A.) Troponin I B.) C-reactive protein C.) Electrolyte asessment 1. most frequently used to assess MI 2. Appropriate levels of K, Ca, Mg allow fornormal electrial conduction through the heart 3. Measures amount of protein blood 4. Isotype in myocardium 5.Signals acute inflammation 6. 100% cardiac specific 7. determine risk of heart disease --> high sensitivity C-reactice protein assay is available

1. A 2. C 3. B 4. A 5. B 6. A 7. B

LEC 2.1 (ACUTE CARE) Flashcards by BIJAY KENT HIRATA

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Medical conditions associated with falls:

neurologic, orthopedic, cognitive, postural/orthostatic
hypotension

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Either allergic to the natural rubber in latex, or the chemicals used to
produce latex

Includes gloves, stethoscopes, cuffs, airway and IV tubing, electrodes;
etc.

Latex Allergy

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State of being unhealthy for a particular disease or situation

Morbidity

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number of deaths that occur in a population.

mortality

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It is a place of intensive medical-surgical care for patients who require
continuous monitoring, usually in conjunction with other therapies or
medical interventions such as vasoactive medications, sedation, circulatory assist devices, and mechanical ventilation

May be PICU, CCU, SICU depending on patient distributio

Intensive Care Unit

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Page 14-15

*ICU Delirium or syndrome

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Increased with MV, emergency surgery, polytrauma, organ failure uM
metabolic acidosis, coma, dementia, or advanced age

ICU delirium or syndrom

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A.) Blood Urea Nitrogen (BUN), Plasma creatinine reduced in patients with HE
levels, and urine output
B.) Creatine kinase MB subunit (CK-MB)
C.) B-type natriueretic peptide (BNP)
D.) Hemoglobin and Hematrocrit levels

Assess biomarkers of heart failure
Assess renal function, reduced in HF
Assess the oxygen carrying capacity within the system
Isoenzyme, released into blood and elevates with acute MI

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Other possible risk factors

include hypoxemia, use of certain benzodiazepine and narcotic
medications, infection, immobilization, and pain

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A.) Troponin I
B.) C-reactive protein
C.) Electrolyte asessment

most frequently used to assess MI
Appropriate levels of K, Ca, Mg allow fornormal electrial conduction through the heart
Measures amount of protein blood
Isotype in myocardium
5.Signals acute inflammation
100% cardiac specific
determine risk of heart disease –> high sensitivity C-reactice protein assay is available

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SYSTEMIC EFFECTS OF PROLONGED BED REST

CARDIAC

° Increased heart rate at rest and with submaximal exercise
° Decreased stroke volume, VO2 Max, Left ventricular volume, and
cardiac output
° Myocardial thinning
° Orthostatic hypotension

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RESPIRATORY

° Decreased lung volumes and capacities, (FRC, FVC, FEVI)
° Decreased mucocilliary clearance
° Increased risk of pneumonia, atelectasis, and pulmonary embolism
° Decreased arterial oxygen saturation

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HEMATOLOGIC

° Decreased total blood volume, red blood cell mass, and plasma
volume
° Increased hematocrit
° Venous stasis, hypercoagulability, blood vessel damage

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GASTROINTESTINAL

° Decreased appetite, fluid intake, bowel motility, and gastric
bicarbonate secretion
o GERD
° Difficulty swallowing

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GENITOURINARY

° Increased mineral excretion, kidney stones, difficulty voiding, and
urinary retention
°Increased risk of urinary tract infection

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ENDOCRINE

° Altered temperature and sweating responses, circadian rhythm,
regulation of hormones, increased cortisol and glucose intolerancg
° Decreased overall metabolism

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MUSCULOSKELETAL

° Increased muscle weakness (especially antigravity muscles),
atrophy, decreased muscle endurance, risk of contracture,
weakened myotendinous junction
° Disuse osteoporosis
° Degeneration of cartilage, synovial atrophy, and ankylosis

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NEUROLOGIC

° Sensory and social deprivation
° Decreased dopamine, noradrenaline, and serotonin levels
° Depression, restlessness, insomnia
° Decreased balance, coordination, and visual acuity
° Increased risk of compression neuropathy
° Reduced pain threshold

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INTEGUMENTARY

° Increased risk of pressure injury formation

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IMMUNE

° Increased risk of reactivation of latent viruses
° Reduced immune response and immunity

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PSYCHOLOGICAL

° Impaired self worth and self esteem
° Increased risk of delirium, depression, and post-traumatic stress
syndrome

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BODY COMPOSITION

° Increased sodium, potassium, calcium, phosphorus, and nitrogen loss ° Increased body fat and decreased lean body mass ° Fluid shift from legs to abdomen/thorax/head, diuresis

-Patients may be confined to the hospital setting with an infectious disease process or may develop one caused by the hospital environment. -Therefore a basic understanding of these infectious disease processes is useful in designing, implementing, and modifying physical therapy treatment programs.

