Patient Care

Patient's Bill of Rights

Guarantees receivable of medical care regardless of personal conditions or Financial limitiation

Patient/Client Management Process (6)

Examination

Evaluation

Diagnosis

Prognosis

Intervention

Outcomes

Chart Review

Data collection

interview

Subjective report

prognosis

a forecast of the probable course and outcome of a disease or situation

Prognostic scale: functional expectation

Excellent, Good, Fair, Poor, Guarded

excellent goal qualities are

Sustainable

Measurable

Achievable

Revisable

Individulized

Steps to Communication with patients

1. Introduce self as PT student

2. Confirm correct patient

3. Ensure patient is ok with your presence

4. Give time estimation and session goal

5. Remain professional

6. Mindful of role as a student.

Gait/transfer belt position

Positioned toward lower waist

5 cardinal rules of body mechanics

1. keep load close

2. create appropriate base of support

3. use isometric muscle contraction of trunk

4. lift with legs, not back

5. don't twist, avoid crossing legs

Draping the patient

Done to provide for modesty, comfort, protection and warmth to the patient.

Introducing yourself as what

Student PT

Observe means to do what

Room scanning for equipment/patient scanning how is the patient and what do they need

Why are vital signs important?

To know when to push and when to stop

Normal heart rate

60-100 bpm

How to take manual heart rate of geriatric population

Take pulse for 60 seconds

When is heart rate measured and why

Prior to exertion to establish base line, During exertion looking for silent changes, after exertion and resting for 10 minutes

Pulse grade of heart rate

0 absent

1+ barely perceptible and easily obliterated with pressure

2+ weak, difficult to palpate, but slightly stronger than 1+

3+ normal, easy to palpate

4+ bounding, very strong, hyperactive

Sign of backup of fluid into the heart

Distention of jugular vein

pitted edema

fluid accumulation in the extremities; makes an indentation when pressed

bradycardia

slow heart rate (less than 60 bpm)

Tachycardia

Fast heart rate (HR greater than 100bpm)

Normal heart sounds

S1 and S2 (lub dub)

abnormal heart sounds

S3 and S4

Areas to listen to heart auscultations

Aortic area (second right intercostal space)

Pulmonic area (second left intercostal space

Tricuspid area (fourth left intercostal space)

Mitral area or apex( fifth left intercostal space

When do you use the bell on a stethoscope

When listening for low-pitched sounds and pediactrics

When do you use the diaphragm on a stethoscope

high pitched sounds

A

Binaural

What is the most accurate way to take blood pressure

Manual Blood pressure

B

Ear tips

Which artery did we listen to while we determined blood pressure?

brachial artery

C

Sound Conductor

Circumference of arm covered by blood pressure bladder for adult

80%

D

Binaural Spring

Circumference of arm covered by blood pressure bladder for child

40%

E

Tubing

where should the arm be when taking bp?

heart level and relaxed

F

Acoustic Valve stem

phases of blood pressure measurement

1. Tapping sound

2. Soft swishing sound

3. Crisp sound

4. Blowing sound

5. Silence

G

Drum

How high should you initially pump blood pressure

10 20 mmHg above normal

H

Diaphragm

How much mmHg can differ from a automated vs manual blood pressure measurement

10-15mmHg

I

Bell

What positions can increase diastolic pressure

Sitting and unsupported

J

Acoustic Sound Hole

What positions can increase systolic pressure

Supine and crossed legs

elevated blood pressure

120-129/less than 80

high blood pressure (hypertension) stage 1

130-139/80-89

high blood pressure (hypertension) stage 2

140/90 or above

hypertensive crisis

180/120

white coat hypertension

Elevated BP only at the physicians office

Masked HTN

Abnormnal BP only at home

Primary Hypertension

Elvated BP with unclear underlying etiology (cause)

secondary hypertension

Elevated BP with known cause

pseudo hypertension

Common in elderly population due to arterial noncompliance

orthostaic hypotension indicatior

drop of 20/10 or more

Symptoms of hypertension

Throbbing headache

Symptoms of hypotension

dizziness, fainting

Normal lung auscultation sounds

Tracheal

Bronchial

Bronchovesicular

vesicular

A

Bronchovesicular

abnormal breath ausculatation sounds

High pitch wheezing acoustic quality

Low pitch snoring acoustic quality

B

Vesicular

Normal respiratory rate

12-20 breaths per minute

C

Bronchial/tracheal

bradypnea

less than 12 breaths per minute

Tachypnea

more than 20 breaths per minute

Normal body core temperature

95.9-99.5

oral temperature

98.6

axillary temperature

97.6

rectal temperature

.5-.7 greater than oral temperature (

SpO2

saturation of peripheral oxygen

How effective should hemoglobin binding be (SpO2)

95% or more

Blood pressure and heart is what in younger population

BP lower and HR is higher

What are we testing for during a neurological screening

Alertness and orientation

levels of alertness

alert, lethargic, obtunded, stuporous (semi coma), coma(deep coma)

Anthropometric

Human body measurements and can tell how effective the heart is pumping

alert

Awake,attentive to normal stimuli, appropriate interaction

lethargic

Drowsy, easily sidetracked, may fall asleep

Obtunded

difficult to arouse, confused when awake

Stupor

Responds only to noxious stimuli, unable to interact once aroused

Coma

Unarousable despite stimuli

4 factors of mental status/cognition

Person, place, time, situation

Documentation for some alert and oriented

A and O x 4 (A/O x 4)

Additional considerations for mental status/cognition

Environment/setting

People present

Sleep

Medication

S3-S5 strength/tone assessment

Innervates pelvic floor muscles

Normal "anal wink"

Dermatomes key land marks

No C1

Nipple is T4

Umbilicus is T10

What do you say during dermatome testing procedure

tell me when you feel me touch you

Dermatome scoring

0 unable to detect stimulus

1 inconsistent (could be hypo/hyper sensitive compared to a reference point)

2 normal consistent detection of stimulus

Reflex test procedure

1. Patient relaxed

2. Muscle midway between shortest and longest length

3. Stimulus must be strong and brief

4. Asses and compare bilaterally

Static position should be

No more than max 2 hours and shoulde be moving very 30 mins

prolonged pressure

Patient can't feel sensation of object poking them for a long time

friction

Skin is rubbing against forces of bed sheets

The Braden scale is used to assess

predicting pressure sore risk of integumentary system

Lower the score the higher the risk

Sensory, moisture, activity, mobility, nutrition, friction/shear

orthostatic hypotension

Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions

Before mobility assessment we need to

Have necessary equipment

Cognitive status

Vitals

strength assessment (MMT)

ROM

Level of assist

Independent (level of assistance)

100% on their own

Modified independent (level of assistance)

Can do task with equipment and without supervision

steps of mobility (5)

1. Simple instructions

2. Demonstrate to patient

3. Have paitent perform movement

4. Provide cues to improve

5. Continuous reassessment of comfort and safety

Supervision (level of assistance)

Uses verbal cues for safety and technique.

Someone must be there for safety