Introduction to the ICU Flashcards
1
Q
t/f: there can be profound weakness and delirium w/o early mobility
A
true
2
Q
t/f: it is now realized that early mobility in the ICU improves outcomes, decreased complications, and improves QoL after the ICU
A
true
3
Q
what three body systems are we monitoring in the ICU?
A
cardiac system
pulmonary system
neurologic system
4
Q
what do we monitor in the cardiac system in the ICU?
A
electrical activity of the heart
BP
right arterial pressure (RAP)
left arterial pressure (LAP)
central venous pressure (CVP)
5
Q
how is electrical activity of the heart monitored in the ICU?
A
electrocardiogram (ECG)
6
Q
how is BP monitored in the ICU?
A
automated cuff (noninvasive)
arterial line (invasive)
7
Q
what pressures can be monitored with a central venous catheter (CVC)?
A
central venous pressure (CVP)
R arterial pressure (RAP)
8
Q
what pressures can be monitored with a pulmonary artery catheter (PAC)?
A
central venous pressure (CVP)
R arterial pressure (RAP)
L arterial pressure (LAP)
9
Q
can L arterial pressure (LAP) be measured directly?
A
no, it is measured indirectly
10
Q
what is the only way LAP can be measured?
A
with a pulmonary artery catheter (PAC)
11
Q
what is an arterial line?
A
a catheter going directly into an artery
12
Q
what are the insertion sites for arterial lines?
A
radial artery
femoral artery
sometimes other sites when the radial and femoral are poor quality
13
Q
what is the most common insertion site for arterial lines?
A
radial artery
14
Q
what are the uses for arterial lines?
A
continuous BP monitoring
frequent ABGs
frequent clinical lab tests
drug administration
15
Q
where does the pressure transducer have to be kept with arterial lines?
A
in line with the RA (4th intercostal space and mid axillary line)
16
Q
is elevation in arterial pressure associated with systole or diastole?
A
systole
17
Q
t/f: peaks and troughs with an a-line should be correlated to EKG trace
A
true
18
Q
if the peaks of an a line trace look depressed, what may be going on?
A
you may not be getting an accurate reading and you should look at the placement of the transducer
19
Q
if the transducer of an a line is too high, would the BP read higher or lower than normal?
A
lower BP
20
Q
if the transducer of an a line is too low, would the BP read higher or lower than normal?
A
higher BP
21
Q
t/f: we should avoid WB on the arm with the a line
A
true
22
Q
can we mobilize someone with a femoral a line?
A
yes, but we need to take additional steps to ensure pt safety
23
Q
if an a line is dislodged, what should we do?
A
elevate the limb and apply pressure to stop the bleeding bc it is a high pressure system
24
Q
what does central venous pressure measure?
A
BP in the proximal vena cava close to the RA
25
what is normal CVP (central venous pressure)?
8-12 mmHg
26
why is the CVP pressure low?
bc it measures the low pressure side of the system (venous)
27
what does elevated CVP mean?
there is backflow from the R side
28
what things can cause elevated CVP?
fluid overload
R ventricular failure
tricuspid insufficiency
chronic L ventricular failure
29
what things can cause low CVP?
hypovolemia
dehydration
30
what are the insertion sites for a central venous catheter (CVC)?
jugular vein
subclavian vein
femoral vein
31
what are the most common insertion sites for CVC?
jugular vein
subclavian vein
32
where does the tip of the catheter go with a CVC?
proximal vena cava close to the entrance of the RA
33
what are the uses of the CVC?
continuous CVP monitoring
continuous RAP monitoring (indirect)
medication administration
blood sampling
34
does a CVC give us a direct or indirect measurement of RAP?
indirect
35
what are the clinical implications of a CVC?
bc there is a risk of a pneumothorax, the pt must have a chest x-ray after placement to confirm placement and rule out a pneumothorax b4 they can be mobilized
36
what is another name for a pulmonary artery catheter (PAC)?