INFECTIOUS DISEASES

° Highly specific protein that is manufactured in response to antigens and defends against subsequent infection

ANTIBODY

° Agent that is capable of producing antibodies when introduced into a body of a susceptible person

ANTIGEN

The ability of an infective organism to be transmitted from persor | person, either directly or indirectly

COMMUNICABLE

° Localized or systemic condition resulting from an adverse reaction to the presence of an infectious agents(s) or its toxin(s); there must be no evidence that the infection was present or incubating at the time of admission to the acute care setting

HEALTH CARE ASSOCIATED INFECTION

An immune system that is incapable of a normal response pathogenic organisms and tissue damage

IMMUNOCOMPROMISED

° Decreased or compromised ability to respond to antigenic stimuli by appropriate cellular immunity reaction

IMMUNODEFICIENCY

° The prevention or diminution of the immune response, as by drugs or radiation

IMMUNOSUPPRESION

° Infection acquired in the hospital setting; note that this has b: replaced by the term HAI (see above)

NOSOCOMIAL INFECTION

o An infectious process that develops in immunosuppressed individuals

OPPORTUNISTIC (Opportunistic infections normally do not develop in individuals with intact immune systems.)

° A disease or condition that does not produce clinical symptoms, or the period before the appearance of disease specific symptoms

SUBCLINICAL INFECTION

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Airborne droplet nuclei can stay for ___

More than an hr travel >10 ft d/t small size (<5micrometers)

A single patient room equipped c special air hand and ventilation capacity (e.g. negative pressure)

Airborne Infection Isolation Room (AIIR)

Mask/faceshield required when___

Large particle >5micromter if droplet transmiision <=3 ft is likely spatial seperation of >= 3 ft

Due to inappropriate antibiotic use in healthcare institutions and hospitals

ANTIBIOTIC RESISTANT INFECTIONS

At least one agent in three or more antimicrobial categories

MULTIDRUG-RESISTANT (MDR)

At least one agent in all but two or fewer categories

EXTENSIVELY DRUG-RESISTANT (XDR)

Nonsusceptibility to all agents in all antimicrobial categories’

PANDRUG-RESISTANT (PDR)

Antibiotic Resistant Infections

-Methicilin Resistant Staphylococcus (MRSA) -Vancomycin Resistant Enterococcus (VRE) -Multi-drug resistant Acinetobacter baumannii (MDRAB)

general indication: hypoxemia Indications: severe trauma, shock, acute myocardial infarction, surgery, carbon monoxide/cyanide poisoning

OXYGEN THERAPY - Increase O2 levels in the blood and alveoli to improve oxygenation

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HYPOXEMIA

° SaO2 <90% ° Arterial blood O02 partial pressure is <60 mmHG

VARIABLE OXYGEN DELIBERY FOR SBA

NASAL CANULA OPEN FACE TENT CLOSED FACE MASK TRANSTRACHEAL OXYGEN CATHETER TRACHEOSTOMY MASK/COLLAR PARTIAL NONREBREATHER MASK NONREBREATHER MASK

A) Tracheostomy mask/collar B) Parial non-rebreather mask C) Non-rebreather mask 1. Provides a high Fi02 to the patient while conserving the O2 supply 2. Q2 available via a face mask in a variable-performance system 3. One way valves control inflow of supplemental O2 and outflow of exhaled air so that the patient is only breathing the supplied 02 4. Provides supplemental, humidified O2 or air at a tracheostomy site 5. Fio2 - 28 to 100% 6. Fio2 - 40 to 60% 7. Fio2 - 60 to 80% 8. Mix of supplemental 02 and RA 9. Two-way valves in the mask allow for RA inhalation in addition supplemental O02. 10. Provides the patient with the highest concentration of supplemental

1. B 2. C 3. C 4. A 5. A 6. B 7. C 8. B 9. B 10. C

A) Nasal Cannula B) Open Face Tent C) Closed Face Mask D) Transtracheal oxygen catheter 1. Delivers supplemental O2 mixed with RA 2. Fio2 - 24 to 44% 3. Can also be used for nebulized medications 4. Delivers supplemental O2 mixed with RA (21%), usually I-6 lpm 5. Mask capacity is limited but does allow for the collection of O2 about the nose and mouth 6. Fio2 - 30 to 55% 7. Used for long-term O2 therapy 8. Provides humidified, supplemental 02 mixed with RA 9. Fio2 - 40 to 60% 10. Indicated when there are complications with or suboptimal nasal cannula use, nocturnal hypoxemia despite nasal cannula

