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2) Cardiopulm > 13) Early Mobes, Part 2 > Flashcards

13) Early Mobes, Part 2 Flashcards

1
Q

Indications for ICU admission

A
  • Pt needs close monitoring
  • Unstable critical illness
  • Acute mechanical ventilation
  • IV meds
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2
Q

Types of ICU

A
  • Trauma
  • Medical
  • Surgical
  • Neuro
  • Cardiac
  • NICU
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3
Q

What values need to be monitored in the ICU?

A
  • BP
  • Cardiac fxn
  • Respiratory Rate
  • O2
  • CO2
  • Glucose
  • ICP
  • CVP
  • Temp
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4
Q

What are the 2 ways BP can be measured?

A
  • Non-invasively w/cuff

* Invasively w/A-line

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5
Q

If a pt has an A-line, how should the wrist be positioned?

A

Splinted in neutral

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6
Q

If a pt has an A-line, what do you need to make sure of?

A

That the transducer is at the level of the R atrium

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7
Q

If a pt has an A-line, what should be avoided?

A

ROM & WB to the wrist

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8
Q

What is a swan-ganz?

A

Goes into the neck for R heart, PAP, & PAWP monitoring

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9
Q

What is a central line used for?

A

Give meds, fluids, & monitor CVP

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10
Q

How is ICP measured?

A

W/a bolt or ventriculostomy

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11
Q

Normal range for ICP

A

0-15mmHg

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12
Q

What is a ventriculostomy?

A

Drains CSF from ventricles if ICP gets too high

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13
Q

What needs to be done w/a ventric during mobilization?

A
  • Drain should be clamped during mobilization
  • Be level w/laser
  • Recalibrate after session
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14
Q

What is a lumbar drain?

A

Inserted into the spinal canal to drain CSF

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15
Q

Should a lumbar drain be clamped during mobilization?

A

Yes

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16
Q

Which devices need to be clamped during mobilization?

A
  • Ventric

* Lumbar drain

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17
Q

Femoral Sheath

A

Used for cardiac caths & angiograms

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18
Q

Femoral Line

A

Inserted into an artery/vein for short-term dialysis

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19
Q

If a pt has a femoral sheath, can you do PT w/them?

A

No

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20
Q

CVVHD

A

Continuous Veno-Venous Hemodialysis

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21
Q

Continuous Veno-Venous Hemodialysis

A

For critically ill pt’s w/CRF who need constant dialysis

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22
Q

If a pt is on CVVHD is it safe to mobilize them?

A

Yes

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23
Q

Open Abdomen Sponge

A

Used to cover pt’s who need to have their abdomens open for compartment syndrome, GSW, etc

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24
Q

Is it safe to mobilize a pt w/an open abdomen sponge?

A

Not right now, but research is in the works

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25
Q

ECMO

A

Extracorporeal Membrane Oxygenation

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26
Q

What is ECMO?

A

Pt’s blood is re-O2’ed outside of the body

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27
Q

Where is ECMO access through?

A

*Venoarterial or Veno-venous, through the femoral or jugular

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28
Q

Chest Tube

A

Inserted into pleural space to drain fluid/blood to prevent atelectasis

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29
Q

Mobilizations implications for pt on a chest tube

A
  • 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
30
Q

ET Tube

A

Goes into the trachea through the mouth for short-term ventilation

31
Q

If a pt is on an ET tube, is it safe to mobilize them?

A

Yes, just don’t pull on the tube

32
Q

Tracheostomy

A

Artificial A/W into the neck to the trachea for longterm A/W support

33
Q

Can you mobilize a pt w/a tracheostomy?

A

Yes, just be careful bc the tubing can pull apart

34
Q

CPAP

A

High flow (+) pressure for weaning pt’s from ET tube; Can also be used for sleep apnea

35
Q

Non-Rebreather Mask

A

Used to wean pt’s from trach; Gives 75-100% O2

36
Q

If a pt has a non-breather mask, is it ok to take it off?

A

No

37
Q

Venti-Mask

A

Gives 75-25% O2

38
Q

Nasal Cannula

A

Lowest amount of supplemental O2

39
Q

T Piece

A

Attached to trach to allow for higher flow of O2 & suctioning

40
Q

Trach Collar

A

Plastic collar that sits over trach site

41
Q

PRVC (CMV)

A

Pressure-Regulated Volume Control

42
Q

What is the PRVC setting?

A

Pt can initiate breath, but vent is doing all the work

43
Q

True or false: A ventilator on the PRVC setting adjusts to the pt’s lung compliance.

A

True

44
Q

SIMV

A

Synchronized Intermittent Mandatory Ventilation

45
Q

What is the SIMV setting?

A

Weaning mode that allows for spontaneous breathing

46
Q

What is the pressure support/CPAP setting?

A

Pt is doing most of the work but vent helps a little by providing a small amount of pressure during inspiration

47
Q

PEEP

A

Positive Expiratory End Pressure

48
Q

What is PEEP?

A

Pressure that keeps alveoli open to maintain lung vol bc incr SA=incr gas exchange

49
Q

What does a higher PEEP mean?

A

The vent is working harder

50
Q

Normal range for PEEP

A

5-8cmO2

51
Q

What is FiO2?

A

Amount of O2 in gas exchange

52
Q

FiO2

A

Fraction of Inspired O2

53
Q

How much can skeletal muscle strength decr by per day of bed rest?

A

1-1.5%

54
Q

What makes a pt qualify for early mobes?

A
  • Ability to minimally participate in therapy session
  • Hemodynamically stable
  • Acceptable O2 stats
55
Q

When determining appropriateness for PT, what needs to be considered?

A
  • Chart review
  • Imaging
  • Pharmacology
  • Goals
56
Q

How often should appropriateness for PT be decided?

A

Every session

57
Q

True or False: There’s no early mobe PROM guidelines

A

True

58
Q

Why are there no guidelines for early mobe PROM?

A

Bc its not that beneficial

59
Q

General/Relative Contraindications for Early Mobes

A
  • 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
60
Q

Safe HR range for early mobes

A

40-130BPM

61
Q

Safe RR range for early mobes

A

5-40

62
Q

Safe MAP range for early mobes

A

60-110mmHg

63
Q

Safe O2-sats range for early mobes

A

<90%

64
Q

Safe FiO2 range for early mobes

A

> .6

65
Q

Safe RASS range for early mobes

A

(-4)-(+3)

66
Q

What needs to be eval before doing early mobes?

A
  • 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
67
Q

What should be included in early mobes?

A
  • Sitting balance
  • Transfers
  • Gait/Pre-gait training
  • TherEx
  • Breathing exercises
  • Specialized equipment

*KEEP IT FXNL!

68
Q

How often can you do NMES on a sedated pt?

A

2x/day

69
Q

How long should cycle ergometry be done for?

A

20min/day

70
Q

Why is cycle ergometry good to do?

A

Can improve 6MWT, SF36, & quad strength

71
Q

How often should outcome measures be performed?

A

Weekly

2) Cardiopulm (16 decks)

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