Introduction to the Screening Process PDF

Introduction to the Screening Process  Introduction Physiotherapists must screen the patients/clients to make sure that they are appropriate candidates for physical therapy. Screening: A methodical examination which is aimed to separate into various diagnostic groups. The physiothera...

Introduction to the Screening Process  Introduction Physiotherapists must screen the patients/clients to make sure that they are appropriate candidates for physical therapy. Screening: A methodical examination which is aimed to separate into various diagnostic groups. The physiotherapists must be able to identify signs and symptoms of systemic disease that can cause neuromuscular or musculoskeletal disorders.  Introduction The purpose of screening is not to make the physiotherapists to be medical diagnosticians. The purposes are:  Helping physiotherapists recognize the areas that are beyond the scope of a physical therapist’s practice.  Providing detailed method for physiotherapists to identify clients who need a referral a physician or other health professionals. A large part of the screening process is identifying yellow (caution) or red (warning) flag histories and identifying signs and symptoms during the examination.  Reasons for Screening Direct access: physiotherapist has primary responsibility or first contact. Quicker and sicker patient/client base. Signed prescription: Clients may obtain a signed prescription for physical/occupational therapy based on similar past complaints of musculoskeletal symptoms without direct physician contact. Medical specialization: Medical specialists may fail to recognize underlying systemic disease.  Reasons for Screening Disease progression: Early signs and symptoms are difficult to recognize, or symptoms may not be present at the time of medical examination. Patient/client disclosure: Client discloses information previously unknown or undisclosed to the physician. Client does not report symptoms or concerns to the physician because of forgetfulness, fear, or embarrassment. Presence of one or more yellow (caution) or red (warning) fags.  Red Flags - Constitutional symptoms Fever Diaphoresis (unexplained perspiration) Sweats (can occur anytime night or day) Nausea Vomiting Diarrhea Pallor Dizziness/syncope (fainting) Fatigue Weight loss Elements of Patient/Client Management Examination: History, systems review, and tests and measures Evaluation: Assessment or judgment of the data Diagnosis: Determined within the scope of practice Prognosis: Optimal level of improvement within a time frame Intervention: Coordination, communication, and documentation of an appropriate treatment plan for the diagnosis based on the previous four elements Outcomes: Actual result of the implementation of the plan of care The process of physical therapist patient and client management Diagnosis by the Physical Therapist Physiotherapist should utilize the diagnostic process in order to establish a diagnosis for the specific conditions in need of the physical therapist’s attention. Purpose of the Diagnosis:  Treat as specifically as possible by determining the most appropriate plan of care and intervention strategy for each patient/client  Recognize the need for a medical referral Decision-Making Process GOODMAN SCREENING FOR REFERRAL MODEL Past medical history Personal and family history Risk factor assessment Clinical presentation Associated signs and symptoms of systemic diseases Review of systems  Physician Referral Guidelines for Immediate Medical Attention Client has anginal pain not relieved in 20 minutes with reduced activity and/or administration of nitroglycerin Client has anginal pain at rest Client with angina has nausea, vomiting, profuse sweating Client presents with bowel/bladder incontinence and/or saddle anesthesia secondary to cauda equina lesion or cervical spine pain concomitant with urinary incontinence Client is in anaphylactic shock Client has symptoms of inadequate ventilation or CO2 retention  Physician Referral Guidelines for Immediate Medical Attention Client with diabetes appears confused or lethargic or exhibits changes in mental function (perform finger stick glucose testing and report findings) Client has positive McBurney’s point (appendicitis) or rebound tenderness (inflamed peritoneum) Sudden worsening of intermittent claudication may be caused by thromboembolism Throbbing chest, back, or abdominal pain that increases with exertion accompanied by a sensation of a heartbeat when lying down and a palpable pulsating abdominal mass may indicate an aneurysm  Physician Referral Guidelines for Immediate Medical Attention Changes in size, shape, tenderness, and consistency of lymph nodes; detection of palpable, fixed, irregular mass in the breast, axilla, or elsewhere, especially in the presence of a previous history of cancer  Physician Referral In the upcoming lectures