Midterm Flashcards
For the following domains of practice for SLP, provide a description, why it is important, and provide one example - COLLABORATION
using joint communication and shared decision making to work together with other professionals to provide care for a patient. this is important to meet the patient’s needs in all forms of treatment. for example, a patient who has had a stroke needs to see a PT for mobility challenges, an OT for relearning everyday tasks, and a speech therapist for aphasia concerns. All of these professionals meet to make a comprehensive treatment plan.
For the following domains of practice for SLP, provide a description, why it is important, and provide one example - COUNSELING
Providing support, guidance and education to patients and their families throughout and after care. this is important to explain the ‘why’ of what we do and how it may help them and patients are able to voice concerns and ask questions. for example, a patient is being treated for aphasia. the family may not know what the condition is and everyone would like to know the best way to communicate as a family.
For the following domains of practice for SLP, provide a description, why it is important, and provide one example - PREVENTION & WELLNESS
Prevention/wellness: this aspect focuses on preventative care for patients, reducing health risks, and maintaining health and wellness in all areas. this is important to prevent other health issues from occurring, leading to better overall health. for example, an SLP could present to hospital staff about early signs of aphasia or dysphagia in stroke patients to have more people looking out for at risk patients.
involved in prevention and wellness activities that are geared toward reducing the
incidence of a new disorder or disease, identifying disorders at an early stage, and decreasing the
severity or impact of a disability associated with an existing disorder or disease.
For the following domains of practice for SLP, provide a description, why it is important, and provide one example - POPULATION & SYSTEMS
Population/systems: managing populations to improve overall health and education, improving the experience of the individuals served, and improving the efficiency and effectiveness of service delivery. this is important to treat all patients with the best care and improve the field of SLP. for example, using plain language to clearly communication with patients and their families.
Provide first a description of the setting and then three main activities of a speech-language pathologist in the following settings: ACUTE CARE
Acute care: hospital that provides immediate care for patients with severe conditions (inpatient status). SLP role includes: address urgent needs through screenings/assessments (swallowing), evaluations (communication disorders), and counseling/consultation and discharge planning.
Provide first a description of the setting and then three main activities of a speech-language pathologist in the following settings: SKILLED NURSING FACILITY
Skilled nursing: center that provides long term care and rehabilitation for medically stable patients (inpatient status). SLP role includes less intense therapy bc decreased endurance, functional communication/swallowing, evaluation/intervention relevant to environment, education,
collaboration, counseling
Provide first a description of the setting and then three main activities of a speech-language pathologist in the following settings: INPATIENT REHAB HOSPITAL
Inpatient rehab: intense focus on rehabilitation and recovery from significant health events. SLP role includes setting rehab goals with functional communication/swallowing, evaluation, intervention, counseling, determine prognosis, education.
Provide first a description of the setting and then three main activities of a speech-language pathologist in the following settings: OUTPATIENT
Outpatient: Once medically stabilized in prior setting and ready for discharge, patient able to safely discharge home and has reliable/safe transport for therapy. SLP role: return to prior level of functioning with 3+ hours therapy a day, functional communication/swallowing, mostly intervention, counseling, determine prognosis, education. patient driven goals
Provide first a description of the setting and then three main activities of a speech-language pathologist in the following settings: HOME HEALTH
Home health: once medically stabilized in prior setting and ready for discharge, patient able to safely discharge home, but medical needs require home care. Focus on improving functioning in home environment, functional communication/swallowing mostly intervention, counseling, determine prognosis, education, patient/family driven goals
Provide two circumstances where this might be a challenge for a slp in a medical setting. “As the ASHA Code of Ethics specifies, professionals may practice only in areas in which they are competent, based on their education, training, and experience.”
- If another healthcare professional requests a service from you that falls outside of your training
- If a patient comes in with a rare condition that you don’t have experience with that you are expected to treat
Do you think there may be a role of AI in future medical records or decision making for speech-language pathologists? Will that be a good development, a bad one, or neutral.
AI could make therapy more efficient in terms of medical records and the simple, repetitive practice so SLPs can focus on treatment rather than paperwork. However, there are privacy concerns when it comes to this. I do not think that AI should be involved in decision making as we are educated professionals with a degree and AI is not but with repetitive tasks, it could be very helpful. I feel neutral.
What are the different scopes of practice for PT?
PT focuses on..
gross motor skills
strength and endurance
lower limb alignment
musculoskeletal concerns
flexibility and posture
orthotic management
gait analysis and training
Scope of practice for OT
OT focuses on…
fine motor skills
visual perception
visual motor integration
emotional regulation
play skills
self-care
sensory integration
executive function
Overlaps of OT & PT
They overlap in….
goals to increase motor skills
hand eye coordination
motor planning
coordination and balance.
What are the two overlaps between SLP and OT? Does this mean that there will be, by definition, conflicts between these two fields?
