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Medically Based Pediatrics > Medically Based Pediatrics from Hospital to Outpatient > Flashcards

Medically Based Pediatrics from Hospital to Outpatient Flashcards

1
Q

What is the pediatric continuum of care starting in the hospital and ending in community based settings?

A

1) Acute:
- - Intensive care unit (PICU)
- - Medical or surgical care unit: specialized areas in cardiac, hemoc, and psychiatric
2) Inpatient rehabilitation
3) Ambulatory or outpatient services
4) Community based settings

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2
Q

What is acute admission?

A
  • Child is usually typically developing prior to current referral; medical management of symptoms is key focus
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3
Q

What is rehabilitation admission?

A
  • Usually follows acute stay, designed to be a longer time designated for restoring strength, endurance, function, and impacted skills in order to return home
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4
Q

What is chronic hospitalization?

A
  • Admissions occur due to exacerbations of chronic conditions or progression of illness, may need modified continuation of outpatient services
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5
Q

What is special program admission?

A
  • Admission of child to a specialized program such as feeding or day rehab program
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6
Q

What are external influences on pediatric hospital-based services?

A
  • Health care laws
  • Health care costs
  • Insurance/3rd part reimbursement
  • Accrediting agencies
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7
Q

What are OT goals for acute pediatric hospital stays?

A
  • Time spent at the hospital can be very short
  • LTGs usually are designed to be met within 1-2 weeks
  • STGs usually are designed to be met quickly within a few days
  • Goal is to improve client factors:
    • Improve full active ROM and strength to prevent deformity, contracture, or scar formation
    • Improve safety of swallow
    • Improve visual perceptual deficits
    • Improve cognitive/processing functions
  • Another goal is to improve occupational level:
    • Enable child to return to pre-morbid level in school or community
    • Return to age appropriate play and ADL skills
    • Support and improve child’s social participation
  • Must know biomechanical factors before assessing occupations and activities
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8
Q

What types of diagnoses are seen in pediatric rehabilitation?

A
  • Accidental injury
  • Violence
  • Disease (TBI, SCI, Cancer, Stroke, Encephalitis, CP)
  • Surgical intervention
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9
Q

What are two common surgeries for cerebral palsy?

A
  • Crouched Gait Surgery

- Dorsal Rhizotomy

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10
Q

What are traditional pediatric requirements for rehabilitation?

A
  • Same as adult rehab
  • 3 hours of therapy a day, 5 days a week (only includes PT/OT/SLP and there are fewer therapy hours on the weekend)
  • Evaluations must be completed within 48 hours of admission
  • WeeFIM assessments on a weekly basis
  • Weekly Team Progress Note to submit to insurance in order to maintain coverage
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11
Q

What are pediatric rehabilitation requirements for neuro-trauma?

A
  • Less than 3 hours of therapy a day
  • Reduced therapy status due to medical severity. tolerance, or due to young age/endurance
  • May focus on family education: positioning, oral stim, how to keep child safe during ADLs
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12
Q

What are pediatric rehabilitation goals?

A
  • Often looking at a 2-8 week stay
  • LTGs within one month
  • STGs within a week
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13
Q

What are pediatric rehabilitation OT interventions?

A
  • Prevention
  • Restoration
  • Modification/adaptations for ADL skills
  • Equipment evaluation/reassessment
  • Community re-introduction
  • Resumption: using existing skills to foster independence and resumption of activities
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14
Q

What are frames of reference in the pediatric rehabilitation setting?

A
  • Biomechanical: ROM, strength, muscle tone, can they track, does the child tolerate sensation?
  • NDT: weight bearing status, tone - normalizing synergistic patterns, trunk control
  • Sensory processing: inpatient and outpatient - music/sound, lighting, weighted blankets, therapy balls
  • Visual information processing: how can environment or activity be reorganized so that the child can be successful in the hospital?
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15
Q

What are pediatric outpatient interventions?

