Acute Care

Question 1

Who is in the PICU? What are they at risk for?

Answer 1

• Intense close monitoring of critically ill or injured children.

• At risk for:
– respiratory, neuro, CV failure 
– post-op 
– mechanical vent 
– multi-system organ failure 
– acute trauma

Question 2

What is the role of a PT in the PICU?

Answer 2

– Positioning
– Mobility
– Stimulation

Question 3

True of false: TBI is the most common cause of

traumatic death in children and adults

Answer 3

True

Question 4

Shaken baby syndrome

Answer 4

most often in infants up to

one year, with infants aged two to four months being most at risk

Question 5

What are the categories of a GCS for kids?

Answer 5

Eye opening
Verbal responses
Motor response

Question 6

What are the ranges a kid could score on a GCS? Which is good?

Answer 6

Higher is better

15-3

Question 7

True or False: Treating kids with TBI is, in some ways, easier because they’re attracted to all toys

Answer 7

FALSE you could really freak them out if you over stimulate them

Question 8

What should be documented as a child progresses out of a coma?

Answer 8

– Generalized/specific responses
– Movement: purposeful, spontaneous, random
– Communication status: +/- following commands
– If the child is agitated, what
increases/decreases agitation?

Question 9

What are some factors that affect final prognosis of a child with TBI?

Answer 9

Age, mechanism of injury, co-traumas/ insults, and extent of injuries

Question 10

Very young and pre-school-aged children
have ________ mortality and long-term disability
outcomes.

Answer 10

Poorest

Question 11

The GCS motor component is a better predictor of _____________ at 72 hours after injury

Answer 11

functional outcomes and future disability

Question 12

What are 3 factors that may prevent a child from OOB clearance

Answer 12

• WB-ing status
• Neuro concerns
• Intracranial pressure

Question 13

True or false: Mobility usually returns before cognition and

judgment

Answer 13

True

Question 14

ORGAN TRANSPLANT?! Damn it, Jim. I’m a PT, not a general surgeon.
What can physical therapists do for patients?

Answer 14

• help children maintain optimal level of pre-operative function.
• Counteract the sequelae of post-operative immunosuppression

**star trek reference

Question 15

Who are PTs more involved with, patients getting a heart or lung transplant?

Answer 15

Heart

Question 16

True or false: PT is recommended before surgery in pulmonary lung transplant candidates

Answer 16

False: PT is contraindicated until after surgery in

pulmonary lung transplant candidates

Question 17

PT should ALWAYS be able to view EKG

monitor and note stress changes such as:

Answer 17

• Circumoral cyanosis/other changes
• Diaphoresis
• Decreased verbalization
• Change in respiratory pattern

Question 18

What is the goal of Pre-transplant PT?

Answer 18

To maintain optimal condition and function

as tolerated by child

Question 19

Why is positioning important?

Answer 19

• Optimize respiration
• Facilitate symmetry
• Normalize tone
• Encourage behavioral organization

Question 20

True or false: Don’t teach patient deep breathing, assisted coughing techniques until after surgery because it won’t be the same.

Answer 20

Teach patient deep breathing, assisted coughing techniques to increase post-op function and comfort after surgery.

Question 21

What are you monitoring for with Aerobic Activity?

Answer 21

– Fatigue
– Dizziness
– SOB
– Changes in mental status
– Arrhythmias (increased HR/”pounding”)
– 10% decrease in SaO2

Question 22

PT interventions change with change in

status secondary to:

Answer 22

– New meds 
– Seizure activity 
– Fluid balance problems 
– Behavioral changes 
– Cardiac changes 
– Changes in coagulation times

Question 23

OH NO! My patient’s central line broke! What do I do?

Answer 23

Clamp between the break and the child

Question 24

OH NO! My patient’s central line is dislodged! What do I do?

Answer 24

Place child on their left side with head lower than feet

Question 25

The goals of acute care PT treatment should…

Answer 25

– Be the focus of intervention
– Include concerns of patient, family, and team
– Basic conditioning over functional goals

Question 26

What are some post op precautions ?

Answer 26

– Immunosuppression secondary to meds

– Proper PPE (personal protections equipment)
• Child should wear mask when not in isolation room

– All equipment in child’s room should be disinfected

– If child goes to gym→ no other children in area

Question 27

True or false: after a heart transplant, patients need to warm up and cool down longer during treatment

Answer 27

True

Following surgery, the heart is denervated, so there is a blunted HR response with increased activity.
– This means that although the heart still stretches from increased blood flow and circulating catecholamines from the sympathoadrenal system, children need prolonged warm-up and cool-down for mechanisms to take effect.6
• Monitor BP, SaO2
(>95%) and HR (no more than
50% age-predicted HR)

Question 28

What is level I Nursery in the NICU?

Answer 28

Routine nursing care

Question 29

What is level II nursery in the NICU?

Answer 29

Specialized care
• Short-term mechanical ventilation
• Monitoring
• Some interventions

Question 30

What is level III nursery in the NICU?

Answer 30

Highly equipped for smallest, sickest infants

Question 31

What brings a baby to the NICU?

Answer 31

– Premature infants
– SGA < 10% for gestational age 
– LGA >90% for gestational age 
– Hypoxic ischemic encephalopathy (HIE)
– Compromised respiratory status 
– Persistent feeding problems 
– Seizure disorders 
– Amniotic band syndrome
– Myelomeningecele 
– Genetic syndromes

Question 32

What is Amniotic band syndrome?

Answer 32

Intrauterine development of amniotic stands leading to digital amputations/constrictions/other
restrictions

Question 33

What are some future complications of premature birth?

Answer 33

– Visual impairments
– Sensorineural hearing loss
– Learning disabilities
– ADHD

Question 34

___ is the most prevalent

developmental disability secondary to premature birth

Answer 34

CP

Question 35

Interventricular hemorrhage are present in ___% born before 32 weeks or with a birth weight <1500
grams

Answer 35

35-50

Question 36

What is periventricular leukomalacia?

Answer 36

Ischemic infarct of white matter near lateral ventricles→almost
always found in premies that
later go on to develop CP

Question 37

What are the benefits of ECMO?

Answer 37

• High frequency ventilation
• Modified heart-lung machine
• Allows lungs to nearly completely rest (up to 10 days)
and heal in some cases

Question 38

What are some possible complications with ECMO?

Answer 38

• Seizures
• IVH
• Cortical atrophy
• Muscle tone abnormalities
• Feeding difficulties and other problems

Question 39

True or false: medications have signficant side

effects, including but not limited to decrease in total cerebral tissue volume

Answer 39

True