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DPT 629: Cardio > Intro to Management of Patients in the Acute Care Setting > Flashcards

Intro to Management of Patients in the Acute Care Setting Flashcards

1
Q

how is acute care defined?

A

pts are not stable enough to receive care at an outpatient clinic

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2
Q

what is acute care?

A

a level health care in which a pt is treated for a brief but severe episode of illness

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3
Q

what is typically the entry point of care for acute care?

A

the ED or by another physician for a planned procedure or treatment

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4
Q

what is hemodynamic stability?

A

a medical term that describes a person’s stable blood flow, BP, and HR

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5
Q

t/f: anything that leads to inadequate blood flow to vital organs leads to hemodynamic instability

A

true

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6
Q

what causes homeostatic imbalance?

A

imbalance of ions, water, or electrolytes

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7
Q

what are the most common diagnoses for inpatient stay?

A

livebirth, septicemia, HF, pneumonia, OA, DM complications, acute MI, dysrythmias, COPD excerbation

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8
Q

what is septicemia?

A

a bacterial infection of the blood

very serious life threatening response to infection

pts get very sick very quickly

total organ failure

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9
Q

what is observational status?

A

well defined set of specific clinically appropriate services, which include ongoing short-term Rx, assessment, and reassessment b4 a decision can be made regarding whether pts will require further Rx as hospital pts or if they’re able to be discharged from the hospital

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10
Q

how long is observation status typically?

A

<24 hours

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11
Q

how long can some rare and exceptional cases be in observation status?

A

> 48 hours

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12
Q

what is the purpose of observation status?

A

to monitor a pt to determine if they need to be admitted

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13
Q

what is the Affordable Care Act’s Hospital Readmissions Reduction Program?

A

CMS began reducing Medicare payments to inpatient hospitals deemed to have excessive pt readmissions w/in 30 days of d/c

if pts are classified as outpatients under observation status, their return to the hospital within 30 days isn’t considered readmission

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14
Q

t/f: Medicare is incentivized to to overturn hospital decisions to admit individuals as inpatients, which is more costly to the healthcare system than outpatient admission

A

true

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15
Q

Medicare considers observation what kind of service and is covered under what part of Medicare

A

outpatient covered under Medicare part B

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16
Q

t/f: Medicare part B services have both deductibles and cost-sharing for beneficiaries which means that the cost to the patient of an observation stay is more variable than a traditional inpatient

A

true

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17
Q

does time spent in observation status count towards the 3 day inpatient stay requirement for Medicare SNF coverage

A

nope

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18
Q

will Medicare pay for medically necessary post-acute care in a SNF without a 3 day inpatient stay?

A

nope

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19
Q

what is unique about the acute care setting?

A

there is medical team trained and experienced in identifying and treating instabilities at REST

the therapist needs to be skilled in identifying physiological responses both AT REST and WITH MOVT

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20
Q

t/f: stability can quickly change with movt

A

true

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21
Q

what is involved in sound clinical decision making?

A

be observant

integrate info

predict the pt’s expected level of improvement to determine goals, d/c needs, and rehab prognosis

be aware of your limitations and ask for help when needed

create a comprehensive PT care plan that’s individualized and focused on the pt and caregiver’s goals and circumstances

choose optimal dose-specific interventions

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22
Q

t/f: we should do as much the pt can do and push to fatigue as long as they’re stable

A

true

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23
Q

we should adjust intervention choices and dosage based on what?

A

the pt’s response and d/c needs

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24
Q

what are some important skills for entry level PTs in acute care?

A

you need to know what you know and don’t know

you need to look at the big picture but be able to break down problems into component parts to manage pt’s care

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25
Q

what is the purpose of documentation in acute care?

A

to ensure quality pt care, facilitate communication among healthcare providers, and meet legal and reimbursement requirements

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26
Q

what is the importance of documentation in acute care?

A

proper documentation supports continuity of care, justifies medical necessity, and aids in risk management

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27
Q

t/f: adherence to specific documentation guidelines is set by Medicare and private insurers

A

true

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28
Q

what fxnal outcome/progress measure is often used in acute care?

A

6 Clicks

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29
Q

how soon should documentation be done in acute care?

A

right away!!!

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30
Q

what are the requirements in documentation for Medicare and insurance?

A

date and duration of treatment

specific interventions and their medical necessity

fxnal outcomes and progress measures

timely submission

use of approved terminology and coding

regular reviews and updates of the POC

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31
Q

what is involved in justification for medical necessity?

A

clear articulation of why PT services are required

documentation of fxnal limitations and their impacts on daily activities, potential for fxnal improvement through PT interventions, and skilled nature of the provided services

establishment of measurable fxn based goals

regular reassessment and documentation of progress toward goals

explanation of any changes in the treatment plan or lack of progress

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32
Q

what needs to be documented for justification of medical necessity?

A

fxnal limitations and their impacts on daily activities

potential for fxnal improvement through PT interventions

skilled nature of the provided services

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33
Q

what are the best practices for acute care PT documentation?

A

be concise yet comprehensive

use objective, measurable terms

avoid repetitive or irrelevant info

document in real-time or as soon as possible after treatment

ensure legibility and proper use of abbreviations

regularly review and update documentation practices

participate in ongoing education about documentation requirements

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34
Q

communication in acute care involves communication bw who?

A

bw healthcare workers and the pt/family/caregiver

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35
Q

what is the #1 reason for mistakes made in acute care?

A

poor communication

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36
Q

what is involved in communication in acute care?

A

verbal and nonverbals

listening skills

team communication

documentation

reporting

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37
Q

t/f: professional demeanor and interpersonal communication precedes clinical skills?

