Telehealth, Vitals, PT care

Good telehealth visit examples

Follow-ups; medication checks; mental health visits; minor illness; chronic disease check-ins

Not appropriate for telehealth

Emergencies and visits needing hands-on exams or injections or blood draws

Telehealth identity check

Verify the patient with two identifiers

Telehealth setup

Test audio and video before the visit; use a HIPAA-compliant platform; have a phone backup

Telehealth privacy

Patient and staff should be in a private space

Telehealth consent

Obtain consent for the virtual visit and document it

Telehealth communication

Look at the camera; speak clearly; confirm understanding

Telehealth barriers

No internet or device; low tech skills; vision or hearing problems; language

Patient portal

Secure online access to records and messages and appointments and results

Orthostatic blood pressure order

Lying then sitting then standing (wait 1-3 minutes each)

Positive orthostatic hypotension

Systolic drops 20 or more or diastolic drops 10 or more or patient feels dizzy

Orthostatic safety

Stay close in case the patient faints

Numeric pain scale

0 to 10

Wong-Baker FACES

Pain scale for children and patients who cannot use numbers

Pain assessment details

Location; quality; severity; timing; what makes it better or worse

LMP

Last menstrual period (first day of the last period)

Why ask for LMP

Needed before certain tests or medications in women of childbearing age

Waist circumference higher risk

Men over 40 inches and women over 35 inches

Growth chart percentile

Compares a child's measurement with other children of the same age

Pediatric measurements

Length and weight and head circumference plotted at every well visit

Patient history sections

Medical; surgical; family; social; medications; allergies

Screening examples

Tobacco use; alcohol use; HIV screening; depression screening

Laceration

Cut

Abrasion

Scrape

Contusion

Bruise

Puncture

Deep narrow wound

Avulsion

Tissue torn away

Sprain

Ligament injury

Strain

Muscle or tendon injury

Dislocation

Bone out of its joint

Wound infection signs

Redness; swelling; warmth; pus; pain; odor; fever

Wound healing phases

Hemostasis then inflammation then proliferation then maturation

Primary intention healing

Wound edges closed with sutures or glue

Secondary intention healing

Wound left open to heal from the inside out

Tertiary intention healing

Delayed closure after infection risk passes

Heat stroke

Hot dry skin and confusion and very high temperature (emergency; call 911)

Heat exhaustion

Heavy sweating and cool clammy skin and weakness (move to cool place and give fluids)

Hypoglycemia (low sugar)

Shaky and sweaty and confused (give fast sugar)

Hyperglycemia (high sugar)

Thirst and frequent urination and fruity breath (call the provider)

Crash cart

Emergency supply cart that must be checked regularly with a log

Emergency injectable example

Epinephrine

Emergency action plan

Written steps for who does what in an emergency

Jaeger chart

Tests near vision

Amsler grid

Screens for macular degeneration

Rinne and Weber tests

Tuning fork hearing tests

Peak flow green zone

80-100% of personal best

Peak flow yellow zone

50-80% of personal best (caution)

Peak flow red zone

Below 50% (emergency)

Sputum specimen

First morning deep cough sample after rinsing the mouth

Stool specimen tests

Ova and parasites; fecal occult blood

Chain of custody

Documents every person who handles a legal specimen (drug testing)

Requisition contents

Patient name and DOB; provider; test ordered; diagnosis code; date and time collected

Specimen labeling

Label at the bedside with two identifiers and never pre-label

Preanalytical errors

Mistakes before testing (wrong tube; mislabel; delayed transport)

Analytical errors

Mistakes during testing

Postanalytical errors

Mistakes after testing (reporting or recording results)

Internal quality control

Controls run in your own office per manufacturer

External quality control

Proficiency testing from an outside agency

Centrifuge

Spins blood to separate serum or plasma from cells

Aliquot

A small portion of a specimen poured into a separate tube

Light-sensitive specimens

Protect from light (for example bilirubin)