Intro and Exam of Acute Care (pt 1)- Class 4 Flashcards
as a PT in the acute care setting we must
consider the pathology of the dz
impact of the meds
impact of the meds
while utilizing the benefits but not impeding the physiologic monitoring and pt support equipment
pt support equipment
tubes and lines
it will be common for a PT to make clinical judgement calls that
impact d/c planning
after only 1 pt interaction
exam
history
systems review
tests and measures
d/c planning process
history
systemic gathering of data
from past and present
related to why the pt is seeking the services of PT
when do pts in the hospital request therapy services
rarely
but other HCPs or institutional guidelines recommend it
why do other HCPs or institutional guidelines recommend it
therapy services are beneficial in the ongoing care of the pt
the data from the pts history allows
the clinician to hypothesize about
impairments and fxnal limitations
that are commonly related to a medical condition
common data generated from a pt history
general demographics
social history
living environment
what is the pts current living situation
the hospital
this can be overwhelming to the pt, family and caregivers and also the PT
what must we familiarize ourselves with
monitors
equipment
supplies
alarms
what could not understanding this equipment do
undermine the therapist-pt relationship
the PT must understand what about d/c
the options for the pt
where will the pt be going and what does that environment look like?
what about the d/c environment must we consider
stairs
bathrooms
potential space and access requirements for home hospital equipment
general health status
social health status
family history
medical/surgical history
current condition/chief complaint
family history
health status of the caregiver
early recognition of any issues assists in appropriate d/c management
what else must we consider –> history
is is safe for the pt to participate in PT
what is the story
are there current therapeutic interventions being provided by other HCPs?
WB, activity or positional restrictions –> history
fxnal status
medications
other clinical tests
fxnal status
determining the pt’s prior level of fxning may change your expectations for the episode of care
meds –> PT must consider
impact of meds on the pt’s hemodynamic profiles
–> at rest and with activity
potential connection b/w meds side effects, mental status and NM complaints
other clinical tests can be found
pt’s chart
usually contains extensive amounts of data
what does the data on the medical chart provide
info that may help in determining the pt presentation and clinical responses observed during the exam or interventions
lab values can guide
interventions appropriateness
intensity
duration
look for on daily basis
systems review
brief examination of the other systems
other systems include
CV/pulmonary
integ
MS
NM
communication, affect, cognition, language and learning style
CV/pulmonary should include
BP, HR and RR
b/c vital signs give us a lot of info
the hospitalized pt will likely be monitored
extensively
vital signs will be available to the therapist from nursing documentation and telemetry monitors
resources for vital signs are not
a substitute for not doing them ourselves
we should always…–> vital signs
check what their values are on your own before and after
fragile skin can be caused by
bed rest
poor nutrition
some meds (corticosteroids)
how can integ lesions be avoided
frequent position and postural changes
esp out of bed activities
what must we consider as PTs –> integ
pts fxnal status
body type
pathologies
what are we using these considerations for –> integ
to make suggestions for beds, chairs, mattresses, cushions or assistive devices
what do we asses with MS
gross muscle tole
ROM
fxnal strength
what are common –> MS
contractures
esp in bed bound mechanically ventilated or critically ill pt
what must we consider –> MS
extremities and head and neck
when on mechanical ventilation, how may the pt be positioned –> MS
facing the vent
may develop limitations in cervical ROM
NM
important area for the acute care pt
when might initial signs of NM dyfxn become apparent
when pt attempts to move
PTs are often –> NM
first to mobilize a pt
may be first to observe these signs
what should we asses –> NM
movement patterns
sensation
proprioception
what should we asses for –> communication etc. etc.
consciousness and arousal
what can arousal and alertness be impaired d/t
sedatives
anxiolytics
narcotics
other meds
what can alter or influence communication
artificial airways
tests and measures
different deck!
d/c planning process –> goal in acute care setting is to
transition the pt to the next level of care
while minimizing fxnal limitations and disabilities
what must therapists do –> d/c planning
appropriate d/c recommendations
appropriate d/c recommendations
decisions on assistive devices
appropriate levels of continued inpatient rehab
whether or not pt is safe to go home
who will our recommendations be sought by
pt
family
medical, surgical, nursing, social work and case management teams
what are typical questions a PT must answer about d/c
when is the pt safe to go home
is inpatient rehab required
how much therapy can the pt tolerate per day
if the pt is going home, what adaptive equipment must be ordered
is home PT necessary or are outpatient services appropriate
