Intro Flashcards
Role of PT in Acute Care
Early mobilization
Educate
Treatment (strength, endurance, mobility)
Discharge planning
Exam considerations
systemic gathering of data from past to present prioritize essential info obtain chief complaint must factor social roles, religious beliefs, etc establish PLOF family Hx functional status/activity level meds clinical tests
What are the components of the CV eval
- data to determine hemodynamic and respiratory trends
- determine status before, during, and after pt interaction
- telemetry
- BP, HR, RR
- O2 saturation
- Perceived rate of exertion
- Determine Early Mobility Status
What is involved in Telemetry?
- Interpret HR and Heart rhythm
- MAP
Hemodynamic stability
stable blood flow-stable pumping heart and good circulation
Hemodynamic instability
abnormal or unstable BP which cause inadequate blood flow to organs
What areas should you inspect for integumentary eval?
surgical incisions
indwelling lines
tubes
bony prominences
For the integumentary eval, what patient history will make you suspect fragile skin?
medications (corticosteroids, etc)
poor nutrition
prolonged bed rest
How often should the patient reposition?
every 2 hours
determine what positions to avoid and ID/recommend positioning aids
What are the components of the MSK eval?
- Determine Gross muscle tone and ROM
- ID joint contractures
- Be aware of equipment that creates positioning problems
- ROM for areas required for upright standing
- ID chest asymmetries
- Assess Functional Strength
- Determine early mobility status
What is an example of equipment creating positioning problems?
UE and cervical limitations due to patient’s head put into rotation to face a ventilator
What are the ROM needs for upright standing
- Ankles: need to achieve neutral ROM to WB through balls of feet
- Hips: need to achieve neutral hip flexion / extension ROM for increased standing stability
- Knees: need to achieve full knee extension ROM for increased stability
What are some causes for chest assymetries
surgical incisions/pain
neuromuscular disorders
prior thoracic trauma
orthopedic conditions
What are the components of the Neuromuscular eval?
Gross/fine motor strength proprioception sensation balance DTRs movement patterns determine early mobility status
What are the components of the cognition eval?
- determine consciousness, arousal, alertness, and orientation
- A&O X 4
- Determine short memory (recall), attention to task
- Formal cognitive tests
- Patients may have fluctuating mental status
- Determine early mobility status
What are the components of A&O X 4?
person
place
time
situation
What are two formal cognitive tests
MMSE: mini mental state exam
MoCS: Montreal cognitive scale
Tests and measures for cognition?
Can the patient communicate his/her needs?
Acute hypercapnia/hypoxemia=altered consciousness
Tests and measures for aerobic capacity/endurance?
2MWT, 6MWT
2 min step test
30 sec chair rise
simple STS
Tests and measures for circulation?
Note: BP, MAP, HR heart rhythm palpation of pulse edema claudication
determine risk for DVT
Tests and measures for Integumentary
- Assess sensation, incisions, bony prominences, indwelling lines, edema
- Vascular status: ABI
- Sensory status: 5.07 monofilament
- Pressure Ulcer Scale for Healing
- Braden and Norton Scales
- Classification of wounds
What do the Braden and Norton scales measure?
Likelihood of developing an ulcer
Tests and measures for muscle performance, motor function, and gait/balance?
Muscle performance: MMT, functional testing, UMN vs LMN deficits
Motor Function:
- Assess dexterity and coordination
- Tying shoes, TUG
Gait, locomotion, balance:
- dynamic/functional gait index
- TUG
- Berg, Romberg, Functional reach
Tests and measures for pain?
- assess quality, intensity, location, and duration
- numeric rating scale
- visual analog
- Wong-Baker faces
- FLACC (face, legs, activity, cry, consolability)
- COMFORT
- McGill
- Brief pain inventory
Acute care diagnosis
- Diagnosis already established
- Interpret Lab results and exam/eval findings
- Do you need more info?
Acute care prognosis
- Consider PLOF and current status
- How likely is patient to return to PLOF
- What does patient need in order to return to PLOF
- Will PT be restorative or compensatory?
Key in determining D/C status
What is the goal of D/C planning?
transition patient to next level of care and optimize functional independence
When does D/C planning start?
at the initial eval
What are some considerations for D/C planning?
- is pt safe to return home / prior living arrangement?
- is inpatient PT required?
- How much daily PT can this pt tolerate?
- Does pt need adaptive equipment?
- If pt is returning home, are either home health or outpatient PT needed?
Intense hospital based therapy due to daily 3 hr duration
Inpatient Rehab
Less intense hospital based therapy, usually 2 hr/day
Subacute/TCU
Less intense skilled nursing-based therapy, usually 2 hr or less/day
SNF
Home based therapy, usually 3/week. Patient must be home bound
Home Health
Best for more mobile patients
Outpatient
Appropriate for patients with diagnosis with 6 months or less to live
Hospice
