Introduction: Physical therapist working in various clinical setting should be familiar with the patient 's medical condition including medications that they are actively taking to ensure that any symptoms associated with the drug are appropriately and safely considered. Here is an example of an acute care patient in the orthopedic ward anticipating for a left total hip arthroplasty surgery.
HPI: S.J. is a 67 y/o Caucasian male with a history of left hip pain for two years. He has difficulty walking due to left hip pain and utilizes a cane, can walk five blocks, climbs stairs leading with the right leg. He denies any surgeries on the left lower extremity. He sought physical therapy, but he does not feel that it is improving his pain but does believe it is improving his strength. He is scheduled for a left total hip arthroplasty due to the progression of severe osteoarthritis of the left hip as confirmed by a pelvic x-ray and MRI of the lower extremity without contrast. S.J. has taken various medications that are listed on the current medication section of this note.
PMH: Osteoarthritis, hyperlipidemia, hypothyroidism, sciatica and hypertension.
CURRENT MEDICATIONS:
• Acetaminophen 325 mg tablet PO TID as needed for pain. Max Acetaminophen 4000 mg/day (2000 mg if has liver disease)
• Atorvastatin Calcium 40 mg tablet PO QD for cholesterol
• Chlorthalidone 25 mg tablet PO QD for blood pressure
• Diclofenac Na 75 mg EC tablet PO BID after meals for pain or
Interventions will often include the use of assistive and adaptive devices such as crutches, wheelchairs, orthotics, and prosthetics. An important component of physical therapist patient management involves teaching the patient appropriate ways to move or perform particular tasks to prevent further injury and to promote health and wellness”.
HISTORY OF PRESENT ILLNESS: Patient is a candidate for a total right hip revision. She has 2 units of directed packed red blood cells. It is not autologous. She does had Hepatitis B. She has arthrogryposis. She had a right total hip replacement many years ago by Dr. Dodd at the University of Miami. She has had multiple other surgical procedures as follows. A: She had bilateral foot surgery In the remote past. B: She had left hip surgery a year ago. C: She had right foot
One afternoon a 67 year-old man presented to the emergency department of a small, rural hospital complaining of severe left leg and hip pain following a fall at home. The patient had no past history of falls. He had a history of impaired glucose intolerance, prostate cancer, hypercholesterolemia and hyperlipidemia. The patient’s current medications were atorvastatin and oxycodone for chronic back pain. The patient stated his pain was ten out of ten on a scale of one to ten with ten being the worst. The left leg appeared shorter than the right, edema was present in the calf, as was ecchymosis and he had limited range of motion. After an evaluation in triage by a registered nurse and a subsequent examination by the emergency department physician, a plan was established to sedate the patient using moderation sedation protocol and perform a manual reduction of the hip.
Three factors that create the need for screening are side effects of medicine, comorbidities and Visceral pain mechanisms (Goodman & Snyder, 2013). Physical therapists as direct access providers, have the responsibility to communicate with attending physicians when one of these factors are obvious or even suspected in a patient. Each factor can affect the outcome of a plan of care.
12/24/15 Progress Report describes that the patient has right knee pain. The pain is frequent. It is aching and burning in quality. The current pain level is 0/10 and worst pain is 4/10. Bending, squatting, walking, weight bearing, changing clothes and ROM aggravate the pain. Rest, ice,
Based on the progress report dated 03/02/16 by Dr. Ozaeta, the patient has had a right knee corticosteroid injection one week ago. She had to take a Norco yesterday for right knee pain. She saw Dr. Cantrell, who requested 8 additional physical therapy sessions. She has low back discomfort, notable when sitting. She takes nortriptyline and an antihypertensive.
Second, I observed in the acute department at the main hospital. In the acute care I shadowed physical therapist giving treatments to all ages of patients except children. The main goal of the acute care physical therapist is to focus on basic skills such as getting out of bed, walking safely with crutches or a walker, moving specific joints and muscles of the body.
Based on the progress report dated 08/23/16, the patient complains left knee pain upon walking. Discomfort was described as aching, tingling, intense, severe, continuous, pain, discomfort, increasing with movement and varying with activity. Pain is rated as 5/10 without medications and 4/10 with medications.
Per medical records (2008-2014), the claimant had a history of multiple medical issues, including migraines, right hand tremors, alcohol abuse, obesity, gastro-esophageal reflux disease (GERD), nausea, abdominal pain, endometriosis and degenerative changes in the left knee. In 2014, she was evaluated for hip
The patient is a 74-year-old female who tells me she did see Dr.[____] and she did get a shot into her hip. She states symptoms are "1000 times better". She does tell me he was done ultrasound and thought she might have a [____] tear, which at this point, if this does not work, she will need likely to have a hip replacement, as he did not think this is fixable at her age.
The current statutes and directives from the different states will illustrate the dissonance in the present status on PT and medication management in the US (American Physical Therapy Association [APTA], 2013). The APTA recognizes the role of PTs in the medication reconciliation and use of certain medications, but has no official position regarding the ESP of medication prescription for PTs (APTA, 2013). In stark contrast to the stance of the CSP from which from the start fought for prescriptive rights of PTs in the UK since 1999 (CSP, 2013). Currently, no US state or territory accords prescription privileges to PTs. Hence, the author firmly believes that a federal law or the individual PT state practice acts must be amended for PTs to be able to prescribe certain medications relevant to the scope of practice. The scope of practice of the PT profession is dynamic. Therefore the existing regulations and laws should be adapted to the needs of the profession and most importantly the
As stated earlier, the patient admitting challenge was right total knee replacement related to history of osteoarthritis as evidenced by unrelieved pain. Osteoarthritis (OA) is a disease that “results from cartilage damage that triggers a metabolic response at the level of the chondrocytes” (Lewis, Dirksen, Heitkemper, Barry, Goldsworthy & Goodridge, 2011, p. 1881). As it progress, it causes the cartilage to become “dull, yellow, and granular” instead of being “smooth, white, translucent” (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1881).As a result, it eventually becomes softer, less elastic, and less capable to resist wear during heavy use. Moreover, as the “central cartilage becomes thinner, cartilage and bony growth increases at the joint margins … that results to uneven distribution of stress across the joint” that contributes to a decrease in motion. (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1882). According to this patient, OA has been giving her pain for about two years that lead her to the decision of having the knee replacement.
Physical therapy has come a long way in the last couple of decades, literally transforming the way pain, functional limitations and recovery from surgery is treated. But just as with any other healthcare provider, it’s the people behind the front door - and their treatment philosophy - which makes the critical difference in the patient experience.
Despite contrary belief, hip replacement is not necessarily negative. Many Americans believe that in order to have a hip replacement, your condition must be terrible. A survey conducted in 2012 said that almost 1/3 of respondents to the hip replacement survey felt they would have benefited from having their surgery done earlier. This procedure has and continues to change the lives’ of many people in our world. Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery include increasing mobility, improving the function of the hip joint, and relieving pain. According to the Centers for Disease Control and Prevention, 332,000 total hip replacements are performed in the United States each year. “Hip Replacement.” Questions and Answers about. N.p., n.d. Web. 21 Oct. 2013.
DN is a 68 year old Caucasian male who lives in Pomona, Missouri. On September 14, 2009, DN underwent a scheduled left total knee arthroplasty at Baxter County Regional Medical Center. A consultation appointment about a total knee arthroplasty was scheduled when DN had increasing pain in his knees while doing chores and working on his dairy farm. The increasing pain DN was having been due to a history of osteoarthritis and the wear-and-tear on his joints throughout his life, no specific injury was noted. Depending on the outcome of the left knee, DN was consulted on having his right knee done in the future