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S4- Acute Care > Week 1- Introduction and Outcome Measures > Flashcards

Week 1- Introduction and Outcome Measures Flashcards

1
Q

INTRODUCTION

A

INTRODUCTION

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2
Q

What 2 things make the Acute Care setting unique?

A
  • Complexity of patients

- Duration of stay

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3
Q

What is the role of PT in Acute Care?

A
  • Early mobilization
  • Treatment (strength, endurance, mobility)
  • Educate! (patient, family members, team)
  • Discharge Planning- SHORT LENGTH OF STAY! (family/caregiver training)
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4
Q

What are the (5) parts of the PT Management Model for Acute Care?

A
  • Examination
  • Evaluation
  • Diagnosis
  • Prognosis
  • Interventions
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5
Q

What is done during an examination?

A

Collect critical info such as medical/ social Hx, living environment, chief complaints, functional/activity level, medications.

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6
Q

What is done during an evaluation?

A

Systems review, communication, cognition/affect, anthropometric characteristics, AD, circulation, CN integrity, barriers to function, gait, motor function, orthotics/prosthetics, pain.

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7
Q

What is done during a diagnosis?

A

Interpretation of Exam and Eval data used to determine prognosis and interventions?

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8
Q

What is done during the prognosis?

A

Determine optimal level of improvement for short duration in acute care.

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9
Q

What is done during interventions?

A

Purposeful and skilled interaction between PT and patient used to enable patient to transition to lower level of care.

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10
Q

How are interventions different in acute care?

A

More so gross motor function compared to specific tasks.

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11
Q

With the examination it is important to __________ the essential information.

A

PRIORITIZE

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12
Q

What (5) things are included in the Systems Review of the evaluation?

A
  • Cardiovascular/Pulmonary
  • Integumentary
  • Musculoskeletal
  • Neuromuscular
  • Cognition
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13
Q

When do we want to determine a patients Cardiovascular/Pulmonary status?

A
  • Before
  • During
  • After
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14
Q

Most cardiac patients are hooked up to a ________ which is used to interpret HR and heart rhythm as well as MAP.

A

telemetry

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15
Q

What is the purpose of Integumentary?

A

Observe condition of the skin and inspect surgical incisions, indwelling lines, tubes, and bony prominences.

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16
Q

What things can lead to fragile skin?

A
  • medications
  • poor nutrition
  • prolonged bed rest
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17
Q

Patients should be repositioned every __ hours and PTs should know positions to avoid such as sacral sitting.

A

2

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18
Q

With the Musculoskeletal review, we determine gross muscle ______ and _____. We also identify any joint ___________.

A
  • tone and ROM (AROM and PROM)

- contractures

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19
Q

ROM Areas of Focus for Upright Standing:

  • Ankles: need to achieve _______ ROM to WB through balls of feet
  • Knees: need to achieve full knee _____ ROM for increased standing stability
  • Hips: need to achieve neutral hip _____/_____ ROM for increased standing stability
A
  • neutral
  • extension
  • flex/ext
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20
Q

With the Neuromuscular review, the PTs are often the first healthcare providers to mobilize patients and are thus the first to ID ___________ issues.

A

neuromuscular

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21
Q

With the Cognition review it is important to determine consciousness, arousal, alertness, and orientation. Why?

A

Affects the patients ability to participate in PT and D/C plans.

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22
Q

What are the 4 parts of AOx4?

A
  • person
  • place
  • time
  • situation
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23
Q

What are some formal cognitive tests used to evaluate cognition?

A
  • MMSE

- MoCA

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24
Q

During the evaluations, Tests and Measures may be applied to assess what (13) things?

A
  • Cognition
  • Aerobic Capacity/Endurance
  • Anthropometric Characteristics
  • Circulation
  • Cranial and Peripheral Nerve Integrity
  • Integumentary
  • Muscle Performance
  • Motor Function
  • Gait, Locomotion, Balance
  • Assistive Devices
  • Orthotic, Supportive, Prosthetic Equipment
  • Environmental/Home/Work Barriers
  • Pain
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25
Q

What is an ABI and how is it taken?

A
  • Measurement of how good circulation is in distal extremity.
  • Take SBP ankle/SBP brachial, if lower than .9 indicates impaired circulation.
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26
Q

What monofilament is the cutoff for determining if someone has protective sensation on the bottom of their feet.

