ICU Neurologic Patients

Question 1

Identify: Acute inflammatory demyelinating polyradiculopathy.

Answer 1

GBS

Question 2

Describe how GBS presents:

Answer 2

Bilateral, ascending paresthesia and weakness.

Question 3

Three phases of GBS:

Answer 3

Progression
Plateau
Recovery

Question 4

Two primary treatments for GBS:

Answer 4

Plasmapharesis (plasma exchange)
Intravenous immunoglobulin (IVIg)

Equally effective

Question 5

When is ICU level care needed for GBS?

Answer 5

If respiratory failure occurs

Question 6

During the progressive phase of GBS, what does PT do?

Answer 6

Mostly monitoring

Positioning and splinting (skin breakdown, loss of ROM)

Nerve glides (pain management)

Question 7

What should be avoided during the progressive phase of GBS?

Answer 7

Strength training!
Mobilizing out of bed

Question 8

During the plateau phase of GBS, what does PT do?

Answer 8

Slowly initiate AAROM and AROM

Continue stretching, positioning, and nerve glides

Progress upright tolerance slowly and monitor hemodynamic response.

Question 9

During the recovery stage of GBS, what does PT do?

Answer 9

Progress strengthening activities (low resistance, high sets, concentric exercises)

Functional activities as tolerated

Avoid NM fatigue

Monitor daily for relapse

Question 10

What are main types of brain injuries?

Answer 10

Primary and secondary

Question 11

Three outcome measures typically used to determine severity of Brain injury

Answer 11

Rancho, Glasgow, JFK

Question 12

Rancho level 1:

Answer 12

No response

Question 13

Rancho level 2:

Answer 13

Generalized response

Question 14

Rancho level 3:

Answer 14

Localized response

Question 15

Rancho level 4:

Answer 15

Confused-agitated response

Question 16

Rancho level 5:

Answer 16

Confused-inappropriate response

Question 17

Rancho level 6:

Answer 17

Confused-appropriate response

Question 18

Rancho level 7:

Answer 18

Automatic-appropriate response

Question 19

Rancho level 8:

Answer 19

Purposeful-appropriate response

Question 20

Normal intracranial pressure range:

Answer 20

4-15 mmHg

Question 21

Identify 5 positions that increase intracranial pressure:

Answer 21

Trendelenburg
Lateral neck flexion
Extreme hip flexion
Valsalva and coughing
Noxious stimulation/pain

Question 22

Identify 3 mat activities appropriate for Rancho 3:

Answer 22

• PNF
• Prone -> prone on elbows -> quadruped
• Facilitate head and trunk control

Question 23

Identify the Rancho level

• Confused and frightened
• Does not understand feelings or events
• Recognize family and friends inconsistently
• Difficulty concentrating and following directions
• Overreacts by hitting, screaming, thrashing
• Focused on basic needs
• Inappropriate

Answer 23

Rancho 4: Confused and agitated

Question 24

PT treatment focus and goal for Rancho 4:

Answer 24

• Focus: Decrease confusion and agitation
• Goal: Provide patient sense of safety

Question 25

# Identify Temporary suppression of reflexes below the level of the lesion.

Answer 25

Spinal shock

Question 26

During the 1st treatment after a spinal cord injury, what 3 things should be done?

Answer 26

* Don TED hose, ace wrapes and abdominal binder * TLSO, cervical collar * Gradually raise HOB until in seated position. Monitor HR, BP, O2 sats every 20-30 degrees.

Question 27

What timeframe is the goal to get a stroke patient to the hospital after symptom onset?

Answer 27

ASAP, but within 3 hours is the goal.

Question 28

Why is a head CT done first for a stroke patient?

Answer 28

To rule out a hemorrhage

Question 29

What are the most common sources of emboli? | 3

Answer 29

* Vascular * Cardiac * Infection

Question 30

4 cardiac pathologies that can lead to an embolus:

Answer 30

* A-fib * MI * Patent foramen ovale (PFO) * Valve incompetence

Question 31

1 example of an infection that can lead to an embolus:

Answer 31

Endocarditis

Question 32

Define Penumbra

Answer 32

Ischemic but still viable cerebral tissue

Question 33

2 parts of the stroke bed:

Answer 33

* Core (dead) * Penumbra

Question 34

3 endovascular treatments for an ischemic stroke

Answer 34

* IV thrombolytic agent * Intra-arterial fibrinolysis * Mechanical thrombectomy

Question 35

tPA and TNKase are examples of what?

Answer 35

Thrombolytics

Question 36

What is required after treatment with thrombolytic agents

Answer 36

24 hours bedrest

Question 37

Goal glucose control is __-__ mg/dl after a stroke.

Answer 37

140-180

Question 38

Is higher or lower BP preferred post-stroke?

Answer 38

Higher to perfuse penumbra. May allow up to 200 mmHg.

Question 39

3 impacts of exercise that are relevant to stroke pt implications:

Answer 39

* Increases body temperature * Decreases blood glucose * Increases BP

Question 40

2 classifications of a subarachnoid hemorrhage:

Answer 40

* Aneurysmal * Non-aneurysmal

Question 41

Define an aneurysm

Answer 41

Bulging out that occurs at a site of weakness in vessel wall.

Question 42

80% of subarachnoid hemorrhage strokes are caused by _______.

Answer 42

an aneurysm rupturing

Question 43

During acute stages of stroke how long should PT sessions be?

Answer 43

Short. 2-15 minutes is ideal

Question 44

Three locations aneurysmal subarachnoid hemorrhage typically occur:

Answer 44

* Anterior communicatin artery * Middle cerebral artery * Posterior communicating artery

Question 45

2 classic features of SAH

Answer 45

* Severe HA * Sudden onset

Question 46

3 clinical features of SAH

Answer 46

* Nausea and vomiting * Reduced consciousness * Meningism

Question 47

Two ways to definitively diagnose a SAH

Answer 47

* CT angiography * Digital subtraction angiography

Question 48

# Identify CSF obstructed by clot, leading to increased pressure on the brain

Answer 48

Hydrocephalus

Question 49

4 types of treatment for aneurysm:

Answer 49

* Coiling * Clipping * Coiling and stenting * Stenting

Question 50

5 secondary complications of aneurysmal SAH

Answer 50

* Hydrocephalus * Re-bleeding * Vasospasm * Delayed cerebral ischemia * Electrolye disturbances