1 SWALLOWING & FEEDING.
SLP addresses oropharyngeal musculature, coordination, bolus size/consistency, swallowing. OT addresses sensory, self-feeding, posture and fine motor.
SLP addresses impact on communication and language impact on cognition. OT addresses environment and safety modifications.
Since they address different things, there should not be conflicts. Collaboration is the key to return patients to their highest level of functioning.
What is the difference between a multidisciplinary approach and a transdisciplinary approach? Is one better than the other and explain your answer?
MULTIDISCIPLINARY draws on knowledge from different disciplines but each stay within their boundaries. Each professional has clear roles and responsibilities.
TRANSWDISCIPLINARY is where 2 or more disciplines integrate to form a new holistic approach. Each professional collaborates more closely.
One is not inherently better than the other. Choosing one would depend on the individual’s needs and goals and the team itself that is involved.
What is the difference between a nurse practitioner and a physician assistant (associate)?
A physician assistant (PA) collaborates with the physician, requires supervision by physician, can be specialized or work directly under a specialized physician, and do not have to complete RN training.
A nurse practitioner (NP) is an RN with bachelor’s or master’s degree in a specialty area and can write orders and can perform procedures under MD.
Why is it important for a SLP to know about the specialties among physicians? Do we “work” for or “with” these specialties?
It is important for referrals, treatment plans, holistic patient care, and respect for the medical professionals. We work WITH these specialties to bring all of our knowledge to the table to treat a patient.
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: HOSPITALIST
Hospitalist - treatment plans during rounds and what patients need to be seen
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: CRITICAL CARE SPECIALIST
Critical Care Specialist - help create plan of care for critically ill involving speech and feeding
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: RADIOLOGIST
Radiologist - during a modified barium swallow, help with equipment and interpreting imaging
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: OTOLARYNGOLOGIST
Otolaryngologist - collaboration with voice therapy, ex. if there are nodules, large adenoids or tonsils that need to be removed surgically
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: NEUROLOGIST
Neurologist - performing cognitive communication assessments, collaborating when patients have neurological issues
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: PHYSIATRIST/PHYSICAL MEDICINE & REHAB SPECIALIST
Physiatrist/Physical Medicine & Rehabilitation Specialist - setting goals for patients with impaired communication and physical aspects
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: PRIMARY CARE PHYSICIAN
Primary Care Physician - routine screenings and follow ups & referrals
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: GASTROENTEROLOGIST
Gastroenterologist - handling modified diets and swallowing concerns
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: EMERGENCY MEDICINE/TRAUMA PHYSICIAN
Emergency Medicine/Trauma Physician - assessments during hospitalization after emergencies
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: GERIATRICIAN
Geriatrician - age related communication issues
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: PULMONOLOGIST
Pulmonologist - working with trach/respiratory conditions during speech therapy
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: CARDIOLOGIST
Cardiologist - evaluating stroke risk, patients with communication issues after cardiac trauma
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: PEDIATRICIAN
Pediatrician - working towards developmental milestones when it comes to communication/early intervention
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: PSYCHIATRIST
Psychiatrist - mental health impacts of having decreased communication abilities
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: GERIATRIC PSYCHIATRIST
Geriatric Psychiatrist - help quality of life with older individuals with communication and mental health difficulties
For each physician specialty, provide ONE way that you might interact and work with each one as an SLP: NEPHROLOGY
Nephrology - address swallowing difficulties and collaborate on diet plans and monitor comorbid conditions
What is the distinction between neuropsychologists and speech-language pathologists when it comes to working with people with brain damage?
Neuropsychologists can diagnose neurological conditions and cognitive disorders and focus on the brain behavior relationship. SLPs focus on cognitive communication disorders
What are the four purposes of the medical record?
- Documentation procedure to protect the patient’s safety
- Means to communicate observations and plans among members of the care team
- Verification of services provided to support billing
- Legal record of events
What are the five etiologies of pneumonia? Which may be of concern to you as a speech-language pathologist?
- Community acquired pneumonia (acquired outside of the hospital or at other health care facility)
- Hospital-acquired pneumonia (acquired during hospital stay unrelated to admission diagnosis)
- Ventilator associated pneumonia (acquired while on the ventilator)
- Health care acquired pneumonia (acquired in people who live in long-term care facilities or in outpatient clinics)
- Aspiration pneumonia (acquired from food/liquid in the lungs)
Aspiration pneumonia is the most of concern for an SLP - requires feeding/swallowing evaluation to determine aspiration and a feeding plan.
As a SLP, which parts of the medical record should you be concerned about and why?
Medical history
Orders
Medications
Progress notes
Medical testing
Precautions
Monitors/Lines/Tubes/Catheters
What is the difference between droplet and airborne precautions? Is it always obvious the difference?
Droplet: infection transmittable through air droplets (i.e. coughing, sneezing, talking, close contact with an infected patient’s breathing), 30-50 micrometers, surgical mask protects, wear gown gloves and eye cover.
