Philippine Physical Therapy Standards PDF

STANDARDS OF PT PRACTICE W/ ITS Physical therapist provide an information to his DESCRIPTION client regarding plan of intervention, its effectiveness, risks associated, expected Code...

STANDARDS OF PT PRACTICE W/ ITS Physical therapist provide an information to his DESCRIPTION client regarding plan of intervention, its effectiveness, risks associated, expected Code of Ethics of the Philippine Physical Therapy benefits and alternative modes of intervention → Association → Ethical Considerations Informed Consent Adheres to current legislation regulating the Physical therapist modifies or discontinues the practice of physical therapy → Legal plan of care accordingly throughout the duration Considerations of care → Reassessment/Reevaluation Physical therapist applies research findings to Formal body that represents the PT profession → practice → Research Philippine Physical Therapy Association Physical therapist responsible for the direction of The work of other professional can be done by physical therapy services in the clinic → another discipline provided the services to be Administration done are within the capacity of the provider: → Physical therapist participates in the education of Transdisciplinary physical therapy students and students of other The service is provided by specialists who are allied health professions → Education frequently employed in facilities that focus on Standards of PT practice set the parameters for: → particular health conditions: → Tertiary quality of physical therapy practice and It is provided by the clinicians on a referral basis provide basis for evaluating physical therapy after the individual has received care at the practice primary level: → Secondary Receives patients upon the referral of a duly Patient/Client Management Model (in proper licensed and registered health professional → sequence): → Examination, Evaluation, Patient Acquisition Diagnosis, Prognosis, Intervention Intervention is discontinued when set goals were Each discipline provides its own unique activity achieved or not, patient refuses continuation of for the patient, no lateral communication: → intervention, or patient is unable to continue Multidisciplinary receiving care → Discharge/Discontinuation of Intervention When the services of another discipline are needed, the doctor consults the professional but The physical therapist uses the results of the former will give specific instructions or examination and evaluation to determine the general requests on what is to be done: → Medical diagnosis → Assessment and Diagnosis Cite at least 7 Members of the Rehabilitation Physical therapist develops a plan of intervention Team: → Physician based on results of assessment → Plan of Care Whenever a certain decision is to be made, all of The physical therapist provides or supervises the the members of the team should have been implementation of the plan of care in consulted, lateral communication becomes collaboration with other members of the present: → Interdisciplinary rehabilitation team → Intervention The family and community members may be Nerve entrapment is a medical condition provided at this level: → Primary affecting which SYSTEM? → Musculoskeletal Bursitis is a medical condition affecting which SYSTEM? → Musculoskeletal PROFESIONAL BEHAVIORS EXPECTED IN PT W/ ITS DESCRIPTION Myocardial Infarction is a medical condition affecting which SYSTEM? → Cardiovascular Maintaining open and constructive communication → Communication skills Cystic fibrosis is a medical condition affecting which SYSTEM? → Pulmonary Weighing advantages and disadvantages of solutions → Problem-solving skills Parkinson Disease is a medical condition affecting which SYSTEM? → Neuromuscular Contributing to the provision of a safe and secure environment for patients → Responsibility Amputation is a medical condition affecting which SYSTEM? → Musculoskeletal Demonstrating the ability to say “no” if request made does not add to priorities, or if the activity is Congestive Heart Failure is a medical condition in conflict with the set goals → Effective use of affecting which SYSTEM? → Cardiovascular time and resources Stroke is a medical condition affecting which Researching and studying areas where SYSTEM? → Neuromuscular knowledge base is lacking → Commitment to Emphysema is a medical condition affecting learning which SYSTEM? → Pulmonary Talking about difficult issues with sensitivity and Multiple Sclerosis is a medical condition affecting objectivity → Interpersonal skills which SYSTEM? → Neuromuscular Establishing a support network → Stress Total joint arthroplasty is a medical condition management affecting which SYSTEM? → Musculoskeletal Considering multiple approaches when Burn is a medical condition affecting which responding to feedback → Use of constructive SYSTEM? → Integumentary feedback Fracture is a medical condition affecting which Determining effectiveness of applied solutions → SYSTEM? → Musculoskeletal Critical thinking skills Attending post-professional workshops → Professionalism ICF DISABILITY MODEL Views disability as a feature of the person, directly caused by disease, trauma or other health Traumatic Brain Injury is a medical condition condition which require medical care → Medical affecting which SYSTEM? → Neuromuscular