pre-admission environment. Read the H&P from the doc.
What are the 4 components of orientation?
Person, place, time, orientation.
What does behavior speak to?
Rehab potential.
What constitues cognition?
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).
Why is PLOF important?
Establishes a baseline level of mobility.
What do you want to know about hte pre-admission environment?
Structure (stairs, elevator, etc), assistance at home, surface of floor (hardwood/carpet), type of shower
Systems review: Cardiopulm
Vitals: RR, HR, BP, O2
Heart Rhythm
Keep in mind S/S dec CO.
What should BP do during exercise?
Systolic should increase, diastolic should dip a little at first but should not continue to dip (no more than 10 mmHg)
Where are the most important integumentary areas to check?
FEET!!
Gait belt location
Ischial tub/sacrum
What NM things do you want to check?
coordination on everyone.
& coordination with gait (document this the most)
Tone, Sensation, Pain
What MSK things are you looking at with review?
ROM, MMT (more gross function) - esp knee ext, hip flexion, just the big ones. Functional mobility, balance are other categories.
Whats in our assessment?
PT Dx (what is wrong with the pt), How well did they participate, how well did they tolerate what we did
Impairments
How did the pt move before (interview), PLOF/mobility PTA vs. How does the patient move now? Gap between those = impairment list.
What should you keep in mind when determining rehab potential?
Judgement call. Behavior/command following, act. tol, PLOF, motivation, pain, prognosis. (Excellent, good, poor)
What should goals relate to?
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
Discharge planning
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?
Inpatient rehab facility
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.
SNF
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
Home health
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
outpatient
30-60 min per visit. PRN up to 30 days per certification. Primary goal is rehab.
Long Term Acute Care
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
Extended care facility
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.
