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Neuromanagment > Acute Care > Flashcards

Acute Care Flashcards

1
Q

What are lab values used for?

A
  • Used to screen or establish a diagnosis
  • Rule out a condition
  • Monitor therapies and medications
  • Establish prognosis
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2
Q

What will abnormal values be listed as?

A

L - low
H - high
C - critical

Most abnormal lab values do not contraindicate therapy but if there is a critical lab value then therapy is deferred

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3
Q

What is the CBC used for?

A 
WBC - white blood cell
RBC - red blood cell
Platelets
Hemocrit
Hemoglobin

CBC is used to screen for diseases, make diagnosis, or monitor medical treatments and effects of drug dosages

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4
Q

What are the normal ranges for hemoglobin?

A

Males: 13-18 g/dl
Females: 12-16 g/dl

If hemoglobin gets too low then it may result in heart failure or death (<5 g/dl). If hemoglobin gets too high then it can result in clogging or increased blood viscosity (>20 g/dl)

With hemoglobin levels between 8-10 g/dl, light exercise is appropriate

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5
Q

What do abnormal hemoglobin and hematocrit levels indicate?

A

Low hemoglobin and hemacrit = weakness, fatigue, tachycardia, dyspnea on exertion, heart palpitations, decreased exercise tolerance. Therapist needs to monitor vitals and rest breaks

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6
Q

What are the normal ranges for platelet counts?

A

150,000 - 400,000 /ul

20,000 - 50,000/ul = light AROM (no PROM), light activities of daily living, and ambulation
50,000/ul = resistive exercise ok
80,000-150,000 u/l = moderate resistive exercise

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7
Q

Where is sodium found in the body?

A

85% is in the blood and lymph fluid. Abnormal sodium values will cause cells to shrink or expand.

Determines fluid volume in body, facilitates nerve conduction, neuromuscular function, and glandular secretion

Hypernatremia: Swelling cells can lead to neurological dysfunction
Hyponatremia: low sodium level may be caused by increased levels of antidiuretic hormone, renal disease, congestive heart failure

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8
Q

Why is potassium important?

A
  • It is needed for neuromuscular function, action potentials, and cardiac muscle contraction and conductivity
  • It is controlled by the renal system and excreted in urine
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9
Q

What are normal potassium values?

A

3.5-5.0 mE1/l

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10
Q

What are normal sodium values?

A

135-145 mEq/l

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11
Q

What are normal carbon dioxide values?

A

20-29 mEq/l

Measure of CO2 in blood; used to evaluate pH level and electrolyte status

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12
Q

What are normal glucose levels?

A

70-110 mg/dl when fasting
110-200 mg/dl = prediabetes
> 126 mg/dl = diabetes

Defer therapy if pt is hypoglycemic and feed carbohydrates. Avoid exercising pts before mealtime and after

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13
Q

What are five core competencies of acute care?

A

Sound Clinical Decision Making > Safety > Skills > D/C Planning > Communication

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14
Q

What is clinical decision making?

A
  • Thinking about course of action and ability to anticipate outcome based on previous experience and knowledge of best practice
  • All behaviors, actions, and skills are guided by best evidence
  • Ability to adapt in medically complex/challenging environments
  • Foundation of all competencies

Examples:

1) Observe details of pt history, evaluation, and environment
2) Adjust intervention based on pt response
3) Predict level of improvement and participation restrictions or activity limitations

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15
Q

Discharge Planning Acute Rehab - Red Light

A

Red light:

  • Inability to participate
  • Unwillingness to participate
  • Poor rehabilitation potential
  • Dementia
  • Doesn’t need 2 therapy disciplines
  • Acute illness
  • Procedure or work up pending
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16
Q

Discharge Planning Acute Rehab - Yellow Light

A

Yellow light:

  • Possible poor rehabilitation potential
  • Mild dementia or chronic cognitive impairment
  • Unclear benefit for acute rehab as compared to sub-acute rehab
  • Unclear safe discharge plan
  • Insurance denial
  • Severe behavioral disorder
  • Not one of 13 impairment categories approved by CMS
17
Q

Discharge Planning Acute Rehab - Green Light

A

Medical necessity
- Able to tolerate 3 hours of therapy daily
- Able to actively participate
- Significant potential for improvement within 7-14 days
- Discharge plan
Diagnosis code

18
Q

What do you need to do before working with a pt in ICU that has lines or a catheter?

