1
Q
WEEK 1
A
WEEK 1
2
Q
What are the discontinuation destinations?
A
- ICU
- Acute Care
- Inpatient Rehab
- Subacute/TCU
- SNF
- Home Health
- Outpatient
- Hospice
3
Q
Clinical rationale for D/C to ICU?
A
PT may have a role but it depends on how hemodynamically stable the patient is.
4
Q
Clinical rationale for D/C to Acute Care?
A
Pt is still in critical condition, but more stable.
5
Q
Clinical rationale for D/C to Inpatient Rehab?
A
Intense hospital based therapy (3 HOURS/DAY)
6
Q
Clinical rationale for D/C to Subacute/TCU?
A
Less intense, hospital-based therapy (2 HOURS/DAY)
7
Q
Clinical rationale for D/C to SNF?
A
Less intense skilled nursing based therapy (2 HOURS OR LESS/DAY)
8
Q
Clinical rationale for D/C to Home Health?
A
Home based therapy, patient must be home bound (3x/WEEK)
9
Q
Clinical rationale for D/C to Outpatient?
A
Best for more mobile patients
10
Q
Clinical rationale for D/C to Hospice?
A
Appropriate for patients with diagnosis of 6m or less to live
11
Q
- ____________ based precautions are used for patients documented or suspected to be infected or colonized with highly transmissible or epidemiologically important pathogens; used in addition to standard precautions.
- What precautions are included under this?
- They are used in addition to ________ precautions.
A
- Transmission
- Contact, Droplet, Airborne, Neutropenic
- Standard Precautions
12
Q
Standard Precautions apply to what 4 things?
A
- Blood
- All body fluids (except sweat)
- Nonintact skin
- Mucous membrane
13
Q
- ________ precautions are used for known or suspected infectious microorganisms that are transmitted by indirect or direct contact.
- What are some examples of diseases/viruses that use these precautions?
A
- Contact
- MRSA, VRE, norovirus, C.Diff, chicken pox
14
Q
What are the 5 things included in contact precautions?
A
- Standard precautions
- Private room
- Gloves and gown
- Dedicated non-critical client care items
- Disinfect all equipment/surfaces prior to use by other people
15
Q
- ___________ precautions are type of contact precaution.
- What are some examples of diseases/viruses that use these precautions?
A
- Enteric
- C.Diff, norovirus, rotovirus
16
Q
What are the 3 things included in enteric precautions?
A
- HAND WASHING with soap and water (alcohol-based wont kill spores)
- Equipment cleaned with chlorine-based disinfectant
- All other contact precautions
17
Q
- ________ precautions involves pathogens larger than 5 microns that travel, they travel no further than 3 feet and infect hosts conjuctivae or mucous membrane.
- What are some examples of diseases/viruses that use these precautions?
A
- Droplet
- Pneumonia, influenza, whooping cough
18
Q
What are the 4 things included in droplet precautions?
A
- Standard precautions
- Private room
- Face mask (visitors if in/patients if out)
- Goggles or face shield
19
Q
- ________ precautions involve pathogens smaller than 5 microns that can remain suspended in the air for several hours and infect the host via inhalation or direct transmission.
- What are some examples of diseases/viruses that use these precautions?
A
- Airborne
- TB, measles, chicken pox
20
Q
What are the 3 things included in airborne precautions?
A
- Standard precautions
- Don and doff respirator outside of room
- Isolation room with negative pressure
21
Q
________ precautions are used to protect an immunocompromised patient (<1500/mm3 of WBC) due to chemotherapy, radiation, immunosuppression drugs.
A
Neutropenic
22
Q
What are the 6 things included in neutropenic precautions?
A
- Standard precautions
- WASH HANDS before
- Don mask when in pt room (pt wears mask if leaving room)
- Patient diet restrictions (avoid uncooked fruit and vegetables, tap water/ice from ice machine)
- No fresh flowers
- Restrictions on number of visitors and none who feel ill
23
Q
_________ are used to deliver fluids and medications into a peripheral vein.
-What are the precautions with this?
A
IV Line
- keep the drip bag above level of insertion
- avoid kinking tube
- take BP elsewhere if possible
- notify nurse if area around insertion is red/swollen
24
Q
- ________ _________ __________ are electronically controlled pumps that deliver IV pain medication when the patient pushes a button; the system automatically stops providing medication at a set level to avoid medication.
- Note: Oral pain medication takes 30-45 minutes to take effect but IV takes about ___ minutes.
- What are the 3 options?
