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A 78-year-old male was admitted to the hospital 2 days ago with complaints of right hip pain after falling in his home. Notable previous medical history includes coronary artery disease, glaucoma, and moderate hearing loss. He was diagnosed with a right intertrochanteric femur fracture and underwent an open reduction internal fixation (ORIF) of the fracture without surgical complications. Relevant new inpatient medications include Percocet, Lovenox, Colace, and Benadryl. You are asked to evaluate and treat the patient on postoperative day (POD) 1. Based on a review of his medical chart, you note that the patient has several risk factors for delirium. The patient is expected to be discharged to a skilled nursing facility for continued physical rehabilitation in the next few days. The patient is a retired accountant who lives alone in a single-story home. He ambulates independently within his community and has no history of previous falls.

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What examination signs may be associated with the diagnosis of delirium?

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What are the most appropriate examination tests?

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What are possible complications interfering with physical therapy?

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What is his rehabilitation prognosis?

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What are the most appropriate physical therapy interventions?

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What precautions should be taken during physical therapy examination and interventions?

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  • PRECIPITATING FACTOR: Temporal event that increases the risk for developing a particular disease or disorder
  • PREDISPOSING FACTOR: Intrinsic characteristic of an individual that increases his/her vulnerability of developing a particular disease or disorder
  • PSYCHOMOTOR AGITATION: Excessive and purposeless mental and motor activity
  • PSYCHOMOTOR RETARDATION: Generalized slowing of mental and motor activity

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  1. List predisposing and precipitating factors for delirium in the acute care setting.

  2. Recognize signs and symptoms of hyperactive, hypoactive, and mixed subtypes of delirium.

  3. Identify a reliable and valid clinical tool that can be used to screen for delirium in the acute care setting.

  4. Describe preventative clinical interventions for acute care patients at risk for developing delirium.

  5. Discuss interventions that should be included in the physical therapy plan of care for patients with delirium in the acute care setting.

  6. Recognize the potential effects of adverse drug reactions (ADRs) that may affect physical therapy management of patients with delirium.

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PT considerations during management of the individual with delirium:

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  • General physical therapy plan of care/goals: Prevent or minimize loss of range of motion, strength, and aerobic functional capacity; maximize functional independence; reduce risk of falls and movement-related injuries
  • Physical therapy interventions: Patient and caregiver training regarding reorientation techniques and cognitive stimulation; caregiver training for safe guarding during mobility; seating and positioning interventions to reduce the use of physical and chemical restraints; communication and coordination of care with multidisciplinary team to decrease severity and duration of delirium
  • Precautions during physical therapy: Monitor for physical and emotional distress; close physical supervision ...

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