14. ICU Rehabilitation

Question 1

List common problems experienced by patients post critical Illness

Answer 1

Painful joints
Muscle wasting

Weakness
Poor Mobility

Skin hair / nail disorder

taste loss poor appetite

Persistent renal dysfunction
Manifest low GFR

Dishabituation
tiredness / chronic fatigue like syndr

Question 2

List common problems experienced by patients post critical Illness
cont.

Answer 2

Ongoing resp problems
- ARDS pft 80% normal @ 6 months

Tracheostomy scarring / tach stenosis

Sexual dysfunction

Chronic pain
?drug dependence

Wound healing
stoma nurse
wound therapist - healing laparostomy

MRSA status

Question 3

Other non psychical issues

Answer 3

Anxiety
Depression

PTSD
recurring nightmare
social w/drawal

Relationship difficulty

Poor sleep pattern

Long term cognitive impairment
Dysfunction memory / attention & concentration
linguistic numeric skill

Psychosexual dysfunction

Financial problems
difficulty returning to employment

Question 4

Guidelines for Rehab

NICE Guidelines 09

Answer 4

Key Principles of care

During stay

before discharge

ward based care

before d/c home

3 months post D/c

Question 5

Principles care

Answer 5

Continuity
Patient rehab care pathway

Reg r/b goals sort term & medium

Comm primary other healthcare settings
function reassess

Self directed rehab manual

Question 6

During Stay

Before d.c

Answer 6

Full clinic assess
determ rehab goal

commence asap

avoid further morbidity

Full reassess prior to d/c
Physical & psychological problems

Question 7

During ward based care

prior to d/c

Answer 7

Further reassess
MDT
Structured personalised rehab programme

ID psych issues
PTSD - & refer

Prior d/c

Functional assessment
physical psychological
can patient achieve ADL

Update goas/ referral network in place

Question 8

Post D?C

Answer 8

Review & reassess functional status

Assess progress
-achieving rehab goals?

Psychological counselling r/f prn