A
- Patient Controlled Analgesia
- 5 minutes
- small pumps worn by patient, implantable delivery device, larger sized pump attached to pole
25
- __________ _____ is inserted through the nasal passages to the stomach; removes stomach contents when attached to suction; printed with measurements that can help identify any movement once placed; often taped to nose.
- What are the precautions with this?
Nasogastric Tube
- notify nurse if movement is noted
- often can be disconnected temporarily for mobility
26
- _________ __________ gastrostomy/jejunostomy tube provides portal for long term tube feeding.
- What are the precautions with this?
Percutaneous Endoscopic Gastrostomy/Jejunostomy Tube
- feedings paused 30 minutes prior to supine activity
- do not place gait belt over tube at insertion point
- make sure the cap is tight
27
-_______ _____ is inserted just like NG tube, but is used for short term feeding.
Dobhoff Tube
- feedings paused for 30 minutes prior to supine activity
- do not place gait belt over tube at insertion point
- make sure the cap is tight
28
- ______ _____ _____ Systems provide oxygen at flow rates that are lower than patients' inspiratory demands.
- What are the precautions with this?
Oxygen Low Flow Systems
| -if relocating O2 tubing, always check for flow with your finger before connecting
29
- _______ ______ _____ Systems are used when Oxygen Low Flow Systems haven't worked.
- What are the precautions with this?
Oxygen High Flow Systems
| -if relocating O2 tubing, always check for flow with your finger before connecting
30
_______ ______ Nasal Cannula is a type of high flow nasal cannula; can deliver O2 up to 15LPM; attached to bottle reservoir for humidity.
Salter Labs Nasal Cannula
31
__________ takes gas and heats it up, delivers 100% FiO2 at flow rates up to 60LPM.
OptiFlow
32
________ catheter drains from the bladder, involves a balloon inflated internally to maintain pressure.
Indwelling (Foley)
33
________ catheter drains urine collected externally and can be taped into place.
Condom (Texas)
34
What are the precautions for catheters?
- Empty urine collected in bag before mobility
- If weight of bag is causing tension, have it emptied before mobility
- Avoid any tension on the tubing
- Condom catheters frequently fall off
35
- ______-______/_____ or Hemovac utilizes suction to pull excess fluid from an injury.
- What are the precautions with this?
Jackson-Pratt/Bulb
- Avoid tension on the tubing
- Have the nurse empty if more than half full and have the container supported
36
- _____ ______ is a tube inserted into the pleural space to drain fluid or maintain pulmonary inflation; suction is provided by wall suction or a water seal in the collection box.
- What are the precautions with this?
Chest Tube
- Do not allow box to tip
- Do not place tension on tubing
- Removal from wall suction requires MD order
37
What will patients with chest tubes need at peak effectiveness before mobility?
pain medication
38
- _________/____________ peripheral nerve block is used for regional pain relief; slow infusion of medication over peripheral nerve.
- _______ is used for regional pain relief; slow infusion of medication into epidural space.
- Epineural/Continuous
| - Epidural
39
What are the precautions for epineurals and epidurals?
- Check and monitor sensory function every time you mobilize the patient
- Do not allow tension to be placed on the catheter
40
- __________ __________ _________ (SCDs) assists in venous return; used with or without TED stockings to prevent DVTs.
- What are the precautions with this?
- Sequential Compression Devices
| - Disconnect for mobility, but make sure to reattach if patient is placed back in bed
41
- ________ _____ ("Art Line") is a thin catheter inserted in a artery that directly measures BP. It can also be used for withdrawing blood/administering meds.
- What are the precautions with this?
Arterial Line ("Art Line")
- Limit ROM around line
- Do not dislodge
- If it is disrupted, apply firm pressure and get help
- Maintain the insertion site level with the transducer
42
If you are unsure whether a line is an IV line or an arterial line, what can you do?
Squeeze it, arterial lines have rigid sides while IV lines have flexible sides.
43
_________ ______ is a breathing assistance that can provide anything from complete dependence to pressure support.
Mechanical Ventilation
44
- _________ ________ ________ can be placed to measure epidural or intraventricular pressure.
- What are the precautions with this?
Intracranial Pressure Monitor
- Talk to the nurse before treating
- Expect fluctuations in ICP with mobility, but have the nurse relevel the transducer to assess pressure once stationary again
45
______ _______ catheter/central line/triple lumen is placed into large vein (e.g. jugular, subclavian, femoral); administration of meds/fluids, blood tests, administration of drugs that would hurt small veins, frequent blood draws, peripheral access not possible.
