Week 1- Introduction and Outcome Measures Flashcards
INTRODUCTION
INTRODUCTION
What 2 things make the Acute Care setting unique?
- Complexity of patients
- Duration of stay
What is the role of PT in Acute Care?
- Early mobilization
- Treatment (strength, endurance, mobility)
- Educate! (patient, family members, team)
- Discharge Planning- SHORT LENGTH OF STAY! (family/caregiver training)
What are the (5) parts of the PT Management Model for Acute Care?
- Examination
- Evaluation
- Diagnosis
- Prognosis
- Interventions
What is done during an examination?
Collect critical info such as medical/ social Hx, living environment, chief complaints, functional/activity level, medications.
What is done during an evaluation?
Systems review, communication, cognition/affect, anthropometric characteristics, AD, circulation, CN integrity, barriers to function, gait, motor function, orthotics/prosthetics, pain.
What is done during a diagnosis?
Interpretation of Exam and Eval data used to determine prognosis and interventions?
What is done during the prognosis?
Determine optimal level of improvement for short duration in acute care.
What is done during interventions?
Purposeful and skilled interaction between PT and patient used to enable patient to transition to lower level of care.
How are interventions different in acute care?
More so gross motor function compared to specific tasks.
With the examination it is important to __________ the essential information.
PRIORITIZE
What (5) things are included in the Systems Review of the evaluation?
- Cardiovascular/Pulmonary
- Integumentary
- Musculoskeletal
- Neuromuscular
- Cognition
When do we want to determine a patients Cardiovascular/Pulmonary status?
- Before
- During
- After
Most cardiac patients are hooked up to a ________ which is used to interpret HR and heart rhythm as well as MAP.
telemetry
What is the purpose of Integumentary?
Observe condition of the skin and inspect surgical incisions, indwelling lines, tubes, and bony prominences.
What things can lead to fragile skin?
- medications
- poor nutrition
- prolonged bed rest
Patients should be repositioned every __ hours and PTs should know positions to avoid such as sacral sitting.
2
With the Musculoskeletal review, we determine gross muscle ______ and _____. We also identify any joint ___________.
- tone and ROM (AROM and PROM)
- contractures
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
- neutral
- extension
- flex/ext
With the Neuromuscular review, the PTs are often the first healthcare providers to mobilize patients and are thus the first to ID ___________ issues.
neuromuscular
With the Cognition review it is important to determine consciousness, arousal, alertness, and orientation. Why?
Affects the patients ability to participate in PT and D/C plans.
What are the 4 parts of AOx4?
- person
- place
- time
- situation
What are some formal cognitive tests used to evaluate cognition?
- MMSE
- MoCA
During the evaluations, Tests and Measures may be applied to assess what (13) things?
- 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
What is an ABI and how is it taken?
- Measurement of how good circulation is in distal extremity.
- Take SBP ankle/SBP brachial, if lower than .9 indicates impaired circulation.
What monofilament is the cutoff for determining if someone has protective sensation on the bottom of their feet.
5.07 monofilament
What are some tools used for wound care and what are they?
- 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.
What are the (3) classifications of wounds?
- Decubitus ulcers (pressure sores)
- Diabetic neuropathic ulcers
- Chronic venous insufficiency ulcers
Should we assess pain in acute care?
Yes, it is a huge issue in acute care.
What (4) things should we assess in regards to pain?
- quality
- intensity
- location
- duration
What are some scales used to assess pain?
- Numeric rating scale
- VAS
- Wong-Baker faces pain scale
- FLACC scale (face, legs, activity, cry, consolability)
- COMFORT scale
- McGill pain scale
- Brief pain inventory
It is important to know patients pain management via their __________ or __________/__________ strategies to avoid increasing pain.
- medication
- positions/mobility
Diagnosis:
- _________ diagnosis already established
- Interpret lab results
- Interpret findings from PT examination and evaluation
- Do you need more information?
- What is your ____ diagnosis?
- Medical
- PT
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?
- D/C
- PLOF
- What is the goal of discharge planning?
- When does it start?
- Transition patient to next (lesser) level of care and optimize functional independence.
- Starts during Initial Evaluation.
List the Physical Therapy Settings from highest level of care to lowest level of care.
- ) ICU
- ) Acute Care
- ) Rehab, Subacute/TCU, SNF
- ) Outpatient, Home Health, Hospice
Does PT have a role in ICU care?
Yes, but depends on how hemodynamically stable that patient is so they can handle activity.
What is a PTs job in acute care?
- Where the patient will be discharged.
- If they still need care they go to rehab,subacute/TCU, or SNF which or still acute care.
What are the PT Settings if a patient can’t go home?
- Rehab
- Subacute/TCU
- SNF
- When can patients be admitted to inpatient rehab?
- When can patients be admitted to Subacute/TCU?
- When can patients be admitted to SNF?
- 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.
What are the PT Settings if a patient can go home?
- Home Health
- Outpatient
- Hospice
- When can patients be admitted to Home Health?
- When can patients be admitted to Outpatient?
- When can patients be admitted to Hospice?
- 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.
What (4) things should we do in regard to patient identification?
- Have patient state name and DOB
- Check wrist band
- Watch for name duplications/similarities
- Adhere to HIPAA
What are (4) things we can do to prevent falls?
- 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
Communication consists with ability to communicate with the ________ and ____________________.
