Case Management Test

Paul David Hewsome, 60, comes to the office with chronic low back pain, left SI pain that radiates down his anterior thigh. Pain is 5/10. His pain is provocative when bending down and palliative when sitting on a chair with cushions. Multiple ortho and neurological findings came back positive. Paul explain that he can't carry his grandchildren due to the pain. He also added that he is diabetic and smokes a package of cigarettes a week all his life and his mother died from lung cancer.


What should be in his problem list?
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Paul David Hewsome, 60, comes to the office with chronic low back pain, left SI pain that radiates down his anterior thigh. Pain is 5/10. His pain is provocative when bending down and palliative when sitting on a chair with cushions. Multiple ortho and neurological findings came back positive. Paul explain that he can't carry his grandchildren due to the pain. He also added that he is diabetic and smokes a package of cigarettes a week all his life and his mother died from lung cancer.


What should be in his problem list?
1. Diabetes
2. Family History of Lung Cancer
3. Personal History of smoking
4. Note: An initial problem must include the symptoms your patient is presenting.
Problem list are not optional
true
Problem list must be ________________ on every encounter
updated
Problem must include active problems?
true
What must be deleted from problem list
Duplicates and inaccurate problems.
If a patient has neck stiffness, and abdominal pain. Should it be on the problem list?
true
These are example of things that should NOT BELONG on the problem list
1. Patients concerned
2. Procedures
3. Relationship Issues
4. Sore abdominal muscles after a workout example
Age, previous trauma, anatomical characteristics, degree of degeneration are examples of?
Personal factors that CANNOT be altered
Smoking, BMI, diet, use of stimulants are examples of?
Personal factors that CAN BE altered
Work ergonomics, household, child rearing, some social exposure is an example of?
Factors that are difficult to modify
Is obesity a risk factor for LBP?TrueHeavy physical work specially when spent in flexion, repetitive rotation and lifting is a risk factor for?LBPLack of exercise predisposes one to back injury while sudden increase in active levels can cause insult due to lack of core strength is correlated to be a factor for?LBPIs smoking a risk factor for LBP?TrueProlonged sitting/driving is not linked to LBPFalseThis are risk factors for neck pain1. Highly repetitive work 2. Forceful exertion 3. Prolonged static load or extreme working posture (Desk computer job)What do you want to do but can't This is an example of what?Developing functional goalsIf your patient want to be able to sit for one hour at a desk without having neck pain. Is this a good functional goal?TrueFunctional Goals should be _____________________MeasurableAll of these are items that you should know to develop Functional Goals1. Realistic for your patient 2. Can be based on their ADLS 3. Should be measurableThis is a good example of Functional GoalsPatient will be able to increase lumbar flexion by 20% in 12 weeks so he can tie his shoesPatient will begin walking 20 minutes a day at least 2 times a week to increase activity levels is an example of a good?Functional GoalsPatient is going to lose weight with treatment as the care plan terminates is a good example of?A bad functional goalWhat is the purpose for a prognosis?Predict the outcome of a disease/injurt and is used to forecast the probable results of treatment for a patient's conditionAre both symptomatic and functional measures considered part of the prognosis?trueExcellent requires how many weeks?2-4 weeksGood requires how many weeks?4-8 weeksFair requires how many weeks?8-12 weeksThe prognosis is ______________________ in the patient file along with a _________________________ statement that provides support for the patients forecast.recorded, descriptiveFull symptomatic and functional recovery expected within 2-4 weeks is an example ofexcellentSymptomatic and functional recovery expected in approximately 4-8 weeks, but the patient may experience intermittent and mild pain and some restriction of motion is an example of?goodPatient can expect to have a reduction of symptoms although some persistent pain and stiffness from injury is expected and may require ONGOING REHABILITATIONfairUnlikely to resolve is an example of?PoorPatient is exhibiting multiple, objective physical signs and significant neurological deficits you prognosis in mind should be?poorChiropractic may be contraindicative with what type of prognosis?guardedis it possible to co manage for palliative or supportive care for