Key Point/Main Topics Flashcards
Regulations encoutntered in Acute and Post-Acute Care Setting
When is it indicated to use restraints on a patient?
- Patient who poses a risk to themselves or others
- Patient that requires it in order to provide treatment (surgical)
Regulations encoutntered in Acute and Post-Acute Care Setting
What are the requirements need in order to restrain a patient?
- MD that must be updated every 24 hours
- Depending on the type of restraints and facility policy -> Patient must be monitored continuously, hourly, every 4 to 6 hours
Regulations encoutntered in Acute and Post-Acute Care Setting
What are some risk associated with the use of Restraints?
- Strangulation/Asphyxiation
- Mobility limitations
–Pressure ulcer formation
–Urinary incontinence
–Constipation
–Pneumonia
–Deconditioning
Regulations encoutntered in Acute and Post-Acute Care Setting
What is HIPAA?
Health Insurance Portibility and Accountability Act
- A federal law enacted to protect health care-related information
Regulations encoutntered in Acute and Post-Acute Care Setting
With HIPPA, what are Violations of the Privacy rule?
- Providing PHI to other health care professionals that are not involved with the patients care
- Accessing a patients record taht you are not treating
- Not being compliant with a patients request for their medical record within 30 days
Communication
What is Verbal Communication? How can it be presented to the listener or patient? How is raport built?
Verbal communication should be represented in a language that the listener understands
- Brief and concise
- Your tone, volume, and inflection of your voice can detract or add to the message
–Can stimulate or calm a patient based on your voice and behavior
Build rapport by showing:
–Active listening
–Empowerment
–Empathy
Communication
What is Attentive/Active Listening?
This is essential for effective communication
- You evaluate the patients tone of voice
- Observe non-verbal cues
- Listen for the main theme of the message then reflect that information back to the patient/colleague
- Focus on the content of the message instead of the way its being communicated
- Clarify the message to ensure understanding
Miscommunication can attribute to medical errors
Communication
How is Non-verbal communication demonstrated?
Through facial expression, posture, gestures, body movements and changes in body responses
This is demonstrated through therapeutic touch
This makes up the majority of human connection
Communication Problems tend to be classified into four categories, what are they?
- Late delivery of communication thus not being effective
- Not communicating with all the relevant individuals on the team
- Content not consistently complete or accurate
- Communications whose purpose were not achieved, thus leaving issues unresolved
What is SBAR?
This stands for:
Situation: what is going on with the patient?
Background: What is the clinical background or contex?
Assessment: What do I think the problem is?
Recommendation: What do I think needs to be done for the patient?
How can SBAR be effective for Communication?
- SBAR provides a standardized means for communicating in patient care situations
- SBAR provides a common and predictable structure for communication, can be used in any clinical domain, and has been applied in obstetrics, rapid response teams, ambulatory care, ICUs and other teams
- SBAR also present guidelines for organizing relevant information when preparing to contact another team member, as well as the framework for presenting the information, appropriate assessment, and recommendations
What is Cultural Competence in Health Care?
This refers to meeting the needs of people from distinctive ethic and racial groups as well as those with disabilities, diverse socioeconomic status, and LGBT communities
- This can:
–Improve patient outcomes
–Decrease health disparties
–Secondary benefits are improved patient satisfaction, increased adherence to medical advice
What are the 3 dimensions of Cultural Competence?
- Self awareness and reflection:
–Biases, prejudices and values - Respectful communication
–Lern about cultural norms and traditions of diferent ethnic and religious groups - Collaborative partnerships
–Mutural respect, expectations and acceptance of plans
Clinical Decision Making
What takes place in the Examination?
- Review of the medical record
- Communication of relevant information and interpretation with support staff re: patient condition
- Select appropriate examination screens and measure
- Communicate with the patient
- Observe of situation, enviornment and patient current condition
Clincal Decision Making
What takes place in the Plan of Care?
- ICF model: current condition medically, tolerance of activity, level of assistance
- Anticipation of needs/prognosis upon discharge
- Access to resource/insurance limitation
- Need for continued therapy post discharge
- GOALS
- Intervention selection
Clinical Decision Making
What takes place in the Discharge Planning?
