Patient Management Flashcards
what are the 6 elements to the patient management model?
1: examination
2: evaluation
3: diagnosis
4: prognosis
5: intervention
6: outcome
*patient related- satisfaction
service delivery- efficacy & efficiency
examination
process of obtaining a history, performing a relevant systems review and selecting and administering specific tests & measurements to obtain data
- used to generate a diagnosis
- ongoing process throughout treatment to evaluate response to intervention
examination- history
- dynamic process used to generate and refine hypothesis
- thorough and detailed hx is critical to the problem solving process leading to dx
- good questioning: non-leading, educational level
- active listening: red flags, word choices
- controlling the conversation
- many different forms to help organize- all will need a review of the pt response
- demographic profile & social hx
- occupation
- general health hx (co morbidities, surgeries, properly managed?)
- past (PMH) and current (HPC) hx of physical condition
- extra-individual & intra-individual interventions (sucess? pt experience?)
get the story-history
**think SINSS
what happened? when? why? what did you do about it? where does it hurt now? has it changed? have you experienced this before? what makes it better/worse?
examination- systems review
cardiopulmonary (HR)
musculoskeletal (gross ROM)
neuromuscular (coordinated movement)
integumentary (skin integrity)
communication ability, affect, cognition, language, and learning style (consciousness, orientation)
examination- tests and measures
- guide organizes tests and measures performed by PTs into 24 categories
- hx and systems review guides to choice of relevant tests and measures
- observation/inspection
- palpation
- clearing tests
- movement tests
- muscle strength
- neurological
- special tests
- functional tests
for MS system:
- pain
- strength/endurance
- goniometry/flexibility
- reflexes/sensory/peripheral nerve
- posture/gait/balance
- anthropometrics
- accessory joint motion
- special tests
evaluation
=dynamic process in which the PT makes judgements based on data gathered during the exam
- prioritize problems to be assessed based on PMH, systems review, subjective complaints
- implement the examination
- interpret the data
“which tests have i done?”
“do i have enough info to proceed w/ rx?”
“do my objective tests match subjective complaints?”
evaluation- interpretation of data
interpretation used to determine:
- progression, stage and stability of the signs & symptoms (SINSS)
- presence of preexisting conditions
- relationships among involved systems and sites
evaluation- pathology
lab tests
radiologic studies
neurologic exams
these tests help identify the pathology, and lead to medical dx. PT focus should be on examination and evaluation of impairments, functional limitations and disabilities.
**elevator speech
impairment questions
- is the impairment directly related to a functional limitation?
- is the impairment secondary to the pathology or impairment?
- can the impairment be related to future functional limitation?
- is the impairment unrelated to the functional limitation?
**target impairments that are related to functional limitations!!
functional limitations
- lack of function (unable to make the bed) is why the pt seeks therapy
- which and to what degree are the impairments linked to functional limitations?
- success=ability to achieve functional outcomes
tests/measures of physical functional limitations
- self reports or proxy reports of the level of difficulty performing tasks
- observation of performance, rating the level of difficulty (measuring distances, weight lifted, # of reps, or quality of motion)
- clinical tests of physical mobility
- equipment based evaluation of performance
disability
involves social context of functional loss- limits patient’s ability to function socially
social interaction
social activity
social role
social interaction-disability
limited due to functional limitations (unable to leave the home)
social activity-disability
limited due to functional limitation (unable to attend functions where stair climbing is required)
social role-disability
limited due to functional limitation (unable to perform tasks that require stair climbing)
diagnosis
the process and end result of information obtained in the exam and veal
Includes:
- examination (hx & systems review)
- evaluation (interpretation)
- diagnosis=clinical classification- organization into cluster, syndrome, or category
cluster
a set of observations or data that frequently occur as a group or single patient
syndrome
an aggregate of signs and symptoms that characterize a given disease or condition
diagnosis
a label encompassing a cluster of signs and symptoms commonly associated with a disorder, syndrome, or category of impairment, functional, limitation or disability
prognosis
the process of determining level of optimal improvement that may be obtained from intervention, and the amount of time required to reach that level
plan of care
specify interventions to be used and the proposed duration and frequency of intervention(s) that are required to reach the anticipated goals and outcomes
why do we need to form a prognosis?
- grasp potential course a patients care can take
- to guide expectations for recovery
- to assist in planning, formulating interventions, promoting lifestyle changes
- to identify those as risk for poorer outcomes
- to guide future assessment
- to craft appropriate educational messages
- to identify opportunities to intervene and alter outcomes