Oce Part 1 Flashcards
Accepting the pt in a private clinic
Review the referral ( who it came from, purpose,does it fall under pt scope?)
Have the pt complete intake forms ( all relevant info, pmhx,hpi)
Ensure they are appropriate candidate for physio( msk in nature)
Confirm pt identity and dob
Accepting pt in the hospital setting
Review the referral
Perform a chart review ( familiarize w pt medical course)
Check wb orders, check o2 orders
Liaise w medicak tean involved in pt care.
Liaise w bedside nurse prior to see pt
Ensure that it’s an appropriate time for PT ax
Introduce yourself
Confirm pts identify
Why is this pt appropriate for physio?
Possible answers
In this case, there is no contra indication as of now for PT ax and TX.
The pt has a problem/concern/disease/presentation that falls under the PT scope of practice and expertise
This pt will benefit from physio interventions to help manage their condition effectively and to support their recovery.
Ex: based on the scenario the pt has a cc of lateral elbow pain due to repetitive movements. To treat this condition falls under the pt scope of practice.
Also based on the case, the ptdoes not have any contraindications as of yet for pt ax and tx. No apparently red flags. The physio interventions will help him in managing and treating his cc.
How would u determine if this pt is appropriate for physio?
I would self reflect to see if the pt is seeking services that fall under the physio scope of practice.
The pt Injured his back and is having difficulty w pain and physical functioning ( summarize pt problem)
They require and ax to investigate their current status as well as tx to assist in managing their pain and functional impairments
The ax, diagnosis and tx of their current issue fall within my scope of practice and through my pt training i am competent tonax and tx them
If u deem the pt is not suitable for physio
What to say?
Describe the service being requested
Why they do nor fall under the pt scope
Why u feel u are not competent to carry out this activity
Provide options for appropriate referral
Some reasons why the pt would not be appropriate for physio interventions
Client condition requires medical intervention
Findings remain inconsistent w what is expected for a neuromuscular dysfunction
No apparebt movem dysfunction,causative factors or syndromes can br identified
Client fails to improve w intervention
Informed consent
How to obtain informed consent to begin an ax?
Introduce self by name and title
Explain why u are there ( doctor x. Ask me to come see u…)
Determine cognitive status ( ax orientation, determine if pt has capacity to consent/ understand the info about what they are consenting to, understand the consequences)
Describe what it is that u will be doing in the ax, purpose of it,benefits, any potential risks, any side effects and any alternative options if they declined and consequences of not engaging in the ax
Explain their rights as a pt: right to refuse and to withdraw their consent at any time
How to determine cognitive status?
I will have a conversation with the pt and see his interactions and based on the pts behavior and actions, I wl use my judgement to determine his ability to provide consent.
Able to carry on a conversation
Make appropriate questions
Pay attention in the information
Answer appropriately
Also, based on the pmhx present there is nothing that make me believe he does not have capacity
What to do if the pt does not have capacity to consent?
Identity a sdm,guardian, poa, someone appointed bu the board
Informed consent- glass and hearing aid
If the case says pt wears glasses and hearing aid,verbalize u would ask pt to wear it during your interaction
Informed consent example
The nature of the ax is : I will ask unfirst some questions related to your pain and also adls,work, pmhx
Then during the ax I will conduct a few mov test to determine what’s going on and that will help me create a tx plan to helpy on your rehab process
Subjective ax components
History of present illness/moi
Pmhx
Nature of pain (location,type)
Aggravating and ease factors
Activity levels
Social hx: jobs,sports, type of house
Goals
Red flag screening
What are the cauda equina questions?
Have u noticed any changes in your bowel or bladder function?
Have u noticed any changes in your sensation in your seated area or groing area?
Pain and needles in bl legs?
What are the ca questions?
Unexplained weight lost?
