Acute Care Final
Chart review for Medical & Surgical Considerations for the Acute Care Physical
Therapist
Might be looking at nitrogren levels for kidney surgies, ammonia levels for liver and
more closey WBC as well as blood considerations
-For this population there isnt necessarily levels that would make you not do
treatment but just be aware of the cognitive levels that might be affected by some of
the values
Anticoagulant examples (3)
Heparin, Lovenox, Coumadin/Warfarin
•Used in MOST hospitalized patients
What should you do is continuous herapin is stopped?
ALERT RN IMMEDIATELY
Implications for PT with anticoagulants
easy bleeding and bruising
What are the most common pulmonary diagnoses in the acute care setting? (4)
COPD exacerbation, Pneumonia, and Cystic Fibrosis exacerbation or Pulmonary
Fibrosis
What are the goals of PT for patients with pulmonary disease? (5)
functional mobility
What are the implications for PT for patients who use bronchodilators?
They may tolerate exercise better, may also experience tachycardia
What are the implications for PT for patients who use mucolytics?
They likely will have improved secretions
How should activity be monitored for patients with pulmonary disease?
With RPE and the Modified BORG Dyspnea Scale
What types of lines and tubes will patients with a pulmonary disease most likely
have? (3)
Yaunker suction (goes into throat and clears secretions for you; like if they have a
trach in), chest tube, supplemental O2 (nasal cannula)
What are the most common GI diagnoses in the acute care setting?
GERD, hernia repairs, GI tumors (resection), intestinal obstructions
liver cirrhosis: lab values (ammonia), pre/post-transplant
Dysphagia: Be aware of dietary orders, IE: NPO, thin vs thick liquids, ice chips,
position while and after eating
What are the goals of PT for patients with GI issues in the acute care setting? (3)
,1) Optimization of function
2) Maximization of activity tolerance and endurance
3) Prevention of post-op complications
What are the primary functions of GI tubes?
Alert RN immediately if removed
What are the primary functions of drains?
To drain blood or fluid in patients with GI issues
What are the most common types of drains? (5)
Jackson-Pratt (JP) drain, Blake Drain, Hemovac, Pigtail catheter, Nephrostomy
What is the purpose of a Wound Vac?
To provide negative pressure wound therapy to promote healing in acute or chronic
wounds
What are the typical abdominal precautions for a patient's following an abdominal
surgery? (3)
1) Lifting restriction of 5-10 lbs
2) Perform log rolling for transitioning from supine to sit
3) Abdominal binder can assist with pain
What is the purpose of a fecal management system? What are some
considerations?
For patients with excessive loose stools in order to protect the skin. Need to avoid
shearing forces with transfers
What are the most common genitourinary diagnoses in the acute care setting? (3)
Acute kidney injury, chronic kidney disease, and UTI's
What are the goals of PT for patients with genitourinary disease? (3)
1) Optimization of function
2) Maximization of activity tolerance and endurance
3) Prevention of post-op complications
What are the different forms of urinary catheters? (4)
1) Condom (ask nursing staff to reapply if it falls off)
2) Foley (call RN if dislodged)
3) Suprapubic (call RN if dislodged)
4) External female (remove prior to mobility)
How does the renin-angiotensin system work?
-Someone with kidney or liver disease will have lower BP because one of the
systems is not working properly to create this system
,PT implications for pts. that have end stage liver failure
Pts. can have BP as low as 80/40 as their baseline.
This does not mean you cant treat them, it just means they will not be able to tolerate
as much
What are the different types of renal replacement therapies? (3)
1) Peritoneal dialysis: Not going to see this in hospital setting, you will see this at
home for end stage kidney disease waiting for kidney transplant
2) Intermittent hemodialysis: See the most common,( R). 2-3 days a week.
3) Continuous renal replacement therapy: ICU ill patients with constant blood
replacement
Implications for PTS when patient has dialysis that day
most concerned about they are likely to be tired after
-Try to see them before dialysis if possible
For patients with an A-V fistula, what is a contraindication?
Taking BP in that arm
What are the most common endocrine diagnoses in the acute care setting?
Type I and Type II Diabetes
What are the goals of PT for patients with endocrine disorders in the acute care
setting? (5)
1) Optimization of function
2) Maximization of activity tolerance and endurance
3) Prevention of skin breakdown in patients with altered sensation
4) Decrease pain
5) Maximize safety for the prevention of falls
What are the implications for PT for patients who use insulin for blood sugar control?
