Week 1- Introduction and Outcome Measures Flashcards
1
Q
INTRODUCTION
A
INTRODUCTION
2
Q
What 2 things make the Acute Care setting unique?
A
- Complexity of patients
- Duration of stay
3
Q
What is the role of PT in Acute Care?
A
- Early mobilization
- Treatment (strength, endurance, mobility)
- Educate! (patient, family members, team)
- Discharge Planning- SHORT LENGTH OF STAY! (family/caregiver training)
4
Q
What are the (5) parts of the PT Management Model for Acute Care?
A
- Examination
- Evaluation
- Diagnosis
- Prognosis
- Interventions
5
Q
What is done during an examination?
A
Collect critical info such as medical/ social Hx, living environment, chief complaints, functional/activity level, medications.
6
Q
What is done during an evaluation?
A
Systems review, communication, cognition/affect, anthropometric characteristics, AD, circulation, CN integrity, barriers to function, gait, motor function, orthotics/prosthetics, pain.
7
Q
What is done during a diagnosis?
A
Interpretation of Exam and Eval data used to determine prognosis and interventions?
8
Q
What is done during the prognosis?
A
Determine optimal level of improvement for short duration in acute care.
9
Q
What is done during interventions?
A
Purposeful and skilled interaction between PT and patient used to enable patient to transition to lower level of care.
10
Q
How are interventions different in acute care?
A
More so gross motor function compared to specific tasks.
11
Q
With the examination it is important to __________ the essential information.
A
PRIORITIZE
12
Q
What (5) things are included in the Systems Review of the evaluation?
A
- Cardiovascular/Pulmonary
- Integumentary
- Musculoskeletal
- Neuromuscular
- Cognition
13
Q
When do we want to determine a patients Cardiovascular/Pulmonary status?
A
- Before
- During
- After
14
Q
Most cardiac patients are hooked up to a ________ which is used to interpret HR and heart rhythm as well as MAP.
A
telemetry
15
Q
What is the purpose of Integumentary?
A
Observe condition of the skin and inspect surgical incisions, indwelling lines, tubes, and bony prominences.
16
Q
What things can lead to fragile skin?
A
- medications
- poor nutrition
- prolonged bed rest
17
Q
Patients should be repositioned every __ hours and PTs should know positions to avoid such as sacral sitting.
A
2
18
Q
With the Musculoskeletal review, we determine gross muscle ______ and _____. We also identify any joint ___________.
A
- tone and ROM (AROM and PROM)
- contractures
19
Q
ROM Areas of Focus for Upright Standing:
- Ankles: need to achieve _______ ROM to WB through balls of feet
- Knees: need to achieve full knee _____ ROM for increased standing stability
- Hips: need to achieve neutral hip _____/_____ ROM for increased standing stability
A
- neutral
- extension
- flex/ext
20
Q
With the Neuromuscular review, the PTs are often the first healthcare providers to mobilize patients and are thus the first to ID ___________ issues.
A
neuromuscular
21
Q
With the Cognition review it is important to determine consciousness, arousal, alertness, and orientation. Why?
A
Affects the patients ability to participate in PT and D/C plans.
22
Q
What are the 4 parts of AOx4?
A
- person
- place
- time
- situation
23
Q
What are some formal cognitive tests used to evaluate cognition?
A
- MMSE
- MoCA
24
Q
During the evaluations, Tests and Measures may be applied to assess what (13) things?
A
- Cognition
- Aerobic Capacity/Endurance
- Anthropometric Characteristics
- Circulation
- Cranial and Peripheral Nerve Integrity
- Integumentary
- Muscle Performance
- Motor Function
- Gait, Locomotion, Balance
- Assistive Devices
- Orthotic, Supportive, Prosthetic Equipment
- Environmental/Home/Work Barriers
- Pain
25
What is an ABI and how is it taken?
- Measurement of how good circulation is in distal extremity.
- Take SBP ankle/SBP brachial, if lower than .9 indicates impaired circulation.
26
What monofilament is the cutoff for determining if someone has protective sensation on the bottom of their feet.
5.07 monofilament
27
What are some tools used for wound care and what are they?
- Pressure Ulcer Scale for Healing (PUSH) = Monitors healing over time via (3) parameters which are; SA of wound, wound exudate, type of wound tissue.
- Braden and Norton Scales = Predict likelihood of developing ulcer.
28
What are the (3) classifications of wounds?
- Decubitus ulcers (pressure sores)
- Diabetic neuropathic ulcers
- Chronic venous insufficiency ulcers
29
Should we assess pain in acute care?
Yes, it is a huge issue in acute care.
30
What (4) things should we assess in regards to pain?
- quality
- intensity
- location
- duration
31
What are some scales used to assess pain?
- Numeric rating scale
- VAS
- Wong-Baker faces pain scale
- FLACC scale (face, legs, activity, cry, consolability)
- COMFORT scale
- McGill pain scale
- Brief pain inventory
32
It is important to know patients pain management via their __________ or __________/__________ strategies to avoid increasing pain.
- medication
| - positions/mobility
33
Diagnosis:
- _________ diagnosis already established
- Interpret lab results
- Interpret findings from PT examination and evaluation
- Do you need more information?