Persistant night pain
Malaise( general feeling of discomfort)
Vbi questions
5d dipoplia, disphagia,disarthria,dizziness,drop attacks
3n nystagmus, nausea and numbness
Infection symptoms/signs
Night sweats
Recent infection
Fever or chills
Knee especial questions
Any locking
Clicking
Did unhear a pop?
OA questions
Morning stiffness less then 30m
Pain w movement
Wb joints
RA questions
Am stiffness more than 1hr
Family hc
Pain at rest
Swelling
Bilateral
Diabetes questions
What are they taking?
How are they managing?
Social hx questions
What they do for a living?
Type of job
Do u practice any sports or hobbies?
What are your pt goals
What fo u see as a progression frim this session to the next session?
Acute care subjective ax
Observe notes: vitals,wb,changes,nurse,doctor notes
Ax orientation
Pt explanation of their story + aggrav and ease factors
Hx of presenting condition
Prior level of function
Gait aid?
Pmhx
Check meds they are on
Social hx: type of house,stairs,handrail, who they live w, supports,family nearby?
Goals
Objective ax
Observation: swelling,redness, deformities,gait aid, posture,muscke wasting
Rom: screen joints. Arom and prom
Stregth: all major muscles
Special tests
Palpation
Functional screening: gait, gait aid ad,squat,stairs
Neuro screening: miotomes,dermatomes,reflex, ultt,babinski and clonus
Objectve ax on acute care
Consent
Observation: room for hazard,lines,tubes. Who is present
Palpation: temperature,pain,pulses,dc from incision
Chest ax:
Inspection: rate of breathing,depth,pattern,accessory muscle use,distress
Palpation: tracheal position,expansion of chest,flexibility of chest,tactile fremitus
Percussion: dull resonat
Auscultation
Rom
Strength especially le
Transfer ax
Balance
Gait ax:level required, gait aid,supervision
Neuro screening
Respiratory interventions
Teach db techniques to enhance ventilation
Functional mob to prevent deconditioning
Arom for les to prevent dvt
Incentive spirimetwr to increase the e expansion in the lobes
Educate the pt on surg precautions
Educate the pt on the importance to adhere the exercises
Plb to promote o2 saturation
Rom interventions
Heel slides
Cycling
Strength interventions
Quad set
Qor
Seated knee ext
Mini squat
Single leg squat
Glute bridges
Nmes eletrical stimulation
Gait intervention
Gait retraining
Transfer training bed chair
Stairs practice
Informed consent
I would explain to the patient that the nature of our session would be to perform an assessment where I would be asking some questions and performing some tests.
1 would explain that the risk of the assessment is that some tests may exacerbate their symptoms, but l would talk through those tests before they were performed and let the patient know if alternate options exist.
• I would explain that the benefit of the assessment is that I can form a clinical impression and determine if PT is recommended and, if so, the plan for treatment.
• I would provide the patient with the opportunity to ask questions and receive answers about the proposed plan.
Outcome measures for lower extremity MSK condition
Lower extremity functional scale
Self reported questionnaire (adls,balance,coordination,mobility,life participation,rom, strength
Outcome measures for upper extremity MSK condition
Upper extremity functional scale index
Outcome test to measure ankle DF
Knee to wall test
Outcome measure for grip force
Hand dynamometry
Outcome for upper extremity in sh
Disability arm shoulder hand (DASH)
Outcome measures for pr with hip disability (with or without Oa’A)
Hip injury and osteoarthritis outcone score
Outcome measures for knee disability ( with or without OA)
Knee injury and osteoarthritis outcome score
Outcome for lower back pain
Roland morris disability questionarie
Oswestey disability index
Outcome for neck pain
Neck disability index
Outcome for pain
Numeric pain rating scale
Visual analogue scale
Outcome for chronic pain
Mc guill pain questionarie
Outcome dor muscle strength
Mmt
Outcome for rom
Goniometry
Outcome for amb or biomechanics
Functional movements
Subjective ax framework
- Past Medical History
- History of Present Illness
• Social History
• Red Flags Questions (cancer questions and mandatory questions)
• Goals
Why is pmhx important?
