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Physical Therapy Intervention for a Child Admitted with Influenza A

Physical Therapy Intervention for 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.

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Physical Therapy Intervention for a Child Admitted with Influenza A

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  1. Physical Therapy Interventionfor a Child Admitted with Influenza A Dana Mieczkowski, PT, DPT A.I. duPont Hospital for Children

  2. What do you need to know before going in to see patient?? • What will you do in initial evaluation??

  3. 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

  4. 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?

  5. 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

  6. Now what will you measure, what data will you collect?

  7. 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?

  8. 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

  9. What goals will you set for this patient?

  10. 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?

  11. Treatment • Splints: why would you or wouldn't use them? • How will you encourage optimal positioning?

  12. 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?

  13. 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?

  14. 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

  15. 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

  16. 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?

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