During this supervised clinical practice, students are responsible for learning the skills of systems review and validate the need for physical therapy services. Students learn to objectively review each system under the supervision of trained physical therapists. Students become familiar with performance of these skills in all settings (inpatient and outpatient) as well as on all types of patients (surgical, non-surgical, pediatric, geriatric, etc.) 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 COMPETENCIES
Perform review of systems to determine the need for referral or for physical therapy services. Systems review screening includes the following.
GENERAL HEALTH CONDITION (GHC)
Fatigue Malaise Fever/chills/sweats Nausea/vomiting Dizziness/lightheadedness Unexplained weight change Numbness/Paresthesia Weakness Mentation/cognition.
CARDIOVASCULAR SYSTEM (CVS)
Dyspnea Orthopnea Palpitations Pain/sweats Syncope Peripheral edema Cough.
PULMONARY SYSTEM (PS)
Dyspnea Onset of cough Change in cough Sputum Hemoptysis Clubbing of nails Stridor Wheezing.
GASTROINTESTINAL SYSTEM (GIS)
Difficulty with swallowing Heartburn, indigestion Change in appetite Change in bowel function
URINARY SYSTEM (US)
Frequency Urgency Incontinence
GENITAL REPRODUCTIVE SYSTEM (GRS)
MALE
Describe any sexual dysfunction, difficulties, or concerns.
FEMALE
Describe any sexual or menstrual dysfunction, difficulties, or problems.
RECOGNITION OF RED AND YELLOW FLAGS
Initiate referral when positive signs and symptoms identified in thereview of systems are beyond the specific skills or expertise of thephysical therapist or beyond the scope of physical therapist practice Consult additional resources, as needed, including other physical therapists, evidence-based literature, other health care professionals, and community resources Screen for physical, sexual, and psychological abuse.
CARDIOVASCULAR AND PULMONARY SYSTEMS
Conduct a systems review for screening of the cardiovascular and pulmonary system (heart rate and rhythm, respiratory rate, blood pressure, edema) Read a single lead EKG.
INTEGUMENTARY SYSTEM
Conduct a systems review for screening of the integumentary system, the assessment of pliability (texture), presence of scar formation, skin color, and skin integrity.
MUSCULOSKELETAL SYSTEM
Conduct a systems review for screening of musculoskeletal system, the assessment of gross symmetry, gross range of motion, gross strength, height and weight.
NEUROLOGICAL SYSTEM
Conduct a systems review for screening of the neuromuscular system, a general assessment of gross coordinated movement (balance, gait, locomotion, transfers, and transitions) and motor function (motor control and motor learning). Documentation of all listed competencies in SOAP notes format