A

5.07 monofilament

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27
Q

What are some tools used for wound care and what are they?

A
  • Pressure Ulcer Scale for Healing (PUSH) = Monitors healing over time via (3) parameters which are; SA of wound, wound exudate, type of wound tissue.
  • Braden and Norton Scales = Predict likelihood of developing ulcer.
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28
Q

What are the (3) classifications of wounds?

A
  • Decubitus ulcers (pressure sores)
  • Diabetic neuropathic ulcers
  • Chronic venous insufficiency ulcers
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29
Q

Should we assess pain in acute care?

A

Yes, it is a huge issue in acute care.

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30
Q

What (4) things should we assess in regards to pain?

A
  • quality
  • intensity
  • location
  • duration
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31
Q

What are some scales used to assess pain?

A
  • Numeric rating scale
  • VAS
  • Wong-Baker faces pain scale
  • FLACC scale (face, legs, activity, cry, consolability)
  • COMFORT scale
  • McGill pain scale
  • Brief pain inventory
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32
Q

It is important to know patients pain management via their __________ or __________/__________ strategies to avoid increasing pain.

A
  • medication

- positions/mobility

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33
Q

Diagnosis:

  • _________ diagnosis already established
  • Interpret lab results
  • Interpret findings from PT examination and evaluation
  • Do you need more information?
  • What is your ____ diagnosis?
A
  • Medical

- PT

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34
Q

Prognosis:

  • Key piece of info to determine ____ status
  • Consider patient’s _____, current medical status
  • How likely is patient to return to PLOF?
  • What does patient need in order to return to PLOF?
  • What is direction of physical therapy?
A
  • D/C

- PLOF

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35
Q
  • What is the goal of discharge planning?

- When does it start?

A
  • Transition patient to next (lesser) level of care and optimize functional independence.
  • Starts during Initial Evaluation.
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36
Q

List the Physical Therapy Settings from highest level of care to lowest level of care.

A
  1. ) ICU
  2. ) Acute Care
  3. ) Rehab, Subacute/TCU, SNF
  4. ) Outpatient, Home Health, Hospice
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37
Q

Does PT have a role in ICU care?

A

Yes, but depends on how hemodynamically stable that patient is so they can handle activity.

38
Q

What is a PTs job in acute care?

A
  • Where the patient will be discharged.

- If they still need care they go to rehab,subacute/TCU, or SNF which or still acute care.

39
Q

What are the PT Settings if a patient can’t go home?

A
  • Rehab
  • Subacute/TCU
  • SNF
40
Q
  • When can patients be admitted to inpatient rehab?
  • When can patients be admitted to Subacute/TCU?
  • When can patients be admitted to SNF?
A
  • If they can handle daily 3 hour duration intense hospital-based therapy.
  • If they can handle less intense, hospital-based therapy usually 2 hours a day.
  • If they can handle less intense nursing-based therapy usually 2 hours or less a day.
41
Q

What are the PT Settings if a patient can go home?

A
  • Home Health
  • Outpatient
  • Hospice
42
Q
  • When can patients be admitted to Home Health?
  • When can patients be admitted to Outpatient?
  • When can patients be admitted to Hospice?
A
  • Patients must be “home-bound”, therapy usually 3x a week.
  • Best for more mobile patients.
  • Appropriate for patients with diagnosis with 6m or less to live.
43
Q

What (4) things should we do in regard to patient identification?

A
  • Have patient state name and DOB
  • Check wrist band
  • Watch for name duplications/similarities
  • Adhere to HIPAA
44
Q

What are (4) things we can do to prevent falls?

A
  • Appropriate footwear (non-skid socks or well-fitting shoes)
  • Check bed alarms (disarm before and rearm after)
  • Determine fall status of patient (evaluate for fall risk and never leave fall-risk patient unattended in WC alone)
  • Leave bed call within patient reach
45
Q

Communication consists with ability to communicate with the ________ and ____________________.

A

Patient

  • cognitive level
  • education level
  • pt understanding of condition

Interprofessional Team

  • understanding role of team members
  • when to make referrals
  • SBAR
46
Q

What positions make up the healthcare team?

