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Flashcards in Acute Care PT Deck (36)
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1

What are some consequences of prolonged bed rest?

  1. fluid volume redistribution
  2. altered distribution of body weight/pressure
  3. muscular inactivity
  4. aerobic deconditioning

 

2

PTs must establish a ________ in acute care units

Culture of Mobility

3

How is the cardiovascular system affected by bed rest/immobility?

  1. HR, SV, CO affected leading to poor endurance and ability to complete ADLs
  2. reduced cardiac, vagal tone, increased plasma NE enhanced beta-adrenergic receptor sensitivity
  3. hypovolemia
  4. increased venous compliance → venous pooling
  5. Orthostatic hypotension

 

4

what are some treatments for OH?

  1. early mobilizations → specifically getting them to EOB and sitting up
  2. LE exercises to increase blood circulation
  3. compression stockings
  4. Tilt table for very prolonged immobilization or profound ANS issues (SCI)

 

5

How is the hematologic system affected by bed rest/immobility?

  1. changes in blood composition place pts at risk for DVT and PEs
    • RBC mass reduced by 5-25%
    • decreased total blood volume, RBC mass, and plasma volume 
    • elevated HCT → increased risk for DVT
  2. reduced capillarization of peripheral muscle beds

 

6

what are the components of Virchow's triad?

  1. Venous stasis
  2. hypercoagulability
  3. blood vessel damage

 

7

T/F: the length of bed rest is directly related to frequency of DVT

TRUE

there are often no clinical signs of DVT best way to screen/catch them is via doppler US, contrast venography

8

how are venous thromboembolisms treated?

  1. early ambulation, LE exercises
  2. compression stockings
  3. leg elevation
  4. Prophylactic methods
    • low-dose heparin, intermittent, pneumatic compression
  5. pharmalogically to decrease blood coagulability
    • unfractionated heparin (UFH)
    • low molecular weight heparin (LMWH)

 

9

how is the MSK system affected by bed rest/immobility?

  1. changes in soft tissue affect muscle strength and size and greatly impair functional mobility
  2. immobilization in shortened position → enhances atrophy
  3. immobilization in lengthened/stretched position → may decrease loss of muscle fiber proteins
  4. changes in muscle metabolism greatly impairs endurance
    • decreased aerobic metabolism
    • early fatigue
    • fiber atrophy reduced mitochondria content

 

 

10

what are some factors that contribute to joint contractures?

  1. denervated muscle (no opposition to antagonist)
  2. spasticity 
  3. improper bed positioning
  4. adaptive shortening (cast)
  5. disease process (scleroderma, OA, burns)

 

11

what are some treatment options for MSK dysfunction resulting from bed rest/immobility?

  1. early mobilization is key
  2. perform AROM/PROM manual stretching
  3. modalities
  4. Splinting
    • static vs dynamic
    • hinged casts
    • CPM

12

what is disuse osteoporosis?

reduced bone mass density (occurs within one week of bedrest)

hypercalciuria and negative calcium balance results from immobilization

loss of bone is the result of increased bone reabsorption

13

how is the neurologic system affected by bed rest/immobility?

  1. sensory and sleep deprivation
  2. decreased dopamine, noradrenaline, and serotonin levels
  3. depression, restlessness, insomnia
  4. decreased balance, coordination, visual acuity
  5. increased risk compression neuropathy
  6. reduced pain threshold

14

how is the integumentary system affected by bed rest/immobility?

changes in skin and prolonged immobility lead to decubitus ulcers

15

describe the pathogenesis of a pressure ulcer

  1. pressure causes ischemia (compresses capillaries and occludes blood flow)
  2. excessive pressure can lead ot tissue necrosis
  3. if pressure relieved, we can see temporary reactive hyperemia and no tissue damage
  4. if it is NON-BLANCHABLE ERYTHEMIA (Stage 1) then damage has begun

 

16

describe stages 2-4 for a decubitus ulcer

  • Stage 2 → worn down to epidermis and dermis
  • Stage 3 → worn down to the subcutaneous tissue
  • Stage 4 → worn down to muscle and bone 

 

 

17

describe the treatment for pressure ulcers

Prevention is key!!

bed-positioning with bed-bound pts (reposition high-risk pt at least every 2 hours)

wheelchair cushioning and unweighting/pressure relief exercises

18

how is the respiratory system affected by prolonged bed rest/immobility?

  1. reduced lung volumes, airflow rates, respiratory muscle strength, gas exchange
  2. supine position + prolonged bed rest = diminished vital capacity
  3. increased RR
  4. decreased FRC, FVC, and FEV1

19

prolonged bed rest increased the risk for what respiratory conditions?

  1. pneumonia
  2. atelectasis
  3. dyspnea on minimal exertion

 

20

how does prolonged bed rest/immobility impact metabolic systems?

  1. overall decreased metabolism
  2. insulin resistance
    • muscle activity essential for expression of Glut4 proteins
    • can occur after only 3 days
  3. plasma and urinary electrolyte concentrations
  4. endocrine function changes
    • decreased EPO concentration

 

21

how does prolonged bed rest/immobility impact thermoregulatory systems?

  1. threshold for cutaneous vasodilation and sweating (for heat dissipation) shifted to higher core temp
  2. exercise limited by impaired regulation of body temp
  3. increased risk for heat-related abnormalities 
    • cramping, fatigue, syncope, heat stroke

 

22

what are some psychiatric effects of prolonged bed rest/immobility?

  1. more than 50% of pts of all ages experienced mood alterations during prolonged hospitilizations
    • anxiety, agitation, delirium, depression
  2. reduced pysch functioning leads to increased morbidity and mortality
  3. intellectual and perceptual deficits result from altered sleep patterns, circadian rhythms, presence of noxious stimuli

 

23

list some acquired neuromuscular disorders 

  1. CIP (critical illness polyneuropathy)
  2. CIM (critical illness mylopathy)
  3. CIPNM (ciritical illness polyneuromyopathy)
  4. Steroid induced myopathy
  5. Rhabdomyolysis

 

24

what is CIP?

impaired neuromuscular system

  1. weakness, decreased DTRs, impaired pain, temp and vibratory sense
  2. facial weakness (CNs spared)
  3. associated w/abnormal nerve conduction studies
    • electrodiagnostic testing critical to confrim dx

 

 

25

what is CIM?

profound weakness, especially of proximal msucles

  1. DTRs may be preserved or diminished
  2. sensation intact
  3. EMG studies show preserved sensory nerve APs and an overall reduction in force generation of unhealthy muscle fibers

 

26

describe the score breakdown for the Medical Research Council Scoring System

scores range from 0-60

  • scores less than 48 ID sig weakness
  • scores less than 36 ID severe weakness that is a trigger for whether the person may have CIP or CIM

 

27

what is steroid induced mylopathy?

occurs acutely or from chronic glucocorticoid maintenance therapy

steroid induce muscle catabolism and myocyte apoptosis 

28

what is rhabdomyolysis?

muscle injury that involves myoglobinuria, electrolyte abnormalities, and acute kidney injury

injury to myocyte membrane that results in increased intracellular Ca+ concentration

elevated Ca+ causes pathologic interaction of actin and myosin = muscle destruction and fiber necrosis

 

29

what are common clinical manifestations of rhabdomyolysis?

  1. myalgia
  2. pigmenturia
  3. elevated creatine kinase (CK) levels
  4. acute renal failure
  5. muscle weakness

 

30

T/F: early mobility is safe and important to do!

TRUE

as long as the pt is hemodynamically stable and meeting some criteria set aprior

getting out of bed w/PT is safe and effective