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2) Cardiopulm > 7) Early Mobilization > Flashcards

7) Early Mobilization Flashcards

(49 cards)

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1
Q

Safe HR range for exercise:

A

40-130BPM

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2
Q

Safe RR range for exercise

A

5-40 breaths/min

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3
Q

Safe SpO2 range for exercise

A

> 88%

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4
Q

Safe MAP range for exercise

A

65-110mmHg

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5
Q

Safe systolic BP range for exercise

A

<200mmHg

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6
Q

Safe RPE range for exercise

A

10-15

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7
Q

When should you not have a pt exercise?

A

If they devo arrhythmia, angina, or complaints of fatigue

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8
Q

PMV

A

Need for mechanical ventilation for >3wks

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9
Q

Risk factors for PMV

A
  • Age
  • Comorbidity
  • Illness severity
  • Sepsis
  • Duration of ICU delirium
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10
Q

Post-ICU Syndrome

A

Decline in physical, cognitive, or mental status that continues after ICU d/c

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11
Q

Long-term complications associated w/PICS:

A
  • Physical dysfxn
  • Neuromuscular dysfxn
  • Pulmonary dysfxn
  • Cognitive decline
  • Psychiatric decline
  • Decr QOL
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12
Q

Is there a recognized rehab protocol for PICS?

A

No

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13
Q

What is ICU-associated weakness

A

Clinically detected weakness in critically ill pt’s where there’s no cause other than critical illness

*Refers to bilateral, generalized, & diffuse muscle weakness

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14
Q

Types of ICU-AW

A
  • Critical Illness Myopathy (CIM)
  • Critical Illness Polyneuropathy (CIP)
  • Critical Illness Neuromyopathy (CINM)
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15
Q

What needs to be addressed w/ICU-AW?

A

Pt’s fxnl weaknesses

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16
Q

Which type of ICU-AW devos later & less frequently but is associated w/long ICU stays?

A

CIP

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17
Q

Clinical Features of ICU-AW

A

1) Weakness devo after onset of critical illness
2) Weakness involving proximal & distal muscles, limbs, & respiratory muscles
3) Spares CN’s
4) MRC score <48/60
5) Dependency on vent
6) Weakness is not related to any underlying critical illness

*Need to have 1,2, & 6, &/or 4 & 5

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18
Q

What are important mechanisms for ICU-AW-associated weakness & why?

A

Immobility & inflammation–>Shift of pro-inflammatory cytokines during critical illness leads to incr systemic infection which causes further muscle damage

*This combined w/production of reactive O2 species (ROS) w/incr anti-oxidative defenses causes further disruption between muscle synthesis & proteolysis

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19
Q

True or false: Pt’s w/ICU-AW have weakness before there’s detectable muscle wasting

A

True

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20
Q

How much of a decrease in strength can ICU-AW pt’s see in the first week?

21
Q

How much of a decrease in strength can pt’s w/disuse atrophy see in the first week?

22
Q

What is disuse atrophy associated with?

Study These Flashcards
A

Structural & metabolic changes of muscle:

  * Net loss of muscle mass &amp; CSMA
  * Decr contractile strength
  * Shift from slow twitch to fast twitch fibers
23
Q

Complications associated w/ICU-AW & VIDD

Study These Flashcards
A
  • Incr time on a vent
  • Muscle weakness ranging from mild to paralysis
  • Adverse effects to the diaphragm
  • Hypoglycemia
  • Muscle Atrophy
  • Muscle fiber shift to type 2
  • Protein loss & malnutrition
  • Anabolic resistance
24
Q

VIDD

Study These Flashcards
A

Ventilator Induced Diaphragmatic Dysfunction

25
What can hypoglycemia cause & why?
Decr diaphragmatic strength bc of oxidative stress & decr troponin
26
Risk factors for ICU-AW
* Vent >7days * Sepsis * Multi Organ Failure * Hyperglycemia * Systemic Inflammatory Response Syndrome * Corticosteroid Use * Neuromuscular blockers * Muscle immobilization
27
What is prolonged mechanical ventilation associated w/?
* Incr oxidative stress * Oxidative modifications to diaphragmatic proteins * Upregulation of autophagic system * Activation of proteolytic pathways * Muscle atrophy
28
Delirium
Brain dysfxn characterized by acute disturbance of consciousness w/inattention, disorganized thinking, & perceptual disturbances that fluctuate over a short period of time
29
Hypoactive Delirium
Lethargy & inattention
30
Hyperactive Delirium
Agitated & combative
31
Mixed Delirium
*
32
What does delirium do to critical illness?
Complicates it
33
What percentage of vented ICU pt's get delirium?
60-80%
34
What effect does delirium have on pt's even after d/c?
* Prolonged neurocognitive impairments * Poor fxnl status * Incr rate of LTC facility entry * Decr QOL
35
What positions decr dyspnea & why does this work?
Upright & leaning forward w/arms on thighs *Incr intra-abdominal pressure, which incr the curvature of the diaphragm, so it optimizes the diaphragm's MA & its ability to generate pressure
36
What is ICU exercise prescription based on?
* Analysis of factors that contribute to impaired O2 transport * Hierarchy of body positions
37
Implications for ICU exercise prescription
* Incorporate active movement w/body changes * Extremes of body positioning have great benefit * Upright mobilization incr TV, RR, flow rates, mucocilliary transport, A/W clearance, & cough effectiveness
38
How many PT's will be needed for prone positioning of ICU pt's?
Probably >1
39
Protocols for exercise in the ICU
* Bedside cycling improves MMT, 6MWT, & QOL * Incr strength=Decr vent time * Program should be 6wks * Start w/ROM progressing to positions progressing to amb * Do bed mobility progressed to transfers & standing * Do deep breathing * Tx the whole body * UBE * NMES * IMT * ECT
40
What is a safe HR range?
40-130BPM
41
What is a safe RR range?
5-40
42
What is a safe SpO2 range?
>88%
43
What is a safe MAP range?
65-110mmHg
44
What is a safe SBP range?
>200mmHg
45
What is a safe range for RPE?
10-15
46
When should you not have a pt do activities?
W/devo of: * Arrhythmia * Angina * Complaints of fatigue
47
If a pt devos arrhythmia, angina, or complains of fatigue, should you exercise them?
No
48
ICU-AW
ICU-Associated Weakness
49
What does upright mobilization incr?
* Tidal Volume * RR * Flow rate * Mucocilliary Transport * A/W Clearance * Cough Effectiveness

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