Flashcards in Decision Making & Clinical Handover Deck (17)
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1
What needs to be considered when making decisions in cardio physio?
- Info from medical file
- Info from patient (subjective)
- Physical assessment findings
- Tests & investigations
- Evidence from literature
- Clinical experience
- Patient preference
- Availability, cost time
2
What is the step by step process of making decisions?
- Clearly understand the story so far
- Conduct patient-specific assessment (subjective/objective)
- Interpret data
- Select best treatment
- Implement and evaluate
3
What is involved in understanding a patient's story so far?
- Why is the patient here (HPI)
- Background (PHx, SHx)
- What investigations have been done/what do the results mean
- What is the current diagnosis (impression)
- What is the medical plan
- Who has referred the patient to physio
4
What are the different types of referrals?
Blanket referral:
- Screening list of patients on a ward
- Identify those who may benefit from physio
- Liase with MDT
Referral from other HCP:
- Requires clinical handover
5
What is a clinical handover?
Transfer of professional responsibility for care of a patient to another person
6
What is the ISBAR method of clinical handover?
Introduction
- Yourself/role
- Patient (age, location, context)
Situation
- Main symptoms/problems/concern
- Patient stability/urgency of concern
Background
- Relevent medical/surgical history
- May include SHx
Assessment
- Current findings/interpretation
- What have you done so far
Recommendation (plan)
- What you want done
- Treatment that requires monitoring
- Review (when/by whom)
7
What data needs to be interpreted following an objective assessment?
- Vital signs
- Observation/palpation
- Auscultation
- ABGs
- CXR/CT/MRI
- Comparison to normal values
- What is normal for the patient
8
What are the 3 main respiratory problems amenable to physio?
- Increased WOB (dyspnoea)
- Impaired sputum clearance
- Lung collapse (atelectasis)
9
What are some of the acute respiratory problems that are not amenable to physio?
- Acute pulmonary oedema (APO)
- Pleural effusion (only resolved by catheter)
- Pneumothorax
- Bronchiolitis (babies)
- Asthma (bronchoconstriction)
- Pulmonary embolism
- Consolidated pneumonia (no evidence of sputum)
10
What should you do if you identify a problem that is not amenable to physio?
- Go back to the referral source
- Explain why physio can't help
- Document accordingly
11
What needs to be considered when selecting a treatment?
- What does the evidence suggest
- What does the patient prefer (what has worked well in the past)
- What is available
- What is practical/feasible
- What is cost-effective
- Short term vs long term
- Contraindications & precautions
12
What are the treatment options for increased WOB?
- Support accessory muscles
- Pursed lip breathing
- IMT (long term)
13
What are the treatment options for impaired sputum clearance?
- Mobilisation
- PEP
- ACBT
- Postural drainage
- Percussion & vibration
14
What are the treatment options for lung collapse (atelectasis)?
- PEP
- Gravity
- Positive pressure
- Mobilisation
15
What is an important thing to remember when selecting a treatment?
Explain to the patient how the treatment will help them with their problem
16
What needs to be considered during re-evaluation?
- What changed
- Is it improving/worsening/staying the same
17
