Core Competency: Patient Management

Question 1

What in the medical record should you look at for precautions and plans?

Answer 1

• Past medical history
• Current medical status
• Laboratory Values
• Medications
• Mental status
• Fall risk
• Risk of medical deterioration

Question 2

What note will give you the most information

Answer 2

Admission note (H&P):
* Tests and measures
* Medical decisions
* Why they came

Question 3

What should you do when you see information about discharge/home life?

Answer 3

Confirm with the patient.

Question 4

Patient Specific Orders

Answer 4

• Restrictions
• Weight Bearing Status
• Activity Orders

Question 5

Activity Orders List

Answer 5

• Bedrest (strict – not out of bed for any reason)
• Bedrest with Bathroom Privileges / Commode Privileges
• Dangle at Edge of Bed (may be specific with durations)
• Up to Chair (may be specific with durations)
• Activity as Tolerated (no restrictions, but must be supervised / may require assistance for mobility)
• Up Ad Lib (no restrictions, can walk freely about the room and unit)

Question 6

What is the average hospital stay duration for all acute diagnoses? TKA? THA? Hip Fracture (s/p stabilization)?

Answer 6

• Avg Overall: 3-5 Days
• TKA & THA Overnight
• Hip fracture (s/p stabilization) - 2-3 Days (Depends on how they stabilized

Question 7

When getting someone an AD to go home with, what do you need to do?

Answer 7

• Talk to multiple people about the things that need to be done to get the AD. Putting it in the chart will not get sent and read by the people that need it.

Question 8

What kind of information are you going to gather as your objective portion of exam?

Answer 8

• Based off Dx (Ex: Don’t need to do UE reflex or senation testing for a TKA)
• Pain (where? Rating? Description?)
• ROM (PROM or AROM? Patient position?)
• Sensation (sharp / dull? Light touch? Hot / cold?)
• Reflexes (which reflexes? Which side?)
• Outcome measures (ensure relevance; know duration to complete; understand norms)
• Integumentary (identify where incision / wound is)
• Edema (be specific about where measures are taken; compare to contralateral / uninvolved side)

Ex: SCI - sensation testing may not be necessary if the physician has done it recently

Question 9

What should you start with in your exam?

Answer 9

Functional Mobility

Question 10

Components of Written Assessment

Answer 10

• Summary statement (brief review of current condition and interpretation of patient response to tests and measures)
• Diagnosis statement (list impairments and how they affect activity and participation)
• Need of ongoing skilledPT
• Prognosis (contextual factors influencing outcomes)
  – Poor > Fair > Good > Excellent (and why)

Question 11

Components of Goal Writing

Answer 11

• A (actor) – who will accomplish goal?
• B (behavior) – what is expected task / activity?
• C (conditions) – with what devices? With what level of assist?
• D (degree) – consistency? Frequency? What environment / context? Efficiency?
• E (expected time) – setting specific

Make it functional!

Do NOT need to create goals that go beyond the acute care setting. This would be outpatient PTs job.