Acute PT Flashcards
What is acute care?
< 14 days
hospital setting
goal of all acute care- discharge patient once stable
Types of Inpatient care settings
Long term acute care: certified hospitals, patient stays>25 days, more than one serious condition, PT >3hrs day
Skilled Nursing facility: after 3 days hospital stay, therapy services>MD, 24 hr nursing, meds and custodial care, <1 hr day
Inpatient rehab: 3 hrs/day, 24 hr nursing, team approach
Long term care: therapy 1-3 days/week 30-60 mins, daily tasks
Diff acute care environments
gen med/surgery ortho oncology neuro ICU step down pedes trauma cardio pulm vascular transplant
Role of PT in Acute care
- consult
- multidisciplinary patient care
- patient/family education
- clinical judgements that impact discharge
- chart reviews
Components of In Patient
demographic info physician orders history/physical progress notes operative reports consult reports nursing notes/flow sheets medication sheets lab values other diagnostic tests
Common acute care health conditions
total knee/hip spine surgery ortho fractures acute stroke acute MI/cardiac bypass organ failure/transplant pneumonia dehydration fall
Precautions
confirm physicians orders FIRST
know surgical procedure
know weight bearing staus
know your physician
Total hip precautions (post approach)
risk for dislocation of new prosthetic joint
positions to avoid: hip flex>90 degrees, hip adduction over neutral, hip internal rotation
Spine precautions
positions and movements to avoid to prevent loosening of hardware/fusion
no spine flexion
no spine rotation
no lifting >5-10 lbs (milk jug)
BLT
Orthopedic Fractures
ORIF (open reduction internal fixation) OREF Cast WAlking casts Foot wear Assistive devices
Weight bearing restrictions
NWB TTWB (toe touch; <10%--egg under toe) PWB (50%) WBAT (as tolerated) FWB
Sternal Precautions
No push/pull/lift more than gallon of milk
Avoid reaching posteriorly
no shoulder flexion>90 degrees
Functional Independence Measure (FIM) for assist level
Independence
Mod Independenc: requires use of device, no physical assistance
Min A: 75% or more of task can perform
Mod A: 50-74%
Max A: 25-49% task
Total A: <25% or requires more than one person to assist
other report types: COntact guard (CGA), close supervision, distant supervision, Total Ax2, show their deficits!!!
Fundamental signs/symptoms to look for in distressed patient
- 20mmHg change in SBP; 10 in DBP
- tachycardia, Bradychardia
- Increased RR
- Decreased oxy sat
- Complaints of dizzy, nausea, slurring of speach
- Change in level of awareness/following directions
Elements of Patient Management
Exam
Eval: dynamic judgement formulated
Diagnose: diff than MD, impact of condition on mvmnt
Prognose: plan of care, interventions/volume, time to reach improvement
Interventions: skilled PT techniques
Outcomes: impact of intervention
