Acute Care PT: An Overview, some of the slides
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| Roles of the Acute Care PT | show 🗑
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| More roles of the acute care PT | show 🗑
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| show | Pts are dependent on outside means & care of others to meet basic physiologic needs
Require close supervision, monitoring, & care & have medically complex needs
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| show | Initiate mvmt & prevent complications associated with immobility
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| Normal Vital Signs: HR, O2 Sat, BP, Respiratory Rate | show 🗑
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| Indications for Discontinuing or Modifying Activity (vital signs) | show 🗑
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| Oxygen Delivery Methods | show 🗑
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| SaO2 monitoring | show 🗑
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| show | Partial pressure of arterial O2
Measured via arterial blood gases
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| show | 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
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| show | 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
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| Cardiac Arrhythmias | show 🗑
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| Normal Sinus Rhythm | show 🗑
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| Atrial Fibrillation | show 🗑
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| Dead (Ventricular) Rhythms | show 🗑
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| Monitoring Your Patient: Tubes & Lines | show 🗑
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| show | 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)
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| show | PICC- peripherally inserted central catheter
Triple lumen
Tunneled
Port-a-cath
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| PICC (Peripherally Inserted Central Catheter) | show 🗑
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| Triple Lumen Catheter | show 🗑
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| show | 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
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| Port-a-Cath | show 🗑
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| PT Implications of Central Venous Lines | show 🗑
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| Arterial Line | show 🗑
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| show | 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.
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| show | 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
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| External Ventricular Device (EVD)/Ventriculostomy | show 🗑
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| Chest Tubes & Indications | show 🗑
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| show | 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
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| show | Water seal, suction chamber, collection chamber
Continuous air bubbles in the water seal chamber indicative of air leak
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| show | 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
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| show | 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
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| show | 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
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| Rectal Tube | show 🗑
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| show | 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
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| Hemoglobin Values | show 🗑
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| Platelets | show 🗑
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| show | 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
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| Absolute Neutrophil Count (ANC) | show 🗑
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| show | 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
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| Blood Glucose | show 🗑
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| Slide 52 Picture | show 🗑
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| The Bariatric Patient: BMI Review | show 🗑
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| Medical Complications of Obesity | show 🗑
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| What is Fornier's Gangrene? | show 🗑
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| Treatment Concerns with Bariatric Patient | show 🗑
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| show | 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
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| Communication with Physicians | show 🗑
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| show | Great source of info
Concerns/questions about medical status
Report back-share info
Be visible
Build relationships
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| Communication with other staff | show 🗑
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| D/c Planning- one of the most important roles acute care PT plays is in DC planning | show 🗑
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| D/C Planning- what to consider | show 🗑
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| Discharge Options | show 🗑
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| show | 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
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| show | 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
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| LTACH | show 🗑
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| show | 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?
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