pt. management of patients w/SCI in the ICU Flashcards
(37 cards)
Hemoglobin and Hematocrit
-risk:
-mobility implications
anemia, bleeding, need for transfusion
do not mobilize below if too low
Hb and Hct: critical values
hb: <6.5 g/dL
hct: <20% or >56%
Hb:
-no exercise
-light exercise
-resistive exercise
<8 g/dL
8-10 g/dL
>10 g/dL
hct:
-no exercise
-light exercise
-resistive exercise
<25%
>25%
>35%
INR: (international normalizing ratio)
-risk
-mobility implications
too high –> bleeding out
do no mobilize if too high
INR vs Activity Level:
normal activity =
<4.0 =
no resistance exercises, light exercises only =
hold exercise =
>6.0 =
.8 -1.2 (normal)
safe for eval and regular exer. program, no increase in intensity of exercise
4.0-5.0
5.0-6.0
bed rest
MAP: (mean arterial pressure)
-risk:
mobility implications:
too low means there is not enough pressure in the system to refuse organs including the brain, risk fo anoxic brain injury
do not mobilize is this is too low, may need pressors prior to mobility
resting map vs pressure
normal =
low =
70-105 mmHg
<60 mmHg
blood pressure (BP)
hypotension is common in SCI especially ________ spinal levels.
-risk
-mobility implications
higher
too low, pt. may become unresponsive, too high –> AD, pt. may stroke
position patient to increase BP if they are orthostatic, DO NOT mobilize if resting BP is in HTN emer.
Categories of BP
-normal
-preHTN
<120, <80
120-139, 80-89
Categories of BP
-HTN emer.
-orthostatic hypotension
> 180, >110
drop ≥20 , drop ≥ 10
Heart rate (HR)
-risks:
-mobility implications
too low, may become unresponsive, too high may have a cardiac event
consider HR parameters prior to mobility, know how much HR can increase safely based on Dx
resting HR vs rate (bpm)
bradycardia =
normal =
tachycardia =
<60
60 -100
>100
SpO2
-patients with _______SCI injuries. may be ventilated.
-assistance from ______ and ______ for breathing may be impacted
upper
intercostals; diaphragm
SpO2
-risks:
-mobility implications:
too low pt. might become hypoxic, risk cognitive decline and anoxic brain injury
may need supplement O2 to prevent desaturation –> stop and rest if it drops
SpO2 values:
normal =
low normal =
hypoxemia =
95-100%
90-95%
<90%
Respiratory rate (RR)
-risks:
-mobility:
could impact gas exchange
if someone is mechanically ventilated w/ RR of 20 at rest, they do not have much reserve to tax pulmonary system, may require higher vent settings to mobilize
RR: resting rate vs rate (bpm)
bradypnea =
normal =
tachypnea =
<12
12-20
>20
early medical management:
immobilize?
intubate if _______ level
screen for _______
imaging?
Sx
-common cause of SCI is _______ fx.
yes
cervical
sec. injuries
MRI, CT, Xray
spinal stabilization & decompression (first 24 hrs. has better outcomes for B, Cand D
burst
pharmacologic management: neuroprotective: corticosteroids to _______ vasogenic edema, increase SC blood flow, and decrease inflammation
-give in first ______ hours
-can cause hrm past ______ hours
-BP management: ________ to keep BP up
decrease
8 hours
48
vasopressors
Common Concomitant Injuries:
TBI
Fractures
Vertebral artery injuries & BPPV - cervical
Integ compromise - road rash
Organ damage - stabbing
Common Bracing
C collar
-miami j
-aspen vista
-halo (upper cervical)
TLSO
-clamshell
arterial line is a way to measure ___________ in real-time
goes directly into _______
often in _____ but can be found in femoral artery
more accurate than using _______
arterial blood pressure
artery
wrist
BP cuff
considerations for mobility w/arterial line:
-if pulled there will be heavy ________
-need ______ to place it on the pt.
-may limit _______ or _____ movement
bleeding
physician
wrist/hip