A
  • Physicians
  • Nurses
  • CNAs
  • Case Manager/Social Worker
  • PT/PTA
  • OT/OTA
  • Speech Language Pathologists
  • Respiratory Therapists
  • Dieticians/Nutritionists
47
Q

What does SBAR stand for?

A
  • Situation
  • Background
  • Assessment
  • Recommendations
48
Q

For the following, we should report to who?

  • Unusual vital signs or behaviors
  • Amount voided
  • When patient is out of bed and plan for returning to bed
A

Nursing

49
Q

For the following, we should report to who?

  • Concerns that require change in care plan
  • You may not see physician very often
A

Physician

50
Q

If we have concerns about D/C plans, equipment or other special needs for home who should we report to?

A

Case Manager

51
Q

If the patient progresses towards D/C who should we report to?

A

Rehab Team

52
Q

Standard Precautions:

  • Aims to control ___________ infections by reducing risk of transmission of blood-borne pathogens and pathogens from moist body substances.
  • What do standard precautions apply to?
A
  • nosocomial

- blood, all body fluids except sweat, nonintact skin, and mucous membrane

53
Q

What is the most effective way to prevent spread of disease?

A

Handwashing

54
Q

What PPE equipment is used in acute care?

A
  • Gloves
  • Gowns
  • Face mask
  • Face shield
  • Protective eyewear
55
Q

Transmission Based Precautions:

  • When are they used?
  • Are standard precautions still used?
  • What are the 4 main types?
A
  • Used for patients documented or suspected to be infected or colonized with highly transmissible or epidemiologically important pathogens.
  • Yes, used in addition to standard precautions.
  • Contact, Droplet, Airborne, Neutropenic
56
Q

Contact Precautions:

  • When are they used?
  • Examples?
A
  • Infectious microorganism transmitted by direct or indirect contact.
  • MRSA, VRE, norovirus, C.diff, chicken pox
57
Q

Contact Precautions Include:

  • ________ precautions
  • ________ room
  • _____ and _____ prior to entering room, remove and place in designated container before leaving room
  • Dedicate non-critical client care items to this patient (stethoscope, gait belt, cuff weights, goniometer, assistive devices)
  • Disinfect all equipment/surfaces with approved disinfectant prior to use by other people
A
  • standard
  • private
  • gloves and gown
58
Q

Enteric Precautions:

  • Type of ________ precaution.
  • Used for containing what infectious agents?
A
  • contact

- c.diff, norovirus, rotovirus

59
Q

Enteric Precautions Include:

  • _______________ with soap and water (alcohol will not kill spores)
  • Equipment cleaned using ________-based disinfectant
  • Use all other contact precautions
A
  • HAND WASHING

- chlorine

60
Q

Droplet Precautions:

  • Involves pathogens larger than __ microns that travel in droplets.
  • Droplets travel no more than __ feet and infect host’s conjuctivae or mucous membranes.
  • Examples?
A
  • 5 microns
  • 3 feet
  • pneumonia, influenza, whooping cough
61
Q

Droplet Precautions Include:

  • _________ precautions
  • _______ room
  • _________ for visitors or patient if they leave the room
  • Goggles or face shield in case of potential spray
A
  • standard
  • private
  • face mask
62
Q

Airborne Precautions:

  • Involves pathogens smaller than __ microns that can remain suspended in the air for several hours and are dispersed by air currents
  • Infect host via ________ or ________ transmission
  • Examples?
A
  • 5 microns
  • inhalation or direct
  • TB, measles, chicken pox (via coughing and sneezing)
63
Q

Airborne Precautions Include:

  • __________ precautions
  • don and doff _________ outside of room
  • ________ room with negative pressure
A
  • standard
  • respirator
  • isolation
64
Q

Neutropenic Precautions:

-Neutropenia is

A
  • 1500

- immunocompromised

65
Q

Neutropenic Precautions Include:

  • Careful attention to _________________ and equipment before interacting with the patient
  • Healthcare professionals don mask when in patient’s room and patient wears mask if leaving their room
  • Restrictions on patient’s diet including avoidance of _________ fruit and vegetables, ____ water/ice
  • No fresh _______
  • Restriction on number of visitors and no visitors who feels ill
A
  • washing hands
  • uncooked, tap
  • flowers
66
Q

OUTCOME MEASURES

A

OUTCOME MEASURES

67
Q

List some tools specific to Acute Care.

