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 question
Night sweats
Recebt infection
Fever 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
