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Semester 5 PMCP Exam 4 > Mobilizing the ICU patient > Flashcards

Mobilizing the ICU patient Flashcards

(79 cards)

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1
Q

Skills needed by the PT in the ICU

A
  • Knowledge of CP phys, path, pharm
  • Knowledge of ICU equip
    CP assessment and tx rx
  • Ability to practice effectively under pressure and often in congested an suboptimal working conditions!
  • Knowledge in emergency procedures
  • Sensitive to patients
  • Team player
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2
Q

Information needed before treating an ICU patient (bold)

A

Existing or potential medical instability
Indications or necessity for intubation and mechanical ventilation
Invasive monitoring, lines, leads, and catheters
Existence of or potential for complications and multi-organ system failure

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3
Q

Factors that increase metabolic demand and oxygen consumption in patients - Pathophysiologic Factors

A

1) Fever
2) Thermoregulatory
3) Healing and repair
4) Combating infection

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4
Q

Factors that increase metabolic demand and oxygen consumption in patients - Intervention related factors

A

Responses to nursing cares
Feeding
Body positioning
Pharmacologic agents - Diprovan (Propofal)

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5
Q

Factors that increase metabolic demand and oxygen consumption in patients - Psychosocial

A

Social contact
Anxiety
Discomfort
Pain

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6
Q

Factors that increase metabolic demand and oxygen consumption in patients - Misc

A

Noise

ICU psychosis

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7
Q

Tone - Decreased tone

A

LMN lesion (GB)
Atrophy
Ployneuropathy
Paralytic medication and sedatives that are used for a prolonged period of time

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8
Q

Tone - Increased tone

A

UMN lesion - CVA and encephalopathy
Electrolyte imbalance
Bilateral intracranial lesions
Large unilateral intracranial lesion resulting in a midline shift

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9
Q

Tone - ___ will be a very important part of treatment

A

positioning

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10
Q

Strength testing with an ICU patient

A

Modified
Not done against resistance in order to avoid vasalva
In ICU 3/5 is appropriate

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11
Q

Coordination tests include

A 
Finger to thumb opposition
Finger to nose tracking
Rapid alternating hand mvmnts
Heel to shin slide
Rapid foot tapping
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12
Q

Bed mobility

A

Supine to sit through sidelying

Need to make sure it is cleared through physicians and nursing prior

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13
Q

Assessing balance

A

Sitting and standing

Static, with reaching, with perturbations

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14
Q

Lab value - Hgb

A

12-16 F

14-17 M

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15
Q

Lab value - hematocrit

A

36-44% F

41-51% M

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16
Q

Lab value - Hgb A1C

A

4.8-6%

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17
Q

Aneurysm is

Key for pts with aneurysm repair

A

weakng of the arterial wall from a loss of elastin and collagen
Log roll to side to get out of bed - splinting is huge

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18
Q

AAA - abdominal aortic aneurysm repair

A

Incision from xiphoid process to pubis

log roll to get out of bed

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19
Q

Thoracic aortic aneurysm repair

A

Ascending and transverse procedures done through sternal incisions
Descending done through combo of sternal and left thoracotomy incisions
Stenral incision precautions apply!

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20
Q

Thoraco-abdominal aortic aneurysm repair

A

Incision is combo of left thoractomoy and abdominal incisions
High risk procedure

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21
Q

Carotid Endarterectomy is what

A

Surgical procedure involving the left or right common carotid arteries to remove plaque

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22
Q

Carotid Endarterectomy is performed where and what is a complication

A

Performed through the neck
Complication - CVA intra-operatively
PT usually seeing them for complication - tx as would any other ICU patient