Swan-Ganz catheter
37
what are the insertion sites for a PAC?
internal jugular vein
femoral vein
38
where does the catheter tip end up in a PAC?
in the pulmonary artery just distal to the pulmonary valve
39
what is the pathway of a PAC?
vena cava-->RA-->tricuspid--> pulmonary valve-->pulmonary artery
40
what are the uses for a PAC?
continuous CVP monitoring
direct RAP monitoring
direct PAP monitoring
indirect LAP monitoring via PCWP
cardiac output measurement
temporary pacing of myocardium
41
does a PAC or CVC directly measure RAP?
PAC
42
what is the normal range for PCWP?
4-15 mmHg
43
what is PCWP (pulmonary capillary wedge pressure)?
indirect measure of pressure w/in the LV
44
after the catheter for PCWP passes through the pulmonary valve, there is a pressure monitor then a balloon and another pressure monitor, what is the purpose of this?
nursing can inflate the balloon to cut off pressure of that branch of the pulmonary artery to measure the difference bw the R and L side of the heart to calculate L sided pressure for an indication of L sided fxn
45
what are the uses of PCWP cath?
assess LV fxn
assess mitral and aortic valve dysfxn
assess pulmonary edema
assess pulmonary HTN
assess hypovolemic state
46
what are the clinical implications of a PAC?
pts can be mobilized with special training and protocol
PAC needs to be thoroughly secured
the transducer needs to be mid-axillary level
use the waveforms to assess accuracy of the valves
47
where do we have to keep the transducer of a PAC?
at mid-axillary level
48
why does a PAC need to be thoroughly secured?
bc if it is dislodged it could cause malignant arrhythmia, rupture of the pulmonary artery, tear of the pulmonary valve, or introduce significant risk for infection
49
what do we need to monitor with the pulmonary system in the ICU?
oxygenation
CO2 output
50
how do we measure oxygenation in the ICU?
pulse ox
51
how do we measure CO2 output in the ICU?
capnography
52
what is capnography?
measure of the end tidal CO2
53
what information does capnography give us?
info about the efficacy of gas exchange
54
how is capnography measured?
with a specialized nasal canula w/ a reservoir that measures expired CO2
55
is a side stream with capnography for ventilated or non-ventilated pts?
non-ventilated pts
56
is a mainstream with capnography for ventilated or non-ventilated pts?
ventilated pts
57
what are the normal values for CO2 expired with capnography?
35-45 mmHg
58
does the waveform in capnography rise or fall with expiration?
rises
59
does the waveform in capnography rise or fall with inspiration?
fall
60
why is phase one of the capnography waveform flat?
bc it is in dead space of the respiratory system (ie trachea) where there is very little CO2 and gas exchange
61
what is the purpose of capnography?
early detection of respiratory failure
62
if there is an increase in CO2 expired with capnography, are there higher or lower peaks? what does this mean?
higher peaks, greater risk for respiratory failure
63
what things are we monitoring in the neurologic system in the ICU?
ICP
CPP
64
what is the normal range for ICP (intracranial pressure)?
<10 mmHg
65
why does an elevation in ICP cause further damage to the brain?
bc it compresses brain tissue and reduces cerebral blood flow
66
when would we want to monitor ICP in the ICU without a brain injury?
if a pt is mechanically ventilated
67
when do we usually monitor ICP in the ICU?
TBI
hypoxic brain injury
aneurysm
hemorrhage
tumor
meningitis
brain surgery
68
what does CPP measure?
cerebral blood flow
69
why does low CPP lead to further brain damage?
it decreases blood flow and oxygenation
70
CPP is calculated from what two other values?
