week 2 Flashcards
(93 cards)
1
Q
documentation purpose
A
- record of session
- legal document
- reimbursement
- reflects practitioner’s clinical reason and judgement
- chronological record of client’s status
- justifies need of skilled services
- observation + interpretation= documentation
2
Q
fundamentals of documentation
A
- confidential requirements
- client’s full name, date of birth, gender and case number
- type of documentation
- date services
- acceptable terminology, acronyms, and abbreviation are used
- clear rationale for purpose, value and necessity of skilled services
- professional signature (first name or initial, last name) and credential
- all errors are initialed and dated
3
Q
ethical consideration
A
- administrator directs an OT document patient as receiving 60 min of therapy; though patient was fatigued tolerating only 45 min
- OT is asked to co-sign notes of an OTA not supervised by them
- OT asked to use treatment code higher than services
- documenting services not provided, using wrong billing codes, or co-signing notes without proper supervision are infractions possibly resulting in legal and professional sanctions
4
Q
documentation flow and type
A
- screening
- evaluation
- intervention a.k.a treatment plans
- progress note
- discharge note
5
Q
medicare guidelines
A
4 criteria fro reimbursement of services
- medically necessary
- skilled services- safe and effective
- consistent with diagnosis and symptoms
- performed at safe, appropriate and effective level
6
Q
medicare guidelines: medically necessary
A
patient’s condition requires skilled, knowledge and judgement of therapist to safely and effectively carry out POC
7
Q
medicare guidelines: skilled services
A
- intervention requires skills and competencies
- specific to medical condition
- treatment results in functional improvement
- reduction in safety risks
- prevention of secondary complications
- teaching and training of caregivers
8
Q
prognostic statement
A
- best clinical judgement
- establish goals
- establish level of assist
- establishes d/c plan
9
Q
problem list
A
- positive prognostic signs
- negative prognostic signs
10
Q
problem list: positive prognostic signs
A
- arousal
- orientation
- ability to follow directions
- attention span
- self-expression
- ability to solve problems
- medical stability
- motivation
11
Q
problem list: negative prognostic signs
A
- pain
- poor orientation
- inability to attend under maximum structure
- extreme uncooperativeness
- medical instability
- lack of ability
- absent arousal
- lack of intitation
12
Q
problem statements
A
- develop problem list
- identify contributing factors
- prioritize outcomes
client requires (assist level) in (occupation) due to (contributing factor)
13
Q
metacognition
A
- awareness of their own level of cognition
- conscious awareness of one’s thinking processes and ability to relate to processes in some way
14
Q
assessing patient’s readiness for behavioral and lifestyle change
A
transtheoretical model of change
15
Q
precontemplation
A
patient not intending to take action
16
Q
contemplation
A
patient intending to take action in 6 months (ambivalent)
17
Q
preparation
A
patient intending to take action in immediate future
18
Q
action
A
patient makes specific behavior changes within last 6 months
19
Q
enhancing occupational participation through
A
skill development and strategy generation
20
Q
teaching-learning process involves
A
- problem identification
- problem solving
- outcome assessment
21
Q
stages of learning
A
- aquisition
- retention
- transfer
- generalization
22
Q
learning is not merely a cognitive act; nor is it simply physical act of doing
A
also includes patient’s value and meaning placed upon activities in which they participate
23
Q
acquistion
A
new skills and develop strategies for learning with application apply in natural contexts
24
Q
dreyfus model
A
- novice
- advanced beginner
- competent
- profiecient
- expert
25
dreyfus model: novice
concrete steps
26
dreyfus model: advanced beginner
requires greater attention and intention due to lack of experience
27
dreyfus model: competent
automatic
28
acquisiton OT facilitate strategic plans to
problem solve and develop new methods to perform task
29
learning
retention> transfer> generalization
30
cerebrovascular accident
CVA or stroke
31
CVA impacts
brain functioning
32
CVA last more
than 24 hours or leads to death within 24 hrs
33
stroke in one hemisphere of the brain often leads to