- What is your ____ diagnosis?
- Medical
| - PT
34
Prognosis:
- Key piece of info to determine ____ status
- Consider patient’s _____, current medical status
- How likely is patient to return to PLOF?
- What does patient need in order to return to PLOF?
- What is direction of physical therapy?
- D/C
| - PLOF
35
- What is the goal of discharge planning?
| - When does it start?
- Transition patient to next (lesser) level of care and optimize functional independence.
- Starts during Initial Evaluation.
36
List the Physical Therapy Settings from highest level of care to lowest level of care.
1. ) ICU
2. ) Acute Care
3. ) Rehab, Subacute/TCU, SNF
4. ) Outpatient, Home Health, Hospice
37
Does PT have a role in ICU care?
Yes, but depends on how hemodynamically stable that patient is so they can handle activity.
38
What is a PTs job in acute care?
- Where the patient will be discharged.
| - If they still need care they go to rehab,subacute/TCU, or SNF which or still acute care.
39
What are the PT Settings if a patient can't go home?
- Rehab
- Subacute/TCU
- SNF
40
- When can patients be admitted to inpatient rehab?
- When can patients be admitted to Subacute/TCU?
- When can patients be admitted to SNF?
- If they can handle daily 3 hour duration intense hospital-based therapy.
- If they can handle less intense, hospital-based therapy usually 2 hours a day.
- If they can handle less intense nursing-based therapy usually 2 hours or less a day.
41
What are the PT Settings if a patient can go home?
- Home Health
- Outpatient
- Hospice
42
- When can patients be admitted to Home Health?
- When can patients be admitted to Outpatient?
- When can patients be admitted to Hospice?
- Patients must be "home-bound", therapy usually 3x a week.
- Best for more mobile patients.
- Appropriate for patients with diagnosis with 6m or less to live.
43
What (4) things should we do in regard to patient identification?
- Have patient state name and DOB
- Check wrist band
- Watch for name duplications/similarities
- Adhere to HIPAA
44
What are (4) things we can do to prevent falls?
- Appropriate footwear (non-skid socks or well-fitting shoes)
- Check bed alarms (disarm before and rearm after)
- Determine fall status of patient (evaluate for fall risk and never leave fall-risk patient unattended in WC alone)
- Leave bed call within patient reach
45
Communication consists with ability to communicate with the ________ and ____________________.
Patient
- cognitive level
- education level
- pt understanding of condition
Interprofessional Team
- understanding role of team members
- when to make referrals
- SBAR
46
What positions make up the healthcare team?
- Physicians
- Nurses
- CNAs
- Case Manager/Social Worker
- PT/PTA
- OT/OTA
- Speech Language Pathologists
- Respiratory Therapists
- Dieticians/Nutritionists
47
What does SBAR stand for?
- Situation
- Background
- Assessment
- Recommendations
48
For the following, we should report to who?
- Unusual vital signs or behaviors
- Amount voided
- When patient is out of bed and plan for returning to bed
Nursing
49
For the following, we should report to who?
- Concerns that require change in care plan
- You may not see physician very often
Physician
50
If we have concerns about D/C plans, equipment or other special needs for home who should we report to?
Case Manager
51
If the patient progresses towards D/C who should we report to?
Rehab Team
52
Standard Precautions:
- Aims to control ___________ infections by reducing risk of transmission of blood-borne pathogens and pathogens from moist body substances.
- What do standard precautions apply to?
- nosocomial
| - blood, all body fluids except sweat, nonintact skin, and mucous membrane
53
What is the most effective way to prevent spread of disease?
Handwashing
54
What PPE equipment is used in acute care?
- Gloves
- Gowns
- Face mask
- Face shield
- Protective eyewear
55
Transmission Based Precautions:
- When are they used?
- Are standard precautions still used?
- What are the 4 main types?
- Used for patients documented or suspected to be infected or colonized with highly transmissible or epidemiologically important pathogens.
- Yes, used in addition to standard precautions.
- Contact, Droplet, Airborne, Neutropenic
56
Contact Precautions:
- When are they used?
- Examples?
- Infectious microorganism transmitted by direct or indirect contact.
- MRSA, VRE, norovirus, C.diff, chicken pox
57
Contact Precautions Include:
- ________ precautions
- ________ room
- _____ and _____ prior to entering room, remove and place in designated container before leaving room
- Dedicate non-critical client care items to this patient (stethoscope, gait belt, cuff weights, goniometer, assistive devices)
- Disinfect all equipment/surfaces with approved disinfectant prior to use by other people
- standard
- private
- gloves and gown
58
Enteric Precautions:
- Type of ________ precaution.
- Used for containing what infectious agents?
- contact
| - c.diff, norovirus, rotovirus
59
Enteric Precautions Include:
- _______________ with soap and water (alcohol will not kill spores)
- Equipment cleaned using ________-based disinfectant
- Use all other contact precautions
- HAND WASHING
| - chlorine
60
Droplet Precautions:
- Involves pathogens larger than __ microns that travel in droplets.
