Bed, Rest, Deconditioning & Hospital Acquired Weakness: pt. 2

Question 1

what is CIP

Answer 1

• critical illness polyneuropathy
• ICU neuropathy
• caused by prolonged ventilator dependence

Question 2

what do u see with critical illness polyneuropathy

Answer 2

impaired neuromuscular system 
weakness
decreased DTRs
impaired pain
temp/vibratory sense
facial weakness
CNs spared
abnormal conduction studies

Question 3

if CIP is present what should it raise a concern for

Answer 3

acute inflammatory demyelinating polyneurpoathy or traumatic neuropathies

Question 4

what is critical illness myopathy (CIM)

Answer 4

profound weakness - proximal muscles
DTRs may be preserved or diminished
sensation in tact
overall reduction in force generation of unhealthy muscle fibers

Question 5

CIPNM strength of muscle groups: what strength grade is shoulder abduction

Answer 5

5 = normal muscle strength/power

Question 6

CIPNM strength of muscle groups: what strength grade is elbow flexion

Answer 6

4 = active movement against gravity with resistance

Question 7

CIPNM strength of muscle groups: what strength grade is wrist extension

Answer 7

3 = active movement against gravity

Question 8

CIPNM strength of muscle groups: what strength grade is hip flexion

Answer 8

2 = active movement with gravity eliminated

Question 9

CIPNM strength of muscle groups: what strength grade is knee extension

Answer 9

1 = flicker/trace muscle contraction

Question 10

CIPNM strength of muscle groups: what strength grade is ankle dorsiflexion

Answer 10

0 = no active muscle contraction

Question 11

steroid induced myopathy occurs how

Answer 11

• acutely or from chronic glucocorticoid maintenance therapy
• steroids induce muscle catabolism and myocyte apoptosis –> atrophy of type 2 muscle fibers

Question 12

which muscles are most affected with steroid induced myopathy

Answer 12

proximal muscles

Question 13

who is at an increased risk with steroid induced myopathy

Answer 13

elderly
inactive
those with cancer
nutritional depletion

Question 14

what worsens steroid induced myopathy

Answer 14

fasting and inactivity

Question 15

can weakness improve with steroid induced myopathy

Answer 15

yes, when steroids are reduced but full recovery takes a long time

Question 16

what is rhabdomyolysis and what does it involve

Answer 16

• muscle injury that involved myoglobinuria, electrolyte abnormalities and acute kidney injury
• injury to myocyte membrane that results in increased intracellular Ca+ concentrations

Question 17

what is increased when you have rhabdo and what occurs do to that elevation

Answer 17

• elevated intracellular Ca+

- causes pathologic interaction of actin and myosin = muscle destruction and fiber necrosis

Question 18

what is rhabdo associated with in the hospital

Answer 18

muscle compression

static positioning

Question 19

what are common manifestations for rhabdo

Answer 19

myalgia
pimenturia 
elevated CK
acute renal failure
muscle weakness

Question 20

if u have ICU-acquired weakness, what can the PT do

Answer 20

• begin activities upon achieving medical stability to allow for increased vascular and oxygen demands of PT eval and treatment

Question 21

what pulmonary measures would indicate a pt not ready for PT interventions:
SaO2: 
RR:
PEEP:
FIO2:

Answer 21

• <88% or pt experiences a 10% oxygen desaturation below resting
• > 35 breaths/min
• > 10 cm H2O
• greater than or equal to 0.6

Question 22

what lab values would indicate a pt not ready for PT interventions: 
HCT:
HGB:
platelets:
platelets anticoag INR:

Answer 22

• <25% no exercise
• <8 g/dl no exercise
• <20,000 no exercise
• > 2.4-3.0 discuss with MD

Question 23

what CV measures would indicate a pt not ready for PT interventions:
MAP:
resting HR:
systolic:

Answer 23

• <65 or >120; OR greater than or equal to 10 lower than normal systolic or diastolic pressure for pt receiving renal dialysis
• <50 or >140
• <90 or >200
• new arrhythmia developed
• new onset angina-type chest pain

Question 24

what metabolic measures would indicate a pt not ready for PT interventions:
glucose:

Answer 24

• <70 or >200

Question 25

what is response dependent management

Answer 25

delivery of O2 must equate to the consumption of O2 by the body

Question 26

what are the important respiratory/cardiac values for proceeding with interventions

Answer 26

FIO2
PEEP
MAP

Question 27

PEEP

Answer 27

positive end expiratory pressure
pressure required to prevent alveolar collapse at end of expiration
range from 0-24 cm H2O

Question 28

MAP

Answer 28

mean arterial pressure

measures amount of pressure required to maintain tissue perfusion

Question 29

the ability to maintain hemodynamic stability determines what for PT

Answer 29

ability to treat and degree of pt interaction

Question 30

what is the grip strength measure for men and women that would indicate ICU acquired weakness

Answer 30

men: < 11 kg
women: < 7 kg

Question 31

what do u measure to determine ICU acquired weakness in pts

Answer 31

strength
DTRs
respiratory status
sensory status

Question 32

what outcome measures are useful for early mobility

Answer 32

FIM
PFIT
FSS-ICU
ACIF
AM-PAC 6 CLICKS

Question 33

what activities do we measure for post acute care status

Answer 33

turning over in bed
supine to sit
bed to chair
sit to stand
walk in room
3-5 steps w rail