A
  • AM PAC-6 Clicks (Activity Measure for Post Acute Care)
  • PFIT-s (Physical Function in the ICU Test - scored)
  • FSS-ICU (Functional Status Score for the ICU)
  • CPAx (Chelsea Crit Care Physio Ax tool)
  • ACIF (Acute Care Index of Function)
  • Perme ICU Mobility Score
  • DEMMI
  • ICU Mobility Scale
68
Q

What are the tools for short LOS (length of stay)?

A
  • AM PAC-6 Clicks
  • DEMMI
  • PFIT-s
  • FSS-ICU
69
Q
  • What does AM PAC-6 Clicks stand for?

- Raw cut-off score of ___ or less predicts institutional discharge.

A
  • Activity Measure for Post Acute Care

- 17 or less

70
Q

What 6 things do PTs evaluate in the AM PAC-6 Clicks?

A
  1. ) Turning over in bed
  2. ) Supine to sit
  3. ) Bed to chair
  4. ) Sit to stand
  5. ) Walk in room
  6. ) 3-5 steps with a rail
71
Q

What is the scoring for the AM PAC-6 Clicks?

A

1- Unable
2- A lot
3- A little
4- None

72
Q

What 5 things does DEMMI evaluate?

A
  • Bed
  • Chair
  • Static balance
  • Walking
  • Dynamic balance
73
Q

With DEMMI, the higher the score the _______ the mobility.

A

better

74
Q
  • What does PFIT-s stand for?

- What is the scoring?

A
  • Physical Function in the ICU Test - scored

- 0-12

75
Q

What 4 items does the PFIT-s look at?

A
  • Assistance (sit to stand)
  • Cadence (marching steps/min)
  • Shoulder strength (MMT)
  • Knee strength (MMT)
76
Q

With PFIT-s, the higher the score, the __________ level of independence.

A

increased

77
Q
  • What does FSS-ICU mean?

- This is based on ____ scoring but contains items more appropriate for this setting, such as what?

A
  • Functional Status Score for the ICU

- FIM; rolling, supine to sit/sitting to EOB, sit to stand, ambulation

78
Q

The FSS-ICU pulls __ items from the 18 item FIM.

A

4

79
Q

What is the scoring of the FSS-ICU?

A 
7=independent
6=Mod I
5=supervision
4=min assist
3=mod assist
2=max assist
1=dependent
80
Q

FSS-ICU Median Scores:

  • 28=
  • 20=
  • 9=
A
  • 28=home
  • 20=IP rehab
  • 9=SNF
81
Q

What are the tools for longer LOS (length of stay)?

A
  • CPAx
  • Perme ICU Mobility Score
  • ACIF
82
Q

CPAx is unique in its inclusion of __________ function.

A

respiratory

83
Q

What are the 10 components measures with the CPAx?

A
  • Respiratory function
  • Cough
  • Bed mobility
  • Supine to sitting EOB
  • Sitting balance (sitting at EOB unsupported)
  • Sit to stand
  • Bed to chair
  • Standing balance
  • Stepping
  • Grip strength
84
Q

How is the CPAx scored?

A
  • 0-5 with 0=Dependent and 5=Independent

- Total possible score of 50

85
Q

Higher CPAx scores are associated with _______ LOS.

A

shorter

86
Q

What are the items included on the Perme ICU Mobility Score?

A
  • Mental Status
  • Potential Mobility Barriers
  • Functional Strength
  • Bed Mobility
  • Transfers
  • Gait
  • Endurance
87
Q

What is the downside of the Perme ICU Mobility Score?

A

Can take between 15-60 minutes to complete.

88
Q

_______ Perme ICU Mobility Scores indicate few potential mobility barriers and decreased assistance needs.

A

higher

89
Q

-What does ACIF stand for?

A

-Acute Care Index of Function

90
Q

What 4 things does the ACIF look at?

A
  • Mental Status (MS)
  • Bed Mobility
  • Transfers
  • Mobility
91
Q

-With the ACIF, score of <0.4 on ICU d/c predicted to a setting other than home

A

0.4

92
Q

Is the FSS-ICU used for short or long LOS in ICU/acute care?

A

both short and long LOS

S4- Acute Care (15 decks)

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