MAP-ICP
71
a _____ in MAP or a _____ in ICP can cause a decrease in ICP?
decrease, increase
72
where is an epidural sensor placed?
in the epidural space
73
what is the purpose of an epidural sensor?
to monitor ICP
74
where is a subarachnoid bolt placed?
in the subarachnoid space
75
what is the purpose of a subarachnoid bolt?
direct ICP monitoring
76
where is an intraventricular catheter (ventriculostomy) placed?
in the lateral ventricle
77
what is the purpose of an intraventricular catheter (ventriculostomy)?
direct ICP monitoring
drainage or sampling of CSF
78
what are the clinical implications of an intraventricular catheter (ventriculostomy)?
the transducer must be leveled with position changes
79
what is the most reliable form of neurologic monitoring?
an intraventricular catheter (ventriculostomy)
80
where is a fiberoptic transducer tipped catheter placed?
can be in several locations
81
what is the purpose of a fiberoptic tipped catheter?
ICP monitoring
82
what is an EVD (extraventricular drain)?
a device that removes CSF from the ventricle to decrease ICP
83
is an EVD continuous or intermittent?
can be either
84
if an EVD is continuous, what do we have to be aware of?
making sure the collection bag is to gravity
85
can we mobilize pts with EVDs?
yes, but we need special training and protocols
86
where does the transducer have to be kept with an EVD to get an accurate reading of pressures?
level with the external auditory meatus
87
what are the circulatory support devices?
intraaortic balloon pump (IABP)
ventricular assist devices (VADs)
percutaneous VAD (pVAD)
implanted VAD (LVAD)
88
what is the purpose of an IABP?
to assist circulation through the body and reduce myocardial oxygen consumption
89
where is an IABP placed?
in the thoracic aorta via the femoral artery (and more increasingly via the subclavian artery for better mobility)
90
what is the mechanism of action of the IABP?
it is inflated during diastole, increasing aortic pressure distal and proximal to the balloon to increase circulation to the body and perfusion of the coronary arteries to increase oxygenation of the myocardium
it is deflated just prior to systole, decreasing pressure in the aorta and creating a vacuum effect for decreased afterload on the LV
91
how does the IABP increase circulation to the body?
the balloon is inflated during diastole and the increased pressure distal to the balloon increases blood flow out to the body
92
how does the IABP increase oxygenation of the myocardium?
when the balloon is inflated during diastole it increases pressure proximal to the balloon causing a backflow of blood to the coronary arteries to increase oxygenation of the myocardium
93
how does the IABP increase CO and decrease afterload on the LV?
when the balloon deflated in early systole, it decreases pressure in the aorta and creates a vacuum effect to the LV doesn't have to work as hard to get blood out
94
what are the clinical implications of an IABP?
no hip flexion
can do WB w/specialty beds that assist w/transfers to standing or a tilt table
95
t/f: increasing studies are showing that mobility is safe and feasible w/IABP inserted in the L axillary or subclavian arteries
true
96
what is the purpose of ventricular assist devices?
to unload a failing ventricle and directly help the ventricle pump blood
97
what is the percutaneous VAD on the market rn?
Impella
98
is the Impella (pVAD) temporary or long-term?
temporary
99
who would have a pVAD?
a pt we expect to improve
100
do pts leave the ICU with an Impella (pVAD)?
nope
101
how does the Impella (pVAD) work?
is has an axial flow rotary pump in the mitral valve/LV that spins and creates a vacuum effect, sucking blood from the LV through the device and into the aorta
102
where is the Impella (pVAD) inserted?
into the femoral or axillary artery
103
the Impella (pVAD) pumps blood from ____ to _____
the LV, aorta
104
what is the implanted VAD on the market rn?
Heartmate III
105
is the Heartmate III temporary or long term?
long term
106
will people leave the ICU with a Heartmate III?
yes, they can and will even go home with them
107
what is the indication for a Heartmate III?
end stage HF
108
what is the least common reason for a Heartmate III?
bridge to recovery
109
which reason for using the Heartmate III involves an expectation that heart fxn will improve and the pt will no longer need the LVAD?
bridge to recovery
110
which reason to use the Heartmate III involves using it until they find a suitable organ for the pt?
bridge to transplant
111
what is the most common reason for getting a Heartmate III?
destination therapy
112
what is destination therapy with the Heartmate III?
