Patient Care Flashcards
Outcome Measure
Means to determine effectiveness of treatment or performance
–expressed in functional terms
POMR
(Problem-Oriented Medical Record)
System that organizes medical record by using a common list of pt problems as its base
-SOAP notes
SOAP
Component of POMR –> sections in note of pt’s status:
Subjective
Objective
Assessment
Plan
Stereognosis
Recognition of shape/form of an object by touch
Two-point Discrimination
Recognition/differentiation of two points when simultaneously applied to skin
ICF Model
(Intl Classification of Function, Disability and Health)
System of coding used to classify health conditions and develop a common language in describing health conditions
Codes:
--Functioning and Disability
Body function (s)
Body Structure (b)
Activities / Participation (d)
--Contextual factors
Environment (e)
Personal
Numerical values
Qualifiers = describe magnitude, severity,
and level of function
Nagi Model
Medical:
Active Pathology
Impairment
Social:
Functional Limitation
Disability
Preferred Practice Patterns
Musculoskeletal
Integumentary
Neuromuscular
Cardiopulmonary
Six Elements of Patient Management
Examination Evaluation DIagnosis Prognosis Intervention Outcome
Impairment
Any loss or abnormality.
May necessitate functional mobility training (FMT):
- Weakness (MMT)
- Loss of ROM (Goni)
- Balance deficits
- Cognitive deficits (Name, DOB)
- Sensory loss
- Coordination deficits
- Pain
Active Pathology
Interruption of normal processes + body’s efforts to restore itself to homeostasis.
May necessitate FMT:
- Orthopedic Surgery/Injury
- Pain condition
- Rheumatological condition
- Neurological condition
- Genetic/Congenital condition
Functional Limitation
Decreased ability to perform physical task.
May necessitate FMT:
- SAFETY
- Bed mobility
- Ambulation around home
- Assistance going to bathroom
Disability
Inability to perform task expected in sociocultural contexts
May necessitate FMT: -Unable to perform function at home, school or work -Unable to participate in recreational activities/hobbies
Orthosis
Orthopedic appliance used to:
–Support, align, prevent or correct
deformities
–Replace function of parts of body
(Brace or splint)
Body Structure (s)
ICF Code = Anatomical parts
Examples:
Gait - LE body parts
Eyes
Cardiovascular system
Body Function (b)
ICF Code = Physiological function of body systems
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Examples:
Gait - deviation, impairment
Seeing functions
Hypertension
Joint mobility
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Activities / Participation (d)
ICF Code = execution of task or action / involvement in a life situation
Examples:
(Gait - dist amb, moving using
equipment, ability to walk on various
surfaces)
Learning/applying knowledge
Mobility
Self-care, ADL's
Environment (e)
ICF Code = surroundings of pt
Examples:
(Gait - public transportation services)
Products/Technology/Natural Surroundings
Support/Relationships/Attitudes
Services/Systems/Policies
Vision 2020
Evidence-Based Practice Autonomous Practitioner Direct Access Practitioner of Choice Professionalism Doctor of PT
Core Values
Accountability Altruism Caring Communication Excellence Integrity Professional Duty Social Responsibility
Differential Diagnosis
Systematic process of comparing and contrasting symptoms associated with multiple conditions in order to determine what patient actually has.
–Limits possibility of inappropriate
treatment
Intervention
5th of 6 Elements of Patient Management
= Purposeful, skilled interaxn of PT with pt
to improve or alter the pt’s condition /
disease.
-Uses PT procedures and techniques:
Procedural (Restorative/Compensatory/Preventative)
Patient instruction
Coordination / Communication / Documentation
-Look out for:
Safety
Environment
Pt privacy (draping/positioning)
Body Mechanics
Motor planning
Functional Mobility Training
FMT
Primary Intervention provided for pts with:
- Pathologies - Impairments - Functional/Activity Limitations - Disabilities
Includes:
- Bed Mobility - Positioning - Transfers - Wheelchairs - Gait Training - Exercise
ADL’s
(Activities of Daily Living) - Independent vs dependent/needs assistance
May necessitate FMT:
Basic: Instrumental:
- Grooming -Money mgmt
- Bathing/showering -Funct Commun.
- Dressing -Health maintenance
- Feeding -Community mobility
- Toileting
Clinical Reasoning
Wide range of cognitive skills used by PT to process info, make decisions, and take action.
Show how PT’s bring value to setting:
- Skilled
- Purposeful
Examination
1st of 6 elements of Patient Management
= Gathering data and ID problems
- History
- Systems Review
- Tests & Measures
History
Hx
Component of Examination (Pt Mgmt)
=Systematic gathering of past and present data
about the pt
- Chief complaints
- PLOF
- Pt goals
- Medical background
- Medications
- Diagnostic/lab tests
- Pain patterns
- Demographics
- Employment
- Living environment
- Assistance
- Equipment
- Stairs
- Social/health habits
Systems Review
Component of Examination (Pt Mgmt)
=brief exam of anatomical/physiological
functions of MINC
–> PT uses to assess pt’s ability to
initiate, sustain and modify
interventions for maximum functional
potential
- Communication ability
- Affect
- Cognition
- Language
- Learning Style
- Red flags
Tests and Measures
Component of Examination (Pt Mgmt)
=gathering data to rule in/out links between
probs/impairments and functional limitations
–>Establish diagnosis, prognosis, goals, and
interventions.
