geriatric/inpatient Flashcards
1
Q
IP frame of mind - examination
IP/home management
A
- chart review
- pateitn interview: PLOF, current ADLs, support system, living environment
- systems review: cognitive/communication, psycho-emotional, CV/P, integumentary, MSK, NM, movement system benchmark task
- physical exam items: including outcome measures
2
Q
chart review “keys”
IP/home management
A
- PMH, admission information
- PLOF
- living situation and support
- medications
- imaging
- operative report
- precautions (WB status)
- lab values
3
Q
lab values
IP/home management
A
- hemoglobin (Hgb): iron rich protein in RBCs carrying O2 to tissues
- male: 13.5-17.5 g/dl
- female: 12-15.5 g/dl
- hematocrit (Hct): measure of how much space RBCs take up in blood
- male: 38.5-50%
- female: 34.9-44.5%
- prothrombin time (PTT): measure for clotting factors that assesses for clotting deficiencies (too low is blood clot, too high is bleeding risk)
- normal 11-13.5
- international normalized ratio (INR): ratio of PTT in reference to normal range
- normal 2-3 with anticoagulants
- blood glucose levels: fasting 70-110 mg/dL
warfarin/coumadin: PT/INR
heparin: PTT
4
Q
risk factors for DVT
IP/home management
A
5
Q
diagnosing DVT
IP/home management
A
6
Q
PE risk factors
IP/home management
A
7
Q
diagnosing PE
IP/home management
A
8
Q
screening for fall risk
IP/home management
A
- qualitative assessment
- tests/meaures: TUG, 5xSTS, 4m/10m gait speed, functional reach test (FRT)
- additional: 6MWT, 2MWT, Berg, functional gait assessment, dynamic gait index, performance oriented mobility assessment (POMA), short physical performance battery (SPPB)
9
Q
exam essentials - benchmark tasks
IP/home management
A
- bed mobility
- transfers: floor, chair, commode, car
- gait
- stair navigation
10
Q
key considerations after IP exam
IP/home management
A
- prognosis and discharge planning
- screening/referrals
- communication with other providers
- post-discharge recommendations: impacts re-hospitalization rates
11
Q
PT role in early recovery
IP/home management
A
- prevention: complications - pneumonia, DVT, HAD, contractures, debuti, post-surgical precautions
- compensation: promote safe, functional independence with ADs, braces, education and movement training
- remediate: pain, mobility issues, wound healing
- referral to other disciplines: mental health, ADL needs, speech/swallowing
- discharge planning: destiation (home, SNF, IP rehab), level of support equipment/devices needed, safety, recommendation on further rehab (home, OP)
- communication is critical: documenation, verbal handoffs
12
Q
re-admission risks
IP/home management
A
- chances of re-admission 3x more likely is discharge plan by PT not followed
- current level of function
- functional trajectory (stable, improving, declining)
- barriers to care (level of support, availability of services)
- 37% increased risk of readmission with unmet ADL needs
13
Q
home health
IP/home management
A
- qualification for home health
- physician must certify that patient is home bound (patient needs assistance or requires great physical effort to leave)
- patient must be under a doctor’s care
- typically only leave home for appointments (or religious services)
- patient requires skilled therapy (important for documentation)
- considerations
- personal/patient safety: learn who is currently in home, each visit - record falls, ER visits, med changes, vital signs
- bring barrier for bag
- patient in decline/distress: call PCP and provide details, call 911 if decline continues
14
Q
examples of skilled home health services include
IP/home management
A
- wound care for pressure sores or a surgical wound
- patient and caregiver education
- specialized therapy services, including PT, OT, and SLP
- intravenous or nutrition therapy
- injections
- monitoring serious illness and unstable health status
15
Q
most common diagnoses in home health
IP/home management
A
- total joint replacements
- fractures
- CVA
- progressive neurological conditions
- fall risk
- dementia
- chronic pain
- incontinence
- wounds
- COPD
- heart failure
16
Q
skills used by PT in home health
IP/home management
A
- gait training
- transfer training
- home exercise programdevelopment
- home exit management
- fall prevention
- progressive resistaive exercises
- pain management
- incontinence training
- wound care
- neuropathy treatment
17
Q
safety in home health
IP/home management
A
- situational safety: observe your environment, pets/other obstacles, use all situational awareness aspects
- patient safety and emergency response: PCP, 911, dispatch health
- personal safety
18
Q
home health documentation
IP/home management
A
- OASIS: for start of care, 335 pages
- home bound status
19
Q
summary of home health
IP/home management
A
- home health serves a variety of patients who have complex health needs and who are home bound
- team of care providers
- need for outcome measures to show skilled need and progression
- OASIS is standard for initial examination documentation and serves to open the case
- as a new graduate, look for an agency which provides mentoring
20
Q
older adult are what percent of average PT caseload
IP/home management
A
46%
