Acute Care Physical Therapy – Flashcards

Check Orders: Activity Level - Bed Rest, OOB to Chair, Ambulate, Activity as Tolerated Clearance from involved disciplines WB Status and Activity Restrictions History of Present Illness Operative Reports Lab Values Imaging (MRI, CT, X-ray) Progress Notes Orders that are Red Flags: -Xrays/MRIs of spine or extremities Especially if pt has been admitted secondary to fall or trauma -Ultrasounds to rule out DVTs of LE/UE -Arterial Blood Gases or VQ scans to rule out pulmonary embolisms Bed Rest Restrictions May vary in length depending upon procedure Case by case basis

Bed Restx 1 hr after an arterial line is removed Bed Restx 1-3 hrs after pacing wires are removed in cardiac patients Bed Restx 4 hrs after a central line is removed Bed Restx 4-6 hrs after Angiography via Femoral Artery or Cerebral Angiography s/p CVA STRICT Bed Rest (HOB flat) 24-48 hours Bed Rest with patient who has an External Ventricular Drain (EVD) or Lumbar drains unless it has been clamped. Typically, Bed level with patients with femoral lines secondary to no hip flexion > 45 degrees (or RN's discretion).

TRUE

Arousal Level Visual Tracking Orientation Pain Level Speech Vitals PLOF Gross scan of UE and LE Coordination bed mobility transfers gait training Balance Pt ed

Pain scale for non communicative patients - components are Face Legs Activity Cry Consolability Lower scores are better

Bed Mobility - rolling, scooting, supine to sit, bridging EOB activity - sitting balance Standing - weightshifting, marching in place Transfers - stand pivot, lateral scoot, slide board, stand turn, dependant lift Gait - sidestep to head of bed, forward/backward Stairs

Evaluation Form -Goals, POC, HEP Progress Notes -Acknowledge Orders Education Form -Required by JAHCO

Able to tolerate 3 hours therapy (PT, OT, Speech combined) Attainable discharge plan with support available to return home or to ALF 60% of patients admitted to Acute rehab must have the following diagnoses: CVA, SCI, amputation, major multiple trauma, TBI, RA, neurological disorders, bilateral knee replacements

Patient stays in facility short term with goals to return home or to ALF Able to tolerate therapy 5-7 day/week, but at lower levels than acute rehab

Covers a wide range of facility that provide varying level of care for the patient Patient may receive home health therapy while residing at an ALF *some have very strict minimum functioning for acceptance* i.e. ambulate and transfer independently

Patient will receive physical therapy 2-3x/week Patient must be homebound Patient must be able to perform ADLs, bed mobility, and basic functional mobility with the assistance available

Patient is not projected to make gains with physical therapy Patient unable to tolerate physical therapy Patient lives long term in this facility

Patient ambulating independently or supervision in hallways Doctor orders for PROM only Patient is on bed rest Patient is at prior level of function with mobility and ADLs

6-8 weeks No raising arms > 90 degrees in flexion, abduction and scaption No lifting > 5lbs each hand or 10lbs combined No pushing, pulling, or lifting No excessive horizontal abduction

For pts after pacemaker placement No shoulder ROM with LUE

Cardiac Precautions No holding breath, isometrics discouraged

- light headedness, dizziness, diaphoreses, dyspnea

Pt must wear brace when head of bed > 30 degrees (if brace is ordered by MD) Wear one layer (gown, shirt) between skin and brace No bending, lifting, twisting movements Logrolling for bed mobility No bridging or straight leg raises

Do not push or pull on halo rods/vest Never loosen/adjust pins/vest

No flexion > 90 degrees (most common for primary hip replacement) [60 degrees for revisions] No internal rotation No adduction Hip Abduction pillow between LE's while at rest Weightbearing status

No twisting or pivoting on the involved leg Weightbearing status established by the surgeon

Logroll for bed mobility Check abdominal incision before placing gait belt Secure all drains Check with RN to disconnect suction (if able) Body mechanics for healing Educate and encourage to not strain No holding breath

Chest Tube Must stay below the level of the insertion Feeding tube Head of bed > 30 degrees

assists low functioning patients in sit stand and then can be pushed for ambulation Encore lift requires some strength - have plates to block knee buckling - patients can walk with this