Week 1- Intro to Screening for Referral Flashcards
PART 1
PART 1
What is the goal of a PT examination?
Identify NMS dysfunction and design POC that specifically treats dysfunction.
It is possible for systemic disease to mimic NMS dysfunction, what does this mean?
Means there is a need to screen for possibility of systemic disease.
(SQ)
What regions of the body may systemic disease refer to? Which 2 are the most common?
- BACK
- SHOULDER
- Neck
- Chest/ribs
- Hip/groin
- Sacrum/pelvis
(SQ)
What are the (3) options that PTs have after each patient encounter?
- Treat
- Refer
- Treat and refer
Screening:
- Begins with a well developed ________ and _________.
- What can a lack of adequate and thorough attention to clues in the patients Hx result in?
- When do we perform screening?
- history and interview
- Can result in serious condition being overlooked.
- Screening continues throughout care.
Reasons for screening. (7)
- Direct Access
- Quicker and sicker patient base
- Signed prescription w/o direct MD contact
- Medical specialization
- Disease progression
- Patient disclosure
- Presence of one or more yellow or red flags
Is failure to refer to a licensed MD or dentist when patient’s condition is beyond scope of PT unlawful?
YES
The PT diagnostic process begins with a ________ examination.
screening
- What is the (5) step process of PT treatment?
- Where does screening start?
- Examination, Evaluation, Diagnosis, Prognosis, Intervention
- Examination
What are the (2) purposes of the diagnostic process?
- Provide most appropriate POC.
- Recognize need for medical referral.
Should we assume that a referring diagnosis is correct and that the patient has been previously screened by referring provider?
NO
PART 2: GOODMAN SCREENING MODEL
PART 2: GOODMAN SCREENING MODEL
The Goodman Screening Model is carried out through the ____________ and verified during the _____________.
- patient interview
- physical exam
(SQ)
What are the (5) steps of the Goodman Screening Model?
- ) Client Hx
- ) Risk Factors
- ) Clinical Presentation (pain types/patterns)
- ) Associated S/Sx of systemic disease
- ) Review of Systems
What is the difference between red flags and yellow flags?
Red Flags (Clinical Flags) -Signs of serious pathology that require immediate attention.
Yellow Flags (Psychosocial Flags)
- Psychosocial barriers to recovery.
- Potential to increase risk of long-term disability and work loss.
Client Hx:
- Can be accomplished using a standardized intake/medical screening form.
- Should include ______/_______ Hx.
- Good Hx is essential key to a correct diagnosis.
-personal/family Hx
Components of medical screening form. (9)
- Demographic
- Allergies/Health status
- Constitutional symptoms
- Past Medical History
- Functional Status/Activity Level
- Symptom history and behavior
- Medications
- Body Diagram
- Numeric Pain Rating Scale
(SQ)
What are constitutional symptoms?
Constitutional Symptoms (non-specific/non-related)
- Group of symptoms that can affect many parts of the body and are common S/Sx.
- Require further evaluation.
List some constitutional symptoms. (9)
- Fever
- Diaphoresis (unexplained sweating) (night or day)
- Chills
- N/V/D
- Pallor
- Dizziness/syncope
- Fatigue/malaise/weakness
- Appetite loss
- Weight loss
Example Red Flags:
- Age over ___ years
- Personal or family history of ______
- No known cause, unknown etiology, ________ onset
- Recent report of increased _________ could be a neurologic sign, drug-induced (e.g., NSAIDs), postop (e.g., fat embolism), result of abuse or assault
- Recent (last 6 weeks) _________ especially when followed by neurologic symptoms 1-3 wks later, joint pain or back pain (mono, URI, UTI, viral infection such as measles, hepatitis)
- Recurrent _____/____ with cyclical pattern
- Recent history of _______ or minor _______in adult with osteopenia/osteoporosis
- History of immunosupression (ie steriods, organ transplant, HIV)
- History of injection drug use (infection)
- 40
- cancer
- insidious
- confusion
- infection
- colds/flu
- trauma
Risk Factors:
- Important part of disease ___________.
