Decision Making Components/Pitfalls & Applied Clinical Decision Making

Question 1

What 3 things should one be knowledgeable about during clinical decision making?

Answer 1

1. Structure & Function of body systems.
2. Psychosocial behavior of an individual in health and illness.
3. Physical therapy services and the rationale for their use.

Question 2

What are the 7 steps in the PT decision-making process? (STUDY GUIDE)

Answer 2

1. Identify Problem to be addressed.
2. Collect Data pertinent to problem.
3. Evaluate the info.
4. Develop a PT dx.
5. Develop a Prognosis.
6. Come up with Interventions.
7. Evaluate Outcomes (newer, becoming Standard of Practice.

Question 3

What are the treatment priorities when developing a prognosis in order? (3 that we talked about)

Answer 3

1. Life-threatening.
2. Pain reduction.
3. Restoration of Function

Question 4

What type of problems are within the scope of PT?

Answer 4

Neuromusculoskeletal dysfunction.

Question 5

What are 5 extraneous factors affecting the decision making process?

Answer 5

1. Time Schedule (acute vs. OP vs. rehab)
2. Patient Behavior (compliance, what pt wants)
3. Facilities (equipment and space)
4. Multiple Health problems (co-morbidities)
5. Reimbursement (duty of PT to explore options)

Question 6

What are 5 common pitfalls in decision making?

Answer 6

1. Basing decision on external factor solely.
2. Failure to recognize alternate dx.
3. Failure to select critically.
4. Inappropriate assessment tools.
5. Invalid assessment.

Question 7

What is the component that helps dictate the interview process the most?

Answer 7

The Chief Complaint

Question 8

The Chief Complaint will elicit info related to what 5 things?

Answer 8

1. Contraindications/precautions to testing/treatment.
2. Stage of injury or illness (acute/chronic).
3. Location (referring or localized etc.)
4. Symptoms (musculoskeletal vs. systemic)
5. Red Flags

Question 9

What are some of the 6 characteristics of pain that a PT should try to find out from a pt?

Answer 9

1. Location.
2. Description of sensation.
3. Intensity
4. Duration
5. Frequency
6. Pattern

Question 10

Which of the following usually indicates systemic pain? neuromusculoskeletal pain?

1. Pain that decreases with rest.
2. Bilateral pain.
3. Can be modified by position and/or movement.
4. Associated with restriction in movement and/or strength.

Answer 10

1. NMS
2. systemic
3. NMS
4. NMS

Question 11

What are the normal values for heart rate, BP, temperature (oral), and respiratory rate?

Answer 11

HR: 60-100bpm
BP: <120/80 mmHg
Temperature: 96.8-99.5 (oral)
Respiratory Rate: 12-20 breaths/min

Question 12

What are 3 red flags that you should be aware of for heart rate?

Answer 12

1. Pausing of >3s
2. bradychardia with chest pain.
3. HR >140 in elderly or hx of CHF, CAD.

Question 13

What values of BP along with diffuse thoracic pain may indicate a dissecting aneurysm?

Answer 13

Systolic >180, Diastolic >110

Question 14

What values of BP are the limits that MD and ER referral is necessary?

Answer 14

Systolic >220, Diastolic >130

Question 15

What oral temperature (along with other symptoms) is a red flag for temperature?

Answer 15

> 100 or >99 for elderly with confusion or memory issues. <97 in elderly or in pt with fatigue.

Question 16

A respiratory rate >20 is only a red flag in what 2 conditions? A RR of <12 is a red flag if accompanied by what symptoms?

Answer 16

> 20
1. If more than 5 minutes after stopping exercise.
2. If pt is on O2.
<12
1. SOB, asthma flare, or chronic lung problems.

Question 17

Selection of tests should be based on what 3 factors?

Answer 17

1. Reliability of the measure.
2. Validity of the measure.
3. Value of the measure.

Question 18

What are the 4 steps to making a referral?

Answer 18

1. Call the practitioner or their assistant.
2. Give the pt’s name, age, and description of what you were seeing them for.
3. If symptoms are urgent state your concern and give the pt’s symptoms and vital signs.
4. Discuss the appropriate referral (to office, ER etc.)