model Spinal Cord Injury is a medical condition affecting Disability demands a political response → Social which SYSTEM? → Neuromuscular model It provides a coherent view of different ICF FUNCTION perspectives of health including the biological, Reductions in the incidence and severity of individual and social → Biopsychosocial model disability in a population brought about by enhancing the functional capacity of the person and by improving performance by modifying ICF QUALIFIERS features of the social and physical environment → It records the presence and severity of a problem ICF allows to record the information regarding in functioning at the body, person and societal the impact of different interventions levels → Qualifiers For basic public health purposes this include the Body function and structure → Presence of an determination of the overall health of impairment populations, the prevalence and incidence of non-fatal health outcomes, and to measure It includes assistive devices or personal health care needs and the performance and assistance → Performance qualifier effectiveness of health care systems → ICF Describes an individual’s ability to execute a task provides the framework and classification or an action → Capacity qualifier system for these purposes Indicates the highest probable level of Studies show that diagnosis alone does not functioning of a person in a given domain at a predict service needs, length of hospitalization, given moment → Capacity qualifier and level of care or functional outcomes → ICF makes it possible to collect the vital data in a Describes what an individual does in his or her consistent and internationally comparable current environment → Performance qualifier manner ICF provides a standard language and Shift in the focus from hospital-based acute care framework for the description of health and to community-based long-term services for health-related states. chronic conditions → ICF provides the basis for identifying kinds and levels of disability which provides the foundations for country-level ICF USAGE disability data to inform policy development Determine whether resources are effectively used in health care and other social services → Economic analyses ICF DISABILITY DESCRIPTION Functional status of people (social security, Problems an individual may experience involving employment, education and transportation) → life situations → Participation restrictions Policy development Factors which facilitate functioning or hinder Provide framework or structure for functioning hereby contribute to disability → interdisciplinary research → Research uses Environmental factors Body level or impairment interventions are primarily medical or rehabilitative → Intervention studies Problems associated with body systems including physiological and psychological What is the THREE main health condition of the functions → Impairments in body function patient? → asymptomatic HPN, diagnosed with Difficulties an individual may have in executing (L) CVA, (R) hemiplegia actions, task or activities → Activity limitations Structure/s that is/are affected: → Features of the individual which are not part of the cardiovascular, brain, body musculature, health conditions or health status → Personal upper and lower limbs factors Function/s that is/are affected: → CV: pumping of Problems with the anatomical features of the blood to the rest of the body; Brain: body → Impairments in body structure interpretation of impulses; Muscle: body contraction, mobility Entire background of an individual’s life and living situation consisting of environmental and Activities of daily living (ADL) that is/are limited: → personal factors → Contextual factors personal hygiene, bathing, grooming, dressing, toileting, transferring or ambulating, eating Restricted participation in the society (cite at ICF PRINCIPLES least TWO): → work unemployment, going to or Applicable to all people irrespective of health travelling to other places, joining the civic, condition → Universality religious and other organizations, performing the job and other job-related activities, Consists of both positive and negative aspects of participating in the community activities functioning and disability → Neutrality Disability is not differentiated by etiology → Parity CYCLE OF CROSS CONTAMINATION & It includes contextual factors → Environmental factors INFECTION 1. Reservoir for organism/host 2. Method of exit for the organism CASE ANALYSIS 3. Method of transmission of the organism 4. Method of entry of the organism into a new Case Analysis: L.V. a 45-year-old male patient, host has asymptomatic HPN, was diagnosed with (L) 5. Susceptible host CVA, (R) hemiplegia. During examination and 6. Infection develops in new host evaluation, it was found out that the upper extremity is more affected than lower extremity. At present, the patient complains of pain (VS 5/10) on the (R) shoulder, swelling on the (R) hand, PRECAUTIONS and is experiencing difficulty moving his (R) limb It represents a system of infection control in while doing the household chores due to which it is assumed that every direct contact spasticity of his musculature. Using the above with a patient’s body fluids is potentially scenario, answer the following using the ICF infectious. → Standard Precautions model. Most important