This begins with the end in mind
This begins on day of initial evaluation
- Cognition and safety awareness
- Level of support
- Home environment
- Need for durable medical equipement
- Recognize regulations imposed by healthcare systems and insurance companies
- Assess and consider expectations and desires of stakeholders
- Coordinate and communicate with the interprofessional team to ensure patient recives resouce and placement upon discharge
Head Braces/Orthosis
What is the Soft Shell Helmet? What is one major consideration associated with the soft shell helmet?
- This is a helmet of foam material and requires wearing after having a craniectomy or a resection of any part of the skull
- Both adults and children can be prescribed this, and often times the activity order will be written only out of bed with helmet donned
- One major consideration when a patient is wearing this, is if there is a wound present on the top of their scalp, this can cause increase risk of infection. Sometimes gauze of a washcloth may be placed on the top of the head to create some elevation and space between the helmet and skull
Cervical Orthoses
When would a patient wear a Soft Collar?
- This is for Minimal Control
With injuries such as: Whiplash, Cervical weakness
What is a Rigid SOMI Collar? What are they affective at restricting? When are they used?
SOMI stands for: Sterno Occipital Mandibular Immobilizer
- These are for Moderate Control
These include:
-Philadelphia, Apen Collar, Miami J Collar
- The Miami J and Apen Collar can accomodate a tracheostomy
- The SOMI devices are effective at restricting flexion between C1 and C5 and proviodes mandibular support during change in position. also limits extension, lateral flexion, and rotation
- These are often on the neck after traction to stabilize a cervical fracture. They are used during the transitional period for 4 to 6 weeks before unresticted movement is allowed. Sometimes they are used after removing the maximal rigid Halo brace
With Max. Control Cervical Orthoses, What is the Minerva Orthosis? When is this donned?
- The Minerva is non-invasive and has 3 points of control to further reduce motion. Point of control are at the Mandible, the occiput and forehead.
- There is also a custom molded body jacket that helps encase the chin and a posterior skill portion that is extending to the costal margin or pelvis
- Its been reported to have better stabilization than a Halo, execpt for injuries at C1 and C2
- This is donned following cervical Fx
With Max Control Cervical Orthoses, What is the Halo? What is a contraindiation for this? When is this donned on a patient?
- This is an Invasive orthoses, it is fixed to the skull with 4 pins/screws piercing through the skin to the skull and the outer layer of the periosteum is penetrated.
- Its attached to a super structure that is used for attachment and stabilization to that thoracic vest. That vest must fit very intimately with the patient
- If there is movement of the vest, it can translate movement of the C-Spine, which is a contraindication
- It creates increased mass at the head and the neck, and it tends to create a leaning forward of the trunk
- So these patient will need mobility re-training to control the extra mass that is at the top of their head, so they may need a cane or other ADs and then readapt post-halo
- This is donned following facet subluxations and dislocations that have been reduced with traction
There may be infection from the pins, skin irritation, nerve damage. They may also develop TMJ dysfunction and possibly dysphagia
What is a Cash Extension Brace?
This is a Thoracic Orthosis
- This is donned following a compression fracture, this prevents further flexion and further damage
With the Thoracic Spine, what is the Jewett?
- A brace that restricts flexion and encourages hyperextension
- Limits rotation and sidebend to some degree
- Improper adjustment could lead to pressure on throat or genitals in sitting
With the Thoracic Spine, what is the Knight Taylor?
- This is a brace that has a rigid frame worn posteriorly
Thoracic Movement
- Unrestricted rotation and intermediate restriction of flexion, extension and sidebend
Lumbar Movement
- Rotation restricted intermediately other planes effectively restricted
Lumbosacral Movement
- No flexion/extension restrictio, rotation intermediate, Side bend effective
What is a Thoraco-Lumbar-Sacral Orthoses (TLSO)?
This can be used by patients with scoliosis
- Although they do not correct the deformity, they prevent them from getting worse (To correct scoliotic deformities, surgery is required)
- The braces have adjustable straps to create a three-point counter force to try to create stability to work toward preventing further curvatures
What is a TLSO: Bivalved Plastic body Jacket? With this orthosis, what can and cannot be done with rehab?
