Acute care Unit 2: Team decision making in acute care

what common tests and measures are taken in the acute care setting (11)

adaptive and assistive technology

balance

gait

integumentary integrity

functional mobility

muscle performance

pain

ROM

sensory integrity

cognition screens

ventilation and respiration

what is the difference between the medical diagnosis and treatment diagnosis

the medication diagnosis is given by the doctor and the treatment diagnosis is usually the movement disorder

what are common treatments used in the inpatient setting (8)

adaptive and assistive technology

BPA

functional training

respiratory and ventilatory techniques

integumentary repair and protection techniques

manual therapy

motor function/movement training

therapeutic exercise

what has to happen for a pt to be seen by PT in the acute care setting

a physician or designees places an order or hospital privileges

who are typical designees

people who can work on behalf of the physician such as a nurse practitioner, physician assistant, and the charge nurse

what is a charge nurse

the nurse in charge of the floor the pt is on

what are hospital privileges

when the board of directors of the hospital meet and make a decisions that the PT has the privilege of seeing whoever they want, whenever and without a doctor order

who typically gets hospital privileges

PTs who typically have more than 15 years of experience and have a regional and national reputation for acute care PT who apply for them

who typically sets the schedule for a PT in the acute care setting

the director of rehab who usually a PT, the rehab management, or their designee

who do you see first as a PT in the acute care setting

those who are pending discharge so you see them before discharge

who typically sets the setting in an inpatient rehab facility

the manager and they set it to ensure everyone gets seen

what should be identified in advanced directives during chart review (3)

who the health decision maker power of attorney is

code status

organ donor status

what can be seen in the orders during a chart review (4)

all orders for services

precautions/contraindication

restraints, devices, braces, etc.

tests ordered for that day

how long should you wait to see a pt who had orthopedic surgery

typically 30 minutes since they've had their pain meds

what should you do for the pt before entering

knock and ask if you can enter

if you knock loudly and don't get an answer you can enter to see if they are awake

what systems are included in the movement system (6)

endocrine

nervous

CV

pulmonary

integumentary

musculoskeletal

how can the endocrine system be assessed

lab values

what should you do when you first interact with a pt

introduce yourself and your professional designation then verify two identifiers

how is informed consent obtained

discuss the purpose of treatment and the referral source then ask if the pt is okay with that

let them know they have the right to decline PT

what are some special considerations with an oncology pt

be slower and more deliberate

bring a positive energy

what are special considerations for pts with developmental delays

it may take extra time as they may view you as more of a friend than a practitioner

what are some special considerations for pts with infectious disease

they may be on a ventilator or mask so communication may be slowed so a piece of paper may be used for them to write on

what is included in a cognitive assessment

assess if they are conscious

assess orientation to person, place, time, and reason for being in hospital

can they make their needs know

how much time is allotted to see pt in the hospital/ER

30-60 min

how much time is allotted to see a pt in specialized care unitss/ICU

limited to 30-90 min

how much time is allotted to see pts in the LTAC

limited to 30-60 min

how much time is allotted to see a pt in the inpatient rehab facility

limited to 30-90 min

what is the priority of a PT in the ED/ER (3)

mobility

pain

balance

how long do you have with a pt in the ED/ER

24 hours

how long do you have with a pt in the acute care setting

less than a week

how long do you have with a pt in the ICU/LTAC

less than 4 weeks

how long do you have with a pt in the IRF

about 2 weeks

what settings have variable predictability for prognosis (3)

ED/ER

acute care

specialty care/ICU

what setting has a more predictable prognosis

IRF

what is the prognosis timeframe in the ED/ER

24 hours or less

what is the prognosis timeframe for the acute care and ICU

<1 week

what is the prognosis timeframe in the LTAC setting

4 weeks

what is the prognosis timeframe in the IRF setting

2 weeks

who do you recommend referrals to

the charge nurse

what are planned interventions

the interventions that are planned after the first initial assessment which should be communicated to the pt and consent should be obtained

what are three main goals that are common in acute care as the PT is working towards discharge

muscle performance

CVP endurance

ROM

how often are reassessments in the inpatient setting

every week

what outcome measure in used commonly in the acute hospital

AMPAC 6 clicks

what outcome measure in used commonly in specialty care units/ICU

Function status score for the ICU (FSS-ICU)

what outcome measure in used commonly in a IRF

inpt rehabilitation facility patient assessment instrument (IRF-PAI)

what outcome measure in used commonly in the LTAC

long-term care hospital, CARE data set (LCDS)

what pts are at risk for postural hypotension (3)

those on antihypertensive meds

older adults

decreased ability to return venous blood

why are pts with SCI more prone to postural hypotension

they have blood pooling in the abdomen and calves due to lack of muscle activity

when should BP be taken

after at least 5 minutes of rest

what is the difference between orthostatic and postural hypotension

orthostatic is when the BP when standing

postural is when it drops in sitting

how is orthostatic/postural hypotension assessed

when the pt sits or stands we measure the BP and pulse after one minute in that position then we assess again at 3 minutes

a positive is a drop in SBP of 20 mmHg or more or drop in DBP of 10 mmHg or more

then return pt to supine or reclined with legs elevated

what can occur due to vasovagal hypotension

it results in decreased cerebral perfusion or blood to the brain

why does vasovagal hypotension occur

the vagus nerve gets overly stimulated and releases parasympathetic neurotransmitters causing the tone in the veins to drop resulting in blood pooling

when do vasovagal hypotension occur

from anxiety, fear, or pain

how can hypotension be avoided during transfers

slowly raise the bed to slow down the process of the transfer

why are abdominal binders used with SCI pts when getting out of bed

it constricts the abdomen to avoid pooling of blood and pushes it back to the heart

what is a tilt table

a table that tilts a pt up slowly as we measure BP

what is hypovolemic shock

losing too much blood so blood does not reach the brain

what is cardiogenic shock

occurs when there is a heart attack or the heart stops working so blood can't be pumped to the brain

what is distributive shock

Shock due to widespread vasodilation and inflammation related to infection

what are the S/S of hypovolemic and cardiogenic shock

cool clammy extremities with low CO, low O2 saturation, and low MAP

what are the S/S of distributive shock

warm extremities and bounding pulse that progresses to cool and clammy if uncompensated

normal CO, O2 sat, and MAP at first then progressively decreases

how is shock managed

put the pt in the recovery position and raise their legs to get blood towards the brain

start CPR if the heart stopped

what is a focal seizure

a partial seizure on one side of the brain

what does a generalized seizure indicate

a seizure on both sides of the brain

what should be done if a pt has a seizure (4)

place the pt in a safe position

time the seizure

call code blue

maintain airway patency

what is a type I allergic reaction

immediate allergic reaction often seen with pollen, food, insect stings, etc)

what is a type II allergic reaction

organ transplant rejection reaction

what is a type III allergic reaction

a tissue destroying reaction like lupus

what is a type IV allergic reaction

a delayed reaction with the T cells seen in contact dermatitis

what is done if a pt has an allergic reaction and their airway is blocked

start CPR and you will likely have to cut and form an airway at the trachea with the insertion of a straw or tube

when does autonomic reflexia occur

in pts with recent complete cervical or upper thoracic spinal cord injury above T6

what are the S/S of autonomic reflexia (6)

HTN with a drop in HR

profuse diaphoresis above injury level

red skin

goosebumps

convulsing

dyspnea

what should be done to manage autonomic dysreflexia

place the pt in sitting or semi reclines to reduce HTN