what type of prognosis?guardedIf a patient does not respond to care and may even decline after trial of care is an example of what type of prognosis?UnstableAcute:Symptoms began < 6 weeks agoSubacute:Symptoms began > 6 weeks ago but < 12 weeksChronic:Symptoms began > 12 weeks agoInitial trial of care for ACUTE/SUBACUTE a patient should be seen _________times per week for ____________ weeks2-3x , 2-4 weeksWe will re evaluate in _______ weeks for initial trial of care for ACUTE/SUBACUTE4If your patient has no improvement in the first cycle is appropriate to see them for...one more cycleIf 2 cycles has gone passed and your patient hasn't had improvement. What should you do?Refer or co-manageWhen a patient is seen 1-3 times per week for 2-4 weeks is an example of what type of care?Continuing CareWhat are your goals for a continuing care plan?1. encourage more active self-therapy 2. return to usual activity levels without painPatient should be seen 1-6 visits per episode or exacerbationChronic careRule of thumb is to re evaluate every ______ visits or ________ weeks12, 12Patient is encouraged to increase water intake is an example ofwellness promotionDecreasing salt and fast food is a good wellness promotiontrueICA recommends ______ time a week for _______ weeks once condition resolves in a chronic care.1,4Care plan MUST include1. Frequency 2. Duration 3. Method of adjusting 4. contraindication to adjusting 5. Need for referrals 6. PrognosisIf a patient has trouble with his neck which of the following is incorrect to list: Maximal Compression test Spurlings test Jacksons test Beckterews sitting testBeckterews sitting testIf you recommend your patient to get a extra exam done just to be safe due to an abnormal finding you found on an X-Ray by default you hand over your patient a referral/consulatation form(HC 1050) and they say "No I don't want anything else done to me I just want to get adjusted, its by body" You proceed to give them?A "Form" in which the sign to say they avoided/ denied the recommendation so you are not liablePaul David Hewsome, 60, comes to the office with chronic low back pain, left SI pain that radiates down his anterior thigh. Pain is 5/10. His pain is provocative when bending down and palliative when sitting on a chair with cushions. Multiple ortho and neurological findings came back positive. Paul explain that he can't carry his grandchildren due to the pain. He also added that he is diabetic and smokes a package of cigarettes a week all his life and his mother died from lung cancer. What could be a functional goal for this patient and what wellness promotion you tell mister Paul.Functional goal: I want the patient to be able to increase his R.O.M 40% and pain to go down to a 3/10 when flexing forward in order to pick his grandchild. Wellness promotion: Drink 64oz of water for 4 weeks consume less salt and fried food for 4 weeks as well Patient will only smoke 3 cigarets a week for 4 weeks and then 2 for 3 weeks and so forth.Saying to your patient to walk 20 min per day for 4 weeks iswellness promotionPaul David Hewsome, 60, comes to the office with chronic low back pain, left SI pain that radiates down his anterior thigh. Pain is 5/10. His pain is provocative when bending down and palliative when sitting on a chair with cushions. Multiple ortho and neurological findings came back positive. Paul explain that he can't carry his grandchildren due to the pain. He also added that he is diabetic and smokes a package of cigarettes a week all his life and his mother died from lung cancer. On Paul David Hewsome, what would you consider possibly co-manage?His diabetesPaul David Hewsome, 60, comes to the office with chronic low back pain, left SI pain that radiates down his anterior thigh. Pain is 5/10. His pain is provocative when bending down and palliative when sitting on a chair with cushions. Multiple ortho and neurological findings came back positive. Paul explain that he can't carry his grandchildren due to the pain. He also added that he is diabetic and smokes a package of cigarettes a week all his life and his mother died from lung cancer. What prognosis would you consider this case to be?PoorHistoryMust include review of and changes in previous complaints, new complaints, response to care, subjective evaluations, ADLs affected, etcExamObjective observations, outcome markers: ROM, vitals, ortho/neuro tests, key findings used to monitor prognosisAssessmentDiagnosis, status/necessity for care, any clinical correlations, etc.ManagementAdjustments made-segment, listing and technique, how long and why, goals of care and effectiveness, patient's responses to adjustments etc.PlanNext visit and why, self/home care, future plans, referrals, advice, changes, in care etc