- This is very common to patients with SCI in the T- and L-Spine.
- This type of orthosis will allow for skin inspection and bathing
- It immobilizes to allow for the earlier rehab post-SCI to occur
- These patients will likely have spinal precautions, which will make rehab more challenging but still feasible
- When the Lumbar spine is affected and needs immobilizing, there can be no hamstring stretch or hip flexion past 90
- We can still perform UE PROM and AROM symmetrically
What is a Hip Abduction Orthosis used for?
This is used for Total Hip Revisions or to ensure hip percautions arent broken (may be needed for those patients with dementia)
What is the use of the Pressure Relieving Ankle Foot Orthosis (aka PRAFO boot)?
This is provide pressure relief to the heel
- This also helps reduce the risk of losing ROM since it places the foot in a relatively 90° angle to help maintian neutral position
What are Some Percautions after Hip Replacements?
No Hip IR, Hip Add, and no Flexion of the hip and trunk past 90° (Posterior Hip Replacement)
What information is usually in the Physicians Orders?
Who typically writes the Physicians Orders?
This is the Log of all instructions of the POC for the patient
- Medications
- Diagnostic or Therapeutic tests and procedures
- Activity status
- Diet
Typically Written by:
- Physician, Physician Assistant or Nurse Practitioner
- Can be taken by nurse or other health care provider (including PT), according to the departmental, facility and state policies
With Orders, What are the Physical Therapy Considerations?
- Orders should be reviewed prior to providing initial and subsequent PT interventions
-Orders for PT
-Patient activity level
-Weight bearing status
-Vital sign parameters
-Restrictions (Positioning, device needs)
-Changes in medications or health status (diagnostic test request) - If order is not complete or clearly stated, the order must be clarified prior to providing service
In the Admission Notes, what may we find in the History?
Subjective Information
- Data that identifies the patient
- History of present illness (HPI)
- Medical and surgical history, risk factors for disease, allergies
- Family Hx
- Personal and Social Hx
- Current Medication
In the Patient/Client Management Model, the Evaluation consist of?
- Organization and analysis of data collected from the initial examination
-This leads to the development of a problem list - An accurate evaluation supports the therapist’s ability to determine a diagnosis and prognosis and develop a POC
In the Patient/Client Management Model, the Diagnosis consist of?
- This is based on the collection of relevent information that determines if the patient clincial presentation is appropriate for PT intervention
- PT diagnosis includes descriptors used to identify the impact of the condition on function at the level of the system and the whole person
- It guides the prognosis and selection of interventions
- Medical diagnosis identifies the disease, disorder or condition at the cellular, tissue or organ level
In the Patient/Client Management Model, the Prognosis consist of?
- The predicted level of optimal functional gain and the time required to reach this level
- A statement of the patients overall rehabilitation potential that is often expressed as excellent, good, fair or poor
What is the Purpose of the Acute Care Index of Function (ACIF) test?
- This is used in an acute neurosurgical/neuromedicine unit
-
This assesses mental status impairment and activity limitations in bed mobility skills, transfers, and basic gait/wheelchair mobility
-Takes 12 min
-Equipment: Mat, wheelchair, assisted device, stairs
What is the Purpose of the Functional Status Score in the ICU?
Assessment of functional status based on the Functional Independence Measure (FIM) and using a limited number of items routinely examined in the ICU setting and important for activity independence and determination of discharge disposition
-Time: Less than 10 min in most patients
-Equipment: Hospital bed andn AD for the sit to stand and ambulation items, as needed
What is the purpose of the Physical Function ICU Test (PFIT-s)?
- PFIT components were developed and selected for clinical usefulness, primarily in ICU setting with mechanically ventilated patients, by critical care physical therapists.
-
Endurance, muscle strength, and cardiovascular capacity are primarily assessed via the PFIT.
-Time:Routinely less than 5 min
-Equipment: An assistive device for achieving standing may be required, dependent on patient performance
How is the Performance-Oriented Mobility Assessment (POMA or Tinetti) scored?
