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Use the Scenario to Answer Questions 40-46 A  80-year-old patient with a history of osteoarthritis in bilateral hips, knees, and shoulders is referred to outpatient physical therapy in a hospital based outpatient setting. They have had total joint arthroplasties for both hips and the right knee. Patient was diagnosed with a torn rotator cuff in the left shoulder 3 years ago and opted not to have it surgically repaired. Currently complains of severe osteoarthritic pain and limited motion in the right shoulder. PMHx includes hypertension which is managed with low dose diuretics and a beta blocker, adn tramadol for osteoarthritis pain. Six weeks ago the right hip prosthesis was replaced. Patient lives alone in a two-story home and has adapted it so that there is  a bedroom on the first floor and only has to negotiate stairs to do laundry in the basement and to enter and exit the home. There is a railing on the basement stairs and on the stairs entering the home from the garage.  Patient reports prior to the joint replacements, several incidences of falls when getting out of bed due to orthostatic hypotension, which had increased once the patient started taking a beta blocker for hypertension. An increase in orthostatic hypotension in this instance is due to which of the following drugs properties?

Use this scenario for questions 35-39 The physical therapist has received an order to evaluate and treat a 76-year-old patient (Patient A)  who lives in local shelters or on the streets. They believe they last saw a doctor over 20 years ago. The patient was admitted to the hospital in a coma with a blood glucose measure of 423 and diagnosed with diabetes type 2. They are referred to physical therapy for gait and transfer training. Nursing reports that they have been moderate assist for all gait and transfers. The patient also has an open wound on the bottom of the right foot. The wound bed is pale and the skin surrounding it is shiny and tight with no hair growth.  Current medications include:  Lopressor (Metoprolol), Metformin, Insulin, and Cephalexin. The team decides that the patient requires additional therapy in a skilled nursing facility. Based on the patient’s situation, which of the following statements BEST supports the reimbursement process?

In reference to walking speed and as noted in the research, what is the BEST goal that would demonstrate the minimal amount needed for a small but meaningful improvement in a patient who was demonstrating a walking speed of 0.7 m/s?

 If a physical therapist reports a vulnerable adult situation in good faith but the allegations are later found to be unsubstantiated, what legal protection does the PT have?

An 82 year old patient reports difficulty rising from a chair and reduced walking speed. Which physiologic change BEST explains their increased risk for loss of independence?

The physical therapist is treating a patient with Alzheimer’s disease who is status post ORIF following a hip fracture.  The patient has a difficult time communicating verbally, she prefers to gesture and is easily confused especially in new environments.  Which of the following outcome measures should the PT utilize to assess pain?

A 77-year old patient has been transferred to a local skilled nursing facility from the hospital. The patient is 2 weeks post ORIF ( was in the hospital for 2 weeks) and is WBAT with a front wheeled walker (FWW provided by the SNF). The physical therapist has been asked to evaluate and treat this patient. The goal is for the patient is to be discharged  back to the assistive living facility. The patient has Medicare insurance. The patient’s Patient Driven Payment Model (PDPM) Reimbursement rate is determined to be X. Which of the following factors are utilized in determining the Physical Therapy PDPM  

Steps in behavior modification include …

Attentive listening includes …

The ability to reflect on or evaluate one’s own behavior or actions is called