Acute Care PT: An Overview, some of the slides
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| Roles of the Acute Care PT | Communicate/co-treat with other members of therapy team
Assessment is vital to d/c planning for the pt
Initiates mvmt & fxnal activity pt can tolerate
First therspist to see pt after something that impacted ability to fxn
🗑
|
||||
| More roles of the acute care PT | Must possess broad knowledge base of many diagnoses
Understand contraindications/precautions associated w/ dx
Knowledge of lab values
Knowledge of monitoring devices being used
🗑
|
||||
| Critical Care Environment | Pts are dependent on outside means & care of others to meet basic physiologic needs
Require close supervision, monitoring, & care & have medically complex needs
🗑
|
||||
| PT's primary goal in the critical care environment | Initiate mvmt & prevent complications associated with immobility
🗑
|
||||
| Normal Vital Signs: HR, O2 Sat, BP, Respiratory Rate | HR: 60-100 bpm
O2 sat: 90-100%, <85- notify nurse ASAP
BP: 100-140 systolic/70-90 diastolic (some pts may need increased BP for more circulation)
RR: 12-20 breaths/min
🗑
|
||||
| Indications for Discontinuing or Modifying Activity (vital signs) | HR: <40 or >130
O2 sat: <85%
BP: >220 systolic or >110 diastolic
Decrease in systolic 10+ mmHg with increased activity; increased diastolic- disruption in peripheral blood flow, could be in shock
Blood sugar >300
🗑
|
||||
| Oxygen Delivery Methods | Cannula- in the nose
Oximizer- reservoir of O2 under the nose
Mask
BiPAP- maintains pressure to keep airway open
Endotracheal tube- used for ventilator to assist respiration
🗑
|
||||
| SaO2 monitoring | % hemoglobin saturation
Measured via pulse oximetry
🗑
|
||||
| PaO2 monitoring | Partial pressure of arterial O2
Measured via arterial blood gases
🗑
|
||||
| Pulse Oximetry | Non-invasive way of monitoring % hemoglobin saturated with O2;
Keep >90% unless otherwise specified
Nail polish, skin pigmentation, low tissue perfusion, vasoconstriction, anemia can affect readings
🗑
|
||||
| Cardiac Monitoring | All ICU pts have heart monitors;
Select pts have portable heart monitors connected to monitoring station;
Monitors: heart rhythm, need for med changes, response to mvmt, exercise, disease process
🗑
|
||||
| Cardiac Arrhythmias | Look at rate & rhythm on EKG
Rhythm: regular/irregular? patterns to the irregularity? extra beats?
Rate: too fast (tachy) HR >100; too slow (brady) HR <60
🗑
|
||||
| Normal Sinus Rhythm | Regular rhythm
P wave for every QRS complex
Rate 60-100
🗑
|
||||
| Atrial Fibrillation | Irregular rhythm
No discernable p-wave
Narrow QRS complex
Has a saw-tooth pattern
These pts fatique quickly won't tolerate activity
🗑
|
||||
| Dead (Ventricular) Rhythms | Asystole (flat line)
Ventricular fibrillation (irregular pattern)
Pulseless ventricular tachycardia
PEA (pulseless electrical activity): Any rhythm without a pulse
🗑
|
||||
| Monitoring Your Patient: Tubes & Lines | Understand purpose of the tube or line
Understand barriers & precautions created by the physical presence of the tube/line
🗑
|
||||
| Central Venous Lines (CVL's) | Tip of CVL is in superior vena cava
Used for: irritating meds, large-volume blood products, vasoactive meds, rapid fluid infusion, TPN (total parenteral nutrition), Measurement of central venous pressure (pressure of R atrium)
🗑
|
||||
| Types of CVL's | PICC- peripherally inserted central catheter
Triple lumen
Tunneled
Port-a-cath
🗑
|
||||
| PICC (Peripherally Inserted Central Catheter) | Inserted through peripheral vein & advanced toward the heart until the tip lies in the superior vena cava
Don't take BP on the side of the PICC
🗑
|
||||
| Triple Lumen Catheter | Threaded thru jugular or subclavian vein
Short-term catheter for rapid fluid infusion & certain meds
Can be used to measure central venous pressure
🗑
|
||||
| Tunneled Central Venous Lines | Used for long-term IV access: chemo, antibiotics, IV fluids
Usually threaded under skin, then through jugular or subclavian vein to the superior vena cava
🗑
|
||||
| Port-a-Cath | Long-term implantable vascular access device
Accessed through the skin
Often used for chemo
🗑
|
||||
| PT Implications of Central Venous Lines | Don't pull them out! If dislodged, apply pressure at site.