- information related to past medical historyis important as it can determine if there are additional co-morbidities that could impact physiatherapy intervention.
For example, the patient is attending physiotherapy for treatment of mobility-related issues due to Parkinson’s. Their past medical history includes hypertension and severe bilateral knee OA. The activities included in treatment would need to be modifies to accommodate the patient’s bilateral knee OA and it would also be important to monitor the patient’s blood pressure to ensure safe participation in physiotherapy.
Managing Hypoglycemia (Low Blood Sugar
Symptoms
How to manage
S:dizziness, shaking, sweating, confusion, and weakness.
Pre-Exercise Screening:
Assess the patient’s blood sugar levels before exercise to ensure it is within a safe range. If the blood sugar is too low, physical activity should be avoided until the levels stabilize.
Monitor Symptoms:
Keep track of the patient’s responses during physical therapy. If any signs of hypoglycemia (e.g., dizziness, sweating, shaking) appear, the exercise session should be stopped immediately.
Provide Immediate Care:
If a patient shows signs of hypoglycemia during exercise, stop the activity, and provide quick sugar intake, such as glucose tablets, fruit juice, or sugary drinks to raise blood sugar levels.
Adjust Intensity and Duration:
Plan exercise sessions that are moderate in intensity and of shorter duration to avoid sudden drops in blood sugar levels
Patient Education:
Educate the patient on recognizing hypoglycemia symptoms and the importance of always having fast-acting sugar available.
Post-Exercise Monitoring:
Ensure the patient’s blood glucose levels are monitored after exercise to prevent post-exercise hypoglycemia.
Managing Hyperglycemia (High Blood Sugar)
Symptoms
S:Hyperglycemia can cause fatigue, increased thirst, frequent urination, and, if unmanaged, can lead to serious complications.
M: Pre-Exercise Screening:
Monitor blood glucose levels before physical therapy. If the glucose levels are too high (e.g., above 250 mg/dL), physical activity might be contraindicated due to the risk of worsening hyperglycemia or causing ketone buildup.
Monitor Symptoms:
Be alert to symptoms like excessive thirst, fatigue, or dry mouth. If the patient exhibits signs of hyperglycemia, the physiotherapist should adjust the intensity and duration of exercise accordingly.
Moderate Intensity Exercise:
Encourage low-to-moderate intensity exercise. Exercise helps to lower blood glucose levels by improving insulin sensitivity, but intense exercise should be avoided if blood sugar is extremely high, as it may worsen the condition.
Hydration:
Ensure the patient is well-hydrated, as hyperglycemia can lead to dehydration. Advise them to drink water before, during, and after exercise.
Post-Exercise Monitoring:
Monitor the patient’s response after the session to ensure that their glucose levels do not rise further.
Educate patients with hyperglycemia on the importance of monitoring their blood sugar levels regularly and making adjustments to their medication or food intake as needed in collaboration with their healthcare provider.
General Guidelines for Both Conditions:
Hypo and hyperglycemia
Communication with Other Healthcare Providers: Physiotherapists should communicate with the patient’s medical team, including endocrinologists, to tailor exercise programs based on the patient’s medical needs.
Exercise Plan Adaptation: Ensure that the patient’s exercise program is individualized, considering their specific needs and the severity of their blood sugar fluctuations.
Consistency and Monitoring: Regular blood sugar monitoring and consistency in exercise routines are key to managing both hypoglycemia and hyperglycemia effectively.
Social determinants of health
Social determinants of health (SDH) refer to the conditions in which people are born, grow, live, work, and age.
These factors significantly influence health outcomes and include economic stability, education, social and community context, health care access, and the physical environment
How can the social determinant “economic stability affect physio tx?
- Economic Stability:
Impact on Access: Limited financial resources may prevent patients from seeking physiotherapy services, adhering to treatment plans, or affording necessary equipment for rehabilitation.