A

true

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38
Q

what phrase at the end of statements should we avoid?

A

“okay?”

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39
Q

what is SBAR?

A

Situation

Background

Assessment

Recommendations

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40
Q

what is included in the situation part of SBAR?

A

what’s the situation you’re calling about

ID self, unit, patient, room #

briefly state the problem, what it is, when it happened or how it started, and how severe

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41
Q

what is included in the background part of SBAR?

A

pt background info related to the situation could include:

admitting dx and date of admission

most recent VSs

screen/exam results (provide date and time the test was done and results of previous tests for comparison)

other clinical info (response to intervention)

code status

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42
Q

what is included in the assessment part of SBAR?

A

what is your assessment of the situation

what you found and think is going on

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43
Q

what is included in the recommendation part of SBAR?

A

what is your recommendation or what does the pt want

ie. hold off on treatment, clarify orders, or request consult

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44
Q

what is a unique challenge when working with sick patients?

A

it is unlikely they will take in much info you tell them

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45
Q

t/f: effective communication leads to better pt outcomes and satisfaction

A

true

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46
Q

what are some key communication strategies?

A

active listening

clear and simple language

empathy and compassion

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47
Q

how can we actively listen?

A

pay full attention to pts

use nonverbal cues to show engagement

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48
Q

how do we use clear and simple language?

A

avoid medical jargon

use analogies to explain complex concepts

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49
Q

how do we show empathy and compassion?

A

acknowledge pts’s pain and concerns

use a calm and reassuring tone

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50
Q

how do you adapt communication for patient needs?

A

assess pt’s cognitive status and adjust accordingly

consider cultural and linguistic differences

use visual aids or written instructions when appropriate

involve the family members or caregivers when necessary

utilize teach-back method to ensure understanding

prioritize clear, empathetic communication

adapt strategies to individual pt needs

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51
Q

what are common barriers to communication?

A

pain and discomfort

medication effects

anxiety or fear

language differences

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52
Q

what are some strategies for overcoming communication barriers?

A

use pain scales and body language interpretation

schedule therapy sessions around medication timing

practice patience and offer reassurance

utilize interpreter services when needed

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53
Q

what is involved in discharge planning?

A

determine destination, level of support, need for continuity of care in post-acute setting, and critically assess pt safety (cognition and fxn)

determine optimal equipment needs

synthesize the pt’s life context

assess the expectations and desires of stakeholders

understand regulations imposed by the healthcare systems and payers

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54
Q

what are the different destination settings for discharge?

A

rehab, outpatient, home, sub-acute, or other additional services and follow up needs

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55
Q

what factors are involved in determining optimal equipment needs for discharge?

A

reasonable and necessary available funding

individual circumstances

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56
Q

what is included in the synthesis of the pt’s life context in discharge planning?

A

their pre-hospitalization status

age

suitability of home environment

caregiver support

follow-up/transportation needs

risk factors for re-hospitalization

economic resources

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57
Q

who is involved in the assessment of the expectations and desires of the stakeholder for discharge planning?

A

the pt, family, caregiver, medical services, and surgical services

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58
Q

if the patient will not achieve pre-hospital or acceptable level of function prior to discharge, is medically complex, and requires extended stay specialty hospital, where will they be discharged to?

A

LTACH

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59
Q

if the patient will not achieve pre-hospital or acceptable level of function prior to discharge, is not medically complex or requiring extended stay specialty hospital, and could get significantly better in inpatient rehab/can tolerate 3 hours of therapy (OT/PT/SLP) per day/has a significant advantage with regards to medical safety, timeframe, or ultimate level of goal achieved, where will they be discharged to?

A

IRF

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60
Q

if the patient will not achieve pre-hospital or acceptable level of function prior to discharge, is not medically complex or requiring extended stay specialty hospital, and could get significantly better in inpatient rehab/can tolerate 3 hours of therapy (OT/PT/SLP) per day/has a significant advantage with regards to medical safety, timeframe, or ultimate level of goal achieved, and has no skilled nursing or medical needs only/could not reach rehab goals in a less resource intensive environment, where will they be discharged to?

A

IRF

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61
Q

if the patient will not achieved pre-hospital or acceptable level of function prior to discharge, is not medically complex or requiring extended stay specialty hospital, and could get significantly better in inpatient rehab/can tolerate 3 hours of therapy (OT/PT/SLP) per day/has a significant advantage with regards to medical safety, timeframe, or ultimate level of goal achieved, and has skilled nursing or medical needs only/could reach rehab goals in a less resource intensive environment, where will they be discharged to?

A

SNF

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62
Q

can a pt progress from LTACH to home?

A

yes

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63
Q

can a pt progress from SNF to IRF?

A

yes

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64
Q

if the patient will be able to achieve pre-hospital or acceptable level of function prior to discharge, where will they be discharged to?

A

home

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65
Q

what services may be involved in home health?

A

PT/OT

day hospital

community re-entry

outpatient rehab services

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66
Q

will your patient get rehab coverage if you document them as supervision or contact guard?

A

not likely

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67
Q

if you feel the need to stand close by your patient, what level of assistance should they be documented as?

A

min A

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68
Q

if you document that your pt walked >100 feet, will they get rehab coverage?

A

likely not

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69
Q

if your pt walks a total of 120 feet but needs rest breaks, how should you document it so they can get rehab coverage?

A

document the time walking in chunks breaking it up when they needed rest breaks

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70
Q

if a pt is not medically complex for admission to acute rehab, where may they be appropriate to d/c to?

