Acute Inpatient Flashcards
What is Acute Care?
Hospital setting
Goal: D/C patient as soon as the patient deemed healthy and stable, w/ appropriate D/C instructions
LTAC
Long Term Acute Care
certified hospitals, patient stay longer than 25 days, with more than one serious condition
high need for medical services
SNF
Skilled Nursing Facility
after 3 days of hospital stay; therapy services > MD, 24 hour nursing, meds, custodial care
NOT a nursing home
Inpatient Rehab
3 hours of therapy/day, 24 hour nursing (requires 2 out of the 3 therapy services)
Long Term Care
therapy 1-3 days per week for 30-60 mins, nursing services
Subacute Rehab
more intensive skilled than SNF, therapy 1-2 hours/day
What is our role as a PT?
advocate for our patient
what brought them here and what can we do to help them meet the longer goals
which level of care is best…
Acute Care PT
advanced skills and knowledge to thoroughly examine and appropriately intervene with patients in medically compromised situations across the lifespan
high degree of triage skill, integration of complex info from many HCP, and effective interdisciplinary communication are necessary for practice
demonstare awareness and recognition of changes in medical stability w/ onset of activity
skill and resolve focus on body functions and impairments while max the func capabilities of the individual in order to facilitate the best pt outcome
Environments
General Medical/Sx Orthopedics Oncology Neurology ICU Step Down Unit Pediatrics Trauma Cardiology Pulmonary Vascular Transplant
3 acute care considerations:
Infection Control
Universal Precautions
Isolation Precautions
3 levels of Isolation Precautions
Contact - gloves and a gown barrier, skin
Droplet - transmitted through sputum, cough, sneeze, could be on surface
Airborne - most concerning, mask w/ one way movement involved, particles that are transferred in the air
Role of PT in Acute
consultative
member of multidisciplinary patient care team
patient, family/caregiver education
clinical judgements that impacts discharge planning
Common components of inpatient chart
demographic info physician orders H&P progress notes operative reports consult reports nursing notes meds sheets lab values other diagnostic tests
Precautions
confirm physician orders
know surgical procedure
know WB status
know your physician
Total Hip Precautions
Risk for dislocation of new px jt Positions to avoid to decrease risk - Hip flexion >90 - Hip Abd > neutral (do not cross midline) - Hip IR
Spine Precautions
Positions and movements to avoid to prevent loosening of hardware or fusion
- No spine flexion
- No rotation
- No lifting greater than 5-10 lbs (depends)
WB Restrictions
NBW TTWB PWB WBAT FWB
Sternal Precautions
No lifting more than 5-10 lbs
Avoid WB through UE
Avoid reaching posteriorly
No shoulder flexion >90 (depends)
Assist levels (very subjective) Functional Independence Measure (FIM)
Independence
Mod Independence, pt requires use of device, but no physical A
Min A, pt can perform 75% of more of task
(CGA, pt can do 90% of work, w/ PT hand on them)
Mod A, 50-74% of task
Max A, 25-49% of task
Total A,
Fundamental S&S to look for a patient in distress
20 mmHg change in SBP 10 mmHg change in DBP 100 HR Increased RR Decreased O2 sats 92-100% is normal Complaints of dizziness, nausea, speech slur Change in level of awareness/direction
AGAIN… what are the 6 elements of Patient Management
Examination Evaluation Diagnosis Prognosis (Plane of Care) Intervention Outcomes
3 major categories for Examination:
History (HPI)
Review of systems
Specific tests & measures
What is in the Examination: History?
Chart Review
Medical Team
Subjective Interview
Family/Caregiver
History includes:
General Demographics Social History Living Environment General Health Status Social/Health Habits Family Hx Medical/Sx Hx CC/cc Functional status & Activity Level Meds Clinical tests
