L3 Chronic Conditions

Question 1

Medically Complex Patients

Answer 1

severely ill patients with multiple co-morbidities, who require hospitalizations for an extensive period of time

a group of pts of which most have concurrent chronic conditions

Question 2

what is a chronic condition?

Answer 2

any physical or mental condition that lasts one year or more and that requires ongoing medical attention/treatment and/or limits function or ADLs

Question 3

Definition of serious and complex medical conditions

Answer 3

• life threatening
• serious disability w/o necessarily being life threatening
• significant pain or discomfort causing serious interruptions to life activities
• require major commitments of time from caregivers for substantial periods
• frequent monitoring
• severe consequences
• negative consequences for caregiver
• affects multiple organ systems
• tight phsyiological parameters
• coordination of multiple specialities
• adjustment of non-medical environment

Question 4

How many adults have at least one chronic disease?

Answer 4

6 out of 10

Question 5

How many adults have two or more chronic diseases?

Answer 5

4 out of 10

Question 6

What percentage of US adults have 5 or more chronic conditions?

Answer 6

12%

Question 7

Top four practices to help limit prevalence of chronic conditions

Answer 7

don’t smoke
eat healthy
be active
limit alcohol

Question 8

What is our role as HCPs?

Answer 8

Prevent
Manage/rehab
Maintain

Question 9

APTA stance on chronic conditions

Answer 9

PTs roles include education, direct intervention, research, advocacy, collaborative consultation

dynamic bridge between health and health services delivery

Question 10

Medicare and Skilled Therapy

Answer 10

can be used to maintain the pts current condition, improve, or prevent/slow further deterioration of pts condition

Question 11

Considerations for Rehab/Management of Patient with Chronic Conditions

Answer 11

1. Individualized POCs
2. Vital Sign Analysis
3. Standardized Testing
4. Activity/Exercise Prescription

Question 12

Individualized POCS

Answer 12

Short Term Goals: different goals to address chronic timeline

Approaches to tx and therapy: remember that poc will be longer and lighter intensity

patient may demonstrate little to no change in comparison to other patients without chronic conditions

Question 13

Who qualifies for an altered POC?

Answer 13

Presence of an active chronic condition

presence of one or more qualifying impairments

Question 14

Qualifying impairments for altered POC

Answer 14

• SOB/dyspnea
• fatigue/overexertion
• prolonged recovery
• diminished aerobic capacity
• abnormal cardiopulomary response

Question 15

Short Term Goals for chronic patients

Answer 15

• be for sub-tasks vs full functional tasks
• include response measure w/the function
• include a key/limiting impairment with the function
• have a longer recommended duration
• progress POC slower or differently than others

Question 16

General treatment approaches for chronic conditions

Answer 16

• resistance and aerobic
• balance
• fall prevention
• home safety
• disease mgmt
• self monitoring of vitals
• pacing/breathing/energy conservation
• HEP

Question 17

What is a vital sign response measure?

Answer 17

using vitals as baseline for exercise or intervention intensity

Question 18

Why are vital sign measurements important?

Answer 18

1. Safety
2. Shows how well patient is tolerating the selected activity and dosage
3. Supports and guides decisions to progress or regress

Question 19

Assessment of patient response

Answer 19

patient demonstrated ___ cardiopulmonary response during ___ as evidenced by ___

Question 20

Responses of patients list

Answer 20

Normal
Abnormal
Expected
Unexpected

Question 21

Normal response

Answer 21

cardiopulmonary response stays within at or below calculated or expected response measure range or target

Question 22

Abnormal response

Answer 22

cardiopulmonary response does not stay within at or below or goes outside calculated or expected response measure range or target

Question 23

Expected response

Answer 23

cardiopulonary response is calculated and expected to demonstrate a normal or abnormal response given phsiological norms/definitions and exercise/activity/intensities/durations/mods and does

Question 24

Unexpected Response

Answer 24

cardiopulmonary response is calcualted and expected to demonstrate a normal or abnormal reponse given phsyiological norms and exercise and does not

Question 25

ACSM Intensity Guidelines for older adults Resistive

Answer 25

Int = 40-60% of 1 RM
Vol = 10-15 reps
Freq = 2 days/week

Question 26

How to establish correct resistance without one rep max

Answer 26

1. After two reps, ask pt “is that fairly light, somewhat hard, or hard”, change weight appropriately
2. Have pt perform reps until they demonstrate momentary fatigue (inability to go through full ROM)

Question 27

You should maintain the weight if

Answer 27

patient can complete number of reps ≥ minimum reps but less than maximum reps

Question 28

When is skilled therapy needed

Answer 28

1. an unstable pt whose response varies daily so activity/exercise prescription and dosage changes daily
2. Patient who may be safe to transition to a wellness/nursing/restorative/or personal program but need a reassessment, mod, or advancement in 30-60 days

Question 29

ACSM definitions for older adults

Answer 29

65 OR
55 with chronic condition

Question 30

When should a weight be decreased

Answer 30

patient was unable to complete minimum number of indicated reps

Question 31

When should weight be increased

Answer 31

patient completes more than maximal number of indicated reps

Question 32

Resistive exercises for older adults for systemic review

Answer 32

significant improvements in muscle strength and functional performance occur in response to progressive resistance training despite advanced age, presence of chronic diseases, extremely sedentary habits, and functional disabilities in older institutionalized individuals