permanent placement of the device with no plans for transplantation to prolong life and improve QoL in pts with end stage HF
113
which reason for getting the Heartmate III is not common at all and uses the device when deciding if a pts is or is not a good candidate for a transplant?
bridge to decision
114
how is the Heartmate III inserted?
via sternotomy
115
what is a clinical implication of a pt with a Heartmate III?
bc it is done via sternotomy, we have to follow sternal precautions
116
t/f: the Heartmate III provides augmentation of CO (cardiac output)
true
117
where is the Heartmate III implanted?
directly into the apex of the heart through the LV wall
118
how does the Heartmate III work?
if drains blood directly from the LV and brings it around the heart through an artificial vessel to a hole made in the aorta
119
the Heartmate III takes blood directly from the ____ to the _____
LV, aorta
120
t/f: pts with a Heartmate III may or may not have any natural heart fxns
true
121
t/f: the controller box attached to the Heartmate III must be battery powered or wall powered at all time
true
122
what are the forms of ventilatory support?
noninvasive positive pressure ventilation
artificial airways
tracheostomy tube
123
is there a need for an artificial airway with non-invasive positive pressure ventilation?
nope
124
what is noninvasive positive pressure ventilation?
mechanical ventilation using a mask instead of an artificial airway
125
is noninvasive positive pressure ventilation for long term or short term ventilatory support?
short term ventilatory support
126
t/f: pts must be breathing spontaneously to be on noninvasive positive pressure ventilation
true
127
t/f: the pt drives inspiration and expiration with non-invasive positive pressure ventilation
true
128
how is the efficacy of noninvasive positive pressure ventilation monitored?
via ABGs
129
what is continuous positive airway pressure (CPAP)?
a form of noninvasive positive pressure ventilation where there is a constant stream of compressed air during inspiration and expiration to splint open airways
130
what is the purpose of CPAP?
to splint open airways
131
what is CPAP used for in the ICU?
respiratory failure
132
what is the gold stand for treatment of sleep apnea?
CPAP
133
t/f: the mask for CPAP must be tight fitting to work
true
134
why don't many pts like CPAP?
bc they don't like the pressure of the tight face mask
135
what is bilevel positive airway pressure (BiPAP)?
a form of noninvasive positive pressure ventilation that delivers high pressure during inspiration and low pressure during expiration for those who can't tolerate CPAP or have a harder time getting air out
136
why would a pt use BiPAP over CPAP?
they can't tolerate CPAP
they have a harder time getting air out
137
what are airway adjuncts?
artificial airways that make sure airways stay patent w/ventilation
138
what do airway adjuncts do?
provide a conduit for oxygenation, ventilation, and suctioning
139
what two artificial airways cannot be attached to mechanical ventilation but can be attached to bag masks?
oropharyngeal and nasopharyngeal airways
140
what is the purpose of naso/oropharyngeal airways?
maintanence of airways patency
141
what is an oropharyngeal airway?
artificial airways that goes through the mouth to the pharynx in fully sedated pts
142
why are oro/nasopharyngeal airways used in fully sedated pts?
bc of where they end, they can induce a gag reflex
143
what is a nasopharyngeal airway?
an artificial airways through the nose to the pharynx in fully sedated pts
144
what is an endotracheal tube (ETT)?
an oral or nasal artificial airways that does past the pharynx into the trachea just b4 the bifurcation
145
what is the purpose of having a balloon on the end of an ETT?
to secure it in place and make sure no air escapes if it attached to mechanical ventilation
146
can an ETT be attached to mechanical ventilation?
yes
147
what is a tracheostomy?
a surgically creates airway opening over the trachea below the vocal cords
148
what is a tracheostomy tube?
an artificial airways inserted into the trachea via a tracheostomy
149
if a tracheostomy is planned, why would a PEG tube be placed for nutrition?
bc the tracheostomy tube compresses the esophagus, so the pt won't be able to eat
150
why is a tracheostomy tube used?