- Droplets travel no more than __ feet and infect host's conjuctivae or mucous membranes.
- Examples?
- 5 microns
- 3 feet
- pneumonia, influenza, whooping cough
61
Droplet Precautions Include:
- _________ precautions
- _______ room
- _________ for visitors or patient if they leave the room
- Goggles or face shield in case of potential spray
- standard
- private
- face mask
62
Airborne Precautions:
- Involves pathogens smaller than __ microns that can remain suspended in the air for several hours and are dispersed by air currents
- Infect host via ________ or ________ transmission
- Examples?
- 5 microns
- inhalation or direct
- TB, measles, chicken pox (via coughing and sneezing)
63
Airborne Precautions Include:
- __________ precautions
- don and doff _________ outside of room
- ________ room with negative pressure
- standard
- respirator
- isolation
64
Neutropenic Precautions:
| -Neutropenia is
- 1500
| - immunocompromised
65
Neutropenic Precautions Include:
- Careful attention to _________________ and equipment before interacting with the patient
- Healthcare professionals don mask when in patient’s room and patient wears mask if leaving their room
- Restrictions on patient’s diet including avoidance of _________ fruit and vegetables, ____ water/ice
- No fresh _______
- Restriction on number of visitors and no visitors who feels ill
- washing hands
- uncooked, tap
- flowers
66
OUTCOME MEASURES
OUTCOME MEASURES
67
List some tools specific to Acute Care.
- AM PAC-6 Clicks (Activity Measure for Post Acute Care)
- PFIT-s (Physical Function in the ICU Test - scored)
- FSS-ICU (Functional Status Score for the ICU)
- CPAx (Chelsea Crit Care Physio Ax tool)
- ACIF (Acute Care Index of Function)
- Perme ICU Mobility Score
- DEMMI
- ICU Mobility Scale
68
What are the tools for short LOS (length of stay)?
- AM PAC-6 Clicks
- DEMMI
- PFIT-s
- FSS-ICU
69
- What does AM PAC-6 Clicks stand for?
| - Raw cut-off score of ___ or less predicts institutional discharge.
- Activity Measure for Post Acute Care
| - 17 or less
70
What 6 things do PTs evaluate in the AM PAC-6 Clicks?
1. ) Turning over in bed
2. ) Supine to sit
3. ) Bed to chair
4. ) Sit to stand
5. ) Walk in room
6. ) 3-5 steps with a rail
71
What is the scoring for the AM PAC-6 Clicks?
1- Unable
2- A lot
3- A little
4- None
72
What 5 things does DEMMI evaluate?
- Bed
- Chair
- Static balance
- Walking
- Dynamic balance
73
With DEMMI, the higher the score the _______ the mobility.
better
74
- What does PFIT-s stand for?
| - What is the scoring?
- Physical Function in the ICU Test - scored
| - 0-12
75
What 4 items does the PFIT-s look at?
- Assistance (sit to stand)
- Cadence (marching steps/min)
- Shoulder strength (MMT)
- Knee strength (MMT)
76
With PFIT-s, the higher the score, the __________ level of independence.
increased
77
- What does FSS-ICU mean?
| - This is based on ____ scoring but contains items more appropriate for this setting, such as what?
- Functional Status Score for the ICU
| - FIM; rolling, supine to sit/sitting to EOB, sit to stand, ambulation
78
The FSS-ICU pulls __ items from the 18 item FIM.
4
79
What is the scoring of the FSS-ICU?
```
7=independent
6=Mod I
5=supervision
4=min assist
3=mod assist
2=max assist
1=dependent
```
80
FSS-ICU Median Scores:
- 28=
- 20=
- 9=
- 28=home
- 20=IP rehab
- 9=SNF
81
What are the tools for longer LOS (length of stay)?
- CPAx
- Perme ICU Mobility Score
- ACIF
82
CPAx is unique in its inclusion of __________ function.
respiratory
83
What are the 10 components measures with the CPAx?
- Respiratory function
- Cough
- Bed mobility
- Supine to sitting EOB
- Sitting balance (sitting at EOB unsupported)
- Sit to stand
- Bed to chair
- Standing balance
- Stepping
- Grip strength
84
How is the CPAx scored?
- 0-5 with 0=Dependent and 5=Independent
| - Total possible score of 50
85
Higher CPAx scores are associated with _______ LOS.
shorter
86
What are the items included on the Perme ICU Mobility Score?
- Mental Status
- Potential Mobility Barriers
- Functional Strength
- Bed Mobility
- Transfers
- Gait
- Endurance
87
What is the downside of the Perme ICU Mobility Score?
Can take between 15-60 minutes to complete.
88
_______ Perme ICU Mobility Scores indicate few potential mobility barriers and decreased assistance needs.
higher
89
-What does ACIF stand for?
-Acute Care Index of Function
90
What 4 things does the ACIF look at?
- Mental Status (MS)
- Bed Mobility
- Transfers
- Mobility
91
-With the ACIF, score of <0.4 on ICU d/c predicted to a setting other than home
0.4
92
Is the FSS-ICU used for short or long LOS in ICU/acute care?
both short and long LOS