A
  • Continuation of rehab or inpatient services. The focus is to return to pre-morbid function in all occupational areas
  • Focus on habilitation and establishing new developmental skills including:
    • Sensory processing
    • Fine motor skills
    • Strengthening
    • Splinting needs
    • Attention
    • Coordination
    • Feeding
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16
Q

What are pediatric outpatient goals and frequency of interventions?

A
  • Goals: time varies
    • LTGs are written for 6 month-increments
    • STGs are written for 1-2 months (4-8 visits)
  • Frequency of intervention varies based on setting and client’s needs
  • Outpatient day programs: 3-5x/week. Typically seen for 3-5 hours a day - PT/OT/SLP
  • Standard outpatient: 1-2x/week or 1-2x/month. Typically seen for 45 min to an hour a session
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17
Q

What setting are infant toddler programs and school based therapies?

A
  • Pediatric community-based settings
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18
Q

What does OT look like in pediatric community-based settings?

A
  • May or may not charge for OT services
  • May work in conjunction with other team members towards a common goal, not necessarily for direct OT intervention (i.e. OT as part of autism diagnostic group or OT working as a group leader at community substance abuse camp)
  • May work as a consultant: may evaluate current programs and give suggestions for program quality improvement (i.e. work with an educational team at a school to select furniture to support better sitting and movement postures for children with special needs
  • May work at community re-integration programs: therapists work with children in actual childhood environments to better re-integrate them into the community after illness or injury (i.e. have therapy in McDonald’s Play Place to work on child play in a typical environment or have an adolescent work on visual motor integration at a video arcade
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19
Q

What does OT look like in the pediatric community Clubhouse model?

A
  • Community based facility where participants are “members” and have a share in responsibilities to maintenance and operation of clubhouse with staff
  • Focus on function and interdependence
  • IADL training:
    • Social development
    • Self-care education/training
    • Job training
    • Healthy leisure exploration
    • Time management
20
Q

What are common roles and goals of OT in pediatric community settings?

A
  • May vary depending on nature of community based agency
  • Advocacy for children and families
  • Encouragement of improved function within naturalistic environment
  • Types of intervention:
    • Promote/create
    • Maintain (daily routines and health management)
    • Establish/restore
    • Prevent
    • Adapt/modify
21
Q

What is the evaluation progression in inpatient pediatrics?

A
  • Focus on current skill level
  • Be mindful of limited medical stability: always identify precautions prior to evaluation (i.e. weight bearing precautions, EVD’s, PO status)
  • Start with biomechanical evaluation: ROM, head control, sitting balance, cognitive awareness
  • Progress to functional skills as able: ADLs, fine motor skills, feeding/swallow, social skills
  • Standardized testing: Coma-Near-Coma, CRS-R (Coma Recovery Scale-Revised), MMT, WeeFim - if child is participating in ADLs, Bayley, Peabody, HELP
  • There is usually less standardized testing to start with when evaluating a child in the hospital
  • The Bayley, Peabody, and HELP are usually done closer to time of discharge
22
Q

What is the progression of graded sensory input in inpatient pediatrics?

A
  • Visual input: eyes open > tracks > locates objects on command
  • Auditory input: turns to sounds > tolerates TV or music, follows commands
  • Tactile inputs: tolerates touch (provide different sensations that are soft/rough/textured) > holds an object and does tactile exploration > tolerates handling for positioning
  • Olfactory input: provide various familiar smells and watch for reactions: vanilla, orange, peppermint, cinnamon, chocolate
  • Vestibular input: tolerates position changes
23
Q

What are important things to remember with pediatric inpatient strengthening and ROM?

A
  • Strengthening should begin on day 1 because strength is lost after just 3 days of laying in a hospital bed
  • Strength is necessary for all functional skills
    • Patients may require more strength than is typical for their age in order to be independent in all functional areas
    • Good strength allows children to move in a more efficiently
  • Provide passive stretch where movement is limited
    • Tenodesis stretch to facilitate grasp for SCI C5-C7
    • Consider splinting: resting hand splint, lon or short opponens splint, intrinsic minus splints
24
Q

What does the WeeFIM assess in pediatric eating?