when other forms of ventilation via other airways adjuncts fails
when there is a need for mechanical ventilation for a prolonged period
151
what is mechanical ventilation?
can invasive unit that delivers positive pressure through an artificial airway
152
t/f: breaths can be machine or pt driven with mechanical ventilation
true
153
with mechanical ventilation, during _____ positive pressure pushes air into the lungs causing lung and chest wall expansion
inspiration
154
with mechanical ventilation, during _____, air delivery stops and passive recoil of the lungs and chest wall pushes air out
expiration
155
what are the adjustable parameters of mechanical ventilation?
mode
FiO2
PEEP
TV
RR
156
what is the purpose of PEEP in mechanical ventilation?
to splint airways open, prevent alveolar collapse, and improve functional residual volumes
157
what is the downside of PEEP?
if it is too high, it can cause damage to the lungs
158
what is tidal volume (TV)?
how much air goes in/out of the lungs
159
what are the 4 modes of mechanical ventilation?
controlled mechanical ventilation
assist/control (AC)
synchronized intermittent mandatory ventilation (SIMV)
pressure support ventilation (PSV)
160
what is the most invasive mode of mechanical ventilation?
controlled mechanical ventilation
161
what is controlled mechanical ventilation?
a mode of mechanical ventilation where the pt is usually fully sedated and the machine controls all parameters
162
what is assist/control (AC) ventilation?
a mode of mechanical ventilation where the pt triggers the breaths and if the pt doesn't trigger a breath in a specified time, the machine delivers TV
163
what is synchronized intermittent manditory ventilation (SIMV)?
a mode of mechanical ventilation where the machine delivers a fixed # of breaths ina fixed TV
the pt can breathe spontaneously in bw
164
what is the least supportive mode of mechanical ventilation?
pressure support ventilation (PSV)
165
what is pressure support ventilation (PSV)?
a mode of mechanical ventilation where the pt breathes spontaneously and determines the TV
the machine delivers positive pressure during inspiration
can be added to other modes
166
what are possible complications of mechanical ventilation?
ventilator associated pneumonia
ventilator induced injury
ventilator induced diaphragm dysfxn
elevated ICP
elevated CVP
167
why does ventilator associated pneumonia occur?
bc mechanical ventilation bypasses the body's natural defenses against airborne pathogens
not all lung areas are equally ventilated so some areas become breeding grounds for bacteria
168
why does ventilator induced injury occur?
bc of the cyclical opening and closing of the alveoli bc of the different mechanics of breathing naturally vs on a vent
excessive PEEP or TV
169
what is ventilator induced diaphragm dysfxn?
atrophy/contractile dysfxn that causes weakness or low muscle endurance of the diaphragm
170
what are common pulmonary effects of ICU admission?
ventilator associated pneumonia
ventilator induced lung injury
ventilator induced diaphragm dysfxn
171
what are common psychiatric effects of ICU admission?
delirium
altered arousal
depression
anxiety
172
what is a common neuromuscular effect of ICU admission?
ICU acquired weakness
173
what are common nutritional effects of ICU admission?
cachexia
malnutrition
174
ICU delirium occurs in what % of ppl admitted to the ICU?
20-80%
175
what is ICU delirium?
cognitive impairments specific to the time period of being hospitalized
176
what is ICU delirium associated with?
self extubation
removal of catheters
failed extubation
prolonged hospitalization
177
t/f: ICU delirium can be hyperactive, hypoactive, or mixed
true
178
what is the assessment tool for ICU delirium?
CAM-ICU tool
179
what is the diagnostic criteria for ICU delirium with the CAM-ICU?
pt has to have feature 1 and 2 and either 3 or 4
180
what is feature one of the CAM-ICU?
acute onset or fluctuating course
181
what is feature two of the CAM-ICU?
inattention
182
how does the CAM-ICU test for inattention?
have the pt squeeze your hand when you say a certain letter when calling out a series of letters
183
what is considered an error in feature two of the CAM-ICU?
if the pt squeezes your hand when the letter was not said
if the pt does not squeeze your hand when the letter is said
184
how many errors in feature two of the CAM-ICU is considered a (+) result?
more than 2 errors
185
what is feature three of the CAM-ICU?
altered level of consciousness
186
what is a (+) for feature three of the CAM-ICU?
