roles and responsibilities Flashcards
What is primary healthcare ? what are examples ?
to mgmt pt. needs till point of hand off to other provider 3 C's Comprehensive Coordination Continuity Characteristics include: 1. Safe 2.Effective 3.Timely 4.Efficient 5.Equitable 6.Patient-centered
PTs, NP, PA,Family Physicians/General Practitioners Osteopathic Physician General Internists
What is secondary healthcare ?
Consultative Short Term Disease Oriented Assisting PCP Historically...PT
what is a Family/Osteopathic Physicians/GPs?
- Graduation from medical school
- Complete minimum of 3 years post-grad training
-At least one month learning MSK conditions - Shadowing orthopedist
/sports medicine
what is a General Internist?
med school with 3 years post training
no req for msk training
focus on visceral conditions; DM, HTN, Cardiac disease
what is a PA?
2 years of training
1 year of clinical rotations
no IND practice, always under doc
What is a NP?
clinical focus is variable but those who pursue higher EDU after grad from RN degree
What are potential benefits of Primary Care PT?
A more efficient use of health care resources
Care being delivered in a more timely manner
Interdisciplinary collaboration
What is PT access in the VA like?
- PTs screen patients in the ED
- Primary care clinic then triage by a nurse
- Direct: overweight patients or those who wish to improve their general health
what are goals of the patient centered interview?
- Exploring the patient’s disease/diagnosis and its effect on his or her life.
- Understanding the whole person.
- finding common ground regarding intervention or management.
- Advocating prevention and health promotion.
- Enhancing the patient-provider relationship.
- Providing realistic expectations.
what are different layers to a persons illness experince?
- pt profile
- goals
- fxn limits
- Patient’s perception about the disorder
- Patient’s feelings about the disorder
what are Goals of Patient History?
- Establishing rapport
- Identifying any barriers to communication
- .Identifying the patient’s preferred learning style
- Establishing the patient’s goals for physical therapy
- SINSS
what are examples of open ended questions?
Open-ended Questions
•Can you think of anything that makes your pain worse?
•What makes your pain better?
•What happens to your pain at night?
•How did you feel after our last visit?
•Can you describe the pain for me?
•How do you feel when you first wake up in the morning?
what is important to remember while communicating ?
1 Q at a time
- restate, and summarize
- dont use jargon
- use pt line of thought
- avoid assumptions
- use a self assessment; what do they think or feel
what are examples of questions to get more info?
- Would you tell me more about that?
- What has this been like for you?
- is there anything else?
What are examples of clarifyign statements
I hear you saying…
- I want to make sure I understand you.
- You let me know if I’m off track, OK?
What are responses to tough convos?
- That sounds tough.
- I imagine you might feel …
- I can see that you are …
- You should feel good about that.
what are tips for Patients with Hearing Deficits?
- quiet space
2, should use hearing and visual aids when available.
3.Clinician should position themselves to facilitate lip reading.
4.Use of interpreter (ASL) may be needed.
what are tips for angry patients?
watch out for
- pacing, body behavior, tension in hands like gripping, tone of voice
- try to deescalate and dont push them over the edge
What are tips for depressed pts?
acknowlege it - “it seems like youre struggling do you want to talk about it”
- Impaired concentration.
- Poor compliance with home instructions.
- Clinician should acknowledge the situation.
- Explore potential reasons.
- Recognize potential for suicide.
why is it important to get an important exam?
- Differential diagnosis. 2.Safe delivery of physical examination.
- Review patient’s list of medications.
- Assess potential impact of co-morbidities.
what are elements of the health hx ?
Patient demographics.
- Social history
- Current medical situation
- Past personal medical history Illnesses,Allergies,Surgeries,Injuries,Medicatins
- Social habits
- Family medical history.
What questions should follow the body chart?
area of syms and areas without symps, go through each to clarify
- qualifications of symps; quality
- chronology; what happened 1st
- p1 vs p2 relationships
what are components of social hx and habits?
Social History •Cultural customs •Religious beliefs •Occupation and work status •Living environment •Family and social support
Social Habits •Exercise: Frequency and Intensity •Use of tobacco •Alcohol intake •Caffeine intake
what are risks associated with tobacco?
•Leading cause of preventable death •Smoking leads to disease and disability •Harms virtually every organ system in thebody •Primary risk factor/causes: Cancer Heart disease Strokes Lung diseases Diabetes COPD
what does CAGE stand for?
-Have you ever felt you should Cut down on your drinking?
•Have people Annoyed you by criticizing your drinking? •Have you ever felt bad or Guilty about your drinking? •Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?
what is caffeine intoxication?
-recent consumption of caffeine (≥ 2-3 cups)
•Distress or impairment in social, occupational, rehabilitation, school, etc
Caffeine Withdrawal Presents with: Headache Lethargy
Fatigue
Dysphoric mood
Muscle pain/stiffness
what is a good flow to review collected info ?
- Review patient health history beforehand.
- Begin with patient’s chief complaint.
- Discuss therapy and patient’s own goals. 4.Review patient health history for accuracy, thoroughness
Will a pt volenteer all information freely?
not always, explain to them that theres overlap btwn MSK and visceral pain
what are descriptors for Vascular disorders
–throbbing
–pounding
–pulsating
what are descriptors for Neurologic disorders
–sharp –lancinating
–shocking,
–Burning
what are descriptors for Visceral disorders
–aching, –squeezing –gnawing –burning, –cramping
What elements and behaviors descriptors should be investigated?
•pn at Rest
•Activities
•Time of day (morning, midday, evening, or night) Positions and postures •Constancy
•Frequency
•Duration of symptoms •Fluctuations in intensity; ass ociated with non physical activities such as eating?
- changes in location?
•24-hour behavior
what are considerations for Night Pain ?
- How many nights per week?
- Is there a consistent time when you wake up?
- How does the intensity of the night pain compare with the pain experienced at other times of the day •What do you have to do to fall back asleep?
