Evaluation of medically complex patient Flashcards
Major contributors to disease and disability
Physical inactivity
Sedentary lifestyle
Goals of the Evaluation – All Settings
Complete a thorough evaluation
Develop a proper plan of care
Make appropriate discharge recommendations (acute, SNF, rehab)
Facilitate discharge planning
Delirium
acute decline in mental status associated with transient changes that in many cases, are reversible
Three states of delirium:
hyperactive
hypoactive
mixed
Hyperactive state
patient is restless and agitated
Hypoactive state
patient is lethargic and withdrawn
Mixed state
patient behavior fluctuates between the hyperactive and Hypoactive state
Features of delirium
acute onset of inattention, disorganized thinking, change in the level of consciousness, disorientation, decreased memory, perceptual disturbances, and altered sleep to wake cycles
Heart rate reserve
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
Orthostatic hypotension
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
Standard HR
50-120bpm
Standard Systolic BP
80-180 mmHg
Standard Diastolic BP
40-110mmHg
Standard female hemoglobin
12-16
Standard male hemoglobin
14-17
Standard female hematocrit
37-47
Standard male hematocrit
42-52
Outside normal parameters:
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
Urinary Incontinence
Defined as the complaint of any involuntary leakage of urine
Women have a greater risk of developing this condition
Stress UI
Involuntary leakage of urine that occurs on effort or exertion, or on sneezing or coughing
Urge UI
Involuntary leakage of urine accompanied by or immediately preceded by urgency (a sudden, strong desire to pass urine, which is difficult to deter)
Mixed UI
Involuntary loss of urine associated with urgency and also with exertion, effort, sneezing, and coughing.
Treatment options for UI include
Pharmacotherapy
Surgery
Pelvic floor muscle (PFM) exercise
Other behavioral interventions
What is one mechanism of female stress UI?
Loss of an anatomic support (levator ani muscles, endo-pelvic fascia, and pelvic ligaments) to the proximal urethra
Why is childbirth one factor that predisposes women to stress UI?
Possibly due to pudendal nerve injury, stretching/ tearing of the pelvic ligaments and/ or levator ani muscles, or damage to the urethra
Overactive Bladder
Defined as “urgency, with or without urge UI, usually with frequency and nocturia
Detrusor muscle activity – usually overactive
Medical Conditions that Affect Bladder Function Directly
CHF Peripheral venous insufficiency Renal disease Urinary tract infection Bladder tumor Bladder stones Bladder outlet obstruction Diabetes Neurological conditions Radiation Therapy
Conditions that can precipitate urinary incontinence by increasing intraabdominal pressure
Chronic cough (chronic obstructive lung disease, smoking, asthma, allergies, emphysema)
Constipation
Obesity
Occupation (involving heavy lifting), and/ or
Recreational activities (weight lifting, jogging)
PT Interventions for UI:
Pelvic Floor Muscle Exercise
“Stress Strategy”
Pelvic Floor Muscle Exercise
Exercise variables, including the duration, repetitions, and duration of care, differs greatly across exercise studies.
“Stress Strategy”
The skill of contracting the PFM’s prior to and during circumstances of increased abdominal pressure (cough, sneeze, laugh, heavy lifting)