Central Venous Catheter
46
Central venous ______ _________ involves a central venous catheter placed in the SVC near the RA; inserted via internal jugular; measures pressure in RA (estimation of preload and RA pressure).
pressure monitoring
47
______ catheter is a specialized central venous catheter used in dialysis. It is inserted via the subclavian/jugular vessels.
Vas Catheter
48
_________ ______ ________ Therapy is a slow and steady dialysis used for patients with critically low hypotension to remove water and waste gently, causing little to no hypotension.
Continuous Renal Replacement Therapy
49
What are some outcome measures specific to acute care?
- AM PAC-6 Clicks (Activity Measure for Post Acute Care)
- PFIT-S (Physical Function in the ICU - scored)
- FSS-ICU (Functional Status Score for the ICU)
- CPAx (Chelsea Crit Care Physio Ax tool)
- ACIF (Acute Care Index of Function)
- Perme ICU Mobility Score
- DEMMI (de Morton Mobility Index)
- ICU Mobility Scale
50
Which 4 outcome measures are used for short length of stay (LOS)?
- AM PAC-6 Clicks (Activity Measure for Post Acute Care)
- DEMMI (de Morton Mobility Index)
- PFIT-S (Physical Function in the ICU - scored)
- FSS-ICU (Functional Status Score for the ICU)
51
- Which outcome measure is predictive of discharge setting after acute care?
- What cut-off score predicts institutional discharge?
- The PT evaluates the pt's abilities in what 6 things?
- AM-PAC 6 Clicks
- 17 or less
1. ) Turning over in bed
2. ) Supine to sit
3. ) Bed to chair
4. ) Sit to stand
5. ) Walk in room
6. ) 3-5 steps w/ rail
52
- Which outcome measure measures and monitors mobility in patients making transition from hospital to community?
- What cut-off scores are used?
- The PT evaluates the pt's abilities in what 5 areas?
- DEMMI
- There are no "cut-off" scores, higher scores = better mobility
1. ) Bed
2. ) Chair
3. ) Walking
4. ) Static Balance
5. ) Dynamic Balance
53
- What outcome measure measures mobility and strength in ICU patients?
- Scores range from __-__ with each of the 4 components being graded on a scale of __-__.
- The PT evaluates what 4 things?
- PFIT-s
- 0-12, 0-3 (higher = better)
1. ) Shoulder MMT
2. ) Knee MMT
3. ) Sit to stand
4. ) Marching
54
- Which outcome measure is based on the FIM scoring but contains items more appropriate for the acute care setting and also is predictive of discharge location when measured at time of ICU discharge?
- Scores range from __-__ with each of the 4 components being graded on a scale of __-__.
- 28=_____, 20=________, 9=________.
- The PT evaluated what 4 things?
- FSS-ICU
- 0-28, 0-7 (higher = better)
- 28 = home, 20 = IP Rehab, 9 = SNF
1. ) Rolling
2. ) Supine to sit, sitting to EOB
3. ) Sit to stand
4. ) Ambulation
55
Which 3 outcome measures are used for longer length of stay (LOS)?
- CPAx
- Perme ICU Mobility Score
- ACIF
56
Which outcome measure measures physical function in the ICU; higher scores associated with shorter hospital LOS?
- Scores range from __-__ with each of the 10 components being graded on a scale of __-__.
- What 10 components are measured?
- CPAx
- 0-50, 0-5 (higher = better)
1. ) Respiratory function
2. ) Cough
3. ) Bed mobility
4. ) Supine 🡪 sitting EOB
5. ) Sitting balance
6. ) Sit 🡪 stand
7. ) Bed 🡪 chair
8. ) Standing balance
9. ) Stepping
10. ) Grip strength
57
- Which outcome measure assesses the mobility status of patients in ICU and identifies pts with potential mobility barriers and need for assistance?
- What 7 components are measured?
-Perme ICU Mobility Score
1. ) Mental status
2. ) Potential mobility barriers
3. ) Functional strength
4. ) Bed mobility
5. ) Transfers
6. ) Gait
7. ) Endurance
58
- Which outcome measure is used to predict d/c setting; developed to measure functional status at levels of function required in acute care; should be done within 24 hours of acute care admission?
- Scores
- ACIF
- <0.4
1. ) Mental status
2. ) Bed mobility
3. ) Transfers
4. ) Mobility
59
In General:
- AM-PAC 6 = _______________
- DEMMI = __________, __________
- PFIT-s = ________, _________
- FSS-ICU = ______________
- CPAx = ________, __________, _______, _______
- Perme ICU Mobility Score = ________, _______, ______, _______
- ACIF = __________, ___________
- functional mobility
- functional mobility, balance (sitting/standing)
- strength, mobility
- functional mobility
- functional mobility, strength, respiratory function, balance
- cognition, mobility, strength, endurance
- functional mobility, cognition
60
- Physical therapy _______ _________: untimed charge, can only occur once during that hospital stay; requires a complexity of low, moderate, or high; time starts when you start the chart review and stops when you walk out of the patient’s door.
