During this supervised clinical practice, students are responsible for successful execution of examination, evaluation, and interventions relating to cardiovascular and pulmonary disorders. Students become familiar with performance of these skills in all settings (inpatient and outpatient) as well as on all types of conditions (surgical, non-surgical, pediatric and geriatric,) Students learn to objectively perform these skills under the supervision of trained physical therapists. Student is required to keep a performance record of all listed competencies and successfully perform on real patients during the final evaluation of the course
CLINICAL COMPETENCIESEXAMINATION
Based on best available evidence select examination tests and measures that are appropriate for the patient/client Perform posture tests and measures of postural alignment and positioning. Perform gait, locomotion and balance tests including quantitativeand qualitative measures such as: Balance during functional activities with or without the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment Balance (dynamic and static) with or without the use of assistive,adaptive, orthotic, protective, supportive, or prosthetic devices orequipment Gait and locomotion during functional activities with or without the Use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment to include: Bed mobility Transfers (level surfaces and floor) Wheelchair management Uneven surfaces Safety during gait, locomotion, and balance Perform gait assessment includingstep length, speed,characteristics of gait, and abnormal gait patterns. Characterize or quantify body mechanics during self-care, homemanagement, work, community, tasks, or leisure activities. Characterize or quantify ergonomic performance during work(job/school/play): Dexterity and coordination during work Safety in work environment Specific work conditions or activities Tools, devices, equipment, and workstations related to workactions, tasks, or activities Characterize or quantify environmental home and work (job/school/play) barriers: Current and potential barriers Physical space and environment Community access Observe self-care and home management (including ADL andIADL) Measure and characterize pain to include: Pain, soreness, and nocioception Specific body parts Recognize and characterize signs and symptoms of inflammation. Perform cardiovascular/pulmonary tests and measures including: Heart rate Respiratory rate, pattern and quality Blood pressure Aerobic capacity test* (functional or standardized) such as the 6-minute walk test Pulse Oximetry Breath sounds – normal/abnormal Response to exercise (RPE) Signs and symptoms of hypoxia Peripheral circulation (deep vein thrombosis, pulse, venousstasis, lymphedema).
EVALUATION
Clinical reasoning Clinical decision making Synthesize available data on a patient/client expressed in terms of the International Classification of Function, Disability and Health (ICF) model to include body functions and structures, activities, and participation. Use available evidence in interpreting the examination findings. Verbalize possible alternatives when interpreting the examinationfindings. Cite the evidence (patient/client history, lab diagnostics, tests andmeasures and scientific literature) to support a clinical decision
DIAGNOSIS
Integrate the examination findings to classify the patient/client problem in terms of body functions and structures, and activities and participation (ie, practice patterns in the Guide) Identify and prioritize impairments in body functions and structures, and activity limitations and participation restrictions to determine specific body function and structure, and activities and participation towards which the intervention will be directed.
PROGNOSIS
Determine the predicted level of optimal functioning and the amount of time required to achieve that level. Recognize barriers that may impact the achievement of optimal functioning within a predicted time frame including Age Medication(s) Socioeconomic status Co-morbidities Cognitive status Nutrition Social Support Environment.
PLAN OF CARE
Goal setting Coordination of Care Progression of care Discharge Design a Plan of Care Write measurable functional goals (short-term and long-term) that are time referenced with expected outcomes Consult patient/client and/or caregivers to develop a mutually agreed to plan of care. Identify patient/client goals and expectations Identify indications for consultation with other professionals Make referral to resources needed by the patient/client (assumesknowledge of referral sources) Select and prioritize the essential interventions that are safe and meet the specified functional goals and outcomes in the plan of care (ie, (a) identify precautions and contraindications, (b) provide evidence for patient-centered interventions that are identified and selected, (c) define the specificity of the intervention (time, intensity, duration, and frequency), and (d) set realistic priorities that consider relative time duration in conjunction with family, caregivers, and other health care professionals) Establish criteria for discharge based on patient goals and currentfunctioning and disability Coordination of Care Identify who needs to collaborate in the plan of care. Identify additional patient/client needs that are beyond the scopeof physical therapist practice, level of experience and expertise, and warrant referral. Refer and discuss coordination of care with other health care professionals. Articulate a specific rational for a referral. Advocate for patient/client access to services. Progression of Care Identify outcome measures of progress relative to when toprogress the patient further. Measure patient/client response to intervention. Monitor patient/client response to intervention. Modify elements of the plan of care and goals in response to changing patient/client status, as needed Make on-going adjustments to interventions according to outcomes including environmental factors and personal factors and, medical therapeutic interventions. Make accurate decisions regarding intensity and frequency whenadjusting interventions in the plan of care. Discharge Plan Re-examine patient/client if not meeting established criteria fordischarge based on the plan of care. Differentiate between discharge of the patient/client,discontinuation of service, and transfer of care with re-evaluation. Prepare needed resources for patient/client to ensure timelydischarge, including follow-up care Include patient/client and family/caregiver as a partner indischarge Discontinue care when services are no longer indicated. When services are still needed, seek resources and/or consultwith others to identify alternative resources that may be available. Determine the need for equipment and initiate requests to obtain.
