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Flashcards in Decision Making & Clinical Handover Deck (17)
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1
Q

What needs to be considered when making decisions in cardio physio?

A
  • Info from medical file
  • Info from patient (subjective)
  • Physical assessment findings
  • Tests & investigations
  • Evidence from literature
  • Clinical experience
  • Patient preference
  • Availability, cost time
2
Q

What is the step by step process of making decisions?

A
  • Clearly understand the story so far
  • Conduct patient-specific assessment (subjective/objective)
  • Interpret data
  • Select best treatment
  • Implement and evaluate
3
Q

What is involved in understanding a patient’s story so far?

A
  • Why is the patient here (HPI)
  • Background (PHx, SHx)
  • What investigations have been done/what do the results mean
  • What is the current diagnosis (impression)
  • What is the medical plan
  • Who has referred the patient to physio
4
Q

What are the different types of referrals?

A

Blanket referral:

  • Screening list of patients on a ward
  • Identify those who may benefit from physio
  • Liase with MDT

Referral from other HCP:
- Requires clinical handover

5
Q

What is a clinical handover?

A

Transfer of professional responsibility for care of a patient to another person

6
Q

What is the ISBAR method of clinical handover?

A
Introduction
- Yourself/role
- Patient (age, location, context)
Situation
- Main symptoms/problems/concern
- Patient stability/urgency of concern
Background
- Relevent medical/surgical history
- May include SHx
Assessment
- Current findings/interpretation
- What have you done so far
Recommendation (plan)
- What you want done
- Treatment that requires monitoring
- Review (when/by whom)
7
Q

What data needs to be interpreted following an objective assessment?

A
  • Vital signs
  • Observation/palpation
  • Auscultation
  • ABGs
  • CXR/CT/MRI
  • Comparison to normal values
  • What is normal for the patient
8
Q

What are the 3 main respiratory problems amenable to physio?

A
  • Increased WOB (dyspnoea)
  • Impaired sputum clearance
  • Lung collapse (atelectasis)
9
Q

What are some of the acute respiratory problems that are not amenable to physio?

A
  • Acute pulmonary oedema (APO)
  • Pleural effusion (only resolved by catheter)
  • Pneumothorax
  • Bronchiolitis (babies)
  • Asthma (bronchoconstriction)
  • Pulmonary embolism
  • Consolidated pneumonia (no evidence of sputum)
10
Q

What should you do if you identify a problem that is not amenable to physio?

A
  • Go back to the referral source
  • Explain why physio can’t help
  • Document accordingly
11
Q

What needs to be considered when selecting a treatment?

A
  • What does the evidence suggest
  • What does the patient prefer (what has worked well in the past)
  • What is available
  • What is practical/feasible
  • What is cost-effective
  • Short term vs long term
  • Contraindications & precautions
12
Q

What are the treatment options for increased WOB?

A
  • Support accessory muscles
  • Pursed lip breathing
  • IMT (long term)
13
Q

What are the treatment options for impaired sputum clearance?

A
  • Mobilisation
  • PEP
  • ACBT
  • Postural drainage
  • Percussion & vibration
14
Q

What are the treatment options for lung collapse (atelectasis)?

A
  • PEP
  • Gravity
  • Positive pressure
  • Mobilisation
15
Q

What is an important thing to remember when selecting a treatment?

A

Explain to the patient how the treatment will help them with their problem

16
Q

What needs to be considered during re-evaluation?

A
  • What changed

- Is it improving/worsening/staying the same

17
Q

What follows evaluation?

A

Goal setting (short term & long term)