1. C 2. A 3. B 4. A 5. C 6. B 7. D 8. B 9. C 10. D

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FIXED PERFORMANCE OXYGEN DELIVERY A) Air Entrapment Mask B) BiPAP 1. Fio2 - 24, to 50% 2. Often used in the hospital or home setting for the managemeR 3. Provides a specific concentration of supplemental O2 using color- coded diluter pieces to ensure accurate FiO2 delivery 4. May be used to avoid intubation and mechanical ventilation 5. Pressure-supported, noninvasive ventilation that provides positive inspiratory and end-expiratory pressure 6. Fio2 21 to 100%

1. A 2. B 3. A 4. B 5. B 6. B Both deliver air pressure when you breathe in and breathe out. But a BiPAP delivers higher air pressure when you breathe in. The CPAP, on the other hand, delivers the same amount of pressure at all times. So the BiPAP makes it easier to breathe out than the CPAP.

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Non-Invasive Medical Monitoring A) BP cuff B) Telemetry C) Pulse oximeter 1.) Continuous monitoring of heart rate and rhythm and respiratory 2.) A noninvasive, transcutaneous method of monitoring the percentg of hemoglobin saturated with O2 in arterial blood 3.) Measures arterial BP

BCA

Invasive Medical Monitoring A) Arterial Line B) Central Venous Catheter 1.) Indicated for a patient with significant fluid volume deficit and is used as a guide to overall fluid balance 2.) Measurement of CVP is a direct reflection of right heart function 3.) Direct and continuous monitoring of systolic, diastolic, and MAP; source for repeated arterial blood gas 4.) Also provides vascular access for parenteral nutrition, large fluid volumes, or noxious medications

BBAB

NORMAL VALUES SBP/DBP & MAP

Systolic: 90-140 mmHg Diastolic: 60-80 mmHg MAP: 70-100 mmHg

CVP Normal value:

2-5 mmHg or 3-8 cm water (H20)

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° Provides access for long-term hemodialysis

AV fistula/graft

-Removes and prevents the reentry of air or fluid from the pleural or mediastinal space and provides negative intrapleural pressure -Used to treat pneumothorax, hemothorax, pleural effusion

Chest Tube

For feeding, gastric decompression and keeping the stomach em after surgery

Nasogastric Tube

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MEDICAL SURGICAL MANAGEMENT DEVICE

--------------------------------------------

Delivers aerosolized water or medications to the respiratory tract, lungs, throat, or nose

NEBULIZER

Provides long-term access for nourishment to patients who are unable to tolerate food by mouth or have a nasoenteral obstruction, or for a patient with confusion/ agitation at risk for nasoents tube dislodgement

PERCUTANEOUS ENDOSCOPIC GASTROTOMY/JEJUNOSTOMY

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° Provides temporary access for delivery of medications, fluids, electrolytes, nutrients, or blood product transfusions ° It cannot be used to draw blood

PERIPHERAL IV LINE

° Provides IV access for administration of total parenteral nutrition (TPN), medications, fluid, blood products, or chemotherapy. ° Generally placed for midterm access (weeks to months)

PERIPHERALLY INSERTED CENTRAL CATHETER

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° Provides intermittent pressure to the lower extremities via gradual and sequential inflation and deflation of the air-filled sleeves ° Promotes venous return and prevents deep vein thrombosis (DVT) and venous thromboembolism (VTE) secondary to prolonged or postoperative bed rest or inactivity

SEQUENTIAL COMPRESSION DEVICES

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° Surgically placed catheter to drain the bladder temporarily or permanently after some bladder or gynecologic surgeries in cases of urinary retention (possibly caused by an obstruction tumor, stricture, periurethral abscess) or a severe voiding dysfunction °May be used for SCI patients

Suprapubic catheter

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° Removes excess air, blood, or fluid (serum, lymph, bile, pus, or intestinal secretions) from a surgical site that would otherwise collect internally ° To control ecchymosis and to prevent deep wound infection

SURGICAL DRAIN (PENROSE, JACKSON PRATT, HEMOVAC)

° Noninvasively collects urine via a sheath placed over the penis ° Does not assist with drainage of urine from the bladder

TEXAS CATHETER

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° Used for long-term (months to years) chemotherapy, hemodialysis, TPN, or other intermittent infusion therapy

VASCULAR ACCESS PORT

A catheter inserted through urethra in both M and W to drain and collect urine TEMPORARILY (<3 WKS) Used for urinary incontinence/retention, to assist postoperative bladder drainage, when accurate measurement in urine output is necessary, to prevent contamination in patients With stage 2,3,4 pressure injury on the buttocks/perineum

URINARY CATHETER

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Drains excess CSF from the ventricles into the abdominal cavity/peritoneum (VP) or right atrium of the heart (VA)

VENTRICULOPERITONEAL SHUNT

Clears secretions from the oral cavity or the oropharynx

Yankauer suction

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LEC 2.1 (ACUTE CARE) Flashcards

(83 cards)