Acute Care Physical Therapy

Components of a chart review
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

General bed rest times after:

A-line removal
Pacing wires removed
Angiography (femoral or cerebral)
s/p CVA
EVD placement

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).

T/F Joint commission requires pain levels documented before, during, and after PT treatment.
TRUE

Initial PT assessment in acute care (components)
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

Describe the Flacc Scale
Pain scale for non communicative patients – components are
Face
Legs
Activity
Cry
Consolability

Lower scores are better

Examples of interventions in acute care setting
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

3 types of documentation in acute care setting
Evaluation Form
-Goals, POC, HEP

Progress Notes
-Acknowledge Orders

Education Form
-Required by JAHCO

Requirements for d/c to acute rehab
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

Requirements for d/c to SNF
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

Describe ALF
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

Characteristics and requirements for home health
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

Characteristics of extended care facility
Patient is not projected to make gains with physical therapy

Patient unable to tolerate physical therapy

Patient lives long term in this facility

When is Pt not appropriate for acute care PT
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

Sternal Precautions
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

Pacemaker precautions
For pts after pacemaker placement
No shoulder ROM with LUE

Cardiac precautions
Cardiac Precautions
No holding breath, isometrics discouraged

Signs and symptoms of possible distress with cardiac patients
– light headedness, dizziness, diaphoreses, dyspnea

Spine precautions
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

Halo Precautions
Do not push or pull on halo rods/vest

Never loosen/adjust pins/vest

Hip Precautions
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

Knee precautions after replacement
No twisting or pivoting on the involved leg

Weightbearing status established by the surgeon

Abdominal Surgery Precautions
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

precautions for chest tubes and feeding tubes
Chest Tube
Must stay below the level of the insertion

Feeding tube
Head of bed > 30 degrees

Describe the encore lift
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

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