A
  • Make sure there are no contraindications
  • Ask nurse if line can be disconnected
  • If it accidentally comes out, apply pressure and tell nursing staff

Catheter

  • Always drain before moving
  • Clamp if put above bladder
19
Q

What do you need to do when working with a pt with a chest tube?

A
  • Make sure there are no contraindications and that pt can roll
  • Keep pleuravac upright
  • DC suction only if allowed by nursing
  • Mediastinal - CABG, pleural, pneumothorax (sunction keeps lungs inflated)
  • Keep drains compressed
20
Q

What do you need to do when working with someone that has a central line or pulmonary line?

A

Central Line
- Tunneled - 24 hr decreased activity at site of placement after surgical implant

Arteriral Access
- Pulmonary - watch PA pressure and watch transducer position to R atrium

21
Q

What should you be aware of when working with someone on a ventilator?

A
  • Note point of attachment and how secure it is
  • Watch vitals
  • Alarms
  • Neutral head position
22
Q

What is the neurologic criteria for someone to be on a ventilator?

A
  • Not comatose
  • Pt can respond to verbal stimulation
  • 3/5 correct response:
    Open/close eyes
    Look at me
    Open your mouth and put out your tongue
    Nod your head
    Raise your eyebrows when I have counted up to 5
23
Q

Why would you discontinue ICU treatment?

A
  • Oxygen saturation < 88%
  • Drop in MAP
  • HR greater than maximum heart rate (220-age/60-80%)
  • Change in heart rhythm
  • Increased accessory muscle use for breathing
  • Respiration rate increases to 20 breaths per minute above resting respirations
  • Extreme fatigue or pallor
  • Patient requesting to stop
24
Q

What are general goals for OT treatment in ICU?

A
  • Optimize pt sedation and analgesia practices to decrease delirium and permit physical rehabilitation while maintaining pt comfort: schedule time with RN for “sedation vacation”
  • Increase the frequency of OT/PT consultation to improve patients’ functional mobility in ICU
  • Modify standardized admission orders for default activity level from “bed rest” to “as tolerated”
  • Consult to physiatrist and neurologist
  • Maintain critical lines and airway
25
Q

What does early mobility in ICU mean for a patient?

A
  • Fewer days on ventilator
  • Fewer ICU LOS days
  • Fewer hospital LOS days
  • Faster return to more complete functional independence
26
Q

What is the difference between acute and chronic change in value?

A
  • With an acute change the body has less time to compensate so interventions need to be more conservative
27
Q

What should you do when a pt has abnormal lab values?

A

If lab value is outside of reference range, need to consider risk of intervention versus the benefit of increased mobility. Therefore, it is beneficial to consult medical team

28
Q

What is INR?

A
  • International normalized ratio
  • Used to determine adequacy of blood coagulation system - normal or prolonged time to clot
  • Therapeutic range 2-3 (up to 4.5 for recurrent embolism)

INR > 4: edge of bed, bed mobility, ROM, ankle pumps, no resistive exercise
INR > 5: hold exercise. Evaluate if appropriate to perform bed mobility and EOB
INR > 6: consider bed rest

29
Q

What is the complete blood count?

A
  • Components of all the formed elements of venous blood: WBC, RBC, Hgb and Hct
  • Evaluates the immune system and inflammatory responses, as well as bleeding
30
Q

What does an elevated Hct mean?

A

Increased Hct increases blood viscosity, which may limit blood flow to essential organs, such as brain, or increase likelihood of blood clots

31
Q

White blood cell count

A

< 5,000 with fever = no exercise but can do positioning/breathing techniques
> 5,000 = light exercise progressed to resistive exercise as patient tolerates

32
Q

Red blood cell count

A
  • Decreased RBC (anemia) - frequent rest breaks and monitor vital signs
  • Increased RBC (polycythemia) - consider holding due to increased risk of stroke or blood clot
33
Q

Hemoglobin

A

< 8 = no exercise but can do essential ADLs

8-10 =

34
Q

What does MAP stand for?

A

Mean Arterial Pressure

If less than 60 MAP do NOT treat patient

35
Q

What does potassium do?

A
  • Affects skeletal muscle function and nerve conduction, as well as rate and force of heart contraction

Do NOT do therapy if potassium is <2.8 or >5.1 because abnormal potassium levels could be sign of muscle spasms, arrhythmia, or could be life threatening

Neuromanagment (22 decks)

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