upper motor neuron dysfunction
34
hemiparesis
weakness
35
hemiplegia
paralysis
36
contralateral side
opposite side of body
37
CVA & other impairments
- sensory impairment
- cognitive and perceptual impairment
- visual disturbances
- behavioral changes
- difficulty swallowing
- speech and language function impairment
38
all impairments can significantly impact an individual's ability to engage in chosen occupations
limiting participation and quality of life
39
stroke epidemiology
- #1 cause of long-term disability in U.S
- 795,000 cases on new or recurrent stroke each year
- estimate 20.5% increase from 2011-2030
- incidence higher in men (1.24%) although women have higher lifetime risk
- >50% acute neuro hospitalizations
40
long term effects of stroke
- 50% hemiparesis
- 30% unable to walk without assistance
- 26% dependent in ADLs
- 19% aphasic
- 35% clinically depressed
- 26% during homes
- QOL decreased
41
CVA etiology 2 vascular syndromes causing stroke
- ischemic
| - hemorrhagic
42
ischemic (approximately 87% of all strokes)
- thrombus
- embolism
- also caused by systemic blood flow reduction
43
thrombus
blood clot formed inside cerebral vessel
44
embolism
blood clot originating in heart or arteries outside brain
45
hemorrhagic
- intracerebral (10% of strokes)
| - subarachnoid
46
subarachnoid most common causes of weakened vessels
- aneurysms
| - arteriovenous malformation
47
transient ischemic attack
(TIA)
48
F.A.S.T
Face
Arms
Speech
Time
49
CVA modifiable risk factors
- hypertension
- diabetes mellitus
- disorders of heart rhythm such as arterial fibrillation
- high blood cholesterol and other lipids
- cigarette smoking
- obesity
- lifestyle factors: physical inactivity, poor diet and nutrition
50
CVA non-modifiable risk factors
- age
- gender
- race
- ethnicity
- genetics
51
medical management: acute care CVA
- determining cause and site of stroke
- preventing progression of lesion
- reducing cerebral edema
- preventing secondary medical complications
- treating acute neurological symptoms
52
medical management: acute care CVA: preventing progression of lession
- restoration of blood flow and limitation of neuronal damage for ischemic stroke
- control of intracranial pressure, prevention of rebleeding, maintenance of cerebral perfusion, and control of vasospasm for hemorrhagic stroke
53
medical management: hospital CVA
- dysphagia screening before oral intake
- nutritional support
- maintenance of appropriate blood pressure, body temperature, and blood glucose levels
- cardiac evaluation and monitoring as needed
- treatment of any acute complications that may arise (edema, pneumonia)
- positioning & appropriate mobility
- depression screening
54
postacute care CVA
- majority (2/3) of stroke survivors recieve rehabilitation
- multidisciplinary team (physicians; nurses; occupational, physical and speech language therapist, psychology, social work, counselors
- intensity varies by setting
55
postacute care: intensity by setting
- inpatient rehabilitation
- subacute nursing homes
- community home health
- outpatient clinics
56
recovery from stroke
- varies with nature and severity of initial injury
- spontaneous recovery
- neuroplasticity
- neurological and functional recovery
57
stroke impact on daily occupation
- kinds and mix of impairments vary with stroke but all impact performance and participation
- trunk & postural control limitations impact functional mobility
- upper extremity (UE) impairments affect use & control during daily activities
58
trunk & postural control limitations impact functional mobility
walking, wheelchair use, body stability during reaching, placing
59
upper extremity (UE) impairments affect use & control during daily activities
secondary complications of edema, muscle imbalances, shoulder pain & soft tissue injuries
60
stroke impact on daily occupation: functional communications & QOL
- converse, use email, items or people, understand what is said
- different aphasias impact differently (broca, wernicke, anomic, global)
61
stroke impact on daily occupation: visual impairments affect mobility, communications and object use
driving, functional mobility (falls), money management, use electronic communications, locating objects in environment
62
stroke impact on daily occupation: psychosocial impairments
depression & anxiety frequently observed
63
stroke impact on daily occupation
- decreased or inability to participate
- functional recovery
- decreased social participation