It can lead to an increased risk of hypoglycemia once you get them up and moving
•Blood glucose should be checked prior to meals so check with RN prior to giving a
snack! You do not want to just be giving them sugary snacks and you want to make
sure they are following their plan
How can hypoglycemia be quickly reversed?
Good news for inpatient
What are the most common oncologic conditions in the acute care setting? (7)
, Lung cancer, breast cancer, GI cancers, GU cancers, hematologic cancers,
head/neck cancers, neurological cancers
What are the goals of PT for patients with oncologic conditions in the acute care
setting? (5)
1) Optimize functional mobility
2) Minimize or prevent cancer related fatigue
3) Prevent joint contracture and skin breakdown
4) Prevent or reduce limb edema
5) Prevent post-op pulmonary complications
What are the most common ways that cancer is treated in the hospital? (3)
1) Surgery to remove tumor or ease symptoms
2) Chemotherapy to slow or stop the growth of cancer cells
3) Radiation therapy
What are the risks associated with surgery to remove tumors or ease cancer
symptoms?
Pain and infection
What are the common side effects of chemotherapy? (13)
Fatigue, nausea, vomiting, diarrhea, neuropathy (CPIN), weakness, anorexia,
mucositis, skin rashes, ulcers, alopecia, anemia, VTE
What are the common side effects of radiation therapy? (5)
Fatigue, diarrhea, hair loss, skin changes, and edema
What is the purpose of a PICC line?
For long term delivery of medications (antibiotics usually). This cannot get wet and
requires specific cleaning/flushing
What is the purpose of an implanted port?
For long term delivery of medications, specifically for chemotherapy. This can get
wet
What are the implications for PT for patients who are taking corticosteroids?
Patient may develop proximal muscle weakness
What are the implications for PT for patients who are receiving chemotherapy?
Chemotherapy induced peripheral neuropathy may arise, fatigue, and development
of proximal muscle weakness
What are the implications for PT for patients who are taking antibiotics?
Ototoxicity (hearing/vestibular impairments) may arise
What platelet levels should you be VERY cautious with?
•< 10 x 109/ L
Patients with Dementia/ Cognitive Impairments
-Schedule apt. in morning when pt. is more alert and away possibly
Chart review for Medical & Surgical Considerations for the Acute Care Physical
Therapist
Might be looking at nitrogren levels for kidney surgies, ammonia levels for liver and
more closey WBC as well as blood considerations
-For this population there isnt necessarily levels that would make you not do
treatment but just be aware of the cognitive levels that might be affected by some of
the values
Anticoagulant examples (3)
Heparin, Lovenox, Coumadin/Warfarin
•Used in MOST hospitalized patients
What should you do is continuous herapin is stopped?
ALERT RN IMMEDIATELY
Implications for PT with anticoagulants
easy bleeding and bruising
What are the most common pulmonary diagnoses in the acute care setting? (4)
COPD exacerbation, Pneumonia, and Cystic Fibrosis exacerbation or Pulmonary
Fibrosis
What are the goals of PT for patients with pulmonary disease? (5)
functional mobility
What are the implications for PT for patients who use bronchodilators?
They may tolerate exercise better, may also experience tachycardia
What are the implications for PT for patients who use mucolytics?
They likely will have improved secretions
How should activity be monitored for patients with pulmonary disease?
With RPE and the Modified BORG Dyspnea Scale
What types of lines and tubes will patients with a pulmonary disease most likely
have? (3)
Yaunker suction (goes into throat and clears secretions for you; like if they have a
trach in), chest tube, supplemental O2 (nasal cannula)
What are the most common GI diagnoses in the acute care setting?
GERD, hernia repairs, GI tumors (resection), intestinal obstructions
liver cirrhosis: lab values (ammonia), pre/post-transplant
Dysphagia: Be aware of dietary orders, IE: NPO, thin vs thick liquids, ice chips,
position while and after eating
What are the goals of PT for patients with GI issues in the acute care setting? (3)
,1) Optimization of function
2) Maximization of activity tolerance and endurance
3) Prevention of post-op complications
What are the primary functions of GI tubes?
Alert RN immediately if removed
What are the primary functions of drains?
To drain blood or fluid in patients with GI issues
What are the most common types of drains? (5)
Jackson-Pratt (JP) drain, Blake Drain, Hemovac, Pigtail catheter, Nephrostomy
What is the purpose of a Wound Vac?
