Critical Care Flashcards
(80 cards)
1
Q
what is critical care?
A
- specialist treatment and monitoring for the severely unwell with life threatening illness of injury
2
Q
how many patients in the UK each year are in critical care?
A
- approx 100,000 patients in the UK
3
Q
what is the percentage of people who survive discharge from critical care?
A
- 75% survive for discharge
4
Q
what does critical care cover?
A
- covers multiple specialities and causes for admission
- adult and paediatric
5
Q
what are the levels of inpatient care?
A
- 0 to 3
6
Q
what is level 0 inpatient care? how are needs met?
A
- ward
- needs can be meet through normal ward care
7
Q
what is level 1 inpatient care? how are needs met?
A
- ward
- needs can be met on acute ward with additional advice and support from the ICU team
8
Q
what are level 1 inpatient care at risk of?
A
- at risk of condition deteriorating or recent relocated from higher levels of care
9
Q
what is level 2 of inpatient care? what is required?
A
- high dependency
- require more detailed observation/ including
10
Q
what support do patients in level 2 of inpatients receive?
A
- support for a single failing organ system of post- operative care and those ‘stepping down’ from higher care level
11
Q
what is level 3 of inpatient care? what is required?
A
- intensive care
- requiring respiratory support alone, or basic respiratory support together with support of at least two organ systems
12
Q
what does level 3 of inpatient care include?
A
- includes all complex patients requiring support for multi- organ failure
13
Q
what does critical care require? what does this make the process?
A
- require lots of equipment and resources
- makes the process more costly
14
Q
how much is spent on a bed in ITU for one night?
A
£1900 for a bed in ITU for a night
15
Q
what does multi organ failure require? what assessment is completed?
A
- requires a multi system approach to patient assessment, considering all vital organs and bodily systems
- A to E assessment completed
16
Q
what airway support is needed for a critically unwell patient?
A
- may need support to maintain their airway
- oral or nasal airways to help with suctioning to help patients cough
17
Q
what are two types of suctioning?
A
- tracheostomy
- endotracheal intubation (ET)
18
Q
what does tracheostomy create?
A
- creates an opening in the trachea
19
Q
how is ET connected?
A
- endotracheal intubation connected via the mouth and to the ventilator
20
Q
when would suctioning support be needed?
A
- if patient is in a coma and needs organ controlled
- if they have a stroke, pneumonia, respiratory failure, major surgery, cancer of neck ( inflammation), major burn (oedema around airway), etc
21
Q
how can breathing be supported? why is this important?
A
- patient may also need support with their breathing and ventilation
- to maintain oxygenation and gas exchange
22
Q
what may ICU patients require in relation to breathing?
A
- may require mechanical ventilation via specialist equipment
23
Q
when is ventilation used?
A
- used due to sedation, major surgery and pain
- limits the patients ability to control rate and depth of breathing
24
Q
what are the three different modes of ventilation?
A
- invasive controlled mode
- invasive spontaneous mode
- non- invasive mode
25
what are examples of invasive controlled modes of ventilation? (2)
- bilevel
- SIMV
26
what is an example of an invasive spontaneous mode of ventilation? when may this be used?
- pressure support
- used when recovering as may be able to control the rate but weak muscles can't control the depth
27
what are two examples of non- invasive ventilation?
- BiPap
- CPAP
28
how can you support circulation of critically unwell patients?
- supported to maintain adequate circulation and cardiac function to optimise perfusion of vital organs
29
what two things happen if the cardiovascular system fails? what does this lead to?
- blood pressure and cardiac output drop
- leads to organ failure
30
what monitoring of circulation may ICU patients require?
- continuous monitoring via ECG and arterial lines
31
what delivery can be required for ICU patients circulation?
- delivery of intravenous medication via central lines
32
what are the two types of intravenous medications?
- inotropes
- vasopressors
33
what are the three examples of inotropes?
- dobutamine
- adrenaline
- dopamine
34
what is an example of vasopressor?
- noradrenaline
35
what are the three reasons that critically unwell patients may have an altered conscious state? (disability)
1. induced low arousal by anaesthetic medication
2. consequence of critical illness
3. high risk of delirium
36
what does delirium present as?
- presents as fluctuating arousal and cognitive disturbances
37
what exposure support may ICU patients require? (2)
- may require kidney support with dialysis
- or nutritional/ gastrointestinal support with feeding tubes or infusions
38
what respiratory management would you do while a patient is sedated and mechanically ventilated? (4)
- assess daily
- assist with secretion clearance
- prevent area of collapse
- optimise gas exchange
39
what techniques would you use for someone with an impaired cough and secretion clearance? (3)
- airway devices
- sedation
- positive pressure ventilation
40
what musculoskeletal management would be given to a patient who is sedated and mechanically ventilated? (2)
- maintain passive limb movement
- provide with splints or positioning plans
41
what is there a risk of due to reduced active movement? (2)
- risk of joint stiffness
- risk of loss of range
42
what are the effects of ICU therapies?