- interference with social relationships
- altered sex drive
- altered appetite
64
assessment for transfer
- cognitive function
- visual acuity and perception
- motor function
- sensory function
65
environmental attributes also influence person's abilities during transfer and should be assessed
- to and from bed
- toilet
- bathing equipment
- car
66
documentation of transfers
- visual acuity and perception
- cognition
- motor function
67
documentation for transfers includes
- type of transfer accomplised
- locations: starting and ending surfaces
- amount and type of assistance required
- amount and type of cuing/direction required
- ambulation and or wheeled mobility devices used
68
transfer goals
- perform stand pivot transfer from to wheelchair and bed with distant supervision and occasional safety cues within 2 weeks
- client will demonstrate good safety techniques during controlled fall from wheelchair and when regaining seated position
- client will direct sliding board transfer with wheelchair set up, sliding board placement and removal, demonstrating safe transfer by 1 week
69
intervention for improving transfer
- remediation
| - adaptation
70
intervention for transfers
- address underlying impairments and direct transfer training
- impairment can be addressed alone or in combination
- addressed in several activities while practicing actual transfers
- environmental attributes also varied during training-differing heights of transfer surfaces
71
transfer principles equipment set appropriate
- optimal setup put feet in a position where they can just pivot without having to take any steps
- wheelchair setup at about 45 deg angle from other transfer surface
72
transfer principles weight shifts and body mechanics
- transfer movements eased when person shifts weight forward bringing center of gravity over feet
- maintain best position attainable
- assure low back muscles are not overstretched and tenodesis hand grip is preserved
73
transfer principles prepare for transfer
- ensure wheel locks are engaged
| - position oneself (such as feet off footrests and in position)
74
transfer principles use momentum
compensate for weakness during transfers
| -use assistance when in doubt
75
optimal techniques
- stand pivot transfer
| - modified stand pivot transfer
76
stand pivot transfer
- person pushes up from seat surface-rise to standing and regains balance
- pivots feet to stand with back to transfer surface
- person reaches back and slowly sits
77
modified stand pivot transfer
- person stays in a crouch position
| - reach for or hold on to transfer surface
78
ambulation aids
- canes, crutches and walkers-used to help people move from one place to another-often useful during transfers
- standard walker (four legs) gives bilateral support
- ambulation aid is included in documentation
79
activities of daily living (ADLs)
- basic activities of daily living (BADLs)
| - basic skills-self-care, mobility
80
instrumental activities of daily living (IADLs)
- more advanced problem-solving skills
- meal preparation
- home management - $
- emergency aid
81
both ADL and IADL assessments
- canadian occupational performance measure (COPM)
| - kohlman evaluation of living skills (KELS)
82
ADL assessments
- barthel index
| - functional independence measure (FIM)
83
IADL assessments
- assessment of motor and process skills (AMPS)
| - kitchen task assessment (KTA)
84
methods of teaching ADLs
- physical cueing
- manual guidance
- repetition
- backward chaining
85
backward chaining
- therapist assists client until last step is reached, and client performs last step independently
- repeat as above, but client performs last two steps independently, etc
86
functional independence measures (FIM)
```
7-complete independence
6-modified independence
5-standby assistance/supervision
4-minimal assistance/contact guard
3-moderate assistance
2-maximal assistance
1-total assistance/dependent
```
87
FIM 7
complete independence
| no setup, cues or touching
88
FIM 6
modified independence
| adaptive equipment, longer time needed, safety considerations
89
FIM 5
standby assistance/supervision
| set-up, cues, coaxing, within one arm's reach of patient
90
FIM 4
minimal assistance/contact guard
| 75% or more, any touching
91
FIM 3
moderate assistance
| 50-74% of work, more help than touching, any lifting
92
FIM 2
maximal assistance
| 25-49% of work
93
FIM 1
total assistance/dependent
| <25% of work, automatically a total assist with 2 people assisting
