Fundamentals Quiz 2

PATIENT VERSUS CLIENT

Patient seeks medical care/treatment, more passive

Client seeks professional advice or service, more active strength based approach

Clinical reasoning defined

process of thinking logically and sensibly

Dual Processing Theory thinking systems

System 1: Quick autonomous. Inductive reasoning

System 2: Analytical, effortful. Deductive reasoning

During clinical decision making can steps be repeated

Yes at any time due to new findings, review of judgement, outcomes, new goals, etc.

Whats the entry point to clinical decision making

Physical Exam

Examination Process Steps

Chart Review

Initial Inspection

History & ROS

Physical Exam (Systems Review & Test/Measure)

Chart Review

completed before performing the history taking portion of the patient/client examination, and before every treatment session

Information Gathered

Past Med. History, prior level of function, medical status, laboratory values/medication, mental status, fall risk, movement precautions, weight bearing status

Initial Inspection

first thing you see

- In acute care, you will see what lines or tubes are hooked up, machines, etc.

- Outpatient you encounter a patient in the waiting room, notice how they get up, assistive devices, etc.

History & Review of Systems

SUBJECTIVE HISTORY REVIEW

Reasons to screen include direct access, early detection, disease progression, referral source, and new info from the patient

Systems Review

OBJECTIVE TESTING; first part of the physical exam after history

Ex.) CV, Pulm. MSK, NM, Cog.

Tests and Measures

second part of the physical exam and are based on systems review

When would patient/client management go on for Interprofessional Collaboration

May occur at different points of the examination process

Referral to other HCPs based on data collected during the ROS & SR.

Always reflecting on the data you are collecting

May need to refer or collaborate at any point during the exam A team approach may be optimal for the patient

How much of the population will be older than 65 in 2050

20%

4 Questions the patient in front of you will ask

How long will it take (Prognosis)?

What's wrong with me (Diagnosis)?

What are you gonna do for me?

What can I do for myself (Intervention)?

Impairment vs. Tissue-Based Hypotheses

Supraspinatous Tendinosis (tissue-based)

Neck pain with mobility deficits (impairment-based)

Clinical Evaluation how much is subjective and objective

80% subjective examination; 20% is through objective measures

Constitutional signs/symptoms are things like

nausea, diaphoresis, sweats, fever, vomiting, diarrhea, dizziness, pallor, fatigue, weakness

Structure and Process of History Taking

Provide Structure and Build the Relationship

Involve the Patient

Verbal and Nonverbal Communication

Proper Verbal and Nonverbal Communication with the patient

Active Listening, Mirror patients body language, Mimicry, Adjust voice and speech to manage pace

Close ended questions

questions asking for specific info "does your should hurt when you reach overhead"

Parallel Questioning

aligning questions with patient story, let patient finish monologue, then question where you left off

Directive questioning

purposeful open ended questions "when do you think you're overloading your shoulder"

PHQ-9

This questionnaire is a self-administered tool that assesses depressive symptoms based on the DSM-5 criteria

Patient Specific Functional Scale

3-5 things to improve upon based on involvement of PY

Disablement vs. Disability

Disablement = functional consequence of acute or chronic conditions, comprised of ability to meet needs

Disability = response to health condition that results in activty or participation restriction