13) Early Mobes, Part 2 Flashcards
Indications for ICU admission
- Pt needs close monitoring
- Unstable critical illness
- Acute mechanical ventilation
- IV meds
Types of ICU
- Trauma
- Medical
- Surgical
- Neuro
- Cardiac
- NICU
What values need to be monitored in the ICU?
- BP
- Cardiac fxn
- Respiratory Rate
- O2
- CO2
- Glucose
- ICP
- CVP
- Temp
What are the 2 ways BP can be measured?
- Non-invasively w/cuff
* Invasively w/A-line
If a pt has an A-line, how should the wrist be positioned?
Splinted in neutral
If a pt has an A-line, what do you need to make sure of?
That the transducer is at the level of the R atrium
If a pt has an A-line, what should be avoided?
ROM & WB to the wrist
What is a swan-ganz?
Goes into the neck for R heart, PAP, & PAWP monitoring
What is a central line used for?
Give meds, fluids, & monitor CVP
How is ICP measured?
W/a bolt or ventriculostomy
Normal range for ICP
0-15mmHg
What is a ventriculostomy?
Drains CSF from ventricles if ICP gets too high
What needs to be done w/a ventric during mobilization?
- Drain should be clamped during mobilization
- Be level w/laser
- Recalibrate after session
What is a lumbar drain?
Inserted into the spinal canal to drain CSF
Should a lumbar drain be clamped during mobilization?
Yes
Which devices need to be clamped during mobilization?
- Ventric
* Lumbar drain
Femoral Sheath
Used for cardiac caths & angiograms
Femoral Line
Inserted into an artery/vein for short-term dialysis
If a pt has a femoral sheath, can you do PT w/them?
No
CVVHD
Continuous Veno-Venous Hemodialysis
Continuous Veno-Venous Hemodialysis
For critically ill pt’s w/CRF who need constant dialysis
If a pt is on CVVHD is it safe to mobilize them?
Yes
Open Abdomen Sponge
Used to cover pt’s who need to have their abdomens open for compartment syndrome, GSW, etc
Is it safe to mobilize a pt w/an open abdomen sponge?
Not right now, but research is in the works
ECMO
Extracorporeal Membrane Oxygenation
What is ECMO?
Pt’s blood is re-O2’ed outside of the body
Where is ECMO access through?
*Venoarterial or Veno-venous, through the femoral or jugular
Chest Tube
Inserted into pleural space to drain fluid/blood to prevent atelectasis
Mobilizations implications for pt on a chest tube
- If on suction, can only move as far as tube allows
- If pt is on H20-seal, take chamber w/you
- Don’t knock the drain chamber over
ET Tube
Goes into the trachea through the mouth for short-term ventilation
If a pt is on an ET tube, is it safe to mobilize them?
Yes, just don’t pull on the tube
Tracheostomy
Artificial A/W into the neck to the trachea for longterm A/W support
Can you mobilize a pt w/a tracheostomy?
Yes, just be careful bc the tubing can pull apart
CPAP
High flow (+) pressure for weaning pt’s from ET tube; Can also be used for sleep apnea
Non-Rebreather Mask
Used to wean pt’s from trach; Gives 75-100% O2
If a pt has a non-breather mask, is it ok to take it off?
No
Venti-Mask
Gives 75-25% O2
Nasal Cannula
Lowest amount of supplemental O2
T Piece
Attached to trach to allow for higher flow of O2 & suctioning
Trach Collar
Plastic collar that sits over trach site
PRVC (CMV)
Pressure-Regulated Volume Control
What is the PRVC setting?
Pt can initiate breath, but vent is doing all the work
True or false: A ventilator on the PRVC setting adjusts to the pt’s lung compliance.
True
SIMV
Synchronized Intermittent Mandatory Ventilation
What is the SIMV setting?
Weaning mode that allows for spontaneous breathing
What is the pressure support/CPAP setting?
Pt is doing most of the work but vent helps a little by providing a small amount of pressure during inspiration
PEEP
Positive Expiratory End Pressure
What is PEEP?
Pressure that keeps alveoli open to maintain lung vol bc incr SA=incr gas exchange
What does a higher PEEP mean?
The vent is working harder
Normal range for PEEP
5-8cmO2
What is FiO2?
Amount of O2 in gas exchange
FiO2
Fraction of Inspired O2
How much can skeletal muscle strength decr by per day of bed rest?
1-1.5%
What makes a pt qualify for early mobes?
- Ability to minimally participate in therapy session
- Hemodynamically stable
- Acceptable O2 stats
When determining appropriateness for PT, what needs to be considered?
- Chart review
- Imaging
- Pharmacology
- Goals
How often should appropriateness for PT be decided?
Every session
True or False: There’s no early mobe PROM guidelines
True
Why are there no guidelines for early mobe PROM?
Bc its not that beneficial
General/Relative Contraindications for Early Mobes
- Unstable Fx
- Cerebral edema w/uncontrollable ICP
- Active bleeding
- Hemodynamic instability requiring high does pressors
- O2 dysfxn requiring significant supplemental O2 &/or paralytic drugs
- Transvenous temporary pacemaker
- Open chest/abdomen
- Femoral sheath
- Recent MI
- High inotrope
- LOC
- Fatigue
- Pain
- Abn face color
- Presence of lines that prevent mobility
Safe HR range for early mobes
40-130BPM
Safe RR range for early mobes
5-40
Safe MAP range for early mobes
60-110mmHg
Safe O2-sats range for early mobes
<90%
Safe FiO2 range for early mobes
> .6
Safe RASS range for early mobes
(-4)-(+3)
What needs to be eval before doing early mobes?
- ROM
- MMT
- Bed mobility
- Balance
- Transfers
- Amb
- Arousal
- Tone/spasticity
- Motor control/apraxia
- Ability to follow commands
- Ability to participate in PT session
- Attention/distractibility
- Safety awareness/distractibility
What should be included in early mobes?
- Sitting balance
- Transfers
- Gait/Pre-gait training
- TherEx
- Breathing exercises
- Specialized equipment
*KEEP IT FXNL!
How often can you do NMES on a sedated pt?
2x/day
How long should cycle ergometry be done for?
20min/day
Why is cycle ergometry good to do?
Can improve 6MWT, SF36, & quad strength
How often should outcome measures be performed?
Weekly