Examples:
- Strength testing - Balance/Gait analysis - Endurance testing - Neuromotor/sensory integration
Evaluation
2nd of 6 Elements of Patient Management
= Assessment based on exam and ID of
problems list
-Enablement vs Disablement terms
Diagnosis
3rd of 6 Elements of Patient Management
= ID impact of condition on function
Prognosis
Px
4th of 6 Elements of Patient Management
= Precicted optimal functional improvement
attained by intervention and time to reach
that level
–>POC
POC
(Plan of Care); part of Prognosis (Pt Mgmt)
=Determination of anticipated goals and
expected outcomes + interventions to
achieve them
-Goals/Outcomes:
Short-term
Long-term
Specific / Measurable / Time-Frame / Functional
Outcome
6th Element of Patient Management
= ongoing process of reexamination of pt to
assess efficacy of treatment
Discharge Planning Components
Patient Education Follow-up / Referral Home Education Program (HEP) Home modification Equipment recommendation
FIM Levels of Assist
(Functional Independence Measure)
= Scale indicating pt independence level and
necessary amount of assistant from clinician
7 = Independent (100%, no equip) 6 = Mod Independent (100%, addtl time/equip) 5 = Supervision (100%, SBA / verbal cueing) 4 = Min Assist (>75%, CGA) 3 = Mod Assist (>50%) 2 = Max Assist (>25%) 1 = Dependent (<25%, 1 or more assistants)
Positioning
Treatment intervention used to prevent tightness, contractures, and pressure ulcers
Principles:
1. Support 2. Stabilization 3. Alignment
Positioning Guidelines
Introduction Rationale Motor Planning Draping Support materials/equipment
*See Fairchild p. 87
Positioning:
Rationale
- Prevent pressure ulcers
- Prevent contractures
- Support/stability
- Access to area of treatment
- Optimal function of organ system
Contracture
Shortening or tightening of skin, muscle, fascia or joint capsule that decreases ROM and function
Orthopedic
Branch of medicine dealing with musculoskeletal system
Pressure Ulcer
Bed sore caused by breakdown of skin and tissue.
- Interfere with functional recovery
- Cause pain & Infection
- Lead to excess length of stay
Blood/lymph flow obstructed
Ischemia + Edema
Redness
Open Sores
Muscle/bone destruction
Ischemia
Lack of oxygen delivery to organs
Pressure Ulcer Predisposing/Risk Factors
Poor nutrition Dry skin Immobility Weight loss Decreased sensation Impaired circulation
Erythema
Redness or rash
Lymphopenia
Decreased WBC count
Stages of Pressure Ulcer
I: Intact skin with non-blanchable erythema over
bony prominence
II: Partial thickness with loss of dermis
III: Full thickness of tissue loss; bone, tendon,
muscle not yet exposed
IV: Full thickness of tissue loss; bone, tendon,
muscle exposed
AIDET
Communication tool for improving patient compliance and improving clinical outcomes:
Acknowledge Introduce Duration Explanation Thank you, is there anything else I can do for you?
Bed Mobility
Component of FMT –> activities for patient independence
Increases: Decreases:
- Confidence -Tightness
- Independence -Contractures
- Safety -Pressure ulcers
Ability to:
- Supine movements
- Roll
- Scoot
- Bridge
- Supine to sit
- Sit edge of bed
Body Mechanics
Use of one’s body to produce motion that is safe, energy conserving, and anat/phys efficient to maintain balance and control
- Motor planning
- Reduce adverse effects of gravity/friction
- Keep patient/object close
- CoG close to patient/object
- Increase stability (widen stance)
- Use major muscles
- Avoid trunk flexion/rotation
- Know your own limits
Lifting Techniques
Maintain neutral lordosis in lumbar spine
-reduces stress on lumbar ligaments and
interverterbral discs
Orthostatic HTN
Sudden increase in BP after sitting up / standing
Morbidity
Incidence of disease
Pre-Mobility Screen
Checkpoints to assess in patient before getting them out of bed:
- Able to follow commands?
- Hemodynamically stable?
- Perform straight leg raise against gravity?
- Able to sit unsupported in midline?
