What are the components of an evaluation?
- chart review
- patient interview
- physical exam
- function mobility assessment
- functional tests
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
Describe a patient interview?
- mental status
- --alert and oriented 1, 2, 3 &4
- past medical history
- --impact on current condition
- --education needs
- social history
- --who do they live with?
- --prior level of function
- --are they working?
- --stairs, rails/no rails
- --hobbies and activities
- --support system
- --equipment needs
What is done in a physical exam?
- --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
What is done in a functional mobility assessment?
- bed mobility
- --rolling side to side
- --supine to sit
- --sit to supine
- --use of bed rail
- --stand pivot
- --squat pivot
- --bed-wheel chair
- --device needed? how much assistance?
- --gait deviations
- --functional tests
- --type of surface
- --simple sitting
- --balance tests
Who is it important to communicate with?
What is normal systolic blood pressure?
What is normal diastolic blood pressure?
What is prehypertensive BP?
- Systolic: 120-139
- Diastolic: 80-89
What is considered Stage 1 Hypertension?
- Systolic: 140-159
- Diastolic: 90-99
What is considered Stage 2 Hypertension?
- Systolic: >160
- Diastolic: >100
What is the normal heart rate range?
What can cause a patient to have a heart rate below 60?
- Medications: Betablocker, digoxi
- Conduction disturvances or frequent PVCs
- SSS- type of bradycardia
- Autonomic dysfunction
Whatcan cause a patient to have a heart rate below 40?
- 3rd degree heart block
- emergent if symptomatic-- dizziness
- poor cardiac output
What can cause a patient to have a heart rate above 100?
- normal is some people
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...
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
What is a challenge of an acute care environment?
work as a team with other health care professionals
Who are the members of the health team?
- Registered dietician
- Case managers
What is the role of the Doctor in acute care?
oversees care of patient and writes orders
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
What is the role of the Physical Therapist in acute care as apart of the health care team?
functional mobility and chest PT
What is the role of OTs in acute care?
- ADLs and IADLs (instrumental - cook, clean)
- upper extremities and hand strengthening
What is the role of Respirational Therapist in acute care?
- O2 delivery decives and chest PT, vents, PFT
- can administer prescribed nebulizer medications
What is the role of the Speech Therapist in acute care?
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
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
Who can order PT?
- Case Managers via verbal order
What gets documented from the examination?
- Exam - History, Systems Review
What type of medical testing notes go into the chart review?
- Lab Values
- Diagnostic Imaging
- Pulmonary Studies
- Other tests
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
What is the center of the evaluation?
What is the difference in blood pressure variation from left to right arm?
Normal exercise increases BP and how many mets?
What HR is too high for PT?
What is the normal pulse ox?
What level of pulse ox determines hypoxia?
Components of good documentation?
What are some cardiopulmonary precautions?
- PICC line/A-line
- Lymph removal
- Deep vein thrombosis
- Recent Fracture
How many METS and the Avg HR response from resting HR is it for toileting?
How many METS and the Avg HR response from resting HR is it for bathing?
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
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
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
How many METS and the Avg HR response from resting HR is it for LE exercises
Define Cardiac Output
- Stroke volume x HR
- volume of blood pumped by the heart per minute
Define stroke volume
the volume of blooe, in mL, pumped out of the hear with each beat