Comper Care Outpatient Physical Therapy with Michael Black DPT

MIKE'S FORMS ON RAISING THE CEILING AND LOWERING THE FLOOR FOR VITAL SIGN CONTRAINDICATIONS

HOW DOES PHYSICAL THERAPY COMMUNICATE VITAL SIGN RED FLAGS?

EXAMPLE 1: WHAT DOES YOUR PHYSICAL THERAPY PROGRESS REPORT LOOK LIKE WITH CONTRAINDICATION TACHYCARDIA AND STAGE 5 MALIGNANT HTN THAT DOES NOT REMIT TO INPATIENT MEDICAL INTERVENTION?

The following is a sample physical therapy communication form, delivered to a DON or Wellness director for the physician, NP, or PA to consider with respect to vital sign presentation at rest or with exertion. Identifiers have been removed, but these explains the concept:

Diagnosis: CABG x 4, HTN, atrial fibrillation with contraindication HTN, RR vital sign panel obtained at rest

Subjective: Patient denies chest pain or breathlessness throughout exercise during physical therapy treatment. Patient is highly movitated to continue rehabilitation at this time.

Objective: Patient demonstrates the following vital sign panel at rest: RHR 104 bpm, SpO2 91% on room air, BP 181/102 mmHg, RR 20 breaths/minute. Patient did demonstrate known phase 5 malignant HTN during acute rehabilitation prior to discharge to this SNF setting and exercise treatment was continued secondary to no further stability was attained medically including pharmacologically.

Assessment/Plan: Exercise treatment has been placed on hold pending physician orders to raise the ceiling of RHR/BP contraindication values only if indicated. Orders are included for your convenience. Please check boxes and complete prescription as indicated. Defer to your expertise!

___ Hold physical therapy pending medical management to stabilize VS values above

OR

___ Therapy is to continue with increase in ceiling RHR contraindication value from 100 bpm to 105 bpm to facilitate continued rehabilitation honoring this new physician approved range.

OR

___ Other specified RHR range as follows:

AND

___ Therapy is to continue with increase in BP ceiling contraindication value from 180/100 mmHg to 185/105 mmHg to facilitate continued rehabilitation honoring this new physician approved range.

OR

___ BP value prescription as follows:

AND/OR

Other orders/instructions:

Thank you for your trust with this patient! Michael Black PT, DPT

Physician signature ____________________ Date: __________

EXAMPLE 2: WHAT DOES YOUR PHYSICAL THERAPY PROGRESS REPORT LOOK LIKE WITH A SUPPLEMENTAL OXYGEN PRESCRIPTION WHEN THE SPO2 BEGINS TO STABILIZE?

Diagnosis: COPD, CHF, PVD, B TKA

Subjective: Patient reports no shortness of breath on 2 liters of supplemental oxygen at rest and with exertion. Patient reports they are highly motivated to wean to room air per their recent PLOF 3 months ago.

Objective: Patient demonstrates SpO2 93% to 97% on 2 liters/min supplemental oxygen via nasal canula, at rest and with physical therapy exercise, during the waking day including morning/afternoon assessment times. Nocturnal oxygen including sleep study not assessed and formally deferred to nursing at this time.

Assessment/Plan: Orders for nursing to obtain titrate continuous supplemental oxygen from 2 liters/minute to 1.5 liters/minute dosage during waking day hours are included for your convenience. Please check boxes and complete prescription as indicated. Defer to your expertise!

___ Change continuous supplemental oxygen floor value from 2 L/min dosage to 1.5 L/min with SpO2 > 90% at all times including rest and exertion including exercise treatment during waking day including morning and afternoon with nocturnal recommendation deferred to nursing

AND/OR

___ Other orders/instructions:

Thank you for your trust with this patient! Michael Black PT, DPT

Physician signature ____________________ Date: __________

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