A
  • Assesses safety of swallow
  • Change in hunger: digestion speed and constipation. Consult with dietician/medical team for medications
  • If UE’s are not affected then progress feeding from an inclined bed, to eating in w/c, to eating in standard chair. May use a w/c tray or bedside table for positioning purposes
  • Assesses pace of eating (initiation of bites and swallows), functional motor skills for eating, and need for set-up of meal
25
Q

What is common adaptive equipment for pediatric feeding?

A
  • Universal cuff
  • Plate guard
  • Adaptive utensils
  • Mobile arm support
26
Q

What is the progression of grooming in the pediatric WeeFIM?

A
  • Bedside table > at sink at w/c level > standing at sink
27
Q

What is common adaptive equipment for pediatric grooming?

A
  • Suction tooth brush if needed
  • Universal cuff or built up handle for toothbrush
  • Brush/comb in universal cuff or long handled brush/comb
  • Bath mitt
  • Mounted hair dryers
28
Q

What is the progression of upper extremity dressing in the pediatric WeeFIM?

A
  • Inclined bed > in w/c > ring sit in flat bed > sit EOB
  • Progress is based on patient’s overall balance and trunk mobility
  • May need to learn one handed technique
  • UE dressing is usually easier than LE dressing
29
Q

What is the progression of lower extremity dressing in the pediatric WeeFIM if a child has a TBI or CVA?

A
  • In bed with elevated head and rails > sitting EOB > standing
30
Q

What is the progression of lower extremity dressing in the pediatric WeeFIM if the child has a SCI?

A
  • In bed with elevated head and rails > in flat bed with rails > in flat bed without rails > in w/c
31
Q

What are necessary skills in order to master LE dressing?

A
  • Anterior pelvic tilt
  • No hip precautions
  • Transition supine to ring sit
  • Sitting balance in ring sit
  • Leg management
  • Rolling
32
Q

What is the progression of donning/doffing socks and shoes and common adaptive equipment used?

A
  • Ring sit in bed > in w/c or standard chair
  • Long handled shoe horn (push knee down to push foot into shoe)
  • Leg lifter
  • Reacher
33
Q

What is the progression of bathing in the pediatric WeeFIM?

A
  • Begin with bed baths
  • Dependent lift or use of Hoyer lift to reclining bath chair or supine bath cart (generally completed by nursing. Any incision sites must be cleared for bathing)
  • Begin bathing on transfer tub bench
    • Pt must be able to tolerate sitting upright for 15 min
    • Initially the pt may still need a dependent lift
    • Progress to slide board transfers using a pillow case
    • Goal is to use lateral transfer, SPT, or step into tub/shower
34
Q

What is common AE for pediatric bathing?

A
  • Wall mounted soap pumps
  • Hand held shower attachment
  • Long handled sponge
  • Water control safety gauges
  • OT should provide recommendation for appropriate shower chairs and assist team in obtaining AE prior to discharge
35
Q

What are helpful hints for toilet transfers in the pediatric setting?

A
  • It is difficult to independently complete slide board transfers onto a commode unless it has swing away/drop down arms
  • Stand pivot transfers, Hoyer Lift, or 2 person dependent lift if needed
  • Recommend toilet transfer board to start
  • Public restrooms and home bathrooms often have limited space
  • Patients will need to have advanced dressing skills to dress in a w/c or in standing to be independent with toileting on a toilet
36
Q

What is the catheterization process in pediatrics?

A
  • It is taught by nursing staff
  • OT’s role is to guide and teach positioning techniques: abduction of legs and recline in w/c
  • OTs recommend adaptive equipment as necessary: leg separator with/without mirror, house holder (for boys in order to cath with one hand), and w/c bag to hold supplies
  • Clothing management
  • Teach in bed, then w/c, and then on toilet
37
Q

What is OT’s role with a bowel program?

A
  • The bowel program is taught by nurses
  • OTs guide and teach positioning techniques: forward and lateral lean
  • OTs recommend adaptive equipment as necessary: suppository inserter (child must have good trunk control to lean over and use one hand) and flexible handled mirror
  • Clothing management: onto commode pants on and off
38
Q

What are pediatric IADLs and advanced skills?

