Evaluation of medically complex patient

Question 1

Major contributors to disease and disability

Answer 1

Physical inactivity

Sedentary lifestyle

Question 2

Goals of the Evaluation – All Settings

Answer 2

Complete a thorough evaluation
Develop a proper plan of care
Make appropriate discharge recommendations (acute, SNF, rehab)
Facilitate discharge planning

Question 3

Delirium

Answer 3

acute decline in mental status associated with transient changes that in many cases, are reversible

Question 4

Three states of delirium:

Answer 4

hyperactive
hypoactive
mixed

Question 5

Hyperactive state

Answer 5

patient is restless and agitated

Question 6

Hypoactive state

Answer 6

patient is lethargic and withdrawn

Question 7

Mixed state

Answer 7

patient behavior fluctuates between the hyperactive and Hypoactive state

Question 8

Features of delirium

Answer 8

acute onset of inattention, disorganized thinking, change in the level of consciousness, disorientation, decreased memory, perceptual disturbances, and altered sleep to wake cycles

Question 9

Heart rate reserve

Answer 9

how much the heart can increase its rate from the resting value to respond to demand and it reflects the heart’s ability to increase cardiac output

Question 10

Orthostatic hypotension

Answer 10

Defined as decrease in systolic BP by 20 mmHg or a drop of 10 mmHg with a reflexive increase in heart rate with transitional movements

Question 11

Standard HR

Answer 11

50-120bpm

Question 12

Standard Systolic BP

Answer 12

80-180 mmHg

Question 13

Standard Diastolic BP

Answer 13

40-110mmHg

Question 14

Standard female hemoglobin

Answer 14

12-16

Question 15

Standard male hemoglobin

Answer 15

14-17

Question 16

Standard female hematocrit

Answer 16

37-47

Question 17

Standard male hematocrit

Answer 17

42-52

Question 18

Outside normal parameters:

Answer 18

Dizziness that is not resolved within 60 seconds of obtaining upright position
An increase in the patient’s heart rate of 30 BPM or more over baseline
A change in the patient’s systolic blood pressure of 30 mmHg, or a change in the diastolic blood pressure of 10 mmHg
Blurred vision
Dilated pupils
Angina
Shortness of breath

Question 19

Urinary Incontinence

Answer 19

Defined as the complaint of any involuntary leakage of urine

Women have a greater risk of developing this condition

Question 20

Stress UI

Answer 20

Involuntary leakage of urine that occurs on effort or exertion, or on sneezing or coughing

Question 21

Urge UI

Answer 21

Involuntary leakage of urine accompanied by or immediately preceded by urgency (a sudden, strong desire to pass urine, which is difficult to deter)

Question 22

Mixed UI

Answer 22

Involuntary loss of urine associated with urgency and also with exertion, effort, sneezing, and coughing.

Question 23

Treatment options for UI include

Answer 23

Pharmacotherapy
Surgery
Pelvic floor muscle (PFM) exercise
Other behavioral interventions

Question 24

What is one mechanism of female stress UI?

Answer 24

Loss of an anatomic support (levator ani muscles, endo-pelvic fascia, and pelvic ligaments) to the proximal urethra

Question 25

Why is childbirth one factor that predisposes women to stress UI?

Answer 25

Possibly due to pudendal nerve injury, stretching/ tearing of the pelvic ligaments and/ or levator ani muscles, or damage to the urethra

Question 26

Overactive Bladder

Answer 26

Defined as “urgency, with or without urge UI, usually with frequency and nocturia
Detrusor muscle activity – usually overactive

Question 27

Medical Conditions that Affect Bladder Function Directly

Answer 27

CHF
Peripheral venous insufficiency
Renal disease
Urinary tract infection
Bladder tumor
Bladder stones
Bladder outlet obstruction 
Diabetes
Neurological conditions
Radiation Therapy

Question 28

Conditions that can precipitate urinary incontinence by increasing intraabdominal pressure

Answer 28

Chronic cough (chronic obstructive lung disease, smoking, asthma, allergies, emphysema)
Constipation
Obesity
Occupation (involving heavy lifting), and/ or
Recreational activities (weight lifting, jogging)

Question 29

PT Interventions for UI:

Answer 29

Pelvic Floor Muscle Exercise

“Stress Strategy”

Question 30

Pelvic Floor Muscle Exercise

Answer 30

Exercise variables, including the duration, repetitions, and duration of care, differs greatly across exercise studies.

Question 31

“Stress Strategy”

Answer 31

The skill of contracting the PFM’s prior to and during circumstances of increased abdominal pressure (cough, sneeze, laugh, heavy lifting)