Flashcards in 7) Early Mobilization Deck (49):
Safe HR range for exercise:
Safe RR range for exercise
Safe SpO2 range for exercise
Safe MAP range for exercise
Safe systolic BP range for exercise
Safe RPE range for exercise
When should you not have a pt exercise?
If they devo arrhythmia, angina, or complaints of fatigue
Need for mechanical ventilation for >3wks
Risk factors for PMV
*Duration of ICU delirium
Decline in physical, cognitive, or mental status that continues after ICU d/c
Long-term complications associated w/PICS:
Is there a recognized rehab protocol for PICS?
What is ICU-associated weakness
Clinically detected weakness in critically ill pt's where there's no cause other than critical illness
*Refers to bilateral, generalized, & diffuse muscle weakness
Types of ICU-AW
*Critical Illness Myopathy (CIM)
*Critical Illness Polyneuropathy (CIP)
*Critical Illness Neuromyopathy (CINM)
What needs to be addressed w/ICU-AW?
Pt's fxnl weaknesses
Which type of ICU-AW devos later & less frequently but is associated w/long ICU stays?
Clinical Features of ICU-AW
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
What are important mechanisms for ICU-AW-associated weakness & why?
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
True or false: Pt's w/ICU-AW have weakness before there's detectable muscle wasting
How much of a decrease in strength can ICU-AW pt's see in the first week?
How much of a decrease in strength can pt's w/disuse atrophy see in the first week?
What is disuse atrophy associated with?
Structural & metabolic changes of muscle:
*Net loss of muscle mass & CSMA
*Decr contractile strength
*Shift from slow twitch to fast twitch fibers
Complications associated w/ICU-AW & VIDD
*Incr time on a vent
*Muscle weakness ranging from mild to paralysis
*Adverse effects to the diaphragm
*Muscle fiber shift to type 2
*Protein loss & malnutrition
Ventilator Induced Diaphragmatic Dysfunction
What can hypoglycemia cause & why?
Decr diaphragmatic strength bc of oxidative stress & decr troponin
Risk factors for ICU-AW
*Multi Organ Failure
*Systemic Inflammatory Response Syndrome
What is prolonged mechanical ventilation associated w/?
*Incr oxidative stress
*Oxidative modifications to diaphragmatic proteins
*Upregulation of autophagic system
*Activation of proteolytic pathways
Brain dysfxn characterized by acute disturbance of consciousness w/inattention, disorganized thinking, & perceptual disturbances that fluctuate over a short period of time
Lethargy & inattention
Agitated & combative
What does delirium do to critical illness?
What percentage of vented ICU pt's get delirium?
What effect does delirium have on pt's even after d/c?
*Prolonged neurocognitive impairments
*Poor fxnl status
*Incr rate of LTC facility entry
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
What is ICU exercise prescription based on?
*Analysis of factors that contribute to impaired O2 transport
*Hierarchy of body positions
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
How many PT's will be needed for prone positioning of ICU pt's?
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
What is a safe HR range?
What is a safe RR range?
What is a safe SpO2 range?
What is a safe MAP range?
What is a safe SBP range?
What is a safe range for RPE?
When should you not have a pt do activities?
*Complaints of fatigue
If a pt devos arrhythmia, angina, or complains of fatigue, should you exercise them?