A

IRF

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71
Q

if a pt didn’t use an AD b4 admission, but now does, what should you document?

A

their baseline fxn prior to admission

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72
Q

if someone may otherwise be a good candidate for IRF but cannot handle 3 hours of therapy per day, where may they d/c to?

A

SNF

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73
Q

t/f: we should not refer to SNF as a nursing home

A

true

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74
Q

t/f: SNF is a temporary place to get better and go home once you are more independent and safe to go home

A

true

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75
Q

how do we decide on interventions for acute care pts?

A

breakdown activities and fix what you can while assessing mobility

think about what you can do to make them qualify for rehab

ID what is preventing them from accomplishing the task independently

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76
Q

why is it important to get to know the typical d/c and recovery length post-op for certain surgeries?

A

bc we have to assess their rehab potential on day one and they will not look their best day one post-op so it may skew our interpretation of their rehab potential

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77
Q

what items are included in a safety checklist?

A

check for behavioral issues

check VS from the nurse

nonslip socks and gait belt

bring in all equipment w/you

hand washing and gloves as needed

inform the nurse when you’re done

move barriers

lock chair

safe positioning

turn bed alarm back on

make sure call bell is on and w/in reach

check for correct use of equipment

ADs

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78
Q

before entering the pt’s room, what things should we do to ensure safety?

A

SBAR with nursing or other medical staff as needed

coordinate w/the team on timing of treatment, consider meds, equipment, and personnel availability to optimize effectiveness

make sure PT is indicated and there is an appropriate referral

review medical hx

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79
Q

if a pt doesn’t have an appropriate referral for PT, what should we do?

A

ask nursing, case manager, or physician why there’s no referral

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80
Q

what is involved in the medical review b4 entering a pt’s room?

A

note if PT is indicated based off the prior and/or current medical and surgical hx

note meds that may impact mental status, wakefulness, and ability to follow commands

note meds that may impact HR and BP responses

determine the prior LOF and activity tolerance (use AHA HF classification scale, Borg RPE, MRC breathlessness scale, etc)

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81
Q

during the exam/interventions, what things should we do to ensure safety?

A

observe, evaluate, and modify the environment

protect lines and tubes

observe, evaluate, and modify your approach and rxns to the pt

monitor hemodynamic status

monitor the physiological response of other systems

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82
Q

t/f: we should always step away and come back to pts who are not cooperating

A

false, sometimes the pt needs a good push to get up and moving, but other times you need to step ways for the day or a few minutes then come back

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83
Q

what is involved in observing, evaluating, and modifying the environment?

A

the space to treat (remember you are entering someone else’s space)

lines, tubes, and monitors

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84
Q

how do we protect lines and tubes?

A

keep lines and tubes in front of you and the pt where you can see them

keep Foley catheter and chest tubes below waist level

must be able to manage lines and guard the pt appropriately

always be able to look at your pt’s face

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85
Q

what is involved in observing, evaluating, and modifying your approach and rxns to the pt?

A

physical appearance

mood, affect, emotions, level of cooperation

consider the impact of illness or medical procedures, and meds on pt’s mobility, weakness, incision, trauma, pain, and equipment needs

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86
Q

why is observing mood, affect, emotions, and level of cooperation important in safety?

A

it determines how they feel about mobilization, any concerns they have, and their readiness

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87
Q

what do we monitor to know the pt’s hemodynamic status?

A

monitor VSs of the pt and symptoms throughout

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88
Q

if the pt is not awake and alert, follows simple commands, and has stable mental status, is the pt appropriate for therapy?

A

probably not

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89
Q

if the pt is awake and alert, follows simple commands, and has stable mental status, but is not cardiovascularly stable, is the pt appropriate for therapy?

A

maybe not

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90
Q

if the pt is awake and alert, follows simple commands, and has stable mental status, is cardiovascularly stable, but is not stable in pulmonary values, is the pt appropriate for therapy?

A

maybe not

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91
Q

if the pt is awake and alert, follows simple commands, and has stable mental status, is cardiovascularly stable, is stable in pulmonary values, but doesn’t have safe lab values, is the pt appropriate for therapy?

A

maybe not

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92
Q

if the pt is awake and alert, follows simple commands, and has stable mental status, is cardiovascularly stable, is stable in pulmonary values, and has safe lab values, is the pt appropriate for therapy?

A

probably

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93
Q

what is acceptable HR range?

A

> 50, <150 bpm

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94
Q

what is stable heart rhythm?

A

AFib under 100 bpm

acceptable PVCs

no recent VT

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95
Q

what is acceptable BP range?

A

resting MAP >65, <120 mmHg

SBP >80, <200 mmHg

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96
Q

what makes a pt cardiovascularly stable?

A

acceptable HR and rhythm

acceptable BP

absence of chest pain or pressure

absence of recent DVT/PE

surgical precautions being followed

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97
Q

what makes a pt pulmonarily stable?

A

resting pulse ox >88%

RR<35 breaths/min

acceptable breathing pattern

no observable respiratory distress

no SOB at rest

acceptable O2 delivery

appropriate mechanical ventilation

appropriate ABGs

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98
Q

what is appropriate O2 levels?

A

> 88%

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99
Q

what is acceptable RR?

A

<35 breaths/min

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100
Q

what is appropriate hemoglobin levels?

A

> 7g/dL w/o CV disease and no signs of bleeding

> 8-10 if known CV disease

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101
Q

what is appropriate hematocrit levels?

A

> 25%

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102
Q

what is appropriate platelet count?

A

> 20,000 cells/mm^2

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103
Q

what should we consider when WBC counts are <5,000 cells/mm^2?