Decrease in CVP may indicate decrease in circulating blood volume.
CVP, line will be hooked up to monitor, a transducer, & pressure bag. Mobility will be limited by length of lines.
🗑
|
||||
| Arterial Line | Used for constant BP monitoring
Can draw arterial blood from lines for blood gas monitoring
Usually inserted in wrist (radial a) or groin (femoral a)
Limit ROM at wrist/groin on that side; with femoral line, can't get pt up out of bed
🗑
|
||||
| Epidural Catheter | Pain mgmt
Small catheter usually placed mid to low thoracic spine
Make sure it's taped & dressing secure
Locked infusion pump
Don't lay these patients flat, could affect breathing! Epidural could also affect leg strength.
🗑
|
||||
| PCA Pump | Pt-controlled analgesia
Pt self-administers IV pain meds at pre-determined intervals
Pump "locks out" if it's not time yet
Gives pt more control over pain
🗑
|
||||
| External Ventricular Device (EVD)/Ventriculostomy | Decreases CSF pressure
Tip of drain positioned in lowest part of 4th ventricle
Temporary; laser has to be lined up with tragus (tragus lined up with bottom of 4th ventricle)
Know whether or not EVD can be clamped, must clamp before PT
🗑
|
||||
| Chest Tubes & Indications | Mediastinal/Pleural
Post-thoracic trauma, cardiothoracic surgery, injury/disease causing increased fluid/air in lungs, pneumo-/hemothorax, empyema, metastatic cancer
Know where chest tube is (gait belt); see blue water (good seal, bubbles=poor seal)
🗑
|
||||
| PT Implications for Chest Tubes | Avoid pulling/kinking tube
Keep drainage container upright, below chest level
Chest tube hooked up to wall suction/set to water seal
Suction tubes may limit mobility with pt
Hooked to suction, be sure to ask RN if it can be disconnected for PT
🗑
|
||||
| 3 Compartments of Chest Tubes | Water seal, suction chamber, collection chamber
Continuous air bubbles in the water seal chamber indicative of air leak
🗑
|
||||
| Drains | Can be placed in variety of areas
Drain fluids by creating suction (pulling) in tube
PT implications: Don't pull on drain; secure drain to pt gown; make sure suction is maintained
🗑
|
||||
| Nasogastric Tubes | Decompression or feeding
Inserted thru nose
Tip ends in stomach/small intestine
Decompression- hooked up to wall suction
Avoid pulling/dislodgement
Tubing may limit tx if NG hooked up to suction
🗑
|
||||
| Feeding Tubes | May be N-G or percutaneous
Pt may be getting bolus or continuous feedings
If percutaneous, monitor site (watch gait belt!)