Airborne: infection transmittable through airflow (TB, measles, chickenpox, covid), 5 micrometers or smaller that remain in environment for extended period of time, N95 mask & airborne infection isolation room
Clean hands for both
Is the purpose of contract precautions to keep you from getting sick from your patients?
No, it is to keep the patients in the facility from getting sick. i.e. if you go to see one patient who is sick, then visit another you are putting them at risk.
What is GERD and why important to your profession?
Gastroesophageal reflux disease.
Stomach acid flowing into esophagus irritates the lining and can cause esophageal strictures or ulcers leading to further irritation during swallowing and contribute to possible dysphagia.
What is the difference between a NG tube and a G tube?
NG - nasogastric. soft, plastic tube fed through nose, throat and esophagus and ends at stomach or small bowel. more temporary. clear flexible large or small-bore NG tube or yellow/white small bowel feeding tube.
G/J - soft plastic tube placed through the skin of the abdomen into the stomach. catheter continues on from gastric tube site into small bowel.
What should you as an SLP be concerned about with your patients with cardiac diseases?
Monitoring heart rate & any cords attached to patient, signs of heart attacks
What are the scope of practice areas for SLP for patients with respiratory diseases?
You have to take into account how breathing plays into talking and how much therapy they can actually do comfortably
Can SLPs diagnose neurological diseases? What should you do if we suspect such?
No, conduct proper assessments and evaluations and bring the results to the neurologist or refer the patient to them.
Can neuroimaging always be trusted to detect brain damage?
not always, so it should be used in combination with other diagnostic methods/assessments
What concerns should the SLP have with patients with renal disease?
If they are on dialysis, any dietary restrictions, neurological impacts and energy levels for therapy
How might a SLP be involved in assessment or intervention with persons with cancer?
Maintaining or rehabilitating their speech, language, and swallowing functions. Maintain quality of life and comfort
Lung, esophageal, head and neck, brain (GBM)
Distinguish between aging, disease, and dying. Give examples of each.
Aging - natural process that happens to the body over time. for example, wrinkles/changes in the skin.
Disease - pathological process that lead to significant health complications. for example, alzheimer’s disease or parkinson’s disease.
Dying - final stage of life where all functions of the body begin to shut down. for example, terminal illness or being on hospice
Describe three ethical dilemmas that SLP may face with patients with dysphagia.
- Cultural sensitivity: for example, a patient wanting to receive communion but being NPO.
- Quality of life vs intense care: a patient wants to occasionally have a bite of ice cream or sip of soda towards end of life but is NPO.
- Decision making/consent: what they would like to do does not align with the clinical recommendations/they don’t agree
- Recommendations don’t align with other health care providers
Can an 85 year who just had a stroke have any reasonable chance of benefiting from therapy?
Yes! there can be functional improvement and increased quality of life involved. Age should not be a barrier for treatment.
Respond to the following: “SLP’s should not work with patients with progressive disorders because they are just going to get worse anyway no matter what we do.”
It is still very important for these individuals to have functional communication skills, support and to increase their quality of life as much as possible.
What are the differences between Medicaid and Medicare? Can a patient have both?
Medicaid: free or low-cost health insurance coverage, per state, children, pregnant women, adults, seniors and individuals with disabilities, jointly funded by state and federal gov. no open enrollment period.
Medicare: Federal. 65+, under receiving social security disability after 2 years, under 65 with end stage renal disease. funded by social security and medicare taces, premiums and federal budget, medicare A B C D. Medicare options: traditional (gov pays for benefits) Medicare advantage plan
A person can have both if they have no assets. (under $2000)
Meet the income requirements in your state for Medicaid
Be eligible for Medicare due to age or disability
What are the three categories of people eligible for Medicare?
65+
Under 65 and receiving social security disability insurance (after 2 years)
Under 65 with end stage renal disease
Would the type of Medicare your patient has influence your possible intervention options?
Yes - plan determines what is and how much is paid for
Respond to the following statement from an SLP “Insurance/Medicare/Medicare are such a pain; I went to school to help people not fill out meaningless paperwork”
When you start to think that medicare is evil and you are pure, you will cheat and lie. Do not find the loopholes. It can be frustrating to deal with paperwork and insurance, but at the end of the day, it is an important part of our job that involves us and our clients.
Does Medicare pay for all a patient’s medical bills?
No - depends on part A B C D
Make a prediction- Will Medicare be the same 10 years from now? Explain your answer.
No it will keep changing until the cost is as low as possible and care is as high as possible. because of the generational shift - there will be a lot more older people coming up and the rising costs will cause our government to rethink the way it is funded and the different economical standpoints.
Why are you required to take this class???
To be the best clinician you can be. To learn about issues related to employment settings, medical terminology and diagnoses, interprofessional practice, medical billing/documentation, pharmacology, job exploration/preparation, ethics, legal considerations, and professional advocacy in the profession of speech-language pathology that we can use for a professional lifetime.