A

limit pt exposure to possible infection risks

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104
Q

what should we consider when WBC counts are >10,000 cells/mm^2?

A

consider active infection (febrile vs afebrile)

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105
Q

what are acceptable potassium levels?

A

3.5-5.3 mEg/dL

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106
Q

what are acceptable sodium levels?

A

135-148 mEg/dL

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107
Q

what are acceptable calcium levels?

A

8.5-10.5 mg/dL

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108
Q

what are acceptable magnesium levels?

A

1.8-2.7 mg/dL

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109
Q

what are acceptable glucose levels?

A

> 60 mg/dL, <300 mg/dL

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110
Q

what lab values should be obtained for cardiac conditions?

A

troponins, CPK, and BNP

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111
Q

what lab values should be obtained for renal disease?

A

creatinine

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112
Q

what lab values should be obtained for hepatic disease?

A

LFT

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113
Q

what lab values should be obtained to determine if nutrition status is acceptable?

A

albumin and pre-albumin

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114
Q

what orthopedic conditions should be considered for making a decision on the appropriateness of PT in acute care?

A

WB restrictions

stable spine

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115
Q

what integumentary considerations should be taken into account when making a decision on the appropriateness of PT in acute care?

A

skin grafts-see if ROM and WB restrictions are restricting mobility

vacuum drainage system

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116
Q

what are the red flags in pt responses to treatment?

A

CV-SBP/MAP falls, new onset VT

pulmonary-desaturation <85%

subjective responses-chest pain

^^^ may indicate life threatening change

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117
Q

what are the yellow flags in pt responses to treatment?

A

CV-excessive HR or BP increase

pulmonary->5% decrease in SpO2, excessive DOE/fatigue

MSK change

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118
Q

what are green flags in pt responses to treatment?

A

all appropriate responses

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119
Q

if we see red flags in pt responses to treatment, what may we do?

A

discontinue PT immediately–> return to resting position–> monitor pt closely until they stabilize–>consider need for assistance

discuss with the medical and nursing team

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120
Q

if we see yellow flags in pt responses to treatment, what may we do?

A

decrease the intensity of the PT session

if condition stabilizes, continue with PT

if condition worsens, discontinue PT, return to resting position, monitor closely until pt stabilizes, consider need for assistance

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121
Q

if we see green flags in pt responses to treatment, what do we do?

A

continue with PT and consider increasing the intensity, duration, and frequency of treatment

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122
Q

what is included in a complete blood count (CBC)?

A

WBCs

platelets

RBCs

hemoglobin

hematocrit

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123
Q

what does a complete blood count tell us?

A

concentration of WBCs, RBCs, platelets as well as the concentration of hemoglobin and hematocrit w/in a blood sample

info regarding an individual’s overall health

differential dx for a variety of diseases and conditions

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124
Q

why do we want WBC counts?

A

to ID presence of infection and conditions that cause inflammation, allergic rxns, and cancers of the blood and lymphatic system

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125
Q

t/f: flutuations in WBC occur at any age

A

true

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126
Q

fluctuations in WBCs are most common in what population?

A

infants

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127
Q

what is the reference range for WBCs in newborns?

A

9,000-30,000

128
Q

what is the reference range for WBCs in a child younger than 2 yo?

A

6,200-17,000

129
Q

what is the reference range for WBCs in a child older than 2 and adults?

A

5,000-10,000

130
Q

what are possible critical values for WBCs?

A

<2,500

> 30,000

131
Q

what is an absolute neutrophil count (ANC)?

A

total neutrophil/granulocytes present in the blood

132
Q

what is leukocytosis?

A

upward trending WBCs

133
Q

what are some causes of leukocytosis (upward trending WBCs)?

A

infection, inflammation, bone marrow disease, immune system disorder, severe stress/pain

134
Q

what is the presentation of someone with leukocytosis (upward trending WBCs)?

A

fever, fatigue, bleeding, bruising, frequent infections

135
Q

what are the clinical implications of leukocytosis (upward trending WBCs)?

A

closely monitor s/s

consider timing of PT due to early morning low level and late afternoon high peak

136
Q

what is leukopenia?

A

downward trending WBCs

137
Q

what are some causes of leukopenia (downward trending WBCs)?

A

chemo, radiation, marrow infiltrative diseases, infections, dietary deficiencies, autoimmune disease

138
Q

what is the presentation of someone with leukopenia (downward trending WBCs)?

A

frequent/persistent infections, inflammation/ulcers in and around the mouth, headache, stiff neck, sore throat, fever/chills, night sweats

139
Q

what are the clinical implications of leukopenia (downtrending WBCs)?

A

refer to facility guidlines

monitor s/s of infection

monitor fatigue (Borg and RPE)

educate on fatigue

provide falls prevention screening

140
Q

why do we want platelet counts?

A

platelets help stop bleeding by forming a clot

141
Q

what is the reference range for platelets in a pre-mature infant?

A

100,000-300,000

142
Q

what is the reference range for platelets in a newborn?

A

150,000-300,000

143
Q

what is the reference range for platelets in an infant?

A

200,000-400,000

144
Q

what is the reference range for platelets in a child/adult?

A

150,000-400,000

145
Q

what are the possible critical values for platelets?

A

<50,000

> 1 million

146
Q

what is thrombocytosis and thrombocythemia?

A

upward trending platelets

147
Q

what are some causes of thrombocytosis and thrombocythemia (upward trending platelets)?

A

cancer, polycythemia Vera, splenectomy, acute/chronic inflammation, strenuous exercise, iron-deficiency anemia

148
Q

what is the presentation of someone with thrombocytosis and thrombocythemia (upward trending platelets)?

