13) Early Mobes, Part 2 Flashcards Preview

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Flashcards in 13) Early Mobes, Part 2 Deck (71):
1

Indications for ICU admission

*Pt needs close monitoring
*Unstable critical illness
*Acute mechanical ventilation
*IV meds

2

Types of ICU

*Trauma
*Medical
*Surgical
*Neuro
*Cardiac
*NICU

3

What values need to be monitored in the ICU?

*BP
*Cardiac fxn
*Respiratory Rate
*O2
*CO2
*Glucose
*ICP
*CVP
*Temp

4

What are the 2 ways BP can be measured?

*Non-invasively w/cuff

*Invasively w/A-line

5

If a pt has an A-line, how should the wrist be positioned?

Splinted in neutral

6

If a pt has an A-line, what do you need to make sure of?

That the transducer is at the level of the R atrium

7

If a pt has an A-line, what should be avoided?

ROM & WB to the wrist

8

What is a swan-ganz?

Goes into the neck for R heart, PAP, & PAWP monitoring

9

What is a central line used for?

Give meds, fluids, & monitor CVP

10

How is ICP measured?

W/a bolt or ventriculostomy

11

Normal range for ICP

0-15mmHg

12

What is a ventriculostomy?

Drains CSF from ventricles if ICP gets too high

13

What needs to be done w/a ventric during mobilization?

*Drain should be clamped during mobilization
*Be level w/laser
*Recalibrate after session

14

What is a lumbar drain?

Inserted into the spinal canal to drain CSF

15

Should a lumbar drain be clamped during mobilization?

Yes

16

Which devices need to be clamped during mobilization?

*Ventric
*Lumbar drain

17

Femoral Sheath

Used for cardiac caths & angiograms

18

Femoral Line

Inserted into an artery/vein for short-term dialysis

19

If a pt has a femoral sheath, can you do PT w/them?

No

20

CVVHD

Continuous Veno-Venous Hemodialysis

21

Continuous Veno-Venous Hemodialysis

For critically ill pt's w/CRF who need constant dialysis

22

If a pt is on CVVHD is it safe to mobilize them?

Yes

23

Open Abdomen Sponge

Used to cover pt's who need to have their abdomens open for compartment syndrome, GSW, etc

24

Is it safe to mobilize a pt w/an open abdomen sponge?

Not right now, but research is in the works

25

ECMO

Extracorporeal Membrane Oxygenation

26

What is ECMO?

Pt's blood is re-O2'ed outside of the body

27

Where is ECMO access through?

*Venoarterial or Veno-venous, through the femoral or jugular

28

Chest Tube

Inserted into pleural space to drain fluid/blood to prevent atelectasis

29

Mobilizations implications for pt on a chest tube

*If on suction, can only move as far as tube allows

*If pt is on H20-seal, take chamber w/you

*Don't knock the drain chamber over

30

ET Tube

Goes into the trachea through the mouth for short-term ventilation

31

If a pt is on an ET tube, is it safe to mobilize them?

Yes, just don't pull on the tube

32

Tracheostomy

Artificial A/W into the neck to the trachea for longterm A/W support

33

Can you mobilize a pt w/a tracheostomy?

Yes, just be careful bc the tubing can pull apart

34

CPAP

High flow (+) pressure for weaning pt's from ET tube; Can also be used for sleep apnea

35

Non-Rebreather Mask

Used to wean pt's from trach; Gives 75-100% O2

36

If a pt has a non-breather mask, is it ok to take it off?

No

37

Venti-Mask

Gives 75-25% O2

38

Nasal Cannula

Lowest amount of supplemental O2

39

T Piece

Attached to trach to allow for higher flow of O2 & suctioning

40

Trach Collar

Plastic collar that sits over trach site

41

PRVC (CMV)

Pressure-Regulated Volume Control

42

What is the PRVC setting?

Pt can initiate breath, but vent is doing all the work

43

True or false: A ventilator on the PRVC setting adjusts to the pt's lung compliance.

True

44

SIMV

Synchronized Intermittent Mandatory Ventilation

45

What is the SIMV setting?

Weaning mode that allows for spontaneous breathing

46

What is the pressure support/CPAP setting?

Pt is doing most of the work but vent helps a little by providing a small amount of pressure during inspiration

47

PEEP

Positive Expiratory End Pressure

48

What is PEEP?

Pressure that keeps alveoli open to maintain lung vol bc incr SA=incr gas exchange

49

What does a higher PEEP mean?

The vent is working harder

50

Normal range for PEEP

5-8cmO2

51

What is FiO2?

Amount of O2 in gas exchange

52

FiO2

Fraction of Inspired O2

53

How much can skeletal muscle strength decr by per day of bed rest?

1-1.5%

54

What makes a pt qualify for early mobes?

*Ability to minimally participate in therapy session
*Hemodynamically stable
*Acceptable O2 stats

55

When determining appropriateness for PT, what needs to be considered?

*Chart review
*Imaging
*Pharmacology
*Goals

56

How often should appropriateness for PT be decided?

Every session

57

True or False: There's no early mobe PROM guidelines

True

58

Why are there no guidelines for early mobe PROM?

Bc its not that beneficial

59

General/Relative Contraindications for Early Mobes

*Unstable Fx
*Cerebral edema w/uncontrollable ICP
*Active bleeding
*Hemodynamic instability requiring high does pressors
*O2 dysfxn requiring significant supplemental O2 &/or paralytic drugs
*Transvenous temporary pacemaker
*Open chest/abdomen
*Femoral sheath
*Recent MI
*High inotrope
*LOC
*Fatigue
*Pain
*Abn face color
*Presence of lines that prevent mobility

60

Safe HR range for early mobes

40-130BPM

61

Safe RR range for early mobes

5-40

62

Safe MAP range for early mobes

60-110mmHg

63

Safe O2-sats range for early mobes

<90%

64

Safe FiO2 range for early mobes

>.6

65

Safe RASS range for early mobes

(-4)-(+3)

66

What needs to be eval before doing early mobes?

*ROM
*MMT
*Bed mobility
*Balance
*Transfers
*Amb
*Arousal
*Tone/spasticity
*Motor control/apraxia
*Ability to follow commands
*Ability to participate in PT session
*Attention/distractibility
*Safety awareness/distractibility

67

What should be included in early mobes?

*Sitting balance
*Transfers
*Gait/Pre-gait training
*TherEx
*Breathing exercises
*Specialized equipment

*KEEP IT FXNL!

68

How often can you do NMES on a sedated pt?

2x/day

69

How long should cycle ergometry be done for?

20min/day

70

Why is cycle ergometry good to do?

Can improve 6MWT, SF36, & quad strength

71

How often should outcome measures be performed?

Weekly