L3 Chronic Conditions Flashcards
Medically Complex Patients
severely ill patients with multiple co-morbidities, who require hospitalizations for an extensive period of time
a group of pts of which most have concurrent chronic conditions
what is a chronic condition?
any physical or mental condition that lasts one year or more and that requires ongoing medical attention/treatment and/or limits function or ADLs
Definition of serious and complex medical conditions
- life threatening
- serious disability w/o necessarily being life threatening
- significant pain or discomfort causing serious interruptions to life activities
- require major commitments of time from caregivers for substantial periods
- frequent monitoring
- severe consequences
- negative consequences for caregiver
- affects multiple organ systems
- tight phsyiological parameters
- coordination of multiple specialities
- adjustment of non-medical environment
How many adults have at least one chronic disease?
6 out of 10
How many adults have two or more chronic diseases?
4 out of 10
What percentage of US adults have 5 or more chronic conditions?
12%
Top four practices to help limit prevalence of chronic conditions
don’t smoke
eat healthy
be active
limit alcohol
What is our role as HCPs?
Prevent
Manage/rehab
Maintain
APTA stance on chronic conditions
PTs roles include education, direct intervention, research, advocacy, collaborative consultation
dynamic bridge between health and health services delivery
Medicare and Skilled Therapy
can be used to maintain the pts current condition, improve, or prevent/slow further deterioration of pts condition
Considerations for Rehab/Management of Patient with Chronic Conditions
- Individualized POCs
- Vital Sign Analysis
- Standardized Testing
- Activity/Exercise Prescription
Individualized POCS
Short Term Goals: different goals to address chronic timeline
Approaches to tx and therapy: remember that poc will be longer and lighter intensity
patient may demonstrate little to no change in comparison to other patients without chronic conditions
Who qualifies for an altered POC?
Presence of an active chronic condition
presence of one or more qualifying impairments
Qualifying impairments for altered POC
- SOB/dyspnea
- fatigue/overexertion
- prolonged recovery
- diminished aerobic capacity
- abnormal cardiopulomary response
Short Term Goals for chronic patients
- be for sub-tasks vs full functional tasks
- include response measure w/the function
- include a key/limiting impairment with the function
- have a longer recommended duration
- progress POC slower or differently than others
General treatment approaches for chronic conditions
- resistance and aerobic
- balance
- fall prevention
- home safety
- disease mgmt
- self monitoring of vitals
- pacing/breathing/energy conservation
- HEP
What is a vital sign response measure?
using vitals as baseline for exercise or intervention intensity
Why are vital sign measurements important?
- Safety
- Shows how well patient is tolerating the selected activity and dosage
- Supports and guides decisions to progress or regress
Assessment of patient response
patient demonstrated ___ cardiopulmonary response during ___ as evidenced by ___
Responses of patients list
Normal
Abnormal
Expected
Unexpected
Normal response
cardiopulmonary response stays within at or below calculated or expected response measure range or target
Abnormal response
cardiopulmonary response does not stay within at or below or goes outside calculated or expected response measure range or target
Expected response
cardiopulonary response is calculated and expected to demonstrate a normal or abnormal response given phsiological norms/definitions and exercise/activity/intensities/durations/mods and does
Unexpected Response
cardiopulmonary response is calcualted and expected to demonstrate a normal or abnormal reponse given phsyiological norms and exercise and does not
ACSM Intensity Guidelines for older adults Resistive
Int = 40-60% of 1 RM
Vol = 10-15 reps
Freq = 2 days/week
How to establish correct resistance without one rep max
- After two reps, ask pt “is that fairly light, somewhat hard, or hard”, change weight appropriately
- Have pt perform reps until they demonstrate momentary fatigue (inability to go through full ROM)
You should maintain the weight if
patient can complete number of reps ≥ minimum reps but less than maximum reps
When is skilled therapy needed
- an unstable pt whose response varies daily so activity/exercise prescription and dosage changes daily
- Patient who may be safe to transition to a wellness/nursing/restorative/or personal program but need a reassessment, mod, or advancement in 30-60 days
ACSM definitions for older adults
65 OR
55 with chronic condition
When should a weight be decreased
patient was unable to complete minimum number of indicated reps
When should weight be increased
patient completes more than maximal number of indicated reps
Resistive exercises for older adults for systemic review
significant improvements in muscle strength and functional performance occur in response to progressive resistance training despite advanced age, presence of chronic diseases, extremely sedentary habits, and functional disabilities in older institutionalized individuals