A

headache, dizziness, weakness, chest pain, tingling in hands and feet

149
Q

what are the clinical implications of thrombocytosis and thrombocythemia (upward trending platelets)?

A

screen for VTE

monitor s/s of VTE

collaborate to weight risks vs benefits of PT with abnormal findings

150
Q

what is thrombocytopenia?

A

downward trending platelets

151
Q

what are the causes of thrombocytopenia (downward trending platelets)?

A

hemorrhage/blood loss, damage to developing blood cells, chemo, radiation, and various diseases that lead to decreased platelet counts

152
Q

what is the presentation of someone with thrombocytopenia (downward trending platelets)?

A

petechiae (rash like dots), ecchymosis, oral bleeding, hematoma, epitaxis (nose bleed)

153
Q

what are the clinical implications of thrombocytopenia (downward trending platelets)?

A

education of fall risk strategies

monitor fatigue (Borg and RPE)

154
Q

why do we want RBC count?

A

they transport O2 to the tissues throughout the body and use it to produce energy

155
Q

what cells contain hemoglobin?

A

RBCs

156
Q

what is the reference range for RBCs in a newborn?

A

4.8-7.1

157
Q

what is the reference range for RBCs in a 2-8 week old?

A

4-6

158
Q

what is the reference range for RBCs in a 2-6 month old?

A

3.5-5.5

159
Q

what is the reference range for RBCs in a 6 month-1 year old?

A

3.5-5.2

160
Q

what is the reference range for RBCs in a 1-18 year old?

A

4-5.5

161
Q

what is the reference range for RBCs in a male adult?

A

4.7-6.1

162
Q

what is the reference range for RBCs in a female adult?

A

4.2-5.4

163
Q

what is erythrocytosis?

A

upward trending RBCs

164
Q

what are some causes of erythrocytosis (upward trending RBCs)?

A

high altitude, dehydration, cor pulmonale, pulmonary fibrosis, severe COPD, polycythemia Vera, meds, congenital heart disease

165
Q

what is the presentation of someone with erythrocytosis (upward trending RBCs)?

A

weakness, fatigue, headaches, lightheadedness, dyspnea

166
Q

what are the clinical implications of erythrocytosis (upward trending RBCs)?

A

monitor fatigue (Borg and RPE)

screen for VTE

monitor s/s of VTE

167
Q

what are the causes of anemia (downtrending RBCs)?

A

hemorrhage, bone marrow suppression, oncologic condition, hemoglobinopathy, renal disease, pregnancy, dietary deficiency, prosthetic valves, over hydration

168
Q

what is the presentation of someone with anemia (downtrending RBCs)?

A

OH, weakness, fatigue, dyspnea on exertion, pallor, dizziness, chest pain, leg cramps with exercise

169
Q

what are the clinical implications of anemia (downtrending RBCs)?

A

monitor VSs and cardiac rhythm

monitor fatigue (Borg and RPE)

monitor for leg cramps

assess and monitor for cognitive impairments

provide falls prevention screening and intervention

170
Q

what is hemoglobin?

A

the main component of RBCs that transport O2 and CO2

171
Q

what is the reference range for hemoglobin in a newborn?

A

14-24

172
Q

what is the reference range for hemoglobin in a 0-2 week old?

A

12-20

173
Q

what is the reference range for hemoglobin in a 2-6 month old?

A

10-17

174
Q

what is the reference range for hemoglobin in a 1-6 year old?

A

9.5-14

175
Q

what is the reference range for hemoglobin in a 6-18 year old?

A

10-15.5

176
Q

what is the reference range for hemoglobin in an adult male?

A

14-18

177
Q

what is the reference range for hemoglobin in an adult female?

A

12-16

178
Q

what is the reference range for hemoglobin in a pregnant female?

A

> 11

179
Q

t/f: values for hemoglobin in older adults will be slightly decreased

A

true

180
Q

what are the possible critical values for hemoglobin?

A

<5

> 20

181
Q

what is polycythemia?

A

upward trending hemoglobin

182
Q

what are some causes of polycythemia (upward trending hemoglobin)?

A

severe dehydration, high altitude, smoking, congenital heart disease, chronic pulmonary disorder, HF

183
Q

what is the presentation of someone with polycythemia (upward trending hemoglobin)?

A

fatigue, headache, dizziness, visual changes, TIA, bruising, bleeding, dysrhythmia

184
Q

what are the clinical implications of polycythemia (upward trending hemoglobin)?

A

monitor VS and cardiac rhythm

provide falls prevention screening

implement activity pacing strategies to reduce load and prevent undue stress on the CV system

185
Q

if hemoglobin is at or below ___, we hold PT

A

7

186
Q

what should we do if hemoglobin levels are close to 7?

A

use symptom based approach

187
Q

when would we hold PT for hemoglobin above 7?

A

if they are post-op with high prior levels and now a sudden drop due to surgery

188
Q

if someone lives around 7 for hemoglobin levels, what should we do?

A

monitor for s/s

189
Q

t/f: we should look for signs of active bleeding if hemoglobin is downtrending

A

true

190
Q

what are some causes of anemia (downward trending hemoglobin)?

A

hemorrhage/blood loss, vit B12 and iron deficiency, bone marrow suppression, oncologic conditions, metabolic disorders, various diseases than can impact RBC production, meds

191
Q

what is the presentation of someone with anemia (downward trending hemoglobin)?

A

pallor, tachycardia, OH, dysrhythmias, impaired endurance and activity tolerance

192
Q

what are the clinical implications of anemia (downward trending hemoglobin)?