Generates a balance and a gait score, which are added for a total POMA score. 16 items arescored on an ordinal scale (0-2).
- Balance Score = 16
- Gait Score = 12
- Total POMA Score = 28
What is the Purpose of the Timed Up and Go Test (TUG)?
Developed as a quick, clinical test of functional gait abilities for the elderly
- Time: dependent on patient performance, 1-2 min to set up
- Equipment: Standard chair with arms, 3 meter (~10’) walkway, cone or marker. For TUG manual a cup
of water is needed, and for modified TUG two carpets or mats are needed
What is the Purpose of Timed Walking Test (6 min walk test and 2 min walk test)?
These are tests of functional walking abilities, and can reflect issues around endurance during gait. These tests have been used in people with stroke, head injury, Parkinson’s disease, and various cardiovascular and pulmonary disorders
- Time: Depending on test, either 6 min or 2 min
- Equipment: Stopwatch, method to measure distance walked
What is the Purpose of the Function in Sitting Test (FIST)?
- This test was designed to examine the functional deficits seen with sitting balance dysfunction, using everyday tasks. It includes static and dynamic sitting activities ordered from easiest to hardest.
- Items also cover reactive and proactive balance tasks in sitting. Initial validation was in persons with acute stroke, but other neurologic populations in both acute care and inpatient rehabilitation can use the FIST as well
-Time: Less than 10 min
-Equipment: Hospital bed, stool or step, light weighted object, tape measure, stopwatch
What is the Purpose of the Perme Intensive Care Unit (ICU) Mobility Score?
This test was designed for use specifically with the ICU population. It accounts for limb strength, basic functional mobility tasks, but also includes scoring to account for barriers to movement such as medications, lines, tubes, and cognitive function
- Time: Less than 2 min
- Equipment: Hospital bed, chair, assistive devices for gait as needed
What is Intubation?
This refers to inserting a tube to establish an airway so that the patient can breath
- In most short-term trauma, respiratory failure cases that come in the emergency room the prefered method of intubation is Endotracheal Tube
What is Patient Controlled Analgesia (PCA) Pumps?
What are the side affects?
This is when the patient can control their pain medication delivery
- Only the pt should press the button
- They should not be discouraged if in pain and are asking if they can press the button
- Allergic reaction
- Nausea or vomiting
- Low BP
- Sleepiness
- Constipation
- Respiratory Distress
With patients in the ICU, what are the considerations for safe mobilization?
In the ICU, a patient may have Systemic Inflammatory Respose Syndrome (SIRS), what is this?
An exaggerated defense response of the body to a noxious stressor to localize and then eliminate the endogenous or exogenous source of the insult
With Systemic Inflammatory Response Syndrome (SIRS), what are the more common types of noxious stressors?
- Infection
- Trauma
- Surgery
- Acute inflammation
- Ischemia or reperfusion
- Malignancy
With Systemic Inflammatory Response Syndrome, how is this manifested objectively?
Any 2 of these criteria:
- Body temp >38° C (100° F) or < 36° C
(< 98.6°F) - Pulse rate > 90 beats/min
- RR > 20 breaths/min or PCO2 < 32mmHG
- Leucocyte Count > 12,000 or < 4,000/microliters or over 10% immature forms or bands
PCO2: Partical Pressure of carbon dioxide
What is ICU Acquired Delirium?
Fluctuating disturbance (spectrum) of consciousness and cognition, that is a manifestation of acute brain dysfunction in critically ill patients, occurring frequently in critically ill patients in the ICU
What are the risk factors for ICU acquired delirium?
- Medications (Sedatives and analgesics)
- The environment of the ICU
-sleep deprivation / social isolation / immobilization / unfamiliar surroundings / excessive noise / sensory monotony /no diurnal light variation
What is Post-Intensive Care Syndrome?
Health problems that remain after critical illness. They are present when the patient is in the ICU and may persist after the patient returns home. These problems can involve the patient’s body, thoughts, feelings, or mind and may affect the family members as we
- PICS may show up as critical illness myopathy; problems with thinking and judgment (cognitive dysfunctions); and/or as other mental health problems
With Disease-Specific Isolation Recommendations, what fall under Standard Precautions?
