Acute Care OT (marrillee’s powerpoint) – Flashcards
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patients an OT might see following an elective inpatient procedure
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joint replacements, spinal surgeries, craniotomy, amputations, abdominal and thoracic surgeries
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patients and OT might see following admission to emergency department
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exacerbation of chronic conditions like CHF, COPD, sickle cell disease, acute illnesses or injury (CVA, MI, pneumonia, fall injuries), altered mental status
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Definition of Acute care (per aota cute care fact sheet)
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is an inpatient hospital setting for individuals with a critical medical condition. These patients may have experienced a sudden decline in their medical and functional status due to a traumatic event (e.g., head trauma or spinal cord injury), a worsening of a progressive disease (e.g., emphysema or end-stage renal disease), or the onset of a new condition (e.g., myocardial infarction or stroke)
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get 'em in, get 'em out idea
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primary goal of acute care is to stabilize patient's medical status and address any threats to his or her life and loss of funtion
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General length of stay for acute care
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1 day to 1-2 weeks
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people on acute care rehab team
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doctors (hospitalist and specialist), nurses and CNA's, case managers, discharge planners, rehab staff (OT, OTA, PT, PTA, SLP), respiratory staff, dietitian
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4 characteristics of an acute care environment
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1. Unpredictable because patients are medically unstable 2. fast paced with a quick turnover 3. lots of interruptions 4. not uncommon to be simultaneously evaluating, treating, and discharge planning all at the same time
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Main focuses of OT in acute care
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Assessing, Educating, Initiating discharge process
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What an OT in acute care screens for
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cognition, coordination, endurance, balance, strength, sensation, skin condition, ROM, functional mobility, vision
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OT in acute care may adress
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ADL, transfers and bed mobility, splinting, feeding, positioning, edema management, HEP
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HEP in acute care
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may not actually occur at "home" just yet. may just occur in hospital room
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Some of the formal assessments used in OT acute care
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The Short Blessed The Montreal Cognitive Assessment (MOCA) The Confusion Assessment Method for the ICU (CAM-ICU) Brain Injury Visual Assessment Battery for Adults (BiVABA) AM-PAC '6 Clicks
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formal assessment that is not really used in acute care
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the FIM (functional independence measure)
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informal assesments
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Acute care occupational therapists have little time to administer standardized assessments, but they often rely on occupation-based activities, particularly self-care activities, to perform client evaluations
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assessment may start
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before or from the moment an OT enters a patient's room
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Assess and conclude
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quick assessments must be made because an OT in acute care won't have time to do a whole ADL routine
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Example of assess and conclude: if a person has trouble standing up from a hospital bed
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you can probably conclude that they'll have trouble standing up from a standard toilet
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example of assess and conclude: fit they are unsteady puslling up their pants
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you can probably conclude that they'll be unsteady opening doors or fixing a snack
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example of assess and conclude: if they are out of breath after washing their face at a sink
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you can probably conclude they lack the endurance to shower safely
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Review! Levels of function, disfunction
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Independent Modified Independent Supervision Stand-by Assist (SBA) Contact Guard Assist (CGA) Minimum Assist (Min A) Moderate Assist (Mod A) Maximum Assist (Max A) Dependent
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Triage
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the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately
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4 effects of triage on patients
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1. not every patient gets OT 2. Patients on caseload are rarely seen daily 3. patients are assigned a frequency (ex 3x/wk, 4x/wk) 4. new orders are answered within 24 hours
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typical day for an OT in acute care
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1.set caseload for day 2. triage existing patients 3. do chart reviews for new patients 4. coordinate with PT 5. see patients awaiting discharge clearance 6. see remaining patients for evaluation and treatment 7. complete documentation for each patient 8. pick up additional patients if time
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Basic tools for OT in acute care
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pulse oximeter, gait belt, pen an paper, washcloth
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before entering a room, an OT will have already
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reviewed a chart, checked orders, touched base with a nurse
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Surveying the scene
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surveying the patient, surveying the room
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surveying the patient includes
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getting a general impression, seeing what they're attached to
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surveying the room includes
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seeing who else is there, seeing what equipment is there, asking self what needs to be moved/set up/rearranged for session
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Evaluating a new patient-introduction
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Introduce the role of OT (have elevator speech ready!) Obtain brief patient profile and prior level of function (PLOF) Check Orientation
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evaluating a new patient-education and ADL
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educate on precautions and restrictions, get them moving. if this is too much for a patient, pick just one thing to focus on
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trick/formula for getting a reluctant patient out of bed
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offer them a grooming task, a dressing task, transfers or in-room ambulation
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evaluating a new patient: preliminary recommendations
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Discuss progression of therapy Discuss discharge recommendations, if appropriate Discuss equipment recommendations, if appropriate Update appropriate people (family, RN, Case Manager, PT)
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Levels of discharge recommendation
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Home independently Home with intermittent assistance Home with 24/7 assistance Home with Home Health OT Skilled Nursing Facility Acute Rehabilitation Long Term Acute Care (LTAC) Outpatient Rehabilitation Return to Prior Facility (Hospice, Comfort Care)
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Stressors a patient may experience in a hospital setting
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strained family relations, new diagnoses, medical complications, terminal illness, unexpected lifestyle changes
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Patients who are out of their element
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they don't feel well, they might not like working with you, they might be uncooperative or unpleasant. These things should never be taken personally.
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other roles ot might take on
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Persuasion Encouragement Empathy Tough Love
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Effective way to adjust treatment approach
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adjust treatment approach to patients personality
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normal O2 saturation
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92% or greater
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normal heart rate
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60-100 bpm
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normal blood pressure
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90-120/60-80
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Orthostatic Hypotension
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an excessive drop in BP when an upright position is assume. Consensus definition is a drop >20 mm Hg systolic, >10 mm Hg diastolic, or both
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Medically Complex Patients
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There can be lots of lines and tubes coming out There can be lots of lines and tubes going in They might be intubated A machine might be breathing for them They could be in restraints Machines will be beeping
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Musculockeletal Danger of Immobility
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deconditioning, muscle atrophy
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pulmonary dangers of immobility
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increased risk of pneumonia, DVT, PE
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cardiovascular danger of immobility
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orthostatic intolerance, increased heart rate
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integumentary dangers of immobility
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reduced circulation, skin breakdown
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psych dangers of imobility
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depression, confusion, delirium
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MMLE
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minimal manual lift environment
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spinal precautions
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bending, lifting, twisting (BLT)
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hip precautions-antrolateral
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no bending, no crossing the midline with surgical leg, no turning surgical leg out and back
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hip precautions-posterolateral
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no bending, no crossing the midline with surgical leg, no turning surgical leg inward
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even if patients seem angry with you
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always remember to be compassionate