A

collaborate to weigh risks vs benefits of PT

timing of transfusions b4 PT

monitor VS (esp SpO2) to predict tissue perfusion

monitor pts with pre-existing cerebrovascular, cardiac, or renal conditions for tissue perfusion

provide falls prevention screen

implement activity pacing strategies

monitor fatigue (Borg and RPE)

193
Q

what are some signs of decreased tissue perfusion to watch for with pts with anemia?

A

discoloration, poor peripheral pulses, decreased temperature, and angina

194
Q

what is hematocrit?

A

the % RBCs in total blood volume

195
Q

what may abnormal hematocrit levels indicate?

A

blood loss or fluid imbalance

196
Q

what is the reference range for hematocrit for a newborn?

A

44-64%

197
Q

what is the reference range for hematocrit for a 2-8 week old

A

39-59%

198
Q

what is the reference range for hematocrit for a 2-6 month old?

A

35-50%

199
Q

what is the reference range for hematocrit for a 6 month-1 year old?

A

29-43%

200
Q

what is the reference range for hematocrit for a 1-6 year old?

A

30-40%

201
Q

what is the reference range for hematocrit for a 6-18 year old?

A

32-44%

202
Q

what is the reference range for hematocrit for an adult male?

A

42-52%

203
Q

what is the reference range for hematocrit for an adult female?

A

37-47%

204
Q

what is the reference range for hematocrit for a pregnant female?

A

> 33%

205
Q

t/f: the values for hematocrit in older adults may be slightly decreased

A

true

206
Q

what are the possible critical values for hematocrit?

A

<15%

> 60%

207
Q

what are some causes of polycythemia (upward trending hematocrit)?

A

severe dehydration, congenital heart disease, polycythemia Vera, erythrocytosis, burns, eclampsia, high altitude, hypoxia due to chronic pulmonary conditions (COPD, HF)

208
Q

what is the presentation of someone with polycythemia (upward trending hematocrit)?

A

fatigue, headache, dizziness, visual changes, TIA, dysrhythmia, bruising, bleeding

209
Q

what are the clinical implications for polycythemia (upward trending hematocrit)?

A

screen for VTE

210
Q

what are the causes of anemia (down trending hematocrit)?

A

hemorrhage, leukemia, bone marrow failure, multiple myeloma, dietary deficiency, pregnancy, hyperthyroidism, cirrhosis, rheumatoid arthritis, hemolytic rxn, hemoglobinopathy, prosthetic valve, renal disease, lymphoma

211
Q

what is the presentation of someone with anemia (downward trending hematocrit)?

A

OH, dizziness, headache, pallor, cold hands/feet, angina, dysrrhythmia, dyspnea

212
Q

what are the clinical implications of anemia (down trending hematocrit)?

A

assess and monitor VS (esp SpO2)

provide falls prevention screening and invention

monitor OH

213
Q

what is the definition of acute care PT?

A

specialized area of PT practice in hospital settings

214
Q

what is the focus of acute care PT?

A

treating pts w/acute medical conditions or recovering from surgery

215
Q

what is the goal of acute care PT?

A

improve fxnal mobility and d/c planning

216
Q

what are the different acute care PT settings?

A

ICUs

EDs

med-surg units

specialty units (cardiac, Neuro, Ortho)

post anesthesia care units (PACUs)

217
Q

what is the role of the PT in acute care?

A

early mobilization and rehab

pain management

respiratory care and chest PT

wound care and edamame management

pt and family education

d/c planning and recommendations

218
Q

what are the challenges of acute care PT?

A

time constraints

pt acuity and medically instability

limited space and equipment

infection control protocol

coordinating w/multiple healthcare professionals

rapidly changing pt status

219
Q

what are the parts for the pt exam and assessment in acute care?

A

chart review and medical hx

physical exam (resp assessment and Neuro screening)

fxnal mobility assessment

pain evaluation

220
Q

what are the key components of an acute care assessment?

A

if the pt has surgical precautions, instruct them on appropriate techniques 1st, then assess their ability while providing verbal cues

if no surgical precautions, assess their ability w/o instruction or cuing

only provide physical assistance if necessary

221
Q

t/f: we should be providing min A for assessment of pt mobility

A

false, provide no help at first to assess what they can do themselves

222
Q

what are the key components of intervention in acute care?

A

priority is on fxn and mobility

bed mobility, transfers, gait training

223
Q

mobility is both a(n) ____ and a(n) ____

A

assessment, intervention

224
Q

t/f: when assessing mobility, we are looking at the quality of movt

A

true

225
Q

how is mobility both an intervention and assessment?

A

we first assess the quality of a pt’s movt and if it is impaired, we use it as an intervention

226
Q

what is part of the CVP screen?

A

HR, RR, BP, edema, and temp

227
Q

what is part of the neuromuscular screen?

A

gross movt, maintaining positions, gait, changing body positions, transferring oneself

228
Q

what is part of the MSK screen?

A

gross symmetry, ROM, strength, and height/weight

229
Q

what is part of the integ screening?

A

pliability, presence of scar formation, skin color, skin integrity

230
Q

what is part of the screen of communication ability, affect, cognition, and language?

A

level of arousal

231
Q

if we get a (+) CVP screen, what are some interventions we can use?

A

aerobic capacity, endurance, anthropomorphic s (edema)

232
Q

if we get a (+) NM screen, what are some interventions we can use?

A

assistive and adaptive devices, balance

233
Q

if we get a (+) MSK screen, what are some interventions we can use?