Treatment Adherence: Patients facing financial difficulties might struggle to attend regular therapy sessions or afford home exercise programs
Steps to assign care to ptas
Review roles and responsibilities of pt and pta
Verify the pta knowledge
Learn about the pta experience and ensure it’s adequate
Watch the pta perform the assigned task
Provide education and training to fill any gaps identified
Reciving gifts or money from pts
Thank you so much for your offer but I am able to accept gifts or money from pts.
It’s a rule I follow according to the physio code of ethichs to make sure everything stays fair and professional.
I appreciate your kindness and understanding.
If the physio discovers inaccuracies or erros on their billing what should they do?
Take resonable steps to correct the errors
Document the finding,what action was taken and the outcome.
The PT must ensure that there is a WRITTEN fee schedule for each funding stream. What should the fee schedule state?
Fees for assessments, re ax and tx
Fees for other services and products
Fees for administrative tasks
Late payment penalties or interest charges
Charges for cancellations or missed appointments
How should the PT communicate the fees to the pts?
BEFORE providing care, the PTS must ensure that the pts have a clear information about the fees and that they understand.
This includes:
All fess that might apply to the pt
How bills or accounts for services are calculates
Any financial policies that might affect the pt
Methods of payment that are accepted.
PTs must provide an itemized account for services and or products if the pts or a payer requests one, and it must be FREE OF CHARGE.
False or true
True
Package services cab be done if:
The pt is told what services are covered, the cost of EACH service and the total cost
The pt has the option to buy one service at a time
The pt has the option to receive a refubd for unused services
The fee for each service appears accurately on the billing.
Advertising. What are the College s expectations?
The pts must review the advertisement placed by others on their behaf ti ensure they meet the college requirements.
If they do not, pts must take resonable steps to correct it and DOCUMENT the steps taken
What can not be in a advertisement?
It must not state or imply a guarantee of tx results
It must not state or imply that a pt service os better than the other pt service
What would be resonable steps to fix a wrong advertising?
It may include emailing or calling the person who placed the advertisement and informing her about your PROFESSIONAL OBLIGATION to the college.
Ask for the content of the advertisement to be changed
Document all of it
What are the actions that should be taken when boundaries are breached?
Recognize the breach
Correct inappropriate behavior
Document actions in the pts record
Former pts and romantic relationships
No romantic relationship w pts unless:
One year has passed since discharge
Power of imbalance no longer exists
Pt is no longer dependent on the physiotherapist
Mandatory reposting of sexual abuse
Pts must report if they SUSPECT sexual abuse by a regulated professional
Report to the professional college of the health care professional involved
What are the consequences of failure to report a sexual abuse from a Hcp?
May lead to disciplinary action by the college
If a conflit arrises what should the pt do?
Full disclosure: inform the pt and others involved
Alternative: make pts aeare of options
Document: clearly document how the conflict eas handled
What to say to your employer that wants you to see a pt for more sessions than they need?
The physio code of ethics requires me to always act in the pts best interest. This included not providing unnecessary treatment.
I cant continue sessions that aren’t clinically needed bc it will go against out code of ethics.
I should only provide care that is necessary for the pts recovery. I can’t justify seeing them for more sessions if they don’t need it
How to tell a pt you cant see them for more sessions if they dont need it?
U made great progress and reached your goal. Based on that improvement u don’t need more sessions at this point.
As a physio, follow a standard of care that ensures we only provide tx that are necessary for your recovery. Since u did so well, continue with further sessions wouldn’t ve in your best interests.
When can a physio dc a pt that are still in need of care?
1- if the pt request to discontinue the tx
2- alternative services are arranged or the pt is given a chance to arrange alternative care
3- physio is unable to provide care that meets standards due to lack of resources
4- pt fails to pay for services within a reasonable tune after all attempts to facilitate payment have failed
5-pt does not cooperate with or comply w the tx plan,make the services inefectivo
6- pt is abusive( physically, emotionally or sexually) or has reasonable grounds to believe they may become abusive
7- a progressional boundary is breached and all reasonable steps were made to manage the behavior
How much is household amb
And community amb?
