8B: Lines and ICU Flashcards
What are the precautions for a wound vacuum?
- Mobilization depends on the location
- LE or foot can be a contraindication for movement
- Carry vac if you can move patient
What are the three types of surgical drains?
- Jackson-Pratt
- Hemovac
- Penrose Drain
What is the function of a surgical drain?
Drain excess blood and fluid from inside
What are precautions for a surgical drain?
- Keep drain gravity dependent
- Do not kink lines
- Watch for active bleeding
What are the precautions for surgical fixation?
- Check with MD
- Stabilize area to prevent pain during mobility
- WB restrictions
- Static positioning for best comfort
What is the use of an osetomy bad?
- Intestinal draining
- Surgical removal or intestine, poor motility, improper ability to remove waste
What are the two most common types of osteomy bag?
Colostomy and Ileostomy
What are two types of osteomy bags that are not as common?
Urostomy and nephrostomy
What are precautions for an osteomy bag?
- Do not kink or pull down
- Watch positioning to not put pressure on it
What is a PCA pump?
Patient Controlled Anesesthia - used after surgery or trauma so pt can dose their own pain medication
How is a PCA pump regulated?
There is a max amount that can be dosed per hour
What are PCA pump precautions?
- Battery or plugged in
- Have pt dose themselves prior to PT
- Leave within pt’s reach after session
What are the CVP effects of bed rest?
- Loss of fluid volume
- Higher DVT risk
- Decreased lung volumes
- Increased V/Q mismatch
- Stasis of pulmonary fluids or sputum
What are the MSK effects of bed rest?
- Atrophy and weakness
- Muscle fiber changes
- Postural changes
- Decreased bone density
What are the effects of bed rest on the kidneys?
Increased stress can lead to renal insufficiency
What are additional effects of bed rest?
- Increased insulin resistance
- Urine stasis
- Skin issues
- Decreased GI motility
- Decreased reflexes
- Sleep disturbances
- Mood changes
- Reduced immunity
Do CVP or MSK changes happen more quickly and why?
CVP declines at a faster rate - aerobic capacity decreases faster than muscle and is slower to recover after bed rest stopped
What at the CVP effects of mobilization?
- Increase V/Q matching
- Regulate RR and depth
- Tolerance to upright
- Increase circulation
- Decrease venous stasis
What is the progression for mobilization?
- Elevating HOB
- Sitting EBO
- Standing
- OOB to chair
- Amb
- Stairs and exercise
What should you monitor with mobility?
HR, BP, RR, O2, EKG - watch for signs of intolerance
What are three factors that impact mobilization?
- Lines and tubes
- Level of assistance needed
- Aerobic capacity, weakness, prolonged hospitalization
What are the steps of enironmental management?
- Document pt status
- Set up environment
- Arrange lines and tubes
- Move pt
- Leave pt and document status
What are sub-max tests that can be done in the acute setting?
30 STS, 5x STS, step test, TUG, SPPB
What are the appropriate vitals to initiate exercise?
HR < 120
BP < 200/100
O2 > 90
What are the appropriate vital responses to exercise?
- HR increased 20-30
- SBP increase 20-30
- DBP increase 5-10
- O2 at least 90
What is the intensity of exercise in acute care indicated by RPE?
10-12