Vital Signs
- Respiratory Rate
- Heart Rate
- Blood Pressure
- Temperature
- O2 Saturation
- PT/INR (clotting ability)
RR
(Respiratory Rate)
= Breaths per minute (R/min)
Normal:
Adults: 12-18
Infants: 30-50
HR
(Heart Rate)
= Beats per minute (BPM), measured by taking pt’s pulse
-Increases with activity
-Gradual return to normal at rest
(Fitness increases speed of return to normal)
Normal:
Adults: 60-100, (Avg = 75BPM)
1-7yrs: 80-120
Infants: 100-130
Max: 220 - Age
Target: Within 50-85% of Max
Locations to measure HR
Neck: Carotid A Ventral elbow: Brachial A Ventral wrist: Radial A Groin: Femoral A Behind knee: Popliteal A Medial Malleolus: Tibial A Dorsum of foot: Dorsal Pedis A
Auscultation
Listening to cardiovascular, respiratory and GI sounds using a stethoscope
BP
(Blood Pressure)
= Force of blood against walls of arteries
-Measured as Systolic/Diastolic mmHg
Normal:
Adults: 120 / 80
Elderly: (120-140) / (80-90)
Children: 60-100
Temperature
Normal: 96.8 - 99.3, (Avg: 98.6)
Pyrexic: >100
Hyperpyrexic: >106
Pyrexia
= Fever, temp > 100
O2 Sat
(Oxygen Saturation)
= Level of oxygen dissolved in blood and carried by
RBCs/hemoglobin to systemic organs
-Measured by pulse oximetry
Normal: 97-99%, can be as low as 95%
Hypoxemia: <95%
Hypoxemia
Low concentration of dissolved O2 in blood (O2 Sat)
–>Cyanosis
Pulse Oximeter
Device for measuring level of O2 Sat and HR
-Uses sensor of 2 light sources –> hgb –> photodector
Cyanosis
Bluish skin color due to lack of O2 in blood
Raynaud’s Phenomenon
Condition in which cold temperatures or strong emotions cause blood vessel spasms that block blood flow to the fingers, toes, ears, and nose
–>Cyanosis
Coagulate
Clot
Anticoagulant
Blood-thinning medication
Heparin
PT/INR
(Prothrombin Time / Intl Normalized Ratio)
= Measures ability of blood to clot and how long it
takes
-Increased = bleeding
-Decreased = clot
Normal:
PT: 11-16 sec
INR: 0.8 - 1.3
Recumbent
Long sit position
LRAD
(Least restrictive assistive device)
Bed Mobility:
Assistive Equipment
Bed rails
Overhead bar/frame
Loops
Draw sheet
Bed Mobility Principles
Raise bed Reduce friction Use gravity to help Lock bed Body mechanics
Supine Movements
Bed mobility activities:
- Side to side
- Upward
- Downward
*Can use draw sheet / equipment
Anoxia
Absence of O2 in tissues
Apnea
Absence of breathing
Arrhythmia
Abnormal heartbeat
Bradycardia
HR < 60bpm
Tachycardia
HR > 100bpm
Cardiac Output
CO
Volume of blood pumped out of heart during contraction (systole)
Diaphoresis
Excessive perspiration/sweating
Dyspnea
SOB, labored breathing
Expiration
Exhalation
Inspiration
Inhalation
Intubation
Insertion of tube into larynx to maintain open AW
Occlusion
Obstruction or blockage
Pulse
Palpable wave of blood in walls of arteries with each heart beat / contraction
SOB
Shortness of breath, dyspnea
Rale
Abnormal “crackle” sound heard on auscultation of chest
Stridor
Abnormal shrill, harsh sound heard during inspiration on pt with laryngeal obstruction
Syncope
Fainting
Prosthesis
Artificial replacement of body part
Artificial Limb
Valsalva Maneuver
Increased pressure in chest due to forced exhalation against closed epiglottis
Spasticity
Resistance to stretch bc of abnormal increased tension/stiffness
CoG
(Center of Gravity)
Located in center of pelvis ~ level of S2
How to Increase Stability
Increase BoS
Lower CoG
Maintain vertical gravity line + feet positioning
Rolling Progression for Treatment
Quarter roll –> Full supine
Legs: Bent –> Crossed at ankles –> uncrossed
UE: Adds resistance & increases momentum
Head
Amputees: Avoid compression of residual limb
CVA: Roll either side but position weaker UE appropriately
Post-Op Spine: Log roll only
Post THR: Avoid rolling Hip Precautions
THR Precautions
(Total Hip Replacement) AVOID: 1. Hip internal rotation (toes in) 2. Hip adduction (crossing legs) 3. Hip flexion
Log Rolling Steps
- Supine - Bend pt’s knees
- PT’s hands at opp shoulder and hip –> roll to
side-lying - Drop pt’s legs using your thigh as support
- Reach under trunk/neck to support scapula
- Have pt push up with opp arm or rest it on PT’s
shoulder - On 3, drop legs and swing trunk up at same time.
- Bed height
- Draw sheet
Phlebitis
Inflammation of a vein
Hemiparesis
Weakness on one side of body
Hemiplegia
Paralysis of arm, trunk and leg of one side of the body
Paraplegia
Paralysis of the lower body
Tetraplegia
Paralysis from neck down