A

assistive and adaptive devices, jt mobility, muscles power

234
Q

if we get a (+) integ screen, what are some interventions we can use?

A

wound assessment

235
Q

if we get a (+) pain screen, what are some interventions we can use?

A

check meds, anxiety reducing interventions, deeping breathing, splinting w/movt

236
Q

what is the focus of the exam in acute care?

A

fxn, safety, and d/c planning

237
Q

what are key to CDM and d/c planning in acute care?

A

outcome measures

238
Q

what are the categories of tests and measures in acute care?

A

aerobic capacity and endurance

anthropomorphic characteristics

assistive and adaptive devices

balance

circulation

cranial and peripheral nerves integrity and reflex integrity

environmental factors

gait

integ integrity

jt integrity, mobility, and ROM

mental fxns

mobility, self-care, and domestic life

motor fxn

muscles performance

pain

posture

skeletal integrity

ventilation and respiration

239
Q

what are common tests and measures for the acute care setting?

A

AM-PAC “6 Clicks”

gait speed

6MWT

2MWT

5xSTS

30s chair rise

TUG

SPPB

240
Q

what is the AM-PAC “6 Clicks” good for predicting?

A

d/c decisions (whether a person can go home or not, not WHERE they will go if not home)

241
Q

higher 6 Clicks indicates what?

A

d/c home

242
Q

lower 6 Clicks indicates what?

A

no d/c home

243
Q

a 6 Clicks score of ____ or less indicates a pt is not appropriate to d/c home

A

16

244
Q

what is the cutoff score for community ambulation gait speed?

A

0.8m/s

245
Q

what gait speed distinguishes bw dependent mobility and independent mobility in the hospital for older adults?

A

.35 m/s

246
Q

t/f: there is an association bw gait speed and hospital readmission

A

true

247
Q

gait speeds below ____ were strongly predictive of 30-day hospital readmissions in older adults

A

0.8 m/s

248
Q

what can be used to ID high risk pts prior to d/c?

A

gait speed

249
Q

what is the inpatient MCID for gait speed?

A

0.05-0.10 m/s

250
Q

if a pt has a slow gait speed, what do we do? (important for the practical)

A

fall risk assessment using standardized tools

review for hospital readmission risk factors and collaborate with healthcare professionals

implement strength and fxnal training focusing on the LE strength

add endurance training w/progressive intensity

provide task-specific gait training w/attention to mechanics and AD use

refer to specialists if medical comorbidities are contributing to the slow gait speed

educate the pts and caregivers on mobility maintenance and home exercises

conduct a home environment assessment to ensure safety and reduce fall risk

251
Q

what is the 6MWT a test of?

A

it is a submaximal test of aerobic capacity/endurance

252
Q

can O2 or ADs be used in a 6MWT?

A

yup!

253
Q

what are reasons to stop a 6MWT?

A

chest pain, intolerable dyspnea, leg cramps, staggering, diaphoresis, and pale/ashen appearance

254
Q

what are the predictive values of the 6MWT?

A

hospital readmissions and surgical outcomes

255
Q

for pts with COPD, <___m in the 6MWT predicts risk of rehospitalization w/in 30 days of d/c

A

350

256
Q

the 6MWT predicts surgical outcomes in what population?

A

frail older adults or pts w/chronic diseases

257
Q

t/f: lower distances in the 6MWT prior to surgery may predict risk for complications

A

true

258
Q

for pts undergoing lung surgery, <____m b4 surgery on the 6MWT was associated with higher risk of post-op complications

A

400

259
Q

if you have a pt with a specific dx and you are doing a 6 MWT, what are you going to do to find out the MCID for safe d/c?

A

look it up

260
Q

what is the 2MWT a measure of?

A

gait speed and aerobic capacity in pts who’re unable to complete the 6MWT

261
Q

t/f: in pts with COPD, the 2MWT was shown to correlate to the 6MWT and lower performance on the 2MWT was associated with increased risk of hospital readministration and poorer long term outcomes

A

true

262
Q

t/f: HF pts demonstrated that poor performance on the 2MWT correlated w/increased risk of recovering from acute conditions

A

true

263
Q

what is the MCID for the 2MWT for pts recovering from acute conditions?

A

10-30m

264
Q

what is the MDC for the 2MWT depending on the clinical condition?

A

20-50m

265
Q

what is the commonly reported MDC for the 2MWT when recovering from surgery, stroke, or cardiac events?

A

30m

266
Q

what does the 5xSTS measure?

A

LE strength, balance control, fall risk, exercise capacity

267
Q

a slower 5xSTS is linked to what?

A

increased fall risk, slow gait speed, and deficits in other ADLs for community-dwelling older adults

268
Q

the 5xSTS is a valid tool for predicting what?

A

d/c outcomes and hospital readmission risk, particularly in older adults and pts with COPD, HF, and fraility

269
Q

a 5xSTS time of >___s indicated delayed d/c and higher readmission rates in various populations

A

15

270
Q

what the normal range for 5xSTS in 60-69 year olds?

A

11.4s +/-2.1s

271
Q

what the normal range for 5xSTS in 70-79 year olds?

A

12.6s +/-2.9s

272
Q

what the normal range for 5xSTS in 80-89 year olds?

A

14.8s +/-5s

273
Q

the 30s chair rise is a useful measure for what?

A

LE strength and fxnal capacity

274
Q

the 30s chair rise is useful to measure LE strength and fxnal capacity, which are key in predicting what?

A

fxnal decline

post-op recovery

d/c home or rehab

hospital readmission, esp in older adults and those with chronic diseases

275
Q

a 30s chair rise of <_____ reps indicates a higher risk for complications and a delayed or difficult d/c process

A

8-12

276
Q

how can we use the 30s chair rise for d/c planning?