in infection control → resistant forms like bacterial spores. → Standard Precautions Sterilization Use of PPE → Standard Precautions and Alcohol → Chemical methods (Liquids) Transmission-Based Precautions It is designed to protect the caregiver from ASEPSIS specialized patients with highly transmissible Precautionary measures necessary to prevent pathogens who are known or suspected to be direct transfer of pathogens from person to infected by epidemiologically important person and indirect transfer of pathogens through pathogens that can be spread by direct the air or on instruments, bedding, equipment, contact, droplets or airborne. → and other inanimate objects → Medical asepsis Transmission-Based Precautions Practices in operating rooms, in labor and delivery It relies on the concept of medical and areas, and during invasive procedures → Surgical surgical asepsis & how pathogens can be asepsis transmitted. → Isolation Precautions Goal - exclude pathogens → Medical asepsis It protects the persons or objects from Practices used to render and keep objects and becoming contaminated or infected by areas sterile → Surgical asepsis pathogenic microorganisms thru contact, Goal - exclude all microbes → Surgical asepsis droplet or airborne. → Isolation Precautions It involves procedures and practices that reduce the number and transmission of pathogens → DECONTAMINATION Medical asepsis Physical methods which include autoclaving → Steam sterilization Conversion of temperature from 0F to 0C: → It is a process that reduces microbial 9/5(Degrees C+32) contamination to a low level by the use of Radiation → Transfer of heat from one surface to cleaning solutions, hot water or chemical another without contact between the two disinfectants. → Sanitization surfaces A process that kills non-spore-forming Core body temperature → Temperature of the microorganisms by hot water or steam. → deep tissues of the body Pasteurization Evaporation → Dissipation of heat by It is designed for items that cannot be sterilized by transformation of water to a gas autoclaving like powders, oils and creams. → Dry heat sterilization Conduction → Transfer of heat from one surface to another through direct contact between the Ethylene oxide → Chemical methods (Gas) two surfaces It is a process that completely kills or removes all Convection → Dissipation of heat by air currents types of micro-organisms including the most Highly sensitive to a decrease in PaO2: → Carotid Considered as “body’s thermostat”: → bodies and Aortic bodies Hypothalamus Applying too wide cuff → Falsely low readings Highly sensitive to an increase in PaCO2: → Pons and Medulla oblongata Re-inflating the bladder during auscultation → Falsely high readings Releasing the valve too rapidly → Falsely low DEFINITION OF TERMS (ASEPSIS) readings Microorganisms – a tiny living animal or plant Applying too narrow cuff → Falsely high readings that can cause disease (favors dark, warm, moist environment) Releasing the valve too slowly → Falsely high readings Pathogen – a microorganism that produces disease. Vasculature → Throbbing, diffuse Infection – the production of a disease or harmful Bone → Deep, nagging, dull condition by the entrance of disease-producing Nerve → Sharp, bright, lightning-like germs into an organism Nerve root → Sharp, shooting Sepsis – The presence of pathogenic microorganisms or their toxins in the blood or Muscle → Cramping, dull, aching tissues. Paradoxical pulse → Pulse characterized by a Nosocomial infection – are hospital-acquired decrease in the amplitude of the pulse during disease inspiration Contamination – occurs when something is Atrial fibrillation → Pulse characterized by rendered unclean or unsterile disorganized electrical activity in the atria accompanied by an irregular ventricular response Asepsis – Absence of microorganisms that that is usually rapid produce disease; the prevention by maintaining a sterile condition. Orthopnea → Ability to breathe only in an upright sitting or standing position Medical asepsis – practices that help to reduce the number and spread of microorganisms. Hyperventilation → Consists of an increased respiratory rate and an increased amount of chest Surgical asepsis – practices that render and keep wall movement and volume of air inspired and objects and areas free of all microorganisms. expired during each full inspiration Antisepsis - is the removal of transient Cheyne-Stokes respirations → Alternating microorganisms from the skin and a reduction in periods of deep, rapid breathing followed by the resident flora. periods of apnea Disinfection – The destruction or removal of Biot’s respiration → Varying depth and rate of pathogenic organisms but not necessarily their breathing followed by periods of apnea→ spores. Sterilization – A process by which all Bradypnea – a respiratory rate in an adult less microorganisms, including spores, are destroyed, than 10 breaths per minute either physical (dry heat, moist heat, freezing,) or Constant fever – rise in temperature above chemical methods. normal that remains consistently high with little Isolation – separation from others. fluctuation Decontamination – The use of physical or Diastolic pressure – the lowest pressure on the chemical means to remove, inactivate, or destroy arterial walls when the heart rests between beats