- detrimental short and long term effects
43
what are two examples of ICU therapies?
- immobilisation
- sedation
44
what does ICU reduce? (4)
- physical function
- independence
- return to work
- quality of life
45
what does critical illness lead to? (3)
- PTSD
- anxiety
- depression
46
what are the 4 impairments of post intensive care syndrome?
- physical
- mental
- social
- comorbidities
47
what is intensive care acquired muscle weakness?
- clinically detected weakness in critically ill patients in whom there is no plausible aetiology other than critical illness
48
what is the long term effect of ICU- AW?
- long term weakness and impaired physical function
49
what is increased in ICU-AW?
- increased hospital length of stay
50
what is decreased due to ICU-AW?
- reduced health- related quality of life
- reduced participation
51
when is weakness developed in ICU-AW diagnosis?
- weakness developing after the onset of critical illness
52
what is the weakness described as when diagnosed with ICU-AW?
- generalised (involves proximal and distal muscles)
- symmetrical
- flaccid
- generally sparing the cranial nerves
53
what is the muscle power assessed by? what score is an indicator of ICU-AW diagnosis?
- assessed by Medical Research Council (MRC)
- score of <48 indicates ICU-AW
- or a mean score of <4 in all testable muscle groups
54
for an ICU-AW diagnosis what are patients dependent on?
- dependent on mechanical ventilation
55
what causes of weakness are excluded for an ICU-AW diagnosis?
- not related to the underlying critical illness
56
what are the 4 stages in the cycle of critical illness?
- critical illness
- inflammation
- muscle and nerve injury
- bed rest and immobility
57
what does polyneuropathy and myopathy affect? what do they lead to?
- motor and sensory axons
- lead to severe limb weakness
58
what processes are involved in polyneuropathy and myopathy? (2)
- degeneration
- necrosis
59
what does polyneuropathy and myopathy present as?
- present as flaccid and symmetric paralysis
60
what does critical illness associated weakness also affect?
- affects the respiratory muscles
61
when does diaphragm weakness occur?
- occurs within 12 hours of mechanical ventilation
62
in a ventilated patient, what percentage of diaphragm function is reduced?
- 35% of diaphragm function reduced
63
what can ICU-AW prolong?
- prolongs the duration of needing mechanical ventilation (2-7 fold)
64
what long term effects does ICU-AW cause? (2)
- long term effects on fitness and exercise capacity
65
what are the 5 impacts of prolonged bed rest ?
- loss of appetite
- lack of nutrition
- lethargic, feeling irritable
- poor sleeping
- prone to pressure ulcers, infections, DBT
66
what other condition can ICU lead to?
- leads to frailty
67
what are the 4 stages of the viscous cycle of frailty?
- malnutrition
- sarcopenia
- decreased reserve
- decreased energy expenditure
68
what three factors contribute to malnutrition?
- age
- disease
- environment
69
what does persistent critical illness lead to?
- increased hospital admission
- other health problems
70
what are the main roles of physiotherapists in ICU care? (4)
- optimise respiratory function
- prevent deconditioning and muscle wasting
- maximise function and mobility
- improve short and long term patient outcomes
71
what do the guidelines advocate regarding those admitted to critical care?
- advocate early rehabilitation for patients admitted to critical care
72
what does rehabilitation aim to do?
- aims to reduce duration of ICU therapies to prevent negative consequences
73
what does early rehabilitation optimise? (4)
- strength
- function
- independence
- engagement
74
when should you start rehabilitation for people in the ICU?
- start as early as possible
75
what considerations must be taken into account before starting rehabilitation? (4)
- patient
- environment
- worker
- social history
76
what are the two outcome measures for ICU patients?
- Manchester Mobility Scale
- Chelsea Physical Assessment Tool
77
what are the 7 steps of MMS?
1- in bed interventions
2 - sit on edge of bed
3 - hoisted to chair
4 - standing practice
5 - step transfers with assistance
6 - mobilising with/ without assistance
7 - mobilising > 30m
78
what are the 9 steps of CPAx?
- respiratory function
- cough
- moving within the bed
- supine to sitting on the edge of the bed
- dynamic sitting
- standing balance
- sit to stand
- transferring bed to chair
- stepping
- grip strength
79
how is each aspect measured on the CPAx?
- measured on a scale of 0 to 5
80
who provides early rehabilitation? (9)
- medical team
- nursing staff
- physio
- pharmacist
- dietician
- speech and language therapist
- occupational therapist
- psychologist
- family