A

a fxnal assessment to evaluate whether pts have regained enough strength and mobility for safe d/c

277
Q

how can we use the 30s chair rise to predict hospital readmissions?

A

to ID pts at risk for complications due to insufficient fxnal recovery in pts with HF and post-op

278
Q

what is the difference in using the 30s chair rise or the 5xSTS?

A

we should use the 30s chair rise to measure endurance and overall LE fxn for those who can’t complete the 5xSTS

we should use the 5xSTS to assess power and fxnal LE strength

279
Q

what is the MCID for the 30s chair rise?

A

2-3 reps

280
Q

what is the MDC for the 30s chair rise?

A

1-2 reps

281
Q

what is the MCID for the 5xSTS?

A

2.5-4 sec

282
Q

what is the MDC for the 5xSTS?

A

1.5-2 sec

283
Q

what pts had the highest fall rate with the TUG?

A

pts unable to do to the TUG due to non-physical disability

284
Q

behind those unable to to the TUG due to non-physical disability, who had the second highest fall rate with the TUG?

A

those with physical disability

285
Q

who has the lowest fall rate with the TUG?

A

those able to do the TUG

286
Q

t/f: acutely unwell, immobile pts w/dementia and delirium were not at excessive risk of falls with the TUG

A

true

287
Q

in acute care, the value of the TUG lies in what?

A

the inability to complete the test rather than the time recorded

288
Q

a TUG of >__s indicates high fall risk

A

14

289
Q

what does the TUG measure?

A

mobility, balance, and fxnal independence

290
Q

what can the TUG predict?

A

falls, d/c home, and hospital readmission

291
Q

TUG score of >_____s indicates higher chances of requiring extended care, delayed d/c, or d/c to SNF

A

14-20

292
Q

in pts s/p hip fx, the TUG was a good predictor of what?

A

whether the pt would be d/c home or require further rehab

293
Q

TUG performance at d/c for older hospitalized adults was a strong predictor of what?

A

d/c destination

294
Q

what is the MDC of the TUG?

A

4-5 sec

295
Q

what is the MCID of the TUG?

A

1-2 sec

296
Q

3 components of the SPPB (short physical performance battery)?

A

ability to stand for 10 sec w/feet in 3 dif positions (side to side together, semi-tandem, tadem)

time to rise from a chair 5x

2 timed trials of a 3m or 4m walk

297
Q

what is the min and max score of the SPPB?

A

min=0, max=12

298
Q

t/f: the SPPB is a valid and reliable tool that can support d/c planning and hospital readmission prediction

A

true

299
Q

what population is the SPPB for?

A

older adults and those at risk for fraility or fxnal decline

300
Q

what do lower SPPB scores indicate?

A

higher hospital readmission rates and increased mortality

301
Q

SPPB score of less than or equal to ___ predicts hospital readmission w/in 30 days

A

9

302
Q

what is the MCID for the SPPB?

A

1-2 points

303
Q

what is the MDC for the SPPB?

A

0.5-1 point

304
Q

what are common interventions in acute care?

A

bed mobility

transfer training

gait training w/AD

airway clearance techniques

positioning and pressure relief

therapeutic exercises

fxnal mobility training

305
Q

what are functional mobility training interventions?

A

rolling

scooting

supine to/from sit

sit to/from stand

transfers bw surfaces

pressure relief

locomotor training

gait training w/ or w/o AD

stair training

WC mobility and management

306
Q

what are the purposes of dose-specific interventions in acute care?

A

prevention of hospital-associated deconditioning

maintenance of muscles strength and mobility

reduction of post-d/c disability

improvement in CVP impairments

enhanced recovery and shortened hospital stay

307
Q

low to moderate intensity exercise is good for what?

A

counteracting deconditioning w/o overstressing the pt

308
Q

who is appropriate for higher intensity exercise?

A

those with higher baseline fitness

309
Q

what is moderate intensity exercise good for?

A

greater improvements in muscle strength and fxnal mobility

enhancement of CV fitness

reduction in risk of hospital-assisted complications

310
Q

how often should pts exercise?

A

ideally, daily or near-daily

311
Q

t/f: more frequent PT sessions are associated with better outcomes, reduced hospital stay, and minimized risk of long term disability

A

true

312
Q

what s/s would indicate that we should terminate treatment?

A

dizziness not resolved w/in 60 sec of obtaining upright

nausea

blurred vision

dilated pupils

inc in HR of 20-30 bpm over baseline

change in SBP of 30mmHg or DBP of 10 mmHg

anginal pain

SOB

diaphoresis

Dec in HR from resting values

313
Q

what is the definition of fall risk?

A

an event which results in a person coming out rest inadvertently on the ground or floor or other lower level, even if controlled

314
Q

what are the risk factors for falls?

A

prior fall, DM, visual disturbances, poor balance, age, polypharmacy, incontinence, anyone relying on an AD for ambulation

315
Q

why would a pt be put in restraints?

A

risk of harm to self or others (ie pulling tubes)

316
Q

what are restraints?

A

any manual method, physical, or mechanical device, material, or equipment that immobilizes or reduces the ability of a pt to move their arms, legs, body, or head freely

a med/drug when it’s used as a restriction to manage the pt’s behavior or restrict the pt’s freedom of movt and isn;t a standard Rx or dosage for the pt’s condition

317
Q

can we take off restraints for PT?

A

yes, but keep in mind that they were there for a reason and the team should be consulted as needed

DPT 629: Cardio (11 decks)

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