Discharge Planning in Acute Care Physical Therapy

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What is the main goal of discharge planning in acute care physical therapy?

Discharge location recommendation first and increase functional mobility second.

When is home health aide service typically provided?

Usually 2-3 times per week for one hour each session.

What is the requirement for a patient to be discharged to inpatient rehab?

Patient should be able to tolerate and benefit from 3 hours of therapy per day/5 days per week and utilize at least 2 disciplines of rehab.

What is the 60/40 insurance rule used for determining discharge location to home?

Highly likely to be discharged home if the patient needs nursing care 24/7. Signup and view all the answers

What precautions should be considered when mobilizing a patient with a chest tube?

Maintain the chest tube box below the level of insertion. Signup and view all the answers

What is the purpose of an external pacemaker in post-cardiac surgery patients?

To manage heart rate/rhythm complications. Signup and view all the answers

What are the main causes of delirium?

Inflammatory response, neurotransmitter imbalance, immobilization, sleep deficiency Signup and view all the answers

Describe the characteristics of hypoactive delirium.

Confusion, withdrawal, decreased attention span, apathy, decreased responsiveness Signup and view all the answers

What does the CAM-ICU assess?

Fluctuating course or change in mental status, inattention, altered level of consciousness, disorganized thinking Signup and view all the answers

List some prevention strategies for delirium.

Consistent monitoring, treating underlying diseases, minimizing treatment risks, modifying environmental factors, repetitive cognitive stimulation, early mobilization Signup and view all the answers

What are some long-term effects of post-intensive care syndrome?

Effects can last from 5-15 years, associated with chronic pain and chronic disease Signup and view all the answers

Explain the role of sympathetic nervous system in controlling heart rate.

Increases heart rate via epinephrine/norepinephrine Signup and view all the answers

What is the role of vasomotor center in blood pressure regulation?

Enhances vasoconstriction to increase blood pressure Signup and view all the answers

Define HRV and its significance.

HRV is the measure of SNS and PSNS activity, More HRV indicates more parasympathetic control which is beneficial for cardiovascular health Signup and view all the answers

What happens to blood pressure during vigorous exercise?

Blood pressure increases due to increased peripheral resistance, heart rate, and contractility Signup and view all the answers

Explain the concept of hypoxic drive in the respiratory system.

Primarily stimulated by low levels of oxygen, especially in individuals with chronic lung diseases Signup and view all the answers

Explain the key differences between on-pump and off-pump coronary artery bypass graft (CABG) surgery.

On-pump CABG involves stopping the heart chemically and can lead to short/long term neurocognitive deficits, while off-pump CABG keeps the heart beating and is less complicated. Signup and view all the answers

What are the benefits and risks associated with using arteries versus veins as grafts in CABG surgery?

Arteries (e.g. radial, internal mammary) provide longer-lasting, durable grafts under high pressure, while veins (e.g. saphenous) have a lower risk of plaque buildup but may not last as long. Signup and view all the answers

Describe the exercise prescription principles (FITT) for individuals with coronary artery disease (CAD) in cardiac rehabilitation.

Frequency: 3-5x/week, Intensity: moderate 40-60% HRR or vigorous 60-80% HRR, Time: 20-60 min, Type: rhythmic multi-muscle group exercises. Signup and view all the answers

What are the different methods used to determine exercise intensity for individuals with CAD?

Heart rate reserve (HRR), heart rate max (HRmax), target METs, and VO2max methods can all be used to prescribe appropriate exercise intensities. Signup and view all the answers

List and explain at least three abnormal responses to exercise that would warrant terminating a cardiac rehab session.

Hypertensive response (>220 SBP or >10 mmHg DBP increase), hypotensive response (drop in SBP), abnormal heart rate response (inability to increase or drop >10 bpm), oxygen desaturation >4%, increased PVCs, ST changes, angina/SOB/dizziness. Signup and view all the answers

Differentiate the goals and key components of Phase 2 cardiac rehabilitation versus Phase 2 pulmonary rehabilitation.

Cardiac Phase 2 goals are return to work, prevent events, progressive exercise; with EKG monitoring, graded exercise, resistance training. Pulmonary Phase 2 goals are control dyspnea, improve function/QOL, decrease anxiety; with interval training, resistance training, oxygen/medication/nutrition education. Signup and view all the answers

What are the core components targeted in comprehensive pulmonary rehabilitation programs?

Ventilation strategies, airway clearance techniques, medication adherence education, energy conservation, stress management, smoking cessation, and dietary changes. Signup and view all the answers

Explain the purpose and risks of the following ICU monitoring devices: a) arterial catheter, b) central venous catheter, c) pulmonary artery catheter.

a) Arterial catheter monitors real-time BP and allows ABG sampling, but risks bleeding. b) Central venous catheter delivers medications/fluids/nutrition via large vein access, with risks based on number of lumens. c) Pulmonary artery catheter measures pulmonary pressures, cardiac output, and oxygen utilization to guide interventions, but can cause arrhythmias. Signup and view all the answers

What are the key characteristics used to diagnose delirium in ICU patients? How does delirium differ from dementia?

Delirium is characterized by disordered attention/arousal, cognitive/perceptual disturbance, acute onset, and fluctuating course. It differs from dementia which has a chronic, progressive course. Signup and view all the answers

Calculate the target heart rate range for moderate and vigorous aerobic exercise using the $\textrm{HRR}$ method for a 65-year-old CAD patient with a resting HR of 70 bpm and $\textrm{HR}_{\textrm{max}}$ estimated as 220 - age.

Moderate intensity (40-60% HRR): 70 + 0.4*(220-65-70) = 106-124 bpm. Vigorous intensity (60-80% HRR): 70 + 0.6*(220-65-70) = 124-142 bpm. Signup and view all the answers