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2) Cardiopulm > 13) Early Mobes, Part 2 > Flashcards

13) Early Mobes, Part 2 Flashcards

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1
Q

Indications for ICU admission

A
  • Pt needs close monitoring
  • Unstable critical illness
  • Acute mechanical ventilation
  • IV meds
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2
Q

Types of ICU

A
  • Trauma
  • Medical
  • Surgical
  • Neuro
  • Cardiac
  • NICU
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3
Q

What values need to be monitored in the ICU?

A
  • BP
  • Cardiac fxn
  • Respiratory Rate
  • O2
  • CO2
  • Glucose
  • ICP
  • CVP
  • Temp
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4
Q

What are the 2 ways BP can be measured?

A
  • Non-invasively w/cuff

* Invasively w/A-line

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5
Q

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

A

Splinted in neutral

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6
Q

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

A

That the transducer is at the level of the R atrium

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7
Q

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

A

ROM & WB to the wrist

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8
Q

What is a swan-ganz?

A

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

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9
Q

What is a central line used for?

A

Give meds, fluids, & monitor CVP

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10
Q

How is ICP measured?

A

W/a bolt or ventriculostomy

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11
Q

Normal range for ICP

A

0-15mmHg

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12
Q

What is a ventriculostomy?

A

Drains CSF from ventricles if ICP gets too high

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13
Q

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

A
  • Drain should be clamped during mobilization
  • Be level w/laser
  • Recalibrate after session
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14
Q

What is a lumbar drain?

A

Inserted into the spinal canal to drain CSF

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15
Q

Should a lumbar drain be clamped during mobilization?

A

Yes

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16
Q

Which devices need to be clamped during mobilization?

A
  • Ventric

* Lumbar drain

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17
Q

Femoral Sheath

A

Used for cardiac caths & angiograms

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18
Q

Femoral Line

A

Inserted into an artery/vein for short-term dialysis

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19
Q

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

A

No

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20
Q

CVVHD

A

Continuous Veno-Venous Hemodialysis

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21
Q

Continuous Veno-Venous Hemodialysis

A

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

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22
Q

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

A

Yes

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23
Q

Open Abdomen Sponge

A

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

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24
Q

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

A

Not right now, but research is in the works

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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

2) Cardiopulm (16 decks)

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