Keep head of bed up at least 30-45 deg while feeding is occurring
🗑
|
||||
| Rectal Tube | Works like catheter, but in rectum
Often used if pt immobile & has constant loose stools
Helps protect pt from skin breakdown
Don't pull on/dislodge tube while moving pt
🗑
|
||||
| Ostomies | Small/lg intestine brought outside body where stoma is created to provide pathway for waste
May be permanent or temp, depending on surgery
Ostomy pouch attached to skin to catch contents of bowel
Ileostomy: paste-like/loose stool
Colostomy: thicker st
🗑
|
||||
| Hemoglobin Values | O2-carrying component of RBC
Normal: F (12-16) M (14-18)
Abnormal: Critical <5, check if <9
Decrease: fatigue, weakness, dyspnea; monitor for dizziness/light-headedness
🗑
|
||||
| Platelets | Normal: 150,000-400,000/mL
Abnormal: thrombocytopenia <100,000 affects clotting; critical: <1000
🗑
|
||||
| WBC | Immune system status. Low WBC- pt/PT wear mask during tx
Normal: 4.8-10.8 K/uL
Abnormal: decrease (leukopenia): immune system/bone marrow diseases/chemo or radiation; Increase (leukocytosis): malignancies, infection, trauma
S/sx: Fever, wkness, aches
🗑
|
||||
| Absolute Neutrophil Count (ANC) | Immune system status; body's 1st line of defense in acute infection
Normal: 1900-7000
Abnormal: Low WBC precautions if <1000
Implications: Pt & caregivers need masks, no live plants/flowers, no visitors with cold/flu-like s/sx & no children <12
🗑
|
||||
| INR (International Normalized Ratio) | Blood clotting ability, monitors Coumadin therapy
Normal: 0.9-1.2
Abnormal: Pt. may be on bedrest if INR is >5
Implications: May postpone therapy with abnormally high levels due to increase bleeding risk
🗑
|
||||
| Blood Glucose | Normal: 70-100 mg/dL
Abnormal: Critical <30 or >600
Hold exercise if glucose <60 or >300
🗑
|
||||
| Slide 52 Picture | HgB= hemoglobin (very important)
Hct= hematocrit
BUN= blood urea nitrogen
Creatinine= kidney fxn, kidneys should be getting rid of it
HCO3= bicarbonate (respiration) low HCO3, body tries to compensate for high CO2
🗑
|
||||
| The Bariatric Patient: BMI Review | <25 = normal
25-30 = overweight
>/=30: obese
>/=45: morbidly obese
🗑
|
||||
| Medical Complications of Obesity | Pulmonary disease; Diabetes: CVA; Cataracts; CAD; Pancreatitis; Cancer; Phlebitis; Gout; Skin; OA; Gynecologic abnormalities; Non-alcoholic fatty liver disease
🗑
|
||||
| What is Fornier's Gangrene? | Infection in groin, always occurs in males
🗑
|
||||
| Treatment Concerns with Bariatric Patient | Need for bariatric equipment
Need for more staff to assist with mobility
Staff/pt injuries
More medical complications
Longer length of stay
D/c planning difficulties
🗑
|
||||
| Communication with Patients & Families | Be sensitive to new dx/abilities
Consider culture
Consider level of education/understanding
Find what motivates your pt
Develop goals/PoC together
Involve caregivers
Provide education
🗑
|
||||
| Communication with Physicians | Know when to call (order clarification, with concerns re: medical status, when requested)
Do homework, be prepared
Be visible
Build relationships
🗑
|
||||
| Communication with Nurses | Great source of info
Concerns/questions about medical status
Report back-share info
Be visible
Build relationships
🗑
|
||||
| Communication with other staff | Team with other disciplines
Share info
Be visible
Build relationships
🗑
|
||||
| D/c Planning- one of the most important roles acute care PT plays is in DC planning | Help team determine pt's d/c needs & appropriate next level of care
Beginning at initial eval, we recommend where pt should go & what they will need
PT needs to find out detailed info about pt's home, prior level of fxn, & support the system
🗑
|
||||
| D/C Planning- what to consider | PLOF; How independent do you expect pt to be; Home support system; Pt's restrictions/limitations; Pt home set-up; Any ongoing medical needs; Equipment needed at home
🗑
|
||||
| Discharge Options | IP Rehab
SNF
Long-Term Acute Care Hospital (LTACH)
Nursing home
Assisted Living
Home Health
OP Therapy
🗑
|
||||
| IP Rehab | Pt requires intensive rehab at least 3 hours/day, 5 days/week
PT/OT/ST
Must be expected to achieve fxnal significant improvement over reasonable period of time
Goals focus on max level of independent fxn
50% pts must be Medicare; 60% must have CMS 13
🗑
|
||||
| SNF | 1-3 hrs/day 5 days/week
3 midnights as IP in acute care prior to xfer
Skilled nursing care must be required at least daily
🗑
|
||||
| LTACH | Medical/respiratory needs dominate reason for admission
Must require medical, respiratory, & skilled nursing
Pts. expected to be there @ least 24 days
Sickest pts.
Vent pts, complex wound/infection pts
🗑
|
||||
| Home Health | Requires cares, but not level of rehab/SNF
May receive nursing, therapy, behavioral health
Must be homebound (medical trips/church allowed)
"Leaving home requires considerable & taxing effort"
Will they be safe at home most of the day?
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
1190550002
Popular Physical Therapy sets