Acute Care Toolkit for PTs: Preparing to Assess and Treat Safely

What is included in before you treat

The acute care PT scan

What are the elements of the acute care PT scan?

Chart, patient, bedside and physiological status

What are the components of chart?

• diagnosis/procedure

• orders and activity status

• precautions

• relevant labs/imaging

What are the components of the patient?

• alertness/cognition

• work of breathing/appearance

• pain and symptoms

• current function

What are the components of the bedside?

• oxygen

• lines, tubes, drains, and monitors

• alarms/equipment

• footwear, brakes, and environment

What are the components of physiological status?

• HR, BP, RR, SpO2

• oxygen requirement

• symptoms and trends

After looking at the acute car PT scan, what do we decide?

Treat, modify, hold, clarify

Pain and cognition (quick safety screen)

Pain:

• where is it?

• how severe is it?

• new or unusual?

• does it limit breathing, coughing or movement?

Cognition/alertness:

• alert and able to follow instructions?

• confused, drowsy, restless, or impulsive?

• able to report changes in symptoms?

**can this patient safely understand, participate, and tell me if something changes?

Common bedside language for pain

• numeric scale 0-10

• faces/verbal scales

• observe: guarding, facial expression, vocalization

Common bedside language for cognition/alertness?

• A&O (alert and orientated) need a ¾ score: orientation

• GCS (Glascow coma scale): level of consciousness

• RASS (Richmond Agitation-Sedation Scale): agitation/sedation

• Delirium: acute, fluctuating change in cognition/attention

  • very common in acute care

Alert and orientated

Person: “can you tell me your full name?” x1

Place: “do you know where you are right now?” x2

Time: “what day is it today?” x3

Situation: “can you tell me why you are in the hospital?” x3

Lines, tubes, drains, and devices (think before you move)

1. identify it

• what is it?

• why is it there?

2. understand it

• where is it attached?

• does position matter?

• who manages it?

3. mobilize safely

• can the patient move with it?

• is there enough tubing?

• what could be pulled, kinked, disconnected, or dislodged?

A line, tube, drain, or device does NOT automatically mean “do not mobilize”

Pause → identify → organize → plan

When should we monitor vitals

Before, during, and after activity

Vitals

HR, BP, RR, SpO2

In addition to vitals, what else should we consider?

O2 device/flow, pain, dyspnea, RPE, other signs/symptoms

Never interpret a vital number in insolation, compare with:

• baseline

• diagnosis

• medications

• symptoms

• response to activity

Hemoglobin (Hgb)/ Hematocrit (Hct)

O2 carrying capacity → fatigue, dyspnea/SOB, activity tolerance

White Blood Cell(WBC) Count

Infection/inflammation

Platelets (platelet count)/ International Normalized Ratio (INR)

Bleeding risk

Electrolytes (Na+, K+, Ca2+, Mg2+)

Cognition, muscle function, and cardiac stability

Creatinine/ Estimated Glomerular Filtration Rate (eGFR)

Kidney/ fluid status and medical stability

Before changing your treatment before a lab value, ask:

• what is the patient’s current clinical presentation?

• are vitals stable?

• are symptoms changing?

• is the value new, worsening, or expected?

• do I need to clarify?

**labs inform clinical reasoning they do not replace the patient assessment

Based on the chart + patient presentation + beside environment + vital signs + labs:

Our decision to treat, modify, stop, or clarify

Treat

Appropriate to proceed as planned

Modify

Proceed, but adjust the intervention, intensity, assistance, positioning, or monitoring

Hold

Do not proceed due to an immediate safety/medical concern

Clarify

More information or discussion with the healthcare team is needed before deciding