Lecture 11: ICU and Medically Complex Patients

Question 1

Question 2

she didnt actually answer this

Question 3

leave the bed or chair in the lowest position w/ the wheels locked
* saftey fail if not done

know the equipment you’re going to use

Question 4

confused/disoriented not a contraindication to therapy

leave call bell

Question 5

restraints can be chemical as well as physcial

Question 6

Question 7

supplemental o2
* physcian perscribed - considered medication
* recorded as L/min
* Titration orders
* can the PT increase supplemental O2 - so can’t just go ahead and change their o2 unless there are specific titration orders based on activity level

Question 8

FiO2 = fraction of inspired o2 = percentage of o2 a patient is breathing in - room air is 21% FiO2
* involved in gas exchange at the alveolar level
* can be used to assess lungs’ capacity for gas exhcange (in the ICU)

supplemental o2 and mechanical ventilation can increase to 100% FiO2
* so i think its like the % of total air thats O2 that they’re breathing in

High FiO2 - use for pts w/ low o2 levels (think spo2)

Can cause oxygen toxicity and lung damage - so the goal is to wein the pt off asap - or use the minimal amount of o2 they need

if you can maintain your spo2 w/ room air (21% O2) than your lungs are working properly. If you need extra o2, a higher percentage, your lungs are not exchanging o2 that well. Probs why they’re in the ICU

Question 9

What would you use for low oxygen flow?
* what Fio2 does it have
* what L/min does it have

Answer 9

Nasal cannula

24-50% fio2

1-6 L/min

Question 10

What would you use for moderate oxygen flow?
* what Fio2 does it have
* what L/min does it have

Answer 10

simple face mask

40-60%

5-10L/min

Question 11

What would you use for high oxygen flow?
* what Fio2 does it have
* what L/min does it have

Answer 11

reservoir mask

60-90%

15 L/min

Question 12

What would you use for very high oxygen flow?
* what Fio2 does it have

Answer 12

nasal high flow

up to 100% fio2

Question 13

specialised form of pressure positive ventilation
* can be used for pts w/ sleep apnea or maintain an open airway
* fio2

Answer 13

CPAP

up to 100%

Question 14

invasive form of pressure positive ventilation

required when a pts lungs are severely impaired

Answer 14

ventilator

fio2 = up to 100%

Question 15

canister = used for humidification

may neeed to switch from nasal cannula to face mask because you have a mouth breather

know when you would need to switch a pt from a nasal canula to something higher duty

Question 16

w/ a vent inhaled air in through throat exhaled = out through mouth

dont tell this pt to breath in through nose lol

Question 17

positive pressure ventilation = you’re forcing air in to keep lungs open
* w/ ventilation can be positive or negative pressure ventilatoin

non invasive positive pressure = things like CPAP

Question 18

PEEP = Positive end-expiratory pressure: alveolar pressure above atmospheric pressure that exists at end of expiration on ventilator to keep lungs open - basically just the pressure thats in your alveoli to keep them open - because when on a ventilator you’re not working to keep lungs open - were giving your lungs a break when you’re on a vent
* Improves oxygenation in pts w/ ARDS, pulmonary edema, etc
* High peep = is for critically ill, unstable O2 = what #

Answer 18

high peep = > 10 cm H20

also use positioning strategies, precaution for airway clearance techniques

Question 19

Why do we give a PEEP and FiO2 - remember our goal is to ween pt off o2

Monitor SpO2 during mobility and interventions - i think this is just o2 sat

Healthcare team collaboration for optimal ventilation settings
* Resp therapy

Incorporate positioning, breathing ex, and mobilization techniques to optimize lung function and promote recovery

response to therapy and intervention adjustment

Question 20

FiO2 > what = pts may be unstable and require minimal exertion activities

Answer 20

> 60%

Question 21

PEEP > what = desaturation is common, barotrauma risk, unstable

Answer 21

PEEP > 10 cm H2O

be mindful in interventions

Question 22

when a PT is on how much O2 do we add humidity in order to prevent irritation of the pulmonary mucosa

Answer 22

5 L/min

when the upper airway is bypassed or when flow rates exceed 10L/min, the o2 may be heated to increase its water vapor carrying capacity
* i.e., endotracheal intubation or tracheostomy - bypassing upper airway = bypasses nasal cavitity which does heating/humidification

Question 23

this is for when closed mask interferes w/ coughing, talking, eating and drinking

Answer 23

different colors for different flow rates

Question 24

pressure supported noninvasive ventilation = provides positive inspiratory and end expiratory pressure

lots more o2 than ventori mask

Question 25

decision making tool for o2 therapy

Question 26

because spo2 may plumet w/ activity (because their on O2) so you would want to know if you can change their % if needed * remember O2 is a medication so we need orders from MD

Question 27

mechanical ventilation is not contraindicated for pt * as long as hemodynamically stable, receiving PEEP of 5cm H2O or less, tolerating a weaning mode of ventilation, and does not exhibit abnormal signs and symptoms in response to pre-gait activities

Question 28

helps stabilize chest wall (keeps lungs open)

Question 29

For normal ventilation (just us breathing) - the air is pulled into the lungs because of a negative pressure created through activation of the respiratory muscles Mechanical ventilation = cant generate an effective negative or subatmospheric pressure * mechanical ventilator forces air into the lungs through creation of a positive pressure greater than the atmospheric pressure that exists within the lung **On vnetilator = reduced strength of inspiratory muscles**

Question 30

Question 31

prolonged bed rest = increased heart rate at rest decreased total blood volume = due to not moving as much because they dont need as much blood

Question 32

Question 33

inspiratory muscles impacted * meaning they arent working hard enough * Incentive spirometer focuses the most on inspiratory muscles

Question 34

An acute state of delirium, often termed ICU delirium, ICU syndrome or ICU psychosis * state of delirium that can occur during the stay in the ICU Disturbance in consciousness with inattention accompained by a change in cognition or perceptual disturbance that develops over a short period of time (hours to days) and fluctuates over time * worse the longer you're in the ICU * flucuates over time Relocatiton stress syndrome

Question 35

ICU delirium may present as hyperactive (less common) or hypoactive, or mixed early mobility decreases the risk of icu delrium

Question 36

Question 37

especially important to monitor vitals when pt is getting up - things change quickly slowly increase HOB - helps minimize orthostatic hypotension LE anti embolism stocking = decrease orthostatic hypotension

Question 38

be aware of what mentally prolonged bed rest does to a person mobility wise we always take the lead

Question 39

therapists response and assessment of an adverse event or situation - incident report form only * not in daily note

Question 40

Question 41

Question 42

Question 43

want catheter on working side of bed

Question 44

Telemetry is the process of gathering and sending data from remote locations

Question 45

invasive - may not be able to move far

Question 46

medical surgical devices normally found on the med surge floor this is a chest tube - needs to be kept upright and below so it can drain - very painful if pulled out * dont want it to tip over because theres fluid in there * Drains pleural space in the lungs

Question 47

jackson prat drain * used to remove fluid - done after surgical procedures know jackson prat / chest tube - others are nice to know

Question 48

central venous catheter = goes into subclavian and into the heart babies have different lines than this

Question 49

if you're going to walk have a place to stop just incase something goes wrong