Acute
What is the main role of physical therapy in the acute care setting?
maximize their function, improve strength and endurance, prevent infections and complications of prolonged bedrest and immobility, pt and family education, pulmonary "toileting" (all CVP interventions)
what types of care are including in acute care
emergency, trauma and acute surgery, urgent care, short term stabilization, critical, prehospital care
What is the acute care setting
patients admitted as inpatient status within a hospital setting, wide variety of needs, provide 24 hr care
How can a physical therapist access a patient's medical record in different ways
electronical record, medical team, from patient (if cognitively applicable)
what are the trauma center levels
1. care for any and every aspect of injury
2. able to initiate care for any and all aspects of injury
3. able to provide prompt assesment, resuscitation, surgery, intensive cqare and stabilize injured patients
4. provide advanced trauma life support prior to transfer of patients to a higher-level trauma center
5. provides initial evaluation, stabilization and diagnostic capabilities and prepare patients to transfer to higher level care
what are some unique features to PT in the acute care setting
communication with medical team, making clinical judgements regarding type of PT intervention patients need, understanding thresholds and limits, identify pts with deterioration and where they should go next (home, inpatient, outpatient etc.)
What are the different phases of care within the acute care setting?
Pre-hospital emergency medicine - initial phase of acute patient care, often focused on highly acute conditions like cardiac arrest.
Emergency medicine - acute treatment for life-threatening illnesses or injuries, or for illnesses or injuries that are causing severe pain or may lead to serious consequences.
Palliative care - a crucial component of the standard of care in acute and post-acute settings, and offers support and resources to patients and families dealing with complex medical decisions.
Short-term stabilization - focuses on stabilizing the individual to minimize or control the symptoms of their condition until they can receive definitive treatment.
what questions should be asked during subjective history
assess alertness, orientation and overall mentation (where are you, what year is it, who is the president, do you know why you are here) PLOF, understand social history and available support - are people at home able to help, ability to ambulate/clothe, what responsibilities at home are (who does the cooking/cleaning), pets/people at home
define inpatient
free standing rehabilitation services set within an acute care hospital
label what each code is associated with: pink, orange, silver, purple. triage, black, blue
pink - infant abduction
orange - hazerdous materials incident
silver/gray - security alert (active shooter/threat)
purple - critical saturation
triage - mass casualty/emergency response plan activation
black - utility failure (power outage, EMR outage)
blue - medical emergency(cardiac/respiratory arrest)
what types of conditions do PTs treat in acute setting
Extremely versatile environment: burns/wounds, psychiatric disorders, cardiovascular/pulmonary dysfunction, neurologic dysfunction, failure to thrive, after organ transplant, general surgery pts, cardiac/msk surgeries
name the acronyms for what continuum of care they are:
ICU, CTICU, MICU, SICU, TICU
ICU - intensive care unit
CTICU - cardio thoracic intensive care unit
MICU - medical intensive care unit
SICU - surgery intensive care unit
TICU - trauma intensive care unit
What are the most frequently used physical therapy screens in the acute care setting?
MSK: gross ROM/strength, mobility, 5xSTS/30s STS
Neuro: A&Ox4, tracking movement, gross sensory screen/coordination, gait, transfers, balance
CVP: HR, BP, RR< Sp02, quality of breathing, vital sign and lab value trends, hemodynamics during session
Integ: color, skin, texture, scars, discoloration, open wounds, no-healing wounds
Gait/balance: quality of movement, assistance required, any loss of balance, FGA, DGI, 6-clicks AMPAC
what populations are best suited for intensive rehabilitation in the inpatient setting
SCI, TBI, trauma injuries
with access to medical charts in the hospital, what is the biggest component to remember?
HIPAA - only observe YOUR patients chart, only look at information regarding their care, only discuss with team members assigned to the pt
name some issues that occur with prolonged bed rest
decreased cardiac function : increased resting HR, decreased SV, myocardio thinning, orthostatic hypotension
decreased respiratory function: decreased lung volume capacity, mucociliary clearance, increase risk of pneumonia, decreased Sp02
Decrease in muscle tone, muscle atrophy, risk of contracture, disuse osteoporosis
increase risk of pressure injury
increased depression
name the acronyms for what continuum of care they are:
CCU, OR, PACU, PICU, NICU
CCU - coronary care unit
OR - operating room (CTOR cardiothoracic op room, TOR trauma op room)
PACU - post anesthesia care unit
PICU - pediatric intensive care unit
NICU - neonatal intensive care unit
What are the most frequently used physical therapy examinations in the acute care setting?
Cardiopulmonary, Neuro, Integ, MSK, Communication/alertness/cognition, aerobic capacity/endurance, assistive devices used/level of assistance needed, bed mobility, functional mobility, discharge planning, lab values
how can inpatient rehab provide intensive rehab as an OUTpatient to patients recovered from SCI, TBI, trauma
meet needs of population who continue to require specific and intense skilled services
What are your tasks during the patient encounter before evaluation
review medical charts, restrictions, lab values, communicate with medical team to touch base/clarify, have a general idea of what patient and patients room will look like upon entering, know limitations to scope of practice, always wash your hands before entering a room (and upon leaving)
What are your tasks during the patient encounter during evaluation
introduce yourself and what you are there for, get consent, ask subjective history, screens (CVP, Neuro, MSK, Integ, Gait, Transfers), objective measures, interventions, monitor vitals, alert team if out of range or change in pt during encounter, respond to any pts questions
name the acronyms for what continuum of care they are:
SDU, ER/ED, Palliative, inpatient rehabilitation
SDU - step down unit (swing bed, noncritical)
ER/ED emergency room, emergency department
Palliative - hospice care/end of life
inpatient rehabilitation - long term rehab acute care
Are all patients examined and evaluated the same in the acute care setting?
no, it depends! must be flexible depending on each patient
What are some precautions when assessing a patient in the acute care setting?
what is different in inpatient from outpatient regarding screens?
outpatient: screens mostly performed during subjective exam, often no need to re-screen
inpatient: screens performed during subjective and objective examination, screening continues to occur simultaneously with treatments and during each individual visit