- Physical therapy _________: timed charge, usually in reference to the 8 minute rule; time starts when you walk in the patient’s room and stops when you exit; chart review is not billable time.
- Physical ___________: reestablishes POC for a patient with dramatic change in status; can only be billed once during that hospital stay; no complexity level.
- Physical therapy ___________: updates PT plan of care; no specific reassessment charge; billed following the treatment 8 minute rule.
- initial evaluation
- treatment
- re-evaluation
- re-assessment
61
- Give the times for the 8 Minute Rule.
| - What is an easy way to remember it?
- 8-22 = 1 unit
- 23-37 = 2 units
- 38-52 = 3 units
- 53-67 = 4 units
- 68-82 = 5 units
- 83+ = 6 units
62
Low complexity
- ___ personal factors/comorbidities
- ____ body systems (structures/functions, activity limitations, participation restrictions)
- ______ clinical presentation
- 0 personal factors
- 1-2 body systems
- stable clinical presentation
63
Moderate complexity
- ___ personal factors/comorbidities
- ____ body systems (structures/functions, activity limitations, participation restrictions)
- ______ clinical presentation
- 1-2 personal factors
- 3 body systems
- evolving clinical presentation
64
High complexity
- ___ personal factors/comorbidities
- ____ body systems (structures/functions, activity limitations, participation restrictions)
- ______ clinical presentation
- 3+ personal factors
- 4+ body systems
- unstable
65
- Low complexity = ____ minutes face to face
- Moderate complexity = _____ minutes face to face
- High complexity = _____ minutes face to face
- 20 minutes
- 30 minutes
- 45 minutes
66
In order to be in a complexity category, what must happen?
All 3 parts (personal factors, body systems, clinical presentation) must fall under or above that same category.
67
What are the 5 stages of grief?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
68
WEEK 2
WEEK 2
69
What are the consequences of prolonged bed rest?
- Fluid volume redistribution
- Altered distribution of BW/pressure
- Muscular inactivity
- Aerobic deconditioning
70
- Metabolic and exercise capacity significantly reduced after __-__ weeks of bed rest.
- Survivors of ICU admission experience ____-_____ morbidities.
- How long can impairments and limitations due to bed rest last?
- 1-2 weeks
- long-term
- months to years
71
What are some systems that may be affected by bed rest/immobility?
- CV
- Hematologic
- MSK
- Integ
- Others
72
Effects of Bed Rest on CV System:
- _______ VO2
- _______ resting HR
- _______ CO
- _______ cardiac vagal tone
- _______ plasma norepinephrine
- _______ beta-adrenergic receptor sensitivity
- _______ venous compliance leading to pooling
- reduced
- increased
- decreased
- decreased
- increased
- enhanced
- increased
73
1
1
74
1
1
75
1
1
76
1
1
77
1
1
78
1
1
79
1
1
80
1
1
81
1
1
82
1
1
83
1
1
84
1
1
85
1
1
86
1
1
87
11
1
88
1
1
89
1
1
90
1
1
91
1
1
92
1
1
93
1
1
94
1
1
95
1
1
96
1
1
97
1
1
98
1
1
99
1
1
100
1
1
101
1
1
102
1
1
103
1
1
104
1
1
105
1
1
106
1
1
107
1
1
108
1
1
109
1
1
110
1
1
111
1
1
112
1
1
113
1
1
114
1
1
115
1
1
116
1
1
117
1
1
118
1
1
119
1
1
S4- Acute Care
flashcards
Decks in class (15)
# Cards
-
Week 1- Introduction and Outcome Measures92
-
Week 1- Emergency Department PT and Acute Care Billing26
-
Week 2- ICUAW and Early Mobility55
-
Week 2- Lab Values55
-
Week 3- Cardiac Conditions75
-
Week 3- Pulmonary Conditions50
-
Week 3- Mechanical Ventilation45
-
Week 4- Orthopedic Conditions81
-
Competency7
-
Midterm Study (Incomplete)119
-
Wound Care Module 141
-
Week 5- Lymphedema63
-
Week 6- Oncology and Organ Transplant112
-
Week 6- Patient Positioning/Orthotics/Adaptive Equipment, Integumentary Basics/Burns56
-
Week 7- GI54