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23
Q

Percutaneous Coronary Angioplasty - is what

A

Blockage is either reamed out of destroyed with a balloon

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24
Q

Percutaneous coronary angioplasty is inserted where

A

through the femoral artery

stent can also be placed to keep the artery open

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25
Percutaneous coronary angioplasty - what can occur
Restenosis - usually up to 50% and usually within the first 6 months
26
Arterio-bifem Bypass
Diseased portion of the descending aorta and its bifurcation into the common iliac arteries are replaced by a manmade graft
27
Arterio-bifem Bypass - extends from
the infrarenal abdominal aorta to the common femoral arteries Make sure to check circulation! Log roll to side!
28
Fem-popliteal bypass
diseased portion of the femoral artery is replaced by a manmade graft and connected to the popliteal artery
29
Fem-popliteal bypass - risk factors
diabetes, smokers, high cholesterol, those in jeopardy of having an amputation
30
Cerebral vascular accidents can be ___ or ___
Space occupying lesions | Anoxic lesions
31
CVA - Space occupying lesion from
tumors, hemorrhage, subdural hematomas
32
CVA - Space occupying lesion cause
midline shift of the cerebral contents
33
CVA - Space occupying lesion resulting in
bilaeral increases in pressure and bilateral neurological symptoms
34
CVA - anoxic lesions are what
clot or thrombus travels to the brain cutting off blood flow to that part
35
CVA - anoxic lesions - what can be done
thrombolytic therapy can be used within 3 hours of the event (need to be on bed rest 24 hours after) Takes 48 hrs to show up on a CT scan
36
TBI may be
Subdural hematoma, anoxia, infarction, midline shift and/or damage to the ventricles
37
SCI usually has multiple medical problems such as
``` orthopedic stabilization of a fracture sexual dysfunction respiratory failure paralysis depression incontinence skin breakdown contractures ```
38
Ileus is what
bowel motility stops
39
Ileus symptoms include
abdominal pain distention absent bowel sounds
40
Ileus cause
surgery, medication, immobility, general anesthesia
41
Ileus treatment
NG to suction, NPO
42
GI bleed - what will fall
Hb/Hct | Hgb can be as low as 4
43
GI bleed - cause
malignancy, meds, gastric ulcer, diverticulitis, hemorrhoids, esophageal varices
44
Sepsis is what
infection that has become systemic | can lead to multisystem organ failure
45
Subcutaneous emphysema is what
air that has leaked out from the lung following a pneumothorax into the spaces between tissue layers Pt will have puffy appearance
46
Guillain Barre is what
Ascending polyneuropathy
47
GB is thought to be caused by
an infection
48
GB has varying degrees of progression and recovery - what is the treatment
Plasmaphoresis, IGg, therapy
49
Myasthenia Gravis is what
An acquired autoimmune disorder associated with acetylcholine receptor deficiency at the motor end plates
50
Myasthenia gravis will show
fluctuating weakness of commonly used voluntary mm with symptoms of diplopia, ptosis, difficulty swallowing, limb weakness Abnormal fatigueability
51
Post polio syndrome
polyneuropathy of viral origin | Those that survived polio yrs ago are developing new dennervation resulting in additional weakness
52
Post polio syndrome - exacerbated by
acute illness
53
ALS - Amyotrophic lateral sclerosis
Irreversible hypoventilation will lead to mechanical ventilator dependence May see in later stages
54
Bariatrics - BMI
30 obese | 40 morbidly obese
55
Pathophysiology of obesity
Alveolar hypoventilation (pickwickian syndrome) Results in hypoxemia and cardiopulm failure (low O2 and high CO2) Poor cardiopulm reserve capacity Stress of illness
56
Procedures to reduce weight
Gastric bypass surgery Gastric banding Sleeve gastrectomy Gastric plication
57
Egress test includes what 3 components
Sit to stand Step in place Step forward and return
58
Egress test - sit to stand
patients were requested to complete three reps of sit to stand
59
Egress test - step in place
while standing at a self selected stance width, patients took alternate steps in place
60
Egress test - step forward and return
Patients steps away from the bed once and then returns to starting position
61
Egress test - pass if
completed test independently or with no more than minimal assistance shows that they are okay to get up and walk
62
Glascow coma scale 1 What does it rate 2 Highest score 3 When intubate?
rates patient on eye opening, verbal response, motor response The highest score is 15 below 8 = intubate!!!
63
0-10 numeric scale for who
adults and children over 9 years old
64
FLACC scale for who
2 months to 7 years old
65
CNVI for who
nonverbal patients | behavioral or cognitive impairment
66
Encephalopathy - how does it present
- often confusion, memory deficits, anger (depends on what part of the brain it is impacting though) can be reversible or not treat their deficits
67
Reversible encephalopathy
``` Hepatic liver disease - toxins (can be) Hypertensive BP (can be but usually not caught in time) Toxic metabolic - infection or toxins - best case of these - can be reversible if reverse toxins ```
68
TIA
s/s last less than 24 hours | symptoms can be subtle
69
Brain tumor
know where tumor is located and the procedure used to remove it
70
Aneurysms are often discovered
when they rupture to cause bleeding to the brain
71
Unruptured aneurysm
Coiling Clipping Radiation
72
Bariatrics - exercise - THR
220-age 60% earlier stages Can progress to 80%
73
Glascow coma scale - eye opening points
1 - never opens 2 - open to pain 3 - open to sound 4 - spontaneous opening (active arousal mechanism)
74
Glascow coma scale - verbal response
``` 1 - none 2 - incomprehensible 3 - inappropriate 4 - Confused 5 - Oriented to person place time ```
75
Glascow coma scale - motor response
1 - none 2 - extension synergy 3 - decorticate flexion rigidity with painful stimuli 4 - entire arm flexed n response to painful stimuli 5 - localized - moves a limb to attempt to remove stimulus 6 - obeys commands - no involuntary mvmnts
76
Glascow coma scale - linked to difficulty they will have later on - mild score
Mild - 12 to 15 | they will recover fully in 3-6 months or so
77
Glascow coma scale - linked to difficulty they will have later on - moderate score
moderate - 9 to 12 | they may not have full recovery, maybe some limitations
78
Glascow coma scale - linked to difficulty they will have later on - severe score
below 8 | Will definitely have deficits and could be for up to a yr
79
Wong Baker Face pain rating scale for who
adults and children over 3 years old

Semester 5 PMCP Exam 4 (6 decks)

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