Week 1 Flashcards

1
Q

Who are physical therapists?

A

Health professionals that diagnose and manage movement dysfunction relating to restoration, maintenance, and promotion of optimal health and wellbeing

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2
Q

What do PTs do?

A

Design and implement customized plan of care in collaboration with the patient to base it on the patient’s diagnosis, prognosis, and goals

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3
Q

What are the levels of care?

A

1) Primary care: provision of integrated, accessible health-care services by clinicians who are accountable for addressing a large majority of personal health-care needs, developing a sustained partnership with patients, and practicing within the context of family and community.
Ex: Family Physicians

2) Secondary care: care provided to patients who are initially treated by other practitioners and then referred to specialists/physical therapists.

3) Tertiary care: care provided to patients in highly specialized, complex, and technology-based settings (e.g., burn units) or in response to requests of other health-care practitioners for consultation and specialized services.

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4
Q

What are levels of prevention?

A

1) Primary prevention: prevents target condition in a susceptible population
Ex: General health efforts

2) Secondary prevention: decreases the duration or severity of a condition through early diagnosis and prompt intervention

3) Tertiary prevention: limits the degree of disability and promotes rehabilitation and restoration of function in patients with chronic and irreversible diseases.
Ex: Preventing another condition/complication from developing as a result of the original chronic condition

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5
Q

What is Health Promotion & Wellness

A

Health promotion: any effort, on an individual or community level, that increases health awareness

Wellness: includes all dimensions of one’s like physical, emotional, and spiritual health, as well as social connectivity

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6
Q

Define Clinical reasoning

A

Thinking and decision making process that is:
1) Context dependent reasoning
2) multidimensional in collaboration with the patient, caregiver, and health care team
3) Evidence driven by utilizing information about the patient, the task, and the setting

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7
Q

Define Decision making

A

It is a shared process between the clinician and patient. Each of them brings their characteristics including their beliefs and biases, preferences, and values.

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8
Q

What are possible outcomes in decision as a PT?

A

1) Refer: other PTs or medical professionals
2) Co-manage: in collaboration with other health care professionals
3) Consult: gain insight from other PTs or medical professionals
4) Direct/supervise (retain): developing and acting upon a plan of care

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9
Q

What are the components of patient management?

A

Evaluation/Diagnosis
Examination
Prognosis
Systems review
History
Plan of care
Outcome

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10
Q

What are movement systems?

A

A collection of systems that interact to move the body or its parts
1) Endocrine
2) Cardiovascular
3) Nervous
4) Pulmonary
5) Musculoskeletal
6) Integumentary

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11
Q

What can an initial patient interview accomplish?

A

During the interview, the PT can ask closed ended (YES/NO) or open ended questions to learn the patient’s:
history
current health status (also obtained from medical record)
Goals
This established understanding, rapport, and mutual trust

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12
Q

What is the purpose of examination?

A

To collect baseline data on participation and activity informing evaluation, diagnosis, and prognosis to determine clinical outcomes

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13
Q

What is an evaluation?

A

Interpretation of movement analysis and tests and measures, along with other history/examination data, to arrive at working hypotheses

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14
Q

What is a PTs diagnosis?

A

PT diagnosis is typically made at the impairment, activity, and participation levels. In contrast, the medical diagnosis refers to the identification of a disease, disorder, or condition (pathology/pathophysiology) primarily at the cellular, tissue, or organ level.

Ex: PT diagnosis, Dependent mobility and ADL with impaired motor function and sensory integrity affecting the left non dominant side

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15
Q

Define prognosis

A

The likely outcome of a condition represented by a synthesis that is based on an understanding of the examination findings, health condition, foundational knowledge, theory, evidence, and experience.

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16
Q

What is the purpose of a plan of care?

A

It outlines anticipated patient management by considering factors like condition, age, overall health, resources, and environment

17
Q

What is the purpose of patient documentation?

A

1) To ensure that the patient receives appropriate, comprehensive, efficient, and person centered high quality care services

2) To prove medical necessity which is when healthcare services or supplies are needed to diagnose or treat a condition while meeting practice standards

3) To provide skilled care/services by or under the supervision of a skilled PT for patient safety.
Ex: if the intervention does not require the skills of a PT or a PTA supervised by the PT then it is not considered skilled

18
Q

Is Palliative care by a PT (ex: end of life care) deemed a medical necessity?

A

No
Using the end of life example: If a patient has terminal disease like cancer, then as a PT we can help relieve patient’s pain and maintain functional movement for as long as possible but by definition, the PT’s service here is not a medical necessity

19
Q

Describe maintenance care

A

Type of care that promotes general health and preserves current functional ability or status

Ex: PTs can slow progression of functional loss in conditions like multiple sclerosis or ALS even though the neurological condition is progressive and it is difficult to demonstrate the patient’s progress

Note: CMS now considers maintenance PT a medical necessity

20
Q

Describe Narrative Notes

A

They describe in detail what happened during the encounter with the patient. They are written in paragraph form and have Little/no shorthand use or headings

Best use: to document brief interactions, verbal orders, calls, or for writing a letter of medical necessity

21
Q

Describe Problem Oriented Medical Record (POMR)

A

It is a type of taking notes that utilizes abbreviations and headings to be written in an “outline” format. It starts off with a problem list as a table of contents

22
Q

Describe SOAP notes

A

S: Subjective (relevant info only) - any info the patient or their family/caregiver tell us (can be verbal or written) and documentation/tests that were not done by the PT (MRI result in medical history, documents from the patient’s MD)

O: Objective (specific relevant info) - any data or measurements we collect/perform ourselves as well as any description of “today’s treatment” and documentation of the patient’s medical status that we observe ourselves

A: Assessment (specific relevant info) - any thoughts we have about anything we measure, observe, or test. Here is where we also set goals to mark the patient’s improvement towards their desired outcome. (We can justify medical necessity here by stating the patient needs for skilled PT service because…”)

P: Plan (very specific) - interventions that we will use to fix the patient’s problem (plan of care) and achieve progress towards their goal. A time frame needs to be included as well as any consults we plan to do or any explanation that we need to state regarding how we plan to meet the patient’s goals. (We can justify medical necessity here as well by stating the patient needs for skilled PT service to…)

23
Q

Current problems with SOAP format

A

1) Description of skilled care
2) Justification of medical necessity

24
Q

Describe the ABCDEF format for STGs and LTGs

A

A: Audience - who is doing this? Patient or caregiver (never the PT)

B: Behavior - what is the patient doing? (Action verb)

C: Condition - Under what circumstances is the patient exhibiting this skill? (Stairs, walker)

D: Degree - how well can they do this? (Intensity, # reps, assistance?)

E: Expected Duration - How long will it take the PT to reach the goal (how many sessions, duration, frequency)

F: Function - They will accomplish the goal in order to do what? (The reason behind the POC)

25
Q

Why do we write functional goals?

A

1) Required by our practice & 3rd party payers
2) Accountability to patients
3) Directs our treatments & helps us stay focused
4) Patients make the greatest gains when the goals are meaningful to them (results in improvement in their QOL and function)

26
Q

How to make objective, measurable goals?

A

Measure the change between baseline to the measure after you apply your intervention
Ex: # of reps, distance ambulated, # of degrees of ROM, # trials, assistance level, score on an outcome measure