Household 10-20m
Community - mais de 20m
Benefits of stretches
Improve flexibility and decrease stiffness
Improve posture
Increase blood flow circulation
Improve flexibility
Promote relaxation
Help w pain management
How many steps do we have one a flight of stairs in rehab?
12-15 steps
Short term goal wks
Long term goal
2-6wks
3-6 months
Benefits of strengthening
improve muscle function and support the joints, helping to reduce the risk of joint deformities and pain.
List of goals
Increase rom
Increase strength
Increase function
Decrease pain
Decrease swelling
Increase client knowledge about the condition
Goals for cardioresp pts
Decrease sob
Increase function
Increase general mobility
Increase activity tolerance
Increase or maintain chest expansion
Facilitate effective cough
Optimize gas exchange
Educate about energy conservation
Goals post op
Increase indep w bed mobility/transfers/ambulation
Educate pt on surgery precautions
Reduce the risk of infection /contractures
Physio interventions for pain?
Ice
Heat
Tens
Gentle mobilization grade 1-2
Rest (avoid aggravating acts)
Postural correction
Pt intervention for swelling
Rest
Ice
Compression
Elevation
Us non thermal
Arom
Pt interventions for ROM
Arom/prom
Stretching
Mobilization 3-4
Heat
Us thermal
Pt interventions for sob
Deep diafragma breathing ( not copd pt)
Frequent breaks
Plb
Secretion clerabce technique (acbt)
Pt interventions for Fatigue
Balance period of rest and activity
Do not exercise to the point of fatigye
Educate about energy conservation
Pt interventions for por posture
Frequent positions changes
Sitting upright w back support
Adjustable chair w back support
Proper design of work station
Bend knees when ligfiting
Avoid twisting movs
Pt interventions regarding education
Educate re condition
Educate about specific things not to do
Adaptation of home\work
Take frequent breaks
Assistive devices or special devices for function
Objective measurement fo r swelling
Meausre tape
Objective measurement for strength
Mmt using oxford scale
Dynamometer
Goals questions
Goals/Expectations:
“What do you expect from this session/interaction?”
“What are your goals or what are you hoping to achieve?”
“What would you like to do, that you cannot do right now?”
- Addressing an individual’s goals and expectations are important for compliance and ‘buy-in’ and to align with individual-centred care.
Acute stage goals
Management Implications:
- Immediate pain control.
- Prevention of further tissue damage/sensitization (acute injury).
- Reassurance and other ‘active’ management advice.
Subacute goals
Management Implications
- gradual restoration of functional capacity
- continued pain control as needed to create a therapeutic window to get active
Recurrent goals
(experiencing a new episode of previously experienced musculoskeletal symptoms following a period of being symptom free. )
Management Implications
- Manage immediate symptoms as per acute/sub=acute disorders
.
- Investigation of potential factors contributing to the recurrent/episodic nature of the disorder for long term solutions.
- Reinforce active management
Chronic goals
Implications
- Ensure there is not missed or associated serious pathology that continues to contribute to the chronicity of the disorder.
- Investigation of potential factors contributing to the chronic nature of the disorder for long term management.
Nociceptive (type 1 - tissue damage)
: pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors. This includes pain associated with acute actual tissue damage (ie. post-operative) and inflammatory conditions.
Clinical Tip: Typically short lasting, stimulus-response coupled;
Management Implications…
- Moving early/staying active important; active management vs passive.
- May respond to simple analgesia, ice or other modalities.
Hiv pts
Wear gloves:
When you have open or healing wounds, or skin infections.
When in contact with blood or body fluids, secretions, excretions or non-intact skin.
When in contact with surfaces or articles contaminated with blood or body fluids.
Duty of care
Does not provide a physiotherapy service when the patient’s condition indicates that commencing or continuing the physiotherapy service is not warranted or is contraindicated