A
  • Home accessibility
  • Community re-integration
  • Return to school
  • Wheelchair skills
  • Sports and leisure
39
Q

How is home accessibility addressed in pediatrics?

A
  • Provide universal design book
  • Family can provide pictures and/or video of home
  • Problem solve recommendations
  • Accessible entrance with ramp as needed (2 accessible exits in case of an emergency)
  • Bathroom: width of door and space to access tub/shower and toilet with appropriate equipment and transfer
  • Bedroom: carpet height if propelling a w/c, accessing closets, and height of bed for transfer
  • Kitchen: difficult to access counter tops and sink, accessing items from refrigerator and cabinets, and meal prep training begins as an inpatient
  • Environmental control: Ability KC and Coalition for Independence - telephone access
40
Q

What is are considerations and goals for pediatric community re-integration?

A
  • Considerations: transportation, child’s interests, time restraints, cathing/feeding/medicine schedules, “to go bag!”
  • Setting goals: community mobility, social interaction, confidence, money management, endurance
  • Home visit to prep for discharge
  • Therapist should try and go on one outing before discharge, and in addition, parents should try and take an outing before discharge
41
Q

How are car transfers approached?

A
  • Two person assist slide board transfer
  • Independent slide board transfer
  • Independent lateral transfer
    OR
  • Stand pivot transfer
  • Independent standing transfer
42
Q

What are adaptations for writing and typing when child returns to school?

A
  • Universal cuff/vertical holder
  • Short and long wanchik
  • Klick pen holder
  • Typing sticks
  • Mouthstick
  • Mobile arm support
  • Missouri Assistive Technology: evals, equipment and training for computer access
  • Hardware: adaptive keyboards, switch access (sip and puff, jelly bean, switch adapters)
  • Software: on-screen keyboard, voice activated, word prediction
43
Q

What are common back to school accommodations that need to be made?

A
  • Cathing: schedule (likely one time at school); nurse may need to assist initially as child transitions to independent (lay down vs w/c and store supplies in nurse’s office or bag on w/c)
  • Plan for if bowel or bladder accident occurs
  • Pressure relief at beginning and end of every class
  • School books: may have 2 sets (one for at home and one for at school) and use of iPad to reduce number of supplies carried
  • Accessing backpack or bag on w/c: transport lighter items, AE (reacher, leg loop), or school notebooks, etc.
  • Cafeteria: assistance needed for tray, carrying items, reaching, and navigating
  • Adaptive PE initially
  • Navigation: hallways, locker, classrooms, curbs or ramps at school, elevator pass, may need additional passing time between classes
  • Desk in each room that is w/c accessible
  • Priority seating
  • Transportation to school and fieldtrips
  • Note taker
  • Test accommodations
44
Q

What are w/c skills that are needed with assistance or independence in order to navigate one’s environment?

A
  • Opening doors
  • Ramps
  • Wheelies
  • Curbs
  • Stairs
  • Floor to w/c transfer
45
Q

What are accommodations that may be needed for sports and leisure activities?

A
  • Swimming: goal progression. May need flotation and assistance: static vs swimming. May need assistance transferring in/out of pool: floor raised lateral/slide board transfer to tub bench; from edge/corner of pool: water shallow to deep; w/c to floor transfer
  • W/c sports and events
  • Sports w/c: cambered/angled wheels, click straps at waist and legs, one or two back wheels, front bumpers, low back
  • Special Olympics
46
Q

How does hospitalization impact a child?

A
  • Significant stressor to family
  • Acute phase: family in shock, overwhelmed with feelings of guilt
  • Change or loss: a traumatic or sudden illness may significantly change the child’s personality, level of functioning, and potential for future development
  • Isolation may result since children are away from typical childhood environments. Parents/caregivers may be restricted by visiting hours
  • Homesickness
  • Fear: young children may have distorted views of why they are being hospitalized -punishment or causal result of being bad
  • Anxiety

Medically Based Pediatrics (12 decks)

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