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CardioResp > (3) ICU Assessment & Treatment > Flashcards

(3) ICU Assessment & Treatment Flashcards

1
Q

What are the sequential organ failure assessment score and APACHE II used for?

A
  • identify ICU patients
  • determine risk of acuity and mortality risk
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2
Q

What is the SOFA used for?

A

looks at extent of sepsis related organ failure/function

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3
Q

What areas does the SOFA cover?

A
  • resp
  • coagulation
  • liver
  • neuro
  • cvs
  • renal
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4
Q

What would we want to know from the nurses prior to seeing a patient?

A
  • How is patient + updates
  • any important events
  • suctioning?
  • patient coughing (productive?)
  • pain?
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5
Q

What should be observed in the environment with the patient?

A
  • patient in bed
  • mode & method ventilation
  • drains, lines, wires & attachments
  • evidence of sc evidence
  • level of consciousness
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6
Q

What is involved in Ax in an ICU patient?

A
  • Airway
  • Breathing
  • Circulation
  • Disability
  • Exposure
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7
Q

What is investigated in Airway Ax?

A
  • are they maintaining their own airway
  • do they need an artificial airway
  • invasive or NIV
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8
Q

What is involved in respiratory objective Ax?

A
  • mode ventilation
  • SpO2/FiO2
  • ABG & CxR
  • Auscultation & Palpation
  • chest drains
  • cough & sputum
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9
Q

What is involved in non-invasive ventilation objective Ax?

A
  • Bipap or Cpap
  • interface
  • pressure & volume
  • FiO2
  • ABGs
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10
Q

What is involved in mechanical ventilation objective Ax?

A
  • mode
  • airway
  • level of support
  • pressure & volumes
  • FiO2
  • Nitric Oxide
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11
Q

What is involved in Ax of a patients cough?

A
  • strong or weak
  • moist or dry
  • effective or ineffective
  • sputum
  • any haemoptysis
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12
Q

What are individuals with a peak flow cough of <270L/min at risk of?

A

secretion retention and need manual or mechanical assistance to avoid serious complications

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12
Q

What are the 3 phases of the cough?

A
  1. Inspiratory phase
  2. Compressive phase
  3. Expiration phase
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13
Q

What is the function of the nasopharynx?

A

humidification

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14
Q

What happens following impaired humidification?

A

slow cilia activity and impair mucous clearance

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15
Q

How can humidification be improved in a patient?

A
  • Puritan cold water humidifier
  • Heat and moisture exchanger
  • saline nebs
  • saline instillation
  • overall hydration levels
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16
Q

What is looked out for in a CXR?

A
  • Airways
  • Bones
  • Cardiac shadow
  • diaphragms
  • exposure & expansion
  • lung fields
  • gastric bubbles
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17
Q

What is hypernea?

A

normal rate, but deeper respirations

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18
Q

What is the aim of chest drains?

A
  • provide method of removing air and fluid substances from pleural space
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19
Q

What is checked to assess a patients circulation?

A
  • HR (rate & rhythm)
  • BP (MAP)
  • Temp
  • Urine output
  • Fluid balance
20
Q

What is used to improve blood pressure?

A
  • Noradrenaline
  • adrenaline
  • vasopressin
  • dobutamine
  • GTN
21
Q

What medication is used to control heart rate?

A

beta blockers

22
Q

What is a pulmonary artery catheter used for?

A
  • diagnostic purposes
  • detects HF/Sepsis
  • monitor therapy
  • evaluate effect of drugs
23
Q

What does a low body temperature indicate?

A

body may be in shock

24
Q

What does a high body temperature indicate?

A

sign of infection

25
Q

How does the renal function contribute to maintenance of pH?

A
  • removes products of metabolic breakdown
  • maintain electrolyte balance
  • maintain fluid balance
26
Q

What is the central venous pressure (CVP) and what does it tell us?

A
  • pressure within the right atrium
  • info on body volume status and right ventricular function
27
Q

What is involved in Ax to determine disability in a patient?

A
  • Position
  • GCS
  • Richmond agitation-sedation scale
  • full neuro Ax
  • mobility
  • transfers
28
Q

What are the two ends of the Richmond agitation-sedation scale?

A
  • +4 Combative
  • -5 Unarousable
29
Q

What is said about transfers/mobility in guidelines?

A
  • early, individualised Ax with repetition on regular basis
  • reviewed over duration rehab
  • ROM, transfers and mobility N.B as able
30
Q

What is the Chelsea Critical Care Physical Ax Tool?

A
  • well validated in ICU
  • includes cough and resp function
  • daily Ax
31
Q

What does the Post Intensive Care Syndrome (PICS) involve?

A
  • Physical (intensive care acquired weakness)
  • Cognitive (fatigue, memory)
  • Psychological (anxiety, depression)
  • Socioeconomic and family
32
Q

What is investigated in bloods?

A
  • haemoglobin
  • infection markers
  • clotting
33
Q

What are extra attachments the patient may have?

A
  • epidural
  • stoma bag
  • wound drains
34
Q

What are treatment options available for a physio in an ICU setting (8)?

A
  • positioning
  • manual techniques
  • manual hyperinflation
  • mechanical hyperinflation
  • suction
  • active exercise
  • NIV
  • cough assist machine
35
Q

What are the benefits of positioning?

A
  • improve function inspiratory muscles
  • postural drainage
  • reduce O2 consumption
  • optimise V/Q
  • facilitate chest wall movement
  • side lying (bad lung up)
36
Q

What are the best and worst positions for patients?

A
  • standing & high sitting best for V/Q optimisation
  • supine and head tilt the worst
37
Q

What ROM is aimed for in patients in ICU?

A
  • Passive better than nothing
  • shoulder and hips to minimum 90 degrees
  • particular attention to TAs
  • move all major joints
  • check for areas of increased pressure
38
Q

What is manual hyperinflation?

A
  • also known as “bagging”
  • increase TV and expiratory flow
  • same physiology ACBT
39
Q

What are contraindications of manual hyperinflation?

A
  • High PEEP
  • ARDS
  • Raised ICP
40
Q

What is ventilator hyperinflation?

A
  • aka “mechanical ventilation”
  • manipulate inspiratory rise time to create exp flow bias
  • manipulates PC/PS/VT as appropriate to improve TV
41
Q

What are the effects of mechanical ventilation on secretion clearance (7)?

A
  • Airflow Bias Alterations
  • Sedation
  • decreased cough
  • reduced FRC
  • diaphragmatic atrophy
  • loss inspiratory muscle tone
  • gas trapping behind closed airways
42
Q

When is an endotracheal tube (ETT) used?

A
  • alters generation pressure
  • damage to epithelium
  • decreased cilia activity
43
Q

What is the physio role in secretion clearance (5)?

A
  • ACBT
  • mobilise and exercise
  • manual techniques
  • humidification
  • postural drainage
44
Q

What is the physio role in volume loss (5)?

A
  • controlled mobilisation
  • positioning
  • NIV
  • VHI
  • incentive spirometry
45
Q

What is the physio role in increased WOB (3)?

A
  • breathing control
  • positioning
  • ventilatory support
46
Q

What are guidelines for rehab in the ICU?

A

-ESICM guidelines
- NICE guidelines on critical care rehab

47
Q

What are examples of rehab/exercise a physio can perform with a patient in ICU (6)?

A
  • tilt table
  • standing frame
  • rollator frame
  • mobilising on ventilators etc
  • axillary balloon pump
  • mobilising on Bipap/NIV

CardioResp (9 decks)

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