Patient
- cognitive level
- education level
- pt understanding of condition
Interprofessional Team
- understanding role of team members
- when to make referrals
- SBAR
What positions make up the healthcare team?
- Physicians
- Nurses
- CNAs
- Case Manager/Social Worker
- PT/PTA
- OT/OTA
- Speech Language Pathologists
- Respiratory Therapists
- Dieticians/Nutritionists
What does SBAR stand for?
- Situation
- Background
- Assessment
- Recommendations
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
Nursing
For the following, we should report to who?
- Concerns that require change in care plan
- You may not see physician very often
Physician
If we have concerns about D/C plans, equipment or other special needs for home who should we report to?
Case Manager
If the patient progresses towards D/C who should we report to?
Rehab Team
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?
- nosocomial
- blood, all body fluids except sweat, nonintact skin, and mucous membrane
What is the most effective way to prevent spread of disease?
Handwashing
What PPE equipment is used in acute care?
- Gloves
- Gowns
- Face mask
- Face shield
- Protective eyewear
Transmission Based Precautions:
- When are they used?
- Are standard precautions still used?
- What are the 4 main types?
- 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
Contact Precautions:
- When are they used?
- Examples?
- Infectious microorganism transmitted by direct or indirect contact.
- MRSA, VRE, norovirus, C.diff, chicken pox
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
- standard
- private
- gloves and gown
Enteric Precautions:
- Type of ________ precaution.
- Used for containing what infectious agents?
- contact
- c.diff, norovirus, rotovirus
Enteric Precautions Include:
- _______________ with soap and water (alcohol will not kill spores)
- Equipment cleaned using ________-based disinfectant
- Use all other contact precautions
- HAND WASHING
- chlorine
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?
- 5 microns
- 3 feet
- pneumonia, influenza, whooping cough
Droplet Precautions Include:
- _________ precautions
- _______ room
- _________ for visitors or patient if they leave the room
- Goggles or face shield in case of potential spray
- standard
- private
- face mask
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?
- 5 microns
- inhalation or direct
- TB, measles, chicken pox (via coughing and sneezing)
Airborne Precautions Include:
- __________ precautions
- don and doff _________ outside of room
- ________ room with negative pressure
- standard
- respirator
- isolation
Neutropenic Precautions:
-Neutropenia is
- 1500
- immunocompromised
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
- washing hands
- uncooked, tap
- flowers
OUTCOME MEASURES
OUTCOME MEASURES
List some tools specific to Acute Care.
- 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
What are the tools for short LOS (length of stay)?
- AM PAC-6 Clicks
- DEMMI
- PFIT-s
- FSS-ICU
- What does AM PAC-6 Clicks stand for?
- Raw cut-off score of ___ or less predicts institutional discharge.
- Activity Measure for Post Acute Care
- 17 or less
What 6 things do PTs evaluate in the AM PAC-6 Clicks?
- ) Turning over in bed
- ) Supine to sit
- ) Bed to chair
- ) Sit to stand
- ) Walk in room
- ) 3-5 steps with a rail
What is the scoring for the AM PAC-6 Clicks?
1- Unable
2- A lot
3- A little
4- None
What 5 things does DEMMI evaluate?
- Bed
- Chair
- Static balance
- Walking
- Dynamic balance
With DEMMI, the higher the score the _______ the mobility.
better
- What does PFIT-s stand for?
- What is the scoring?
- Physical Function in the ICU Test - scored
- 0-12
What 4 items does the PFIT-s look at?
- Assistance (sit to stand)
- Cadence (marching steps/min)
- Shoulder strength (MMT)
- Knee strength (MMT)
With PFIT-s, the higher the score, the __________ level of independence.
increased
- What does FSS-ICU mean?
- This is based on ____ scoring but contains items more appropriate for this setting, such as what?
- Functional Status Score for the ICU
- FIM; rolling, supine to sit/sitting to EOB, sit to stand, ambulation
The FSS-ICU pulls __ items from the 18 item FIM.
4
What is the scoring of the FSS-ICU?
7=independent 6=Mod I 5=supervision 4=min assist 3=mod assist 2=max assist 1=dependent
FSS-ICU Median Scores:
- 28=
- 20=
- 9=
- 28=home
- 20=IP rehab
- 9=SNF
What are the tools for longer LOS (length of stay)?
- CPAx
- Perme ICU Mobility Score
- ACIF
CPAx is unique in its inclusion of __________ function.
respiratory
What are the 10 components measures with the CPAx?
- 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
How is the CPAx scored?
- 0-5 with 0=Dependent and 5=Independent
- Total possible score of 50
Higher CPAx scores are associated with _______ LOS.
shorter
What are the items included on the Perme ICU Mobility Score?
- Mental Status
- Potential Mobility Barriers
- Functional Strength
- Bed Mobility
- Transfers
- Gait
- Endurance
What is the downside of the Perme ICU Mobility Score?
Can take between 15-60 minutes to complete.
_______ Perme ICU Mobility Scores indicate few potential mobility barriers and decreased assistance needs.
higher
-What does ACIF stand for?
-Acute Care Index of Function
What 4 things does the ACIF look at?
- Mental Status (MS)
- Bed Mobility
- Transfers
- Mobility
-With the ACIF, score of <0.4 on ICU d/c predicted to a setting other than home
0.4
Is the FSS-ICU used for short or long LOS in ICU/acute care?
both short and long LOS
