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Learn about initial evaluation, treatment plans, and goals for a child admitted with influenza. Includes relevant PT interventions and progress monitoring.
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Physical Therapy Interventionfor a Child Admitted with Influenza A Dana Mieczkowski, PT, DPT A.I. duPont Hospital for Children
What do you need to know before going in to see patient?? • What will you do in initial evaluation??
Question #1 • Based on initial evaluation, what is the main PT concern for this patient? • This patient is too critical, there is nothing I can do for him • ROM • Skin integrity • Neurological status
What is this patient’s prognosis? • What would you expect the treatment plan to include at this time? • What do you think the frequency of treatment would be?
Question # 2 • CICU staff will not allow you to perform ROM on patient. What should you do??? • What is your role as an acute care PT in this situation? • Do nothing, this patient is too unstable for intervention • Educate nurses on importance of positioning and elevation of limbs • Monitor wounds and only provide wound care as needed • Provide resting splints for UE and LE for improved positioning
What is PT diagnosis? • 11 year old boy with significantly decreased ROM, strength and functional mobility secondary to prolonged and complex hospital stay • What is PT plan?
Question # 3 • How would you evaluate neurological status in an intubated and non-sedated patient? • Consult Neurology • Ask patient yes/no questions each session and evaluate for consistency • Ask patient to follow 1-step commands, such as squeeze hand, blink eyes or nod head • A and B • A and C • All the above
Goals • Pt will be able to follow 1 step verbal commands • Pt will maintain eyes open/awake state x15 minutes • Pt will tolerate lotion massage to BLE and BUE with minimal discomfort • Pt will achieve full ROM into knee extension to accommodate prosthetics for likely BKA • Tolerate repositioning as medically appropriate • How can you make these hospital short term goals into functional goals?
Treatment • Splints: why would you or wouldn't use them? • How will you encourage optimal positioning?
PT Evaluation 1/12/10 • Pt is POD #7 from tracheostomy and POD #19 BKA, • Precautions: CVL, necrotic 3rd and 4th DIP left hand, 3 chest tubes, NG tube, replogle drain • What would you measure now?
Plan of Care • Assessment: Pt able to demonstrate good PROM of LE with exception of hip extension, improving strength, difficulty with mobility skill such as rolling and sitting tolerance • What are this patient’s greatest impairments and how might you begin to address them? • What PT treatments might be helpful in resolving these impairments and why? • Is there evidence to support these interventions?
Question # 4 • Now that this patient is s/p B BKA, what is the most important goal / plan of care for this situation? • Increase mobility and ability to transfer • Stump care • Assessment of neurological status • Increasing strength
Question # 5 What muscles are primary focus for strengthening for standing and walking with prosthesis? • Hip adductors • Hip extensors • Knee flexors • Knee extensors • B and D
Outcomes/Results • 2/15 Move to rehab floor and begin inpatient rehabilitation • Pt now able to: • Don shorts in bed independently in supine • Mom independent in donning prosthesis • Sidelying to sit EOB transfer with min assist x1 • Sliding board transfer min assist x2 • sitting 10 minutes at edge of mat • Tilt table x15 minutes at 45-60 degrees • What comes next in rehab? • What would your treatment plan include?