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What are the components of an evaluation?
- chart review
- patient interview
- physical exam
- function mobility assessment
- functional tests
- documentation
- communication
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What goes into a chart review?
- physicians orders
- medical testing
- discharge plan
- history and physical exam
- case management notes
- nursing notes
- observation vs inpatient level of care
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Describe a patient interview?
- mental status
- --alert and oriented 1, 2, 3 &4
- past medical history
- --comorbitities
- --impact on current condition
- --education needs
- --medications
- social history
- --who do they live with?
- --prior level of function
- --are they working?
- --stairs, rails/no rails
- --hobbies and activities
- --support system
- --driving?
- --equipment needs
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What is done in a physical exam?
- observation
- --general appearance/level of alterness
- --posture- kyphotic, fixed/flexible, chest shape
- --skin- color, temp, integrity
- --lines and tubes
- systems review
- --integumentary - skin temp, pain, edema, pulses & where
- --cardiovascular/pulmonary - vital signs, resp rate, SpO2
- --musculoskeletal - ROM, strength, special tests
- --neuromuscular - tone, reflexes, control of movement, balance, sensation
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What is done in a functional mobility assessment?
- bed mobility
- --rolling side to side
- --bridging
- --supine to sit
- --sit to supine
- --use of bed rail
- transfers
- --sit-stand
- --stand pivot
- --squat pivot
- --bed-wheel chair
- --chair-chair
- --device needed? how much assistance?
- ambulation
- --gait deviations
- --device
- --functional tests
- --type of surface
- --stairs
- balance
- --simple sitting
- --standing
- --functional
- --balance tests
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Who is it important to communicate with?
- nurses
- interdisciplinary
- patients
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What is normal systolic blood pressure?
<120 mmHg
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What is normal diastolic blood pressure?
<80 mmHg
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What is prehypertensive BP?
- Systolic: 120-139
- Diastolic: 80-89
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What is considered Stage 1 Hypertension?
- Systolic: 140-159
- Diastolic: 90-99
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What is considered Stage 2 Hypertension?
- Systolic: >160
- Diastolic: >100
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What is the normal heart rate range?
60-100 bpm
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What can cause a patient to have a heart rate below 60?
- Bradycardic
- Well-trained
- Medications: Betablocker, digoxi
- Conduction disturvances or frequent PVCs
- SSS- type of bradycardia
- Autonomic dysfunction
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Whatcan cause a patient to have a heart rate below 40?
- 3rd degree heart block
- emergent if symptomatic-- dizziness
- poor cardiac output
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What can cause a patient to have a heart rate above 100?
- normal is some people
- dysrhythmia
- fever
- hypotension
- anemia
- medications
- hypoxia
- stress/pain
- caffiene
- dehydration
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What is an acute care environment?
- place for people who need around the clock care and treatments
- patients need a diagnosis that is severe enough to be admitted
- --any types of surgeries, major infections in elderly, burn victims, cardiac, syncope, cancer care, ect...
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What are the roles of a PT in acute care rehab?
- return patients back to independence
- prepare for outpatient clinic
- optimize and restore functional mobility
- ensure safe discharge plan
- prevent skin ulcers
- support the team
- patient-family education
- maintain safe environment
- adjunt care to medical interventions
- --determine when appropriate
- continual dynamic assessment
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What is a challenge of an acute care environment?
work as a team with other health care professionals
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Who are the members of the health team?
- MD
- nurses
- PT
- OT
- RT
- ST
- Registered dietician
- Case managers
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What is the role of the Doctor in acute care?
oversees care of patient and writes orders
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What is the role of nurses in acute care?
- nurse practioner: can write orders
- RN: can administer meds
- LPN: may/may not administer meds, assit with IV set up
- nurses aids
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What is the role of the Physical Therapist in acute care as apart of the health care team?
functional mobility and chest PT
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What is the role of OTs in acute care?
- ADLs and IADLs (instrumental - cook, clean)
- upper extremities and hand strengthening
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What is the role of Respirational Therapist in acute care?
- O2 delivery decives and chest PT, vents, PFT
- can administer prescribed nebulizer medications
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What is the role of the Speech Therapist in acute care?
swollowing evaluations
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What are the 4 CORE construct themes?
- 1. collect and construct medical info
- 2. application of specialized PT knowledge
- 3. communicate to gain info
- 4. communicate to provide info
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What are the 3 encompassing construct themes?
- 1. continual dynamic assessment - things are always changing
- 2. professional responsibility - advocate for the patient
- 3. complex care - anticipate the needs of the patient
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Who can order PT?
- MD
- PA
- NP
- Case Managers via verbal order
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What gets documented from the examination?
- Exam - History, Systems Review
- Evaluation
- Diagnosis
- Prognosis
- POC
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What type of medical testing notes go into the chart review?
- Lab Values
- Diagnostic Imaging
- Pulmonary Studies
- Other tests
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What are some key things you should look for when checking a chart?
- Change in status: orders, meds, PO status (anything by mouth)
- always check with nursing staff
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What is the center of the evaluation?
Patient's Goals!!!
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What is the difference in blood pressure variation from left to right arm?
5-10 mmHg
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Normal exercise increases BP and how many mets?
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What HR is too high for PT?
130
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What is the normal pulse ox?
97-99
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What level of pulse ox determines hypoxia?
<90
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Components of good documentation?
- functional
- measurable
- accurate
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What are some cardiopulmonary precautions?
- PICC line/A-line
- Mastectomy
- Lymph removal
- Deep vein thrombosis
- Fistual
- Recent Fracture
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How many METS and the Avg HR response from resting HR is it for toileting?
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How many METS and the Avg HR response from resting HR is it for bathing?
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How many METS and the Avg HR response from resting HR is it for walking?
- flat surface: 2-2.5 METS
- 2 mph: 2.5-2.9 METS
- 2.5 mph: 3-3.3 METS
- HR ^ 5-15 bpm
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How many METS and the Avg HR response from resting HR is it for stair climbing?
- 1 flight = 12 steps: 2.5 METS, HR ^ 10 bpm
- Up 1-2 FOS: 4 METS, HR ^ 10-25 bpm
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How many METS and the Avg HR response from resting HR is it for UE exercises?
- while standing: 2.6-3.1
- HR ^ 10-20 bpm
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How many METS and the Avg HR response from resting HR is it for LE exercises
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Define Cardiac Output
- Stroke volume x HR
- volume of blood pumped by the heart per minute
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Define stroke volume
the volume of blooe, in mL, pumped out of the hear with each beat
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