With Disease-Specific Isolation Recommendations, what fall under Contact Precautions?
With Disease-Specific Isolation Recommendations, what fall under Droplet Precautions?
Caregiver should wear mask or face shield
With Disease-Specific Isolation Recommendations, what fall under Airborne Precautions?
What are common exercise and mobilizations options in the ICU with an unconscious patient?
PROM, positioning and family education
What are common exercise and mobilizations options in the ICU with the patient in bed?
Active extremity movement, bed mobility, contemporary exercise
What are common exercise and mobilizations options in the ICU with a patinet sitting at the edge of bed?
May practice static sitting or dynamic sitting (complete exercise or ADL activity)
What are common exercise and mobilizations options in the ICU with transfers?
Transfer to bedside chair
What are common exercise and mobilizations options in the ICU with those with Advanced mobility?
Standing exercise or gait
With Conteporary Treatments in the ICU, what may Neuromuscular Electrical Stimulation help improve?
The rate in regaining muscle strength in ICU, but still with functional disability after discharge
What is Orthostatic Hypotension?
What are the Sx?
(Hemodynamic Event)
Decrease in systolic blood pressure decrease of at least 20 mm Hg or a diastolic blood pressure decrease of at least 10mm Hg within three minutes of standing.
- Lightheadedness
- Dizziness
- Blurry vision
- Weakness
- Fainting (syncope)
- Confusion
- Nausea
With a person in the ICU, why might a patient exerperince Orthostatic Hypotension?
- Immobilized in a recumbent position for an extended time.
- Older adults
- On antihypertensive medications
- Decreased ability to return venous blood to the heart (SCI)
- Hypotensive
What is the Treatment fo Orthostatic Hypotension?
Compression
- Wrap the patient’s lower extremities from the feet to the groin with elastic compression bandages
- Apply an abdominal binder or corset
- Apply elastic hose (half or full length)
Muscle Pumping
- Instruct the patient to perform active ankle dorsiflexion plantar flexion exercises (“ankle pumps”)
- Alternate knee-to-chest exercises in supine and/or sitting
Titrate the Vascular System
- Allow the patient to accommodate to the upright position gradually by slowly elevating the head of the bed to various levels; or use a tilt table to elevate the patient by increments.
In the ICU a patient may exerience Shock, what is this?
- Shock is an acute circulatory failure threatening multiple organ systems
- Low blood pressure and subsequent poor perfusion.
- The main types of shock are hypovolemic (trauma), cardiogenic (heart attack), and distributive shock (septicemia).
- Shock must be managed rapidly by identifying and treating acute, reversible causes
What are the PT considerations of the those patients with Shock?
- Vitals: Pay attention to trends
- Medications: Vasoactive Drugs
-Dopamine, Norepinephrine, Epinephrine, Vasopressin
-Low, moderate, high level of support
What are Contact Precautions?
Microorganisms are transferred directly from one
infected person to another or indirectly when the transfer of an
infectious agent is through an object, medical equipment, furniture surface, or person
What are Droplet Precautions?
Microorganisms are transferred by direct or indirect
contact, but in contrast to contact transmission, respiratory
droplets carrying infectious pathogens transmit infection when
they travel a short distance directly from the respiratory tract of
the infected individual to the mouth, conjunctivae, or nasal
mucosa of the recipient.
What are Airborn Precautions?
Microorganisms are transferred by small infectious
particles (infective over time and distance) in the respirable size
range
What is the correct way to Don PPEs?
- Hand hygiene
- Apply gown, making sure it covers all your outer garments. Pull the sleeves to the wrist and tie the gown securely at the neck and waist
- Apply either a surgical mask or a fitted respirator around mouth and nose
- Press the metal tab on the mask against your nose for a secure fit
- If eyewear or gogges are needed, fit them snufly around face and eyes
- Apply clean gloves that are unpowdered, gloves should be latex free
What is the correct way to Doff PPEs?
- Remove gloves, grasp the outside with the opposite hand and peel off
- Remove eye protection by using the “Clean” headband at the back or earpieces
- Remove your gown
- Remove mask or respirator
- Wash hands for medical aspesis