blood-borne pathogens on a surface or item (systole) Sterile – containing no microorganisms; free from Dyspnea – difficult or labored breathing germs Dysrhythmia – an abnormal cardiac rhythm; synonym for arrhythmia Disinfectant – a chemical agent used for innate things Eupnea – normal respirations Antiseptic – a chemical agent used for living Febrile – a condition in which the body things temperature is elevated Autolysis - The disintegration of cells or tissues High-grade fever – a fever over 41° C (105.8° F) by the enzymes of the body or cellular Hyperpyrexia – a fever over 41° C (105.8° F) components in wound fluid. Hypertension – blood pressure elevated above Debridement – The removal of devitalized tissues normal for a sustained period from or adjacent to a traumatic or infected lesion to expose healthy tissue. Hyperventilation – consists of an increased respiratory rate and an increased amount of chest Isolation Precautions – rely on the concept of wall movement medical and surgical asepsis & how pathogens can be transmitted Hypotension– blood pressure below normal for a sustained period Hypothalamus – a structure located in the DEFINITION OF TERMS (VITAL SIGNS) diencephalon of the brainstem; called the "body's Afebrile – a condition in which the body thermostat" temperature is not elevated Hypothermia – the state in which an individual's Antipyretic – agent that reduces fever body temperature is reduced below normal range Apical or mitral area – apex of the heart; located Hypoventilation – consists of a decreased in the 5th intercostal space in the left mid- respiratory rate and a moderate amount of chest clavicular line in an adult wall movement Apnea – absence of breathing Intermittent fever – rises or spikes in temperature above normal at some point during a Bradycardia – a heart rate in an adult less than 60 24-hour period beats per minute Korotkoff sounds – series of sounds that Remittent fever – rise in temperature that is correspond to changes in blood flow through an always above normal during a 24-hour period, but artery as pressure is released the amount of elevation above normal fluctuates Low-grade fever – a fever between 37.1 C to 38.2 Surface body temperature – temperature of the C (98.8 F to 100.6 F) surface of the body Orthopnea – ability to breathe only in an upright Systolic pressure – the highest pressure on the sitting or standing position arterial walls Orthostatic hypotension – blood pressure Tachypnea – a respiratory rate in an adult greater decreased below normal associated with than 24 breaths per minute weakness or fainting when one rises to an erect Tachycardia – a heart rate in an adult greater than position 100 beats per minute Pulse – perceptible throbbing sensation Temperature – the balance between the amount (pulsation) felt over a peripheral artery as a wave of heat produced by and heat lost from the body of blood is created by contraction of the left (thermoregulation) ventricle of the heart Vital signs – a person's temperature, pulse, Pulse amplitude – the force of the perceptible respiration, and blood pressure throbbing sensation (pulsation) felt over a peripheral artery as a wave of blood is created by contraction of the left ventricle of the heart POSITIONING & DRAPING Pulse deficit – difference between the apical and For split-thickness burns & grafted burn areas, radial pulse rates ____ and ____ should be avoided. prolonged Pulse pressure – difference between systolic and flexion or adduction diastolic pressures Areas that are red indicate areas of ____ while Pulse rate – the number of perceptible throbbing pale or blanched indicate ____. pressure; sensations (pulsations) felt over a peripheral severe, dangerous pressure artery For transfemoral amputation the recommended Pulse rhythm – the pattern of, and intervals position is: prone between, the perceptible throbbing sensations In supine position, excessive pillow on the (pulsations) cervical area will promote 4, ____ and ____. Pyrexia – increased body temperature excessive neck flexion, upper back flexion, scapular abduction (round shoulders) Radiation – transfer of heat from one surface to another without contact between the two Motions that must be avoided during transtibial surfaces, mostly in the form of infrared rays amputation: prolonged hip and knee flexion Relapsing fever – rises in temperature lasting for several days, alternating with several days of normal temperature The items behind the knees while in supine Pressure on the underlying bony prominence with position will encourage ____ and may contribute localized area of soft tissue will produce local to lower extremity contractures of the ____ ischemia leading to: necrosis muscles. hip flexion and knee flexion; iliopsoas In supine position, rolled towel placed on the and hamstring posterior ankles will relieve pressure on the calcaneus, but knee ____ should be avoided. While in supine position, the hip should be moved knee hyperextension toward ____ rotation. Internal Occipital tuberosity → Supine In prone position, the pillow placed under the Medial epicondyle of humerus → Supine/ Side- lower abdomen will reduce: lumbar lordosis Lying (uppermost & lowermost)/ Sitting A folded pillow placed at the patient’s chest while Malleolus of tibia → Side-Lying (uppermost) in side-lying position will support