Clinical decision making Flashcards

1
Q

the outcomes of clinical reasoning are ?

A

clinical decisions

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2
Q

what is clinical reasoning?

A

the synthesis of information based on evidence
includes patient, caregivers, and care team

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3
Q

what are the three pillars of evidence based practice?

A

best available evidence
clinical expertise
patient or client values

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4
Q

what are systematically developed statements to guide clinicians in using best available clinical evidence in patient’s care?

A

CPGs

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5
Q

CPGs bridge the gap between ______ and ________

A

evidence and recommendation

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6
Q

conceptual framework:
- provides _____
- ______ and ______ data
- influences _______
- guides _______

A

structure
gathers and organizes
decisions
care

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7
Q

conceptual framework is a tool for ______
example?

A

organization or model used for decision making
ex: ICF model, Schenkman model

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8
Q

true or false. integrated framework for CDM focuses on patient centered care and hypothesis-oriented algorithm for clinicians

A

true

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9
Q

Why do we use hypothesis in the clinic and in CDM?

A

helps to determine the relationship between functional limitations and underlying impairment

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10
Q

clarifying the causes of functional movement problems requires the clinician to?

A
  1. generate hypothesis (or multiple)
  2. determine tests and expected outcomes
  3. perform the tests
  4. continue generating and testing hypotheses to refine an understanding of the cause
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11
Q

hypothesis-oriented approach of schenkman model is similar to what other model? what step?

A

hedman model
step 4: treat the problem
(form hypothesis, implement interventions, evaluate outcomes, repeat)

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12
Q

when do you start forming hypotheses for your patient?

A

chart review
patient interview

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13
Q

what type of screen would you perform for
- MSK
- neuromuscular
- cardiovascular/pulm:
- cognitive ability

A
  • motor screen
  • sensory screen
  • vital signs
  • cognitive screen
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14
Q

motor control is governed by what three factors?

A

task
environment
individual

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15
Q

Hedman model step 2:

A

analyze the task. where in the movement continuum does the problem occur?

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16
Q

what are contextual factors of the ICF model that help to interpret clinical information? (5)

A

environmental factors
personal factors
body functions and structure
activity
participation

17
Q

what is the difference between a PT diagnosis and medical diagnosis?

A

PT: includes level of impairment, activity limitation, participation restrictions

med: identification of disease, disorder or condition

18
Q

what is a prognosis?

A

predicted optimal level of improvement in function and amount of time needed to reach
helps determine where they can d/c to

19
Q

list some aspects of motor learning

A

goal
learning variables
dosing of treatments
practice schedules
altering the environment
feedback education
compensation vs restoration
progressions vs regression

20
Q

what are the three stages of learning in order to help with deciding when to progress or regress your patient? describe them

A
  1. cognitive
    - closed environ., massed practice, constant cues & immediate feedback
  2. associative
    - open vs closed, high variability, fading cues, delayed feedback
  3. autonomous
    - open, random, bandwidth for safety
21
Q

how do short term goals differ from long term goals?

A

short term: should be progressible toward similar long term goal

long term: relates to discharge goals

22
Q

what is the ABCDE model goals should be written as in physical therapy?

A

actor
behavior
condition
degree
expected time

23
Q

is the following an example of a short or long term goal for a patient in inpatient rehab:

patient will perform sit to stand in order to transfer out of bed on level surface similar to home independently in 2 weeks

A

short term goal

24
Q

what categories of the ICF model does short term goals fall into?

A

patient’s body function and activity disabilities

25
Q

what categories of the ICF model does long term goals fall into?

A

patient’s participation disabilities

26
Q

true or false. only one discipline of the care team decides on the discharge plan for a patient

A

false - everyone on the team

27
Q

what is PTs role in DC planning?

A

mobility and safety

28
Q

if the patient is discharged before outcomes are reached, reasons for discontinuation of services must be _____ ________

A

carefully documented

29
Q

what are discharge options from acute care setting?

A

home (with HHPT or support system)
sub acute rehab
inpatient rehab

30
Q

what is the flow of the schenkman model?

A

interview history
systems review
exam
diagnosis/prognosis
plan of care interventions
outcome

31
Q

when is a neuro screen conducted?

A

during systems review

32
Q

a neurological screen is a _______ assessment of neurologic aspects of the ______ ______ for patients with suspected neurologic involvement

A

gross/broad
physical examination

33
Q

what are you screening for in a neuro screen of someone with a suspected neurological impairment?

A

sensation
muscle tone, strength
functional movement
coordination
DTRs (clonus)
UMN signs (babinski, hoffman)

34
Q

why do we perform a neurological screen?
- screen for _____ _____ and for _____
- differential _______
- establish ______
- observe for ______

A

red flags and referral
diagnosis
baseline
changes

35
Q

a screen is ______ to rule ____/rule______
an exam is further ______ into a specific _____

A

quick, in, out
investigation, system

36
Q

in your screen, you find that your patient experiences sensory changes in their LEs. what is your next step?

A

go into more testing of light touch, pin prick and determine exact location

37
Q

should you perform a neuro screen on a patient with no neurologic diagnosis?

A

no

38
Q

when should you complete a neuro screen?

A

if the patient’s S&S or history guide you to dig deeper by choosing portions or all of the exam

39
Q

flow of a neuro screen:
_____ review
observations & _____ status
systems review
–> ROM/_____/DTR/______
______ nerve screen
functional ______ screen

A

chart
mental
strength/sensation
cranial
mobility