ICU Assessment Pt. 2

Question 1

Why do we care about electrolyte levels in patients

Answer 1

• Kidney function
• Cardiac function
• Nerve conduction
• Neurological status

Question 2

Role of Potassium

Answer 2

Maintains membrane polarization (intracellular excitation) of muscle and nerve cells

Question 3

Low Potassium =

High potassium =

Answer 3

Low: Decreased excitation in cells - depressed cardiac activity, arrhythmias, weakness including resp muscles, decreased sensation/vomiting/nausea, fatigue

High: INcrease excitation in cells - cardiac arrhythmias/arrest, diarrhea and vomiting, confusion

Question 4

What does sodium do

Answer 4

Controls extracellular excitation and is sensitive to fluid shift. It regulate blood volume, osmotic equilibrium and pH

Question 5

Low Sodium =

High sodium =

Answer 5

Low: Confusion, headaches, seizures, decreased blood volume/BP, swelling, pulmonary and pleural effusion, nausea and vomiting

High: Thirst, fatigue, headaches, confusion, muscle spasm and weakness, seizures and coma, thickening of secretions, tachycardia

Question 6

Role of magnesium

Answer 6

Plays role in over 300 metabolic reactions in your body. One of its most important functions = muscle relaxation

Question 7

High magnesium =

low magnesium =

Answer 7

High: Muscles are too relaxed, therefore low BP/HR, abnormal heart rhythms and asystole, muscle weakness, impaired breathing and respirations

low: Muscles are too excited therefore abnormal heart rhythms and tachycardia, muscle cramps, hyperactive reflexes, tremors, overall weakness

Question 8

Role of calcium

Answer 8

An essential mineral nutrient present in every cell type. It causes neuronal stabilization and controls excitation

Question 9

High calcium:

Low calcium:

Answer 9

High: decrease in neuromuscular excitability - resulting in headaches/stomach aches/muscle weakness/constipation/confusion

Low: increase in neuromuscular excitability

• CNS: paresthesia/seizures
• CVS: arrhythmias, arrest
• MSK: Muscle spasms and twitching
• Resp: Stridor, bronchospasm
• GI: Diarrhea due to smooth muscle excitation

Question 10

What is urea

Answer 10

Waste from protein consumption. Depends on adequate liver and kidney function to excrete

Question 11

Increased Urea =

Decreased Urea =

Answer 11

inc: Renal failure or hypovolemia

Dec: Malnutrition, liver failure, overhydration

Question 12

What is creatine

Answer 12

Waste from muscle use in your body. it’s levels are an indicator of kidney function

Question 13

Inc. creatine =

Dec. Creatine =

Answer 13

inc: Renal failure, muscle injury

Dec: Malnutrition, chronic loss of muscle bulk

Question 14

Why do PTs care about renal failure

Answer 14

Has effects on the resp system and MSK function

• Fluid overload leads to PE and peripheral swelling (difficult to move)
• Electrolyte imbalance: acute = acidosis, which affects diaphragm contractility. Chronic = muscle weakness and myopathy

Question 15

What is normal urine output? What is indicative of renal failure

Answer 15

1ml/kg/hour

<1/2 ml/kg/hour

Question 16

Precautions after dialysis

Answer 16

• Low BP: If fluids removed too quickly
• Nausea: Do to changes in BP
• Cramps: rapid removal of fluid during dialysis may cause muscle cramps
• headaches: Due to changes in fluid and waste levels
• Fatigue: after and before

Question 17

3 types of nutrition tubes

Answer 17

PEG
G-Tube
NG tube

Question 18

Purpose of nutrition tubes

Answer 18

• Provide nutrition for Pts that can’t swallow
• Relieve abdominal bloating
• Drain GI secretion

Question 19

Precautions with Nutrition tubes

Answer 19

• ensure feed are off 20 mins before hand on chest treatment commences. If bolus feeding try and treat pre their feeding
• Every time we turn off feeds we affect patients nutrition and blood sugar levels
• Modify your hand placement for assisted cough maneuver
• Watch you dont pull, kink, or put too much pressure on the tube when mobilising and positioning

Question 20

Nutrition tube concerns

Answer 20

• Aspiration
• infection/septicemia
• Tube dislodgement
• bowel perforation

Question 21

What is total parenteral nutrition? what are the 2 components of it

Answer 21

• Infusion of nutritional substances directly into the bloodstream, usually through a peripheral vein or central line
• most often 2 nutritional bags, one a mixture of essential and non-essential amino acids, the other a solution of fats and lipids

Question 22

What conditions may use total parenteral nutrition

Answer 22

• Inadequate absorption from intestines
• gastrointestinal fistula
• bowel obstruction
• Prolonged bowel rest needed

Question 23

What is a good outcome measure in ICU? Scoring?

Answer 23

Chelsea Critical care physical assessment tool

Closer to the middle worst off you are

Question 24

10 aspects on the Chelsea Critical Care Physical Assessment Tool

Answer 24

• Respiratory function
• Cough
• moving within the bed
• Supine to sitting on EOB
• Dynamic sitting
• Standing balance
• Sit to stand
• Transferring from bed to chair
• Stepping
• Grip strength

Question 25

Concerns with rectal tube

Answer 25

• The balloon can cause rectal damage - so pressures are checked regularly and it may limit at patients ability to sit for <30 mins
• if movement is causing leaking this may also limit mobility if the tube is in to prevent wound contamination

Question 26

What may be causing weakness?

Answer 26

Muscle:

• Medications
• Undiagnosed neuromuscular disease
• SCI
• Critical illness polyneuropathy
• Loss of muscle bulk
• Electrolyte imbalance
• Systemic illness/sepsis