Subjective Flashcards
subjective portion checklist
chief complaint
health history
pyschosocial
screening tools
outcome measures
RAPPORT
what is the difference between an “orange” and “red” level of concern
orange - further investigation by physician
red - ER
what are some screening tools for chronic pain
Orebro
STarT Back
what are screening tools for pain catastrophizing? significant score?
PCS
>30
what is a screening tool for kinesiophobia? significant score?
TSK-11
11-44 (higher more avoidant)
what is a screening tool for fear avoidance? significant score?
FABQ
>15 for physical activity
>34 for work
major difference between an orange and red on yellow flag screening
orange - referral due to mental illness symptoms
red - referral to ER for emergency care response due to severe mental illness (ie suicide)
how is therapeutic alliance formed in subjective? what is it an indicator of
explains flow of visit to patient by setting expectations
the outcome of patient
what do we need to understand about the chief complaint
history
location/behavior of symptoms
previous treatments
what external factors could affect one’s chief complaint
functional status in roles / demands upon the patient
patient’s goals/expectations
what do we use to evaluate symptom behavior
SINSS
what does SINSS stand for
Severity
Irritability
Nature
Stage
Stability
health history includes
review of systems (red flag screen)
surgeries
allergies
illnesses
health habits
history of abuse
pertinent family med hx
local factors that affect MSK tissue healing
tissue perfusion
infection
implants/foreign matter
what affects healing of MSK tissue
local
systemic
synergistic
factors
how does tissue perfusion and oxygenation affect tissue healing
initial hypoxia stimulates healing, but prolonged can lead to chronic inflammation
what systemic factors affect tissue perfusion
smoking
DM
when is infection most relevant
after surgical procedures or open injuries
how does infection affect healing
prolonged inflammation
increased bacteria (oxidative stress)
biofilms
matrix metalloproteinases
what danger do foreign matter and implants pose
trigger immune response via macrophages
inflammation
inhibit cell differentiation
increase osteolysis
what danger do bioabsorbable materials pose
prolonged joint effusion
how does age affect healing
slows rate of nerve regeneration, tendon healing, muscle recovery
what inflammation stages are affected by aging
hemostasis, inflammation, proliferation and remodeling are affected
aka ALL of them
how do estrogen and androgens affect healing
estro - improved
andro - delay, but essential for muscle and nerve regeneration
what medications affect tendon healing
NSAIDS
glucocorticoids
what are age associated traits that can be caused by smoking
increased:
muscle atrophy
strength loss
oxidative stress on tissues
what happens initially after stopping cigarette smoking
blood flow increase
oxygenation
glucose and lactate levels return to normal levels
what happens 4 weeks after cessation of cigarettes
endothelial function are back to level of non-smoker
what happens 2 weeks after cessation of cigarettes
platelet aggregation effects are reverse
what happens 20 years after cessation of cigarettes
c-reactive protein
fibrinogen
white blood cell count
levels of hemostasis
what does diabetes affect
vascular function
angiogenesis
increased oxidative stress
what does obesity cause the body to be in
a pro-inflammatory state
how does obesity affect wound closure
delay healing due to relative avascularity of subcutaneous adipose tissue
skin folds around incision can allow for bacterial growth
protein recommendations for each life stage
younger adults - 0.8g/kg
older adults - 1g/kg
chronic wounds - 1.25-1.5g/kg
step ranges and associated benefits
2200 = lower mortality and CVD risk
9000-10500 = lowest mortality
the patient’s perception of the chief complaint allows for the PT to
bridge gap between patient expectation and possible outcomes
understanding the patient’s:
family social
personal circumstances
environmental barriers
allows the PT to understand
contextual factors and how they can link to prognosis
compare patient recovery expectations and treatment expectations
Patient recovery expectations are commonly associated with patient outcomes
Patient treatment expectations were less clear with patient outcomes
what are the major variables that determine recovery expectations
pain
progress
performance
treatment
how has MSK patient care changed?
framework associated with
- providing a plan
- management
focused around patient education, centered care, healthy lifestyle
x Empathy x Honesty x Empowerment
–> last slide graphic…. probably not important but oh well.