- Knowing risk factors for different diseases and conditions are an important part of screening and may lead PT to make earlier ________.
- Can a single risk factor be significant?
- prevention
- referral
- Can be significant, view in context of whole patient presentation.
- What is the difference between Primary, Secondary, and Tertiary Prevention?
- What is Health Promotion and Wellness?
- Screening plays a part in which of these?
Primary Prevention
-Stopping process that lead to the development of disease/illness through education, risk factor reduction and general health promotion.
Secondary Prevention
-Early detection of disease/illness through regular screening.
Tertiary Prevention
-Providing ways to limit the degree of disability while improving function in patients with chronic/tertiary diseases.
Health Promotion and Wellness
-Providing education and support to help patients make choices that will promote/improve health.
-Screening is involved in primary and secondary prevention, as well as health promotion and wellness.
List possible health risk factors. (9)
- Substance/Alcohol use/abuse
- Tobacco use
- Age
- Gender
- Body mass index (BMI)
- Sedentary lifestyle
- Race/ethnicity
- Occupation
- Exposure to radiation
Clinical Presentation:
- Clinical “________”.
- Identification of specific pain ______/______ that correspond to specific systemic diseases.
- “picture”
- patterns/types
Pain Pattern Red Flags:
- Pain of unknown cause.
- _____/______ pain (need second look due to being most common location for referred pain).
- Pain accompanied by full _____.
- Pain not consistent with emotional/psychological overlay.
- ______ pain (constant and intense).
- Symptoms are ______ and ________.
- Pain made worse by activity and better by rest. (i.e. intermittent claudication or UQ pain with use of LE while UE are inactive suggest cardiac).
- Pain described as throbbing, knifelike, boring or deep aching.
- Pain that is poorly _______.
- Pattern of _______/______ like spasms. (colicky)
- Pain accompanied by S/Sx associated with specific viscera or system.
- Change in MSK symptoms with food intake or increased pain with medication use.
- back/shoulder
- full ROM
- Night pain
- constant and intense
- poorly localized
- coming/going
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Associated S/Sx of Systemic Disease:
- Each system has a typical set of core S/Sx.
- The presence of _______ symptoms is always a red flag.
constitutional
What are some reasons it may be useful to use “symptoms” instead of “pain” during patient interviews? (2)
- If we aren’t careful, we may become to focused on the pain and miss other problems the patient is experiencing.
- Important when dealing with patients with chronic pain in order to move focus away.
- _____________ = “A brief or limited exam of the anatomic and physiologic status of the cardiovascular/pulmonary, integumentary, musculoskeletal and neuromuscular systems”.
- _____________ = “A series of questions or checklists to identify symptoms potentially associated with occult disease, medical conditions, and/or adverse medication events that may mimic conditions that are amenable to physical therapist intervention”
- Systems Review
- Review of Systems
Review of Systems:
- Series of _______/________ to identify symptoms potentially associated with occult disease.
- Review of Systems looks to categorize complaints and S/Sx, why?
- Ask ALL patients _______, _________, and ________/________ question sets.
- questions/checklists
- Identify clusters of S/Sx that may refer to underlying system involved and need for referral. Follow-up questions specific to that system are then asked.
- General, Integumentary, Musculoskeletal/Neurologic
With the Review of Systems, a “yes” answer requires the need to determine what (3) things?
- Explanation?
- Is MD aware?
- If MD is aware, has it worsened?
Fracture CPR. (4)
- Prolonged steroid use
- Age >70
- Significant trauma
- Female
What (4) things warrant a referral?
- Findings inconsistent with NMS dysfunction.
- Presence of cluster of symptoms that indicate involvement of body system.
- Adverse/inappropriate or lack of response to intervention.
- Onset of new systemic symptoms.