the Greater trochanter → Supine/ Side-Lying (uppermost/lowermost) upper extremity and will (lowermost) prevent from rolling forward. Tip of acromion process → Prone It is necessary to place a folded pillow along the Ischial tuberosity → Sitting posterior area of the patient’s trunk while in side- lying position to prevent rolling Lateral acromion process → Side-Lying (backward/forward/sideward). (lowermost) Anterior head of humerus → Prone Pillows under the anterior ankles will relieve stress on the ____ muscles and will allow the Dorsum of foot → Prone pelvis and lower back to relax. Hamstring The pressure sore extends into the tissues beneath the skin including the fat which forms a Complaints of numbness or tingling are small crater → Stage 3 indicators of _____ and _____. excessive pressure; localized edema or swelling There is little or no pain due to significant tissue damage → Stage 3 and Stage 4 The upper extremities while in supine position The pressure sore extends into the muscle and may be elevated on the pillows or maybe bone → Stage 4 positioned in: reverse “T” position or on the chest The skin appears reddened and does not blanch → Stage 1 Two (2) devices that can be used to support or The skin forms an ulcer which is usually tender stabilized body segments: rolled towel and and painful → Stage 2 pillows Frequent changes in positioning should be done In side-lying position, both lower extremities every 2 hours to prevent contractures or to relieve should be (flexed/extended) at the hip and knee pressure on the skin and subcutaneous, in order to promote patient comfort and stability. circulatory, neural, lymphatic or other structures. Rolled towel under each anterior shoulder while in prone position will reduce the stress to the ____ muscles. Interscapular PSYCHOSOCIAL ISSUE Timeliness → The content is provided or available when the audience is most receptive to, or in Parents → Home need of, the specific information. Spouse → Home Reach → The content gets to or is available to the OT → Rehab largest possible number of people in the target population. Self → Home Reliability → The source of the content is credible, Brain → Injury and the content itself is kept up to date. Stress → Injury Understandability → The reading or language Children → Home level and format are appropriate for the specific audience. Psych → Rehab Availability → The content is delivered or placed Speech → Injury where the audience can access it. PT → Rehab Consistency → The content remains internally QOL → Injury consistent over time and also is consistent with information from other sources. Mobility → Injury Repetition → The delivery process of the content is continued or repeated over time, both to PSYCHOSOCIAL COMPONENTS reinforce the impact with a given audience and to reach new generations. - Patient - Pyschosocial Accuracy → The content is valid and without - Social environmental errors of fact, interpretation, or judgment. Evidence-based → It undergone comprehensive review and rigorous analysis to formulate practice BIOPSYCHOSOCIAL COMPONENTS guidelines, performance measures, review - Person criteria, and technology assessments for - Biology telehealth applications. - Psychology Balance → The content presents the benefits and - Social environment risks of potential actions or recognizes different and valid perspectives on the issue. ATTRIBUTES OF EFFECTIVE HEALTH The advancement in medical and consumer COMMUNICATION health informatics does not change the delivery of health information and services to the people. Cultural competence → The design, False implementation, and evaluation process that accounts for special issues for selected Shun interruptions → Diagnostic population groups and also educational levels communication and problem solving and disability. Explore patient’s opinions → Diagnostic 3 VARIETY OF CONTEXTS IN communication and problem solving COMMUNICATION Communicate verbally and nonverbally → Caring - School and socio-emotional communication - Home Investigate further → Diagnostic communication - Work and problem solving Talk through diagnosis, treatment, and EXAMPLES OF HEALTH compliance again → Counselling and education COMMUNICATION Appropriate behaviors used → Caring and socio- emotional communication - Introduction of self and choice of modality - Rationale of the plan of care, Informed Explore patient understanding → Counselling and Consent education - Precaution Recognize patient’s expertise → Caring and - Contraindication socio-emotional communication - Dosage - Instruction to patient Open-ended questions asked → Diagnostic - Diagnosis of the course of disease communication and problem solving - Risks and Possible Solutions Listen to patient → Diagnostic communication - Consequences and problem solving - Advantages and Disadvantages of certain intervention Encourage additional questions, establish follow- up actions, and evaluate patient understanding → Counselling and education 5 VARIETY OF CHANNELS IN Describe and discuss information → Counselling COMMUNICTION and education - Interpersonal Express support → Caring and socio-emotional - small group communication - organizational - community - mass media 3 OUTCOMES OF EFFECTIVE INTERERSONAL COMMUNICATION - Improved patient satisfaction - Improved treatment compliance - Improved health outcomes