INTERVENTIONS
Safety, Emergency Care, CPR and First Aid Standard Precautions Body Mechanics and Positioning Categories of Interventions o Safety, Cardiopulmonary Resuscitation Emergency Care, First Aid Ensure patient safety and safe application of patient/client care. Perform first aid. Perform emergency procedures. Perform Cardiopulmonary Resuscitation (CPR). Precautions Demonstrate appropriate sequencing of events related to universal precautions. Use Universal Precautions. Determine equipment to be used and assemble all sterile and non-sterile materials. Use transmission-based precautions. Demonstrate aseptic techniques. Apply sterile procedures Properly discard soiled items Body Mechanics and Positioning Apply proper body mechanics (utilize, teach, reinforce, and observe) Properly position, drape, and stabilize a patient/client when providing physical therapy Coordination, communication, and documentation may include: Addressing required functions: Establish and maintain an ongoing collaborative process of decision-making with patients/clients, families, or caregivers priorto initiating care and throughout the provision of services. Discern the need to perform mandatory communication and reporting (eg, incident reports, patient advocacy and abuse reporting). Follow advance directives. B. Admission and discharge planning. C. Case management. D. Collaboration and coordination with agencies, including: Home care agencies Equipment suppliers Schools Transportation agencies Payer groups E. Communication across settings, including: Case conferences Documentation Education plans F. Cost-effective resource utilization. G. Data collection, analysis, and reporting of: Outcome data Peer review findings Record reviews H. Documentation across settings, following APTA‘s Guidelinesfor Physical Therapy Documentation, including: Elements of examination, evaluation, diagnosis, prognosis, andIntervention Changes in body structure and function, activities and participation Changes in interventions Outcomes of intervention ▪ Interdisciplinary teamwork ▪ Patient/client family meetings ▪ Patient care rounds ▪ Case conferences Referrals to other professionals or resources. Patient/client-related instruction may include: ▪ Instruction, education, and training of patients/clients and caregivers regarding: Current condition, health condition, impairments in body structure and function, and activity limitations, and participation restrictions) Enhancement of performance Plan of care: Risk factors for health condition, impairments in body structure and function, and activity limitations, and participation restrictions. Preferred interventions, alternative interventions, and alternative modes of delivery Expected outcomes Health, wellness, and fitness programs (management of risk factors) Transitions across settings.
THERAPEUTIC EXERCISE MAY INCLUDE PERFORMING
A.
Aerobic capacity/endurance conditioning or reconditioning Gait and locomotor training Increased workload over time (modify workload progression) Movement efficiency and energy conservation training Walking and wheelchair propulsion programs Cardiovascular conditioning programs
B.
RELAXATION
Breathing strategies Movement strategies Relaxation techniques C. Airway clearance techniques may include o Breathing strategies Active cycle of breathing or forced expiratory techniques Assisted cough/huff techniques Paced breathing Pursed lip breathing Techniques to maximize ventilation (e.g., maximum inspiratory hold, breath stacking, manual hyperinflation) Manual/mechanical techniques Assistive devices. Positioning Positioning to alter work of breathing Positioning to maximize ventilation and perfusion. Functional training in self-care and home management may include Functional training in work (job/school/play), community, and leisure integration or reintegration may include Activities of daily living (ADL) training Bed mobility and transfer training Age appropriate functional skills Barrier accommodations or modifications Device and equipment use and training: Assistive and adaptive device or equipment training during ADL (specifically for bed mobility and transfer training, gait and locomotion, and dressing) Orthotic, protective, or supportive device or equipment training during self-care and home management Prosthetic device or equipment training during ADL (specifically for bed mobility and transfer training, gait and locomotion, and dressing) Functional training programs Simulated environments and tasks Task adaptation Injury prevention or reduction Safety awareness training during self-care management Injury prevention education during self-care management Injury prevention or reduction with use of equipment Prescription, application, and, as appropriate, fabrication of devices and equipment may include Adaptive devices Hospital beds Raised toilet seats Seating systems – prefabricated Assistive devices Canes Crutches Long-handled reachers Static and dynamic splints – prefabricated Walkers Wheelchairs Orthotic devices Prefabricated braces Prefabricated shoe inserts Prefabricated splints. Prosthetic devices (lower-extremity) Protective devices Braces Cushions Helmets Protective taping Supportive devices Prefabricated compression garments Corsets Elastic wraps Neck collars Slings Supplemental oxygen - apply and adjust Supportive taping Electrotherapeutic modalities may include Biofeedback Electrotherapeutic delivery of medications (eg, iontophoresis) Electricals timulation Electrical muscle stimulation (EMS) Functional electrical stimulation (FES) High voltage pulsed current (HVPC) Neuromuscular electrical stimulation (NMES) Transcutaneous electrical nerve stimulation (TENS) Physical agents and mechanical modalities may include: Physical agents: Cryotherapy Cold packs Ice massage Vapocoolant spray Hydrotherapy Contrast bath Pools Whirlpool tanks Sound agents Phonophoresis Ultrasound Thermotherapy Dry heat Hot packs Paraffin baths
MECHANICAL MODALITIES
Compression therapies (prefabricated) Compression garments Skill Category Description of Minimum Skills Vasopneumatic compression devices Taping Compression bandaging (excluding lymphedema) Gravity-assisted compression devices Standing frame Tilt table Mechanical motion devices Continuous passive motion (CPM) Traction devices Intermittent Positional Sustained Documentation of all listed competency in SOAP notes format