discharge
What are examples of when it is time to discharge a patient?
-Have met goals & returning to life role
-Prescription for # of visits has ended
-Exceeded or running out of insurance coverage, or the pt is not paying
-Not making improvements or cannot benefit from more therapy
-Pt is ready to move on to another profession for treatment
-Persistent failure to show up
-Sentinel incident
-Habitual noncompliance
Acute Care: Session duration and times per week
30-45 minute session
5-7x/week
What is cardiac rehab?
After cardiac surgery outpatient, but very specific to cardiac
Ages of...
Young-old
Mid-old
Old-old
Young-Old: 65-74 yo
Mid-Old: 75-84 yo
Old-Old: >85 yo
Osteoporosis
1. More common in ___
2. Peak bone mass in __s, __% bone loss in 80s
3. Hip fx has 25% increase in death rate in __ year
4. What should you do in therapy?
1. Women
2. 30s, 30%
3. 1
4. WB exercises & strength training
What should be included in the discharge summary?
-Current physical/functional status
-Degree of goals achieved & reasons for goals not being achieved
-Discharge plan related to the pt continuing care (ex. HEP, caregiver, referrals)
Inpatient Rehab Unit: How much rehab per day
3 hours of therapy/day
Outpatient Rehab
How long & how many sessions per week?
60-minute session (ik some places do shorter, but for the sake of the test, the PPT said 60)
2-3x/week
What is the difference between primary & secondary aging?
Primary:
-The universal development model for the passage of time
Secondary:
-Results from disease, disuse, & the environment
What are...
1. Age-related, involuntary loss of skeletal muscle mass & strength (2 names)
2. Degenerative joint disease, in which the tissues in the joint break down over time
1. Sarcopenia/Frailty
2. OA
What should you do if you were the last person to see a patient?
Write a progress note or discharge note in which the patient’s status is documented without review of the entire episode
SNF: Hours of rehab per day & days per week
1-3 hours therapy/day
3-7x/week
SNF/Rehab
How many times a day of rehab?
What are the different professions seen here?
What is a benefit of a SNF?
3-7x/day
Speech, OT, PT, Nurses (medications)
Round-the-clock care
What does the STEADI assess?
Fall risk
1. Max HR (Calculation) + (Ex: Age 20, 59, 74)
2. Stroke volume ___ with age = ___ Cardiac output
3. ___ O2 carrying ability
4. ___ BP due to more peripheral vascular ___
1. 220-age, 200, 161, 146
2. Decreases, Decreased
3. Less
4. Increased, Resistance
What are the differences between a discharge plan and discharge summary?
Plan:
-Must be completed by the PT, but can be with PTA input
-PT determines the plan
-Must be signed by the PT
Summary:
-Based on the discharge plan
-Can have PTA input
-Summarizes the treatment
-Must be approved & co-signed by the PT
Long-term Care
Is it temporary or permanent? Covered by insurance?
Permanent placement
Not covered by insurance
Home Care
What is a requirement?
What types of professions can be involved?
Must be home-bound
Nurses, PT, OT, etc.
1. Muscle mass _____
2. Neuro system _____
3. Quality of muscle tissue/tendons _____
4. Healing responses _____
1. Decreases
2. Slows down
3. Decreases
4. Slow down
Recommendation for physical activity
What test can be used to check intensity without any equipment?
-Talk test
What are some ways to discharge a patient who does not want to leave?
-Set expectations in the beginning
-Update HEP often
-When appropriate, inform the physician of impending discharge to be on the same page (they can back you up)
-Encourage pt to follow up with the doctor if they want to update them on progress
-Suggest that the pt set time aside 2-3x/week to consistently perform their HEP as if they were going to a PT appointment
-Emphasize that discharging is an accomplishment & they should be proud (we are not rejecting them)
If home bound & has medical needs
School Based
IEP for years
Depends on kids, diagnoses, needs, etc.
1. With organ reserve changes, after age 30, how much is lost each year?
2. At what age does muscle mass decrease?
1. 1%
2. 40 yo
Flexibility (Use ROM!):
1. __ intensity, __ duration
2. __ in max tensile strength & __ adaptation to change
Balance:
3. Good in __ before __
4. __-__ minutes/day
Resistance Training:
5. Work in __ ROM
6. Recommendation: __x/week, __% 1 RM, _-_ sets
1. Low, slow
2. Decrease, slower
3. Sitting, standing
4. 10-15
5. Pain-free
6. 2-3, 60%, 2-3