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S4- CP3 > Week 1- Prognosis, POC, and Reexamination > Flashcards

Week 1- Prognosis, POC, and Reexamination Flashcards

1
Q

PART 1

A

PART 1

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2
Q

Clinical reasoning should be present in ________ _________ as well as __________.

A
  • patient encounters

- documentation

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3
Q

Documentation helps to ensure ___________ as well as protect your license in the event of a legal inquiry.

A

reimbursement

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4
Q

What is the definition for prognosis?

A

The predicted optimal level of improvement in function and amount of time to reach that level.

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5
Q

The prognosis is established after the ________ is determined and is crucial in the development of the _______.

A
  • diagnosis

- POC

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6
Q

In addition to predicting the optimal level of improvement and amount of time to reach that level, the prognosis must also include what?

A

Discussion of factors likely to influence prognosis to justify reasoning for determining the prognosis. (prognostic factors)

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7
Q

What things will we keep in mind when developing a prognosis?

A
  • Health Condition
  • Impairments
  • Activity Limitations
  • Participation Restrictions
  • Contextual Factors
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8
Q

What are some things that can influence a prognosis?

A
  • Age
  • Motivation/Patient compliance
  • Prior activity level
  • Home support
  • Cognitive/mental status
  • Comorbidities
  • Anatomical changes secondary to dysfunction
  • Health status
  • Psychosocial and socioeconomic factors
  • Availability to resources
  • Acute vs Chronic problem
  • Concomitant conditions
  • Severity of the current condition/level of impairment
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9
Q
  • What model do we use to determine prognosis?

- It is determined by synthesizing the data collected through the __________ process.

A
  • ICF Model

- examination

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10
Q

Examples:

  1. )What are we likely to conclude with a patient that demonstrates significant deficit in quad strength and activation?
  2. ) What are we likely to determine if a patient is highly motivated to return to sport coupled with the fact that the patient was healthy and active prior to injury?
A
  1. ) Likely to conclude that regaining full quad strength/neuromuscular control will exceed normal or expected timeframe.
  2. ) Likely to determine this patient will achieve predicted optimal level of function at an accelerated rate.
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11
Q
  • Whenever documenting a prognosis, it is important to make an _________ (_____________) statement regarding the patient’s capacity to improve to the level you have designated as their predicted optimal level of function.
  • This should include the details on why you are making this judgement and a discussion of the ________ factors influencing this.
A
  • explicit (excellent, good, fair, poor)

- prognostic factors

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12
Q

Why is it important to make an explicit statement when writing a prognosis?

A

Supports or justifies the need for skilled PT

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13
Q

Where is the prognosis documented in the initial evaluation and/or reevaluation?

A

POC or Assessment

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14
Q

Documentation: Prognosis:

  • Need to include ______ _______ as part of your prognosis.
  • This is documented in the _________ or _________.
  • Typically a ____-word statement (excellent, good, fair or poor).
  • However, the statement needs to be substantiated by your clinical reasoning for coming to this conclusion.
A
  • rehab potential
  • POC or Assessment
  • one
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15
Q

What is missing in this prognosis and rehab potential statement?
“The patient demonstrates excellent prognosis & rehab potential.”

A
  • clinical reasoning
  • level of function expected
  • timeframe
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16
Q

For very complex patients, we may need to justify skilled care from the standpoint of ___________ needs and family education training.

A

equipment

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17
Q

PART 2: POC DEVELOPMENT

A

PART 2: POC DEVELOPMENT

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18
Q

What is the POC?

A

Specifies the general interventions to be used and the anticipated frequency and duration of episode of care.

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19
Q

What are the 4 components of the POC?

A
  • Specific goals
  • Predicted level of optimal improvement/anticipated discharge plans
  • General interventions to be used
  • Proposed duration and frequency
20
Q

The POC will always be created with initial evaluations as well as ____________.

A

reevaluation

21
Q

List some factors that are likely to influence POC development.

A

-Accessibility and availability of resources
-Adherence to the intervention program
-Age
-Anatomical and physiological changes related to growth and development
-Caregiver consistency or expertise
-Chronicity or severity of the current condition
-Cognitive status
-Comorbidities, complications, or secondary impairments
-Concurrent medical, surgical, and therapeutic interventions
-Decline in functional independence
-Level of impairment
-Level of physical function
-Living environment
-Multisite or multisystem involvement
-Nutritional status
-Overall health status
-Potential destinations at the conclusion of the episode of care
-Premorbid conditions
-Probability of prolonged impairment in body functions and structures, activity limitations, or
participation restrictions
-Psychomotor abilities
-Psychosocial and socioeconomic factors
-Social support
-Stability of the condition

22
Q

Goals:

  • Can be _____ or _____ term
  • Apply the ICF model to goal writing (_________, ______, and ________ goals)
  • What 5 things must goals be?
A
  • short or long term
  • Participation, Activity, and Impairment Goals
  • patient centered, objective, measurable, functional, and include a time element for achieving the goal
23
Q

It is important to relate goals back to _________.

