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2) Cardiopulm > 7) Early Mobilization > Flashcards

7) Early Mobilization Flashcards

1
Q

Safe HR range for exercise:

A

40-130BPM

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2
Q

Safe RR range for exercise

A

5-40 breaths/min

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3
Q

Safe SpO2 range for exercise

A

> 88%

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4
Q

Safe MAP range for exercise

A

65-110mmHg

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5
Q

Safe systolic BP range for exercise

A

<200mmHg

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6
Q

Safe RPE range for exercise

A

10-15

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7
Q

When should you not have a pt exercise?

A

If they devo arrhythmia, angina, or complaints of fatigue

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8
Q

PMV

A

Need for mechanical ventilation for >3wks

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9
Q

Risk factors for PMV

A
  • Age
  • Comorbidity
  • Illness severity
  • Sepsis
  • Duration of ICU delirium
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10
Q

Post-ICU Syndrome

A

Decline in physical, cognitive, or mental status that continues after ICU d/c

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11
Q

Long-term complications associated w/PICS:

A
  • Physical dysfxn
  • Neuromuscular dysfxn
  • Pulmonary dysfxn
  • Cognitive decline
  • Psychiatric decline
  • Decr QOL
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12
Q

Is there a recognized rehab protocol for PICS?

A

No

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13
Q

What is ICU-associated weakness

A

Clinically detected weakness in critically ill pt’s where there’s no cause other than critical illness

*Refers to bilateral, generalized, & diffuse muscle weakness

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14
Q

Types of ICU-AW

A
  • Critical Illness Myopathy (CIM)
  • Critical Illness Polyneuropathy (CIP)
  • Critical Illness Neuromyopathy (CINM)
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15
Q

What needs to be addressed w/ICU-AW?

A

Pt’s fxnl weaknesses

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16
Q

Which type of ICU-AW devos later & less frequently but is associated w/long ICU stays?

A

CIP

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17
Q

Clinical Features of ICU-AW

A

1) Weakness devo after onset of critical illness
2) Weakness involving proximal & distal muscles, limbs, & respiratory muscles
3) Spares CN’s
4) MRC score <48/60
5) Dependency on vent
6) Weakness is not related to any underlying critical illness

*Need to have 1,2, & 6, &/or 4 & 5

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18
Q

What are important mechanisms for ICU-AW-associated weakness & why?

A

Immobility & inflammation–>Shift of pro-inflammatory cytokines during critical illness leads to incr systemic infection which causes further muscle damage

*This combined w/production of reactive O2 species (ROS) w/incr anti-oxidative defenses causes further disruption between muscle synthesis & proteolysis

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19
Q

True or false: Pt’s w/ICU-AW have weakness before there’s detectable muscle wasting

A

True

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20
Q

How much of a decrease in strength can ICU-AW pt’s see in the first week?

A

40% decrease

21
Q

How much of a decrease in strength can pt’s w/disuse atrophy see in the first week?

A

5% decrease

22
Q

What is disuse atrophy associated with?

A

Structural & metabolic changes of muscle:

  * Net loss of muscle mass &amp; CSMA
  * Decr contractile strength
  * Shift from slow twitch to fast twitch fibers
23
Q

Complications associated w/ICU-AW & VIDD

A
  • Incr time on a vent
  • Muscle weakness ranging from mild to paralysis
  • Adverse effects to the diaphragm
  • Hypoglycemia
  • Muscle Atrophy
  • Muscle fiber shift to type 2
  • Protein loss & malnutrition
  • Anabolic resistance
24
Q

VIDD

A

Ventilator Induced Diaphragmatic Dysfunction

25
Q

What can hypoglycemia cause & why?

A

Decr diaphragmatic strength bc of oxidative stress & decr troponin

26
Q

Risk factors for ICU-AW

A
  • Vent >7days
  • Sepsis
  • Multi Organ Failure
  • Hyperglycemia
  • Systemic Inflammatory Response Syndrome
  • Corticosteroid Use
  • Neuromuscular blockers
  • Muscle immobilization
27
Q

What is prolonged mechanical ventilation associated w/?

A
  • Incr oxidative stress
  • Oxidative modifications to diaphragmatic proteins
  • Upregulation of autophagic system
  • Activation of proteolytic pathways
  • Muscle atrophy
28
Q

Delirium

A

Brain dysfxn characterized by acute disturbance of consciousness w/inattention, disorganized thinking, & perceptual disturbances that fluctuate over a short period of time

29
Q

Hypoactive Delirium

A

Lethargy & inattention

30
Q

Hyperactive Delirium

A

Agitated & combative

31
Q

Mixed Delirium

32
Q

What does delirium do to critical illness?

A

Complicates it

33
Q

What percentage of vented ICU pt’s get delirium?

34
Q

What effect does delirium have on pt’s even after d/c?

A
  • Prolonged neurocognitive impairments
  • Poor fxnl status
  • Incr rate of LTC facility entry
  • Decr QOL
35
Q

What positions decr dyspnea & why does this work?

A

Upright & leaning forward w/arms on thighs

*Incr intra-abdominal pressure, which incr the curvature of the diaphragm, so it optimizes the diaphragm’s MA & its ability to generate pressure

36
Q

What is ICU exercise prescription based on?

A
  • Analysis of factors that contribute to impaired O2 transport
  • Hierarchy of body positions
37
Q

Implications for ICU exercise prescription

A
  • Incorporate active movement w/body changes
  • Extremes of body positioning have great benefit
  • Upright mobilization incr TV, RR, flow rates, mucocilliary transport, A/W clearance, & cough effectiveness
38
Q

How many PT’s will be needed for prone positioning of ICU pt’s?

A

Probably >1

39
Q

Protocols for exercise in the ICU

A
  • Bedside cycling improves MMT, 6MWT, & QOL
  • Incr strength=Decr vent time
  • Program should be 6wks
  • Start w/ROM progressing to positions progressing to amb
  • Do bed mobility progressed to transfers & standing
  • Do deep breathing
  • Tx the whole body
  • UBE
  • NMES
  • IMT
  • ECT
40
Q

What is a safe HR range?

41
Q

What is a safe RR range?

42
Q

What is a safe SpO2 range?

43
Q

What is a safe MAP range?

A

65-110mmHg

44
Q

What is a safe SBP range?

45
Q

What is a safe range for RPE?

46
Q

When should you not have a pt do activities?

A

W/devo of:

 * Arrhythmia
 * Angina
 * Complaints of fatigue
47
Q

If a pt devos arrhythmia, angina, or complains of fatigue, should you exercise them?

48
Q

ICU-AW

A

ICU-Associated Weakness

49
Q

What does upright mobilization incr?

A
  • Tidal Volume
  • RR
  • Flow rate
  • Mucocilliary Transport
  • A/W Clearance
  • Cough Effectiveness

2) Cardiopulm (16 decks)

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