To provide negative pressure wound therapy to promote healing in acute or chronic
wounds
What are the typical abdominal precautions for a patient's following an abdominal
surgery? (3)
1) Lifting restriction of 5-10 lbs
2) Perform log rolling for transitioning from supine to sit
3) Abdominal binder can assist with pain
What is the purpose of a fecal management system? What are some
considerations?
For patients with excessive loose stools in order to protect the skin. Need to avoid
shearing forces with transfers
What are the most common genitourinary diagnoses in the acute care setting? (3)
Acute kidney injury, chronic kidney disease, and UTI's
What are the goals of PT for patients with genitourinary disease? (3)
1) Optimization of function
2) Maximization of activity tolerance and endurance
3) Prevention of post-op complications
What are the different forms of urinary catheters? (4)
1) Condom (ask nursing staff to reapply if it falls off)
2) Foley (call RN if dislodged)
3) Suprapubic (call RN if dislodged)
4) External female (remove prior to mobility)
How does the renin-angiotensin system work?
-Someone with kidney or liver disease will have lower BP because one of the
systems is not working properly to create this system
,PT implications for pts. that have end stage liver failure
Pts. can have BP as low as 80/40 as their baseline.
This does not mean you cant treat them, it just means they will not be able to tolerate
as much
What are the different types of renal replacement therapies? (3)
1) Peritoneal dialysis: Not going to see this in hospital setting, you will see this at
home for end stage kidney disease waiting for kidney transplant
2) Intermittent hemodialysis: See the most common,( R). 2-3 days a week.
3) Continuous renal replacement therapy: ICU ill patients with constant blood
replacement
Implications for PTS when patient has dialysis that day
most concerned about they are likely to be tired after
-Try to see them before dialysis if possible
For patients with an A-V fistula, what is a contraindication?
Taking BP in that arm
What are the most common endocrine diagnoses in the acute care setting?
Type I and Type II Diabetes
What are the goals of PT for patients with endocrine disorders in the acute care
setting? (5)
1) Optimization of function
2) Maximization of activity tolerance and endurance
3) Prevention of skin breakdown in patients with altered sensation
4) Decrease pain
5) Maximize safety for the prevention of falls
What are the implications for PT for patients who use insulin for blood sugar control?
It can lead to an increased risk of hypoglycemia once you get them up and moving
•Blood glucose should be checked prior to meals so check with RN prior to giving a
snack! You do not want to just be giving them sugary snacks and you want to make
sure they are following their plan
How can hypoglycemia be quickly reversed?
Good news for inpatient
What are the most common oncologic conditions in the acute care setting? (7)
, Lung cancer, breast cancer, GI cancers, GU cancers, hematologic cancers,
head/neck cancers, neurological cancers
What are the goals of PT for patients with oncologic conditions in the acute care
setting? (5)
1) Optimize functional mobility
2) Minimize or prevent cancer related fatigue
3) Prevent joint contracture and skin breakdown
4) Prevent or reduce limb edema
5) Prevent post-op pulmonary complications
What are the most common ways that cancer is treated in the hospital? (3)
1) Surgery to remove tumor or ease symptoms
2) Chemotherapy to slow or stop the growth of cancer cells
3) Radiation therapy
What are the risks associated with surgery to remove tumors or ease cancer
symptoms?
Pain and infection
What are the common side effects of chemotherapy? (13)
Fatigue, nausea, vomiting, diarrhea, neuropathy (CPIN), weakness, anorexia,
mucositis, skin rashes, ulcers, alopecia, anemia, VTE
What are the common side effects of radiation therapy? (5)
Fatigue, diarrhea, hair loss, skin changes, and edema
What is the purpose of a PICC line?
For long term delivery of medications (antibiotics usually). This cannot get wet and
requires specific cleaning/flushing
What is the purpose of an implanted port?
For long term delivery of medications, specifically for chemotherapy. This can get
wet
What are the implications for PT for patients who are taking corticosteroids?
Patient may develop proximal muscle weakness
What are the implications for PT for patients who are receiving chemotherapy?
Chemotherapy induced peripheral neuropathy may arise, fatigue, and development
of proximal muscle weakness
What are the implications for PT for patients who are taking antibiotics?
Ototoxicity (hearing/vestibular impairments) may arise
What platelet levels should you be VERY cautious with?
•< 10 x 109/ L
Patients with Dementia/ Cognitive Impairments
-Schedule apt. in morning when pt. is more alert and away possibly
