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Acute Care > Intro > Flashcards

Intro Flashcards

1
Q

Role of PT in Acute Care

A

Early mobilization
Educate
Treatment (strength, endurance, mobility)
Discharge planning

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2
Q

Exam considerations

A 
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
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3
Q

What are the components of the CV eval

A
  1. data to determine hemodynamic and respiratory trends
  2. determine status before, during, and after pt interaction
  3. telemetry
  4. BP, HR, RR
  5. O2 saturation
  6. Perceived rate of exertion
  7. Determine Early Mobility Status
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4
Q

What is involved in Telemetry?

A
  • Interpret HR and Heart rhythm

- MAP

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5
Q

Hemodynamic stability

A

stable blood flow-stable pumping heart and good circulation

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6
Q

Hemodynamic instability

A

abnormal or unstable BP which cause inadequate blood flow to organs

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7
Q

What areas should you inspect for integumentary eval?

A

surgical incisions
indwelling lines
tubes
bony prominences

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8
Q

For the integumentary eval, what patient history will make you suspect fragile skin?

A

medications (corticosteroids, etc)
poor nutrition
prolonged bed rest

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9
Q

How often should the patient reposition?

A

every 2 hours

determine what positions to avoid and ID/recommend positioning aids

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10
Q

What are the components of the MSK eval?

A
  1. Determine Gross muscle tone and ROM
  2. ID joint contractures
  3. Be aware of equipment that creates positioning problems
  4. ROM for areas required for upright standing
  5. ID chest asymmetries
  6. Assess Functional Strength
  7. Determine early mobility status
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11
Q

What is an example of equipment creating positioning problems?

A

UE and cervical limitations due to patient’s head put into rotation to face a ventilator

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12
Q

What are the ROM needs for upright standing

A
  • 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
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13
Q

What are some causes for chest assymetries

A

surgical incisions/pain
neuromuscular disorders
prior thoracic trauma
orthopedic conditions

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14
Q

What are the components of the Neuromuscular eval?

A 
Gross/fine motor strength
proprioception
sensation
balance
DTRs
movement patterns
determine early mobility status
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15
Q

What are the components of the cognition eval?

A
  1. determine consciousness, arousal, alertness, and orientation
  2. A&O X 4
  3. Determine short memory (recall), attention to task
  4. Formal cognitive tests
  5. Patients may have fluctuating mental status
  6. Determine early mobility status
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16
Q

What are the components of A&O X 4?

A

person
place
time
situation

17
Q

What are two formal cognitive tests

A

MMSE: mini mental state exam
MoCS: Montreal cognitive scale

18
Q

Tests and measures for cognition?

A

Can the patient communicate his/her needs?

Acute hypercapnia/hypoxemia=altered consciousness

19
Q

Tests and measures for aerobic capacity/endurance?

A

2MWT, 6MWT
2 min step test
30 sec chair rise
simple STS

20
Q

Tests and measures for circulation?

A 
Note: 
BP, MAP, HR
heart rhythm
palpation of pulse
edema
claudication

determine risk for DVT

21
Q

Tests and measures for Integumentary

A
  1. Assess sensation, incisions, bony prominences, indwelling lines, edema
  2. Vascular status: ABI
  3. Sensory status: 5.07 monofilament
  4. Pressure Ulcer Scale for Healing
  5. Braden and Norton Scales
  6. Classification of wounds
22
Q

What do the Braden and Norton scales measure?

A

Likelihood of developing an ulcer

23
Q

Tests and measures for muscle performance, motor function, and gait/balance?

A

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
24
Q

Tests and measures for pain?

A
  • 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
25
Q

Acute care diagnosis

A
  • Diagnosis already established
  • Interpret Lab results and exam/eval findings
  • Do you need more info?
26
Q

Acute care prognosis

A
  • 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

27
Q

What is the goal of D/C planning?

A

transition patient to next level of care and optimize functional independence

28
Q

When does D/C planning start?

A

at the initial eval

29
Q

What are some considerations for D/C planning?

A
  • 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?
30
Q

Intense hospital based therapy due to daily 3 hr duration

A

Inpatient Rehab

31
Q

Less intense hospital based therapy, usually 2 hr/day

A

Subacute/TCU

32
Q

Less intense skilled nursing-based therapy, usually 2 hr or less/day

A

SNF

33
Q

Home based therapy, usually 3/week. Patient must be home bound

A

Home Health

34
Q

Best for more mobile patients

A

Outpatient

35
Q

Appropriate for patients with diagnosis with 6 months or less to live

A

Hospice

Acute Care (6 decks)

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