Common Pathologies in ICU

Question 1

What is shock?

Answer 1

decrease in tissue perfusion leading to cell death
types:
-hypovolemic (blood loss)
-cardiogenic (heart damage)
-distributed (hypotension and general tissue hypoxia)
-Obstructive (of great vessels of the heart)

Question 2

What is sepsis?

Answer 2

presence of known or suspected infection
systemic inflammatory response syndrome (SIRS) leading to septic shock (widespread vasodilation and vascular permeability)

Question 3

SIRS is Dx when 2 or more of the following are present

Answer 3

1. HR > 90

2. Temp > 38 or 20 or PaCo2 12000 or <4000

Question 4

what are some non-infectious causes of SIRS?

Answer 4

• Trauma, burns, hemorrhage, ischemia
• Pancreatitis
• PE
• Complicated aortic aneurysm
• Cardiac tamponade – compression of the heart when blood or
fluid builds up between the heart mm and outer covering sac
• Anaphylaxis
• Drug overdose

Question 5

what is ARDS?

Answer 5

• Damage to lung tissue creating a stiff lung
• pulmonary artery constriction and bronchoconstriction
• diffuse inflammation
• interstitial edema compresses airways and alveoli

Question 6

what is PT management for ARDS?

Answer 6

• Improve V/Q mismatch by positioning - prone

- intubation and protective ventilation

Question 7

what are CRITICAL ILLNESS POLYNEUROPATHY AND CRITICAL ILLNESS
MYOPATHY?

Answer 7

• widespread muscle weakness and neurological dysfunction
• denervation atrophy of limb and resp muscles

-progression is distal to proximal

Question 8

PT management for polyneuropathy and myopathy?

Answer 8

positioning and ROM

Question 9

what is ventilator associated pneumonia?

Answer 9

hospital acquired if on ventilator for more than 48 hours

Question 10

what is PT management for VAP?

Answer 10

HOB >30
hand washing
postural changes
chest PT if secretions present (including suctioning)

Question 11

what conditions require organ transplants?

Answer 11

some form of progressive end stage disease

• Lung: COPD (emphysema), CF, idiopathic pulmonary fibrosis
• Cardiac: CAD leading to cardiomyopathy

Question 12

what are some transplant complications?

Answer 12

1. Rejection (hyperacute, acute and chronic)
2. Immunosuppression
3. Infection
4. Graft failure
5. Heart (denervated heart, arrythmias (more sensitive to electrolyte imbalances), cardiac dysfunction)

Question 13

what are some side effects of immunosupression?

Answer 13

 Infection
 Muscle tremors
 Muscle weakness
 Peripheral neuropathy
 GI symptoms
 Osteoporosis
 Increased incidence of CAD
 Hypertension
 Nephrotoxicity

Question 14

what are the S&S of a denervated heart?

Answer 14

• higher RHR: 90-100bpm
• lack of sympathetic and parasympathetic control : circulating adrenaline/hormones now controls heart –>changes in HR are slow
• lack of sensation decreases pain in the heart (no Angina sx)
• no spontaneous stimulated cough (lung can also be denervated)

Question 15

what is PT management for transplants?

Answer 15

general: chest PT, mobility, rehab
lung: exercise testing, strength endurance and resp status
post-transplant: secretion removal