Acute Care - Textbook CH19

Question 1

how does an acute care stay affect patients

Answer 1

physical, cognitive, and emotional functioning

Question 2

those in the ICU typically have to use what forms of medication

Answer 2

vasoactive medications
sedatives
circulatory assist devices
mechanical ventilation

Question 3

define acute cardiopulmonary conditions

Answer 3

disease states where the pt’s oxygen transport system fails to meet immediate demands placed on it

Question 4

for those with low-level functional mobility, how can an acute care stay affect them

Answer 4

loss of muscle strength and endurance is much more significant
– can be the difference between going home or nursing home

Question 5

what are the airway clearance techniques

Answer 5

postural drainage
percussion
vibration
cough techniques
manual hyperinflation
airway suctioning

Question 6

when should airway clearance be done? timing wise

Answer 6

at least 30 min after end of meal/feeding

Question 7

explain how medications relate to airway clearance interventions

Answer 7

if pt takes pain medication, should take before

inhaled bronchodilators prior

inhaled antibiotics post-treatment

Question 8

what can be used as discharge criteria for patients receiving airway clearance treatments

Answer 8

their independent ability to perform airway clearance

Question 9

if postural drainage is used exclusively, how long should the treatments be

Answer 9

5-10 min, or longer if tolerated

Question 10

what are signs of postural drainage intolerance

Answer 10

increased SOB
anxiety
nausea
dizziness
hypertension
bronchospasm

Question 11

relative contraindications of postural drainage

Answer 11

increased ICP
hemodynamic instability
esophageal anastomosis
spinal fusion/trauma
head trauma
diaphragmatic hernia
eye surgery

Question 12

relative contraindications for percussion and vibration

Answer 12

hemoptysis
untreated tension pneumothorax
low platelet count
hemodynamic instability
PE
subcutaneous emphysema
thoracic skin injury

Question 13

when is vibration preferred over percussion

Answer 13

acutely ill patients with chest wall discomfort/pain

Question 14

if retained secretions go untreated, what can occur

Answer 14

atelectasis
hypoxemia
pneumonia
respiratory failure

Question 15

what makes an effective cough

Answer 15

1 - pt position that allows for trunk extension/flexion

2 - inspiratory phase maximization via verbal cues, positioning, arm movements

3- improvement of inspiratory holds

4 - intrathoracic/intraabdominal pressure maximization with muscle contraction

5 - pt oriented to respective timing and trunk movement for expulsion

Question 16

what is the ACB

Answer 16

active cycle of breathing

series of maneuvers completed by the patient to emphasize secretion clearance and thoracic expansion

Question 17

explain what breathing control consists of during ACB

Answer 17

diaphragmatic breathing at normal tidal volume for 5-10 sec

Question 18

explain thoracic expansion exercises in ACB treatments

Answer 18

in a postural drainage position

pt performs deep inhalation with relaxed exhalation at vital capacity range

inhalation can be coupled with or without percussion on exhalation

Question 19

what is the purpose of intermittent positive pressure ventilation

Answer 19

to aid inspiration

Question 20

what does maximal insufflation-exsufflation eliminate the need for? what is the scale in which it normally ranges between

Answer 20

eliminates the need for deep airway suctioning

+35 to +65 cmH2O —— -35 to -60 cmH2O

Question 21

for those with ARDS, what is the best position for airway clearance? why?

Answer 21

prone

greater volumes of ventilation
increased PaO2

Question 22

what can be used to engage the diaphragm

Answer 22

sniffing

Question 23

what can be used to increase thoracic mobility

Answer 23

towel roll vertically down t-spine in supine to increase anterior chest wall mobility

side-lying over towel roll to increase lateral chest wall mobility

can have UE movement in each position to further expand chest wall

Question 24

what pt populations is counter-rotation effective for

Answer 24

those with impaired cognitive function

those unable to follow verbal cues

those with high muscular tone

Question 25

explain the dichotomy of an inspiratory muscle training program

Answer 25

either strength or endurance

Question 26

what value is associated with inspiratory muscle wekaness

Answer 26

max inspiratory pressure below 60 cmH2O

Question 27

explain role of incentive spirometer

Answer 27

to practice diaphragmatic breathing to prevent reverse atelectasis to stimulate a cough ****** ultimately will replenish surfactant

Question 28

explain the dosage related to incentive spirometry

Answer 28

slow, relaxed, deep breathing exercises with it 10x every hour

Question 29

what is the RASS? what is its scale?

Answer 29

richmond agitation sedation scale +4 to -3 will be taken prior to administering the confusion assessment method in the ICU (CAM-ICU)

Question 30

what is the CAM-ICU used for

Answer 30

assess patient's delirium

Question 31

Level 1 Cardiac Rehabilitation Exercise HR guidelines

Answer 31

20-30 bpm above resting -- unless taking b-blockers, then use RPE and dyspnea scale

Question 33

on a borg RPE scale, what level should warmup and cool down be at? what is the equivalent of this number?

Answer 33

9-11 with peak activity being below 13 RPE level of 12-14 = 60% of max HR RPE level of 16 = 85%

Question 34

explain duration of exercise during stage 1 cardiac rehab

Answer 34

begin with intermittent bouts of 3-5 min aim for 2:1 exercise-rest ratio

Question 35

what is end duration goal of cardiac rehab phase 1

Answer 35

duration of walking time to 30-45 minutes

Question 36

frequency of phase 1 cardiac rehabilitation

Answer 36

2-3x a day for 6-7x a week

Question 37

aerobic recommendations for those with HF -- frequency -- intensity -- duration

Answer 37

3-5x a week 60-80% of HRR / RPE 11-14 out of 20 progressively increased to 30 upto 60min

Question 38

resistance recommendations for those with HF -- frequency -- intensity -- duration -- mode

Answer 38

1-2 nonconsecutive days a week 40% 1RM for UE / 50% 1RM for LE 2 sets of 10-15 reps for every major muscle group machines = loss of strength/balance

Question 39

flexibility recommendations for those with HF -- frequency -- intensity -- duration

Answer 39

2-3x a week to point of tightness 10-30 sec hold for static, 2-4 reps each