RASS is anything but 0
187
what is feature four of the CAM-ICU?
disorganized thinking
188
how is disorganized thinking tested in the CAM-ICU?
a series of yes or no questions
189
how many errors in feature 4 of the CAM-ICU is considered a (+) result?
more than 1 error
190
what is the definition of arousal?
state of responsiveness to stimulation or physiologic readiness for activity
191
what can affect arousal in the ICU?
use of sedating meds
delirium
neurologic injury
192
how is arousal measured in the ICU?
the Richmond Agitation-Sedation Score (RASS)
193
what is a 0 on the RASS?
pt is alert and calm
spontaneously pays attention
194
anything above a zero on the RASS requires that we do what?
look at the pt
195
what is +1 on the RASS?
restless
anxious, apprehensive, movts NOT aggressive
196
what is +2 on the RASS?
agitated
frequent nonpurposeful movt, fights ventilation
197
what is +3 on the RASS?
very agitated
aggressive, pulls lines and tubes
198
what is +4 on the RASS?
combative
violent
danger to self and staff
199
anything below a zero on the RASS, we have to do what?
talk to and touch the pt
200
what is -1 on the RASS?
drowsy
not fully alert, but has sustained awakening to voice
eye opening and contact >10 sec
201
what is -2 on the RASS?
light sedation
briefly awakens to voice
eye opening and contact <10 sec
202
what is -3 on the RASS?
moderate sedation
movt/eye opening to voice (no eye contact)
203
what is -4 on the RASS?
deep sedation
no response to voice
movt/eye opening to physical stimulation (chest rub)
204
what is -5 on the RASS?
unarousable
no response to voice or physical stimulation
205
what is ICU acquired weakness?
an overarhcing term for profound neuromuscular weakness that occurs during an ICU admission
acute, diffuse, flaccid paralysis
206
t/f: ICU acquired weakness is deconditioning from being ill
false
207
t/f: there is no alterations in muscle tone with ICU acquired weakness, muscles are just globally weak
true
208
what three illnesses are included under ICU acquired weakness?
critical illness neuropathy
critical illness myopathy
mixed critical illness neuropathy and myopathy
209
how is ICU acquired weakness assessed in the ICU?
Medical Research Council Examination (MRC)
210
what movts are assessed with the MRC exam?
shoulder abd
hip flex
knee ext
wrist ext
DF
211
why are specific movts used in the MRC?
they include major muscle groups affected in the ICU
they are easy to perform in supine
they include actions at the major jts of the body
212
how is the MRC exam scored?
like an MMT without any (+) or (-)
213
what is the MRC score to dx ICU acquired weakness?
<48/60
214
critical illness myopathy causes necrosis of what type of muscle fibers?
type 2 muscle fibers
215
t/f: sensory fxns are spared in critical illness myopathy
true
216
critical illness myopathy is associated with what?
meds
liver/lung transplant
hepatic failure
acidosis (metabolic or respiratory)
217
what is a key difference bw critical illness myopathy and polyneuropathy?
myopathy will affect proximal b4 distal
neuropathy will affect distal b4 proximal
218
does critical illness myopathy affect small or large muscle groups first?
large muscle groups b4 small muscle groups
219
what is critical illness polyneuropathy?
axonal neuropathy (damage to axons)
220
what does critical illness polyneuropathy cause?
flaccid tetraplegia
hyporeflexia
muscle atrophy
distal sensory imbalances
221
what is critical illness polyneuropathy associated with?
intense inflammatory states (sepsis, multiorgan failure)
222
how does critical illness affect nutrition?
it puts the body in hypermetabolic and hypercatabolic states that deplete the body tissue stores and protein elements leading to decreased protein synthesis, enhanced protein breakdown, and malnutrition
223
what is hypermetabolism?
