Unit 2: Acute Care

Question 1

Acute Care

Answer 1

-A health care setting where a patient receives active but short term treatment for injury or episodes of illness.
-Rehabilitation services are offered in the hospital while the client is admitted.
-Length of stay can range from a few days (ex. after a knee replacement) to months (ex. someone on life supporting devices awaiting a transplant).

Question 2

Levels of Care within the Hospital Setting
the Intensive Care Unit (ICU)?

Answer 2

-Emergency room: Patients present from the community with
acute medical concerns.
-Intensive Care Unit: Dedicated to treating patients who are critically ill & medically fragile; Typically high levels of staffing & interdisciplinary teamwork.
-Acute Care Unit: Clients may require close monitoring or further diagnostical testing.

Question 3

The Importance of OT in Acute Care

Answer 3

OT in the hospital can improve independence in self care, functional mobility, and improve outcomes upon discharge.

Question 4

Early engagement in occupation and mobility has been found to reduce the risk of:

Answer 4

-Delirium
-Pneumonia
-Bed sores
-GI dysmotility (Bowl obstruction/ constipation)
-Deconditioning and hospital acquired weakness
-Joint contractures

Question 5

Extended bed rest can lead to… (detriments of bed rest)

Answer 5

-Decreased independence with functional
mobility & ADLs
-Negative impact on family and caretakers
-Decreased muscle strength
-In a healthy individual strength can decrease 1.3-3% per everyday spent on bed rest.
-Decreased functional endurance

Question 6

According to the 2015 AOTA workforce survey what percent of occupational therapists work in the hospital setting

Answer 6

26.6%

Question 7

The Role of OT in Acute Care: Evaluation

Answer 7

-Occupational profile & home environment
-ADL & functional Assessment
-Standardized and non-standardized assessments
-Client factors
-Potential for participation in therapy

Question 8

The Role of OT in Acute Care: Treatment

Answer 8

• Review the medical chart before every treatment. Look for any changes in patient status. Is patient medically appropriate to be seen today?
• Assess environment and medical equipment present
• Assess patient’s orientation
• Preparatory activities
• Occupational engagement
• Caregiver training

Question 9

Things to look at as OT in Acute Care for Treatment

Answer 9

• Therapeutic preparatory activities
• Functional mobility
• Endurance
• Strengthening & coordination
• Cognitive/perceptual activities
• Sitting/standing balance
• AROM
• Engagement in Occupation: ADL tasks & mobility; Meaningful activities
• Prevention: Splinting and positioning; Skin integrity/ Pressure sore prevention
• Education: Patient, caregiver, staff
• Psychosocial support
• Advocating for the best interest of the patient

Question 10

The Role of OT in Acute Care: Discharge

Answer 10

-OT works with the interdisciplinary care team to transition the client to an appropriate level of care.
-Discharge Planning: What question should you ask yourself? ( Can this patient go home? What kinds of supports will they need? (Supervision, physical assist, equipment, assistive devices))
-Will the patient need continued therapy?
-What is the best next level of care?: Inpatient acute rehab, Sub-acute rehab, Long term acute care, Day Rehab, Outpatient, Home health

Question 11

Typical Path of Admission for Care

Answer 11

Question 12

What should you do?
Event: Sarah, mid 50 year old woman, has sudden onset of right sided weakness and aphasia.
Diagnosis: Stroke

Answer 12

Admit to: Emergency room.

Question 13

Admit to: ICU

Answer 13

• Medically unstable.
• Risk of major organ failure.
• Requires mechanical breathing assist.
• Requires constant monitoring due to fragile
medical status.

Question 14

Admit to : Acute Neurology Unit

Answer 14

• Need for further diagnostic test.
• Not a risk for major organ/system failure.
• Does not require specialized medical equipment.

Question 15

Admit to: Inpatient Rehabilitation

Answer 15

• Able to tolerate therapy for a minimum of 3 hours for 5 out of 7 days.
• Requires multiple therapy services.
• Medically stable.

Question 16

Admit to: Skilled Nursing Facility

Answer 16

• Requires 24 hour care.
• Requires skilled medical intervention.
• Not able to tolerate 3 hours of therapy per day.
• May bridge the gap until able to tolerate inpatient
rehab.

Question 17

Admit to: Home Therapy Services

Answer 17

• Requires ongoing therapy.
• Require visiting nurse services or physical therapy.
• Considered “Homebound”.

Question 18

Admit to: Outpatient Rehabilitation

Answer 18

• Requires ongoing therapy.
• Access to the community.

Question 19

Summary

Answer 19

• Acute care is an important, exciting, and rewarding practice setting for OTs.
• OTs play an important role in evaluation, treatment, education, psychosocial support, and discharge planning as a part of the patients’ interdisciplinary treatment team.

Question 20

Inpatient Acute Rehab

Answer 20

This would be a recommendation for someone who requires or would benefit from three hours of skilled, interdisciplinary therapy a day.
-This person may be functioning at a lower level than their previous level of functioning, and they have a good potential for rehabilitation. This is a very intensive setting for someone, so they need to be able to tolerate and benefit from three hours of therapy a day, about five days a week.

Question 21

Sub-acute Rehab

Answer 21

-May be a setting for someone who is not really medically stable to go home or functionally able to go home but could benefit from further therapy.
-Someone who may need 24 hour supervision would go to subacute rehab.
-These individuals require one to three hours of therapy a day, and that can be occupational, physical or speech therapy.

Question 22

Long Term Acute Care

Answer 22

-This would be for someone who is less medically stable, may require long‐term ventilation or long‐term medical care.
-These settings do provide therapy in house but these clients are just a little less medically stable than someone who would go to sub‐acute rehab or inpatient rehab.

Question 23

Day Rehab

Answer 23

-This is a setting in which someone goes as an outpatient to receive up to three hours of therapy a day in an outpatient setting.
-An individual to qualify for a day rehab would be able to go home and be safe at home with supports in place, but also would benefit from intensive continued rehab to improve function or return to their prior level of functioning.

Question 24

Outpatient

Answer 24

-This would be for someone who is safe to go home and also safe to go out into the community, and has a means to do so.
-They could schedule outpatient occupational therapy.

Question 25

Home Health

Answer 25

-For someone who’s ready to discharge from the hospital but will likely need assistance in the home and is unable to leave the home without significant amount of assistance.
-Anyone who receives home health therapy, they are required to be home bound, and therefore, the therapists come to them in the home.