A

function

24
Q

Can you reveal new information in the goals that has not been discussed previously in your note?

A

No

25
Q

Your ________, ______ measures, and ________ goals obtained in your history should guide goal writing.

A

tests and measures, outcome measures, and patient’s goals

26
Q

Goals should be directly related to what 3 things?

A
  • impairments
  • activity limitations
  • participation restrictions
27
Q

Predicted Level of Optimal Improvement/Anticipated Discharge Plans:

  • Can be documented in ____ or __________.
  • Important to also list additional details regarding _________ plans including coordination with any other team care members.
A
  • POC or Assessment

- discharge

28
Q

General Interventions to be Used:

  • Indicate _______ areas of intervention necessary to achieve goals.
  • Remember, if you did not measure a specific characteristic, you ______ set a goal for it.
  • It is also appropriate to indicate how the intervention is intended to be ________.
A
  • broad
  • cannot
  • delivered (PT/PTA team, PT other than evaluating PT)
29
Q

Interventions should be specifically chosen for the patient based on what 4 things?

A
  • impairments
  • activity limitations
  • participation restrictions
  • contextual factors
30
Q

Implementing interventions based solely on an intervention protocol or by diagnosis goes against the ___________ and is not representative of _______-_________ care.

A
  • ICF model

- patient-centered

31
Q

Proposed Duration and Frequency:

  • What is frequency?
  • What is duration?
  • Both may be estimated by taking what into consideration?
  • Be sure to include the _______ (and family member/caregivers when appropriate) in this decision.
A
  • Frequency=how often you will provide PT services
  • Duration=anticipated length of the episode of care
  • setting practicing in, capacity of patient to participate in POC, patient transportation needs, limitations from 3rd party payers
  • patient
32
Q

When do you document progress?

A

Essentially at every patient encounter.

33
Q

Documenting progress can occur in what 3 areas?

A
  • Daily note (brief summary of progress)
  • Progress report (more detailed summary of progress than in daily note, compares current status to previous timeframe)
  • Reexamination (most detailed form of summary of progress)
34
Q

PART 3: POC MODIFICATION AND REEXAMINATION DOCUMENTATION

A

PART 3: POC MODIFICATION AND REEXAMINATION DOCUMENTATION

35
Q

When does assessment of the patients response to treatment occur?

A

Every patient encounter

36
Q

Alterations of the POC need to occur with what patient change in status?

A
  • diminished
  • not changed
  • improved
37
Q

Modifications to a POC require what to be performed?

A

Reevaluation

38
Q

Describe each of the situations as diminished, not changed, or improved.

  1. ) Treating a patient for non-operative rotator cuff tear and the patient had surgery.
  2. ) Treating an athlete for a mild ankle sprain and they have currently achieved the goals set at initial evaluation
  3. ) Treating a patient for low back pain that has made no progress after 4 weeks of treatment
  4. )Treating a patient for poor balance and they had a fall at home that has limited their function compared to how they presented at initial evaluation
A
  1. ) diminished
  2. ) improved
  3. ) not changed
  4. ) diminished
39
Q

Why is a reexamination performed?

A

To evaluate progress and to modify or redirect intervention.

40
Q

What are some reasons to perform a reexamination?

A
  • unanticipated change in patient status
  • failure to respond to PT interventions as expected
  • need for a new POC and/or time factors based on state practice act or other requirements
41
Q

What are the (4) components of the reexamination?

A
  1. ) Clinical impressions or diagnosis
  2. ) Objective reassessment of tests and measures and outcome tools
  3. ) Goal status
  4. ) Evaluation
42
Q

Clinical impressions or diagnosis is where we update the patients ___________ status, based on ___________ limitations and _________ restrictions.

A
  • functional

- activity limitations and participation restrictions

43
Q

During the reassessment of tests and measures and outcome tools, can we add new ones?

A

Yes, if the patient’s current presentation requires

44
Q

During goal status we list progress towards goals, can we add new goals?

A

Yes, or revise current goals

45
Q

During the evaluation (assessment):

  • Interpretation of _____ and _______ and _________
  • Interpretation of _____ achievement status
  • _________ status
  • Updated frequency and duration of the episode of care
  • Statement of why skilled intervention is recommended
  • Statement of plan to transition to next level of care
A
  • tests and measures and outcome tools
  • goal
  • prognostic

S4- CP3 (7 decks)

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