increased energy needs
224
what is hypercatabolism?
increased breakdown of energy stores
225
what does malnutrition cause?
muscle wasting
reduced muscle strength and endurance
increased infection rates
reduced pulmonary fxn
increased mortality
226
what is the ABCDEF bundle?
an approach to care designed to maximize active pt and family engagement in care
227
what does the A in the ABCDEF bundle stand for?
assess, prevent, and manage pain
228
what does the B in the ABCDEF bundle stand for?
both spontaneous awakening trials (SAT) and spontaneous breathing trials (SBT)
229
what does the C in the ABCDEF bundle stand for?
choice of analgesia and sedation
230
what does the D in the ABCDEF bundle stand for?
delirium (assess, prevent, and manage)
231
what does the E in the ABCDEF bundle stand for?
early mobility and exercise
232
what does the F in the ABCDEF bundle stand for?
family engagement and empowerment
233
what is a good definition of early mobility?
any active exercises where the pt can assist w/the activity suing their own muscles strength and control
234
t/f: early mobility is generally applied to ppl receiving mechanical ventilation and other life support machines
true
235
early mobility starts how many days after intubation?
1-4 days after intubation
236
t/f: early mobility programs are broadly safe and feasible
true
237
are adverse events common in early mobility programs?
no
238
what are some temporary and non-life threatening adverse events that may arise with early mobility?
temporary desaturation
tachypnea
HR changes
loss of devices (pulling Foley or IV out)
postural hypotension (OH)
239
what CV signs are we monitoring in the ICU for safe early mobility?
HR 50-150 bpm
MAP 65-120 mmHg
vasopressor dose is stable or decreasing with appropriate BP/MAP
240
what do vasopressors do?
elevate HR
241
what pulmonary signs are we looking for in the ICU for safe early mobility?
RR <35 breaths/min
SpO2 >90%
PEEP less than or equal to 10 cmH2O
FiO2<0.7
242
what neurologic signs are we looking for in the ICU for safe early mobility?
RASS -1 to +1
following simple commands
243
what are some improvements associated with early mobility programs?
shorter ICU LOS
shorter hospital LOS
increased return to fxnal independence
shorter duration of delirium
increased ventilator free days
improved fxnal independence at hospital d/c
244
t/f: there are many different protocols for early mobility
true
245
is a pt at level one in mobility fully conscious and participating in therapy?
no, they are completely unconscious and unable to participate
246
when is skilled therapy needed in early mobility levels?
level 2
247
what early mobility activities are involved in level 1?
preventative measures (PROM, position changes every 2 hours, using HOB to achieve sitting, passive transfer)
248
to progress to level 3, pts must have what MMT scores in the UEs?
at least 3/5
249
to progress to level 4, pts must have what MMT scores in the LEs?
at least 3/5
250
what early mobility is involved in level 2?
all of level 1 activities
resistive exercises, sitting EOB, passive transfers
251
what early mobility is involved in level 3?
all level 1 and 2 activities
active transfers, standing actively with asssitance as needed
252
what level is full participation in early mobility?
level 4
253
what early mobility is involved in level 4?
all level 1, 2, and 3 activities
ambulation (marches, walking in hall/room), commode use
254
what are some low level activities for early mobility?
sitting EOB
seated ADLs
sitting balance
dependent transfers using Hoyer lift
tilt table
supine exercises
255
what are some supine low level exercises?
AAROM
AROM
light weights
resistance bands
cycle ergometry
Moveo
NMES
256
what are some mid level activities for early mobility?
sitting balance activities with less support and more dynamic
active transfers
standing balance
STS machine
257
what are some higher level activities for early mobility?
standing ADLs
marching
ambulation
standing ther ex
258
how do we know what level of activity a patient can handle in early mobility programs?
monitor their face and VSs
259
what are some ICU specific outcome measures?
physical fxn intensive care test scored
ICU mobility scale
fxnal status for the ICU
