Undersøkelse på akutt avdeling

Fysiobasen
Oct 4
6 min read

A physiotherapeutic assessment in the acute care environment should follow the same core structure as in other settings, but there are also unique aspects that must be emphasized on an acute ward. These assessment components ensure a thorough and efficient approach to the patient’s needs.

Review of the Patient Record

In an acute ward, physiotherapists often have access to extensive information about the patient’s current and previous medical status through electronic health records. This provides valuable insight and can streamline the assessment process.

Important information to collect:

Primary reason for admission: It is crucial to understand why the patient was admitted to hospital, whether for surgery, injury, or illness.
Surgical/operative notes: If the patient has undergone surgery, details of the procedure may indicate mobility and restrictions.
Recent nursing notes: Provide updates on the patient’s status, including symptoms, behaviour, and response to treatment.
Specific physician or nursing orders: For example, measures that may affect mobilisation or assessment, such as activity limitations.
Isolation precautions: Infection control information is essential to protect both the patient and healthcare personnel.
Movement restrictions: For example, sternal, spinal, or other postoperative precautions.
Weight-bearing status: Important for planning mobilisation, especially after orthopaedic procedures.
Laboratory values: Certain values, such as haemoglobin, may affect endurance and tolerance for physical activity.
Medications: Knowledge of drugs that may affect balance, blood pressure, or muscle weakness is necessary.

Why is this important?

A thorough review of the patient record provides the physiotherapist with:

Preparation: A clear understanding of the patient’s medical background and current status before the physical assessment begins.
Risk management: Identification of any red flags or contraindications.
Treatment focus: The ability to tailor assessment and treatment based on the patient’s individual needs.

For example, if a patient has recently had hip surgery with weight-bearing restrictions, this may influence which mobility exercises are recommended.

Reviewing medical information is a critical first component of a physiotherapy assessment in the acute care environment. This step ensures that the physiotherapist is well-informed and can provide safe and effective treatment tailored to the patient’s specific situation.

Intervju: Kartlegging av Pasientens Funksjonsnivå

Determining the patient’s previous functional level prior to hospital admission is essential for setting realistic and appropriate treatment goals. This information gives the physiotherapist insight into the patient’s usual level of independence and can help tailor the treatment plan.

Information on Previous Functional Level

Use of medical equipment: Has the patient used gait aids, a wheelchair, or other assistive devices?
Independence level for gait: What was the patient’s ability to walk without assistance?
Independence level for transfers: Could the patient move between bed and chair without help?
Independence level for bed mobility: Could the patient move in bed independently?
Independence level for activities of daily living (ADL): Could the patient independently perform activities such as dressing, eating, or going to the toilet?

Information about the Home Environment

Even though not all patients will be ready for discharge home, it is important to collect information about the home environment. This can influence treatment goals and preparations for transition from the hospital.

Home Environment Characteristics:

Type of dwelling: Is it a detached house, an apartment, or a mobile home?
Number of steps: How many stairs are there to enter and inside the home?
Handrail placement: Are there handrails on the stairs, and where are they located?
Type of bed: Is there access to a bed at an appropriate height or a specialised bed?
Type of shower: Is there a walk-in shower or a bathtub?
Available equipment: Which assistive devices are already available at home?
Social support: Who lives with the patient, and are they able to help if needed? If the patient lives alone, who can assist when required?

Physical Examination

A comprehensive physical assessment provides valuable information about the patient’s current status and limitations, which is essential for a successful treatment plan.

Musculoskeletal Screening: Strength and Range of Motion

The following areas should be assessed:

Hip: Flexion and extension
Knee: Flexion and extension
Ankle: Flexion and extension
Shoulder and elbow: Flexion and extension (important for the ability to pull up or provide support)

Example:

If the patient only has weak muscle contraction in right knee extension, this will limit how much weight can be borne on that limb.
Limited range of motion in the left ankle may prevent the patient from standing with the left foot flat, which affects gait.

Neurological Screening

Specific tests should be performed where clinically indicated.

Coordination tests:

Finger-to-nose test
Heel-to-shin and push test

Sensation tests:

Light touch across selected dermatomes

This information provides the physiotherapist with a clear picture of the patient’s sensory and motor status and any neurological limitations that may affect treatment.

Pain Assessment

It is important to record the patient’s pain level both at rest and during activity. This provides a basis for evaluating treatment effect and adjusting interventions.

Pain Measurement Tools

Numeric Pain Rating Scale (NPRS): The patient rates pain on a scale from 0 (no pain) to 10 (worst imaginable pain).
Faces Pain Scale: Used especially for children or people with cognitive challenges, where the patient selects the facial expression that best reflects their pain.
FLACC scale (Face, Legs, Activity, Cry, Consolability): Used for patients who cannot communicate verbally, such as small children or people with reduced cognitive function. The scale assesses facial expression, body position, activity, crying, and consolability.

Cardiovascular Screening

Patients in an acute setting are often haemodynamically unstable. Collecting baseline vital signs is essential to assess the risk of cardiovascular events.

Required Measurements:

Blood pressure: Check and monitor both systolic and diastolic values.
Pulse: Record frequency and rhythm.
Respiratory rate: Assess rate and pattern.
Oxygen saturation (SpO₂): Important for patients with cardiac or respiratory challenges.

Note: Physicians may specify vital sign parameters that the patient must remain within. It is important to be aware of these values throughout the assessment.

Required measurements:

Blood pressure: Check and monitor both systolic and diastolic values.
Pulse: Record frequency and rhythm.
Respiratory rate: Assess rate and breathing pattern.
Oxygen saturation (SpO₂): Particularly important in patients with cardiac or respiratory conditions.

Note: Physicians may prescribe specific vital sign parameters that the patient must remain within. It is crucial to monitor these values throughout the assessment.

Skin Screening (Integumentary Assessment)

Patients in acute care often present with surgical incisions, invasive catheters, or medical lines. Careful visual inspection of these areas is essential to ensure safe mobilisation.

Steps for skin screening:

Before movement:

Inspect surgical incisions and entry/exit sites for tubes and catheters.
Check for signs of infection, redness, or swelling.

After movement:

Re-inspect the same areas to detect any changes, such as leakage or increased redness.
Notify the nursing team if changes are observed.

Current Functional Level

To evaluate the patient’s current functional capacity, the following areas should be assessed:

Transfers

Supine to sitting
Sitting to standing
Standing to sitting
Sitting to supine
Toilet transfer
Bed-to-chair transfer

Important considerations:

Maintain any movement restrictions the patient is under.
During the initial assessment, patients may require significant guidance to remain within restrictions.

Gait Function

Assess the patient’s ability to ambulate.
Document whether the patient can walk independently or requires assistance.

Note: Not all patients will be able to perform all transfers or ambulation tasks. Assist as little as possible to encourage independence. Record the level of assistance provided for each transfer and ambulation.

Functional Goals

The patient’s performance during assessment provides the foundation for establishing the current functional level, which should be combined with the pre-admission level to set appropriate treatment goals.

Outcome Measures

To quantify function and track progress, the following tools may be used:

Functional tools:

Barthel Index
Elderly Mobility Scale
Rivermead Mobility Index
AM-PAC 6 Clicks Score

Mobility:

10-Metre Walk Test
Gait speed

Balance:

4-Item Dynamic Gait Index
Tinetti Balance Assessment and Gait Evaluation

Sources:

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