Acute Care Flashcards
What are lab values used for?
- Used to screen or establish a diagnosis
- Rule out a condition
- Monitor therapies and medications
- Establish prognosis
What will abnormal values be listed as?
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
What is the CBC used for?
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
What are the normal ranges for hemoglobin?
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
What do abnormal hemoglobin and hematocrit levels indicate?
Low hemoglobin and hemacrit = weakness, fatigue, tachycardia, dyspnea on exertion, heart palpitations, decreased exercise tolerance. Therapist needs to monitor vitals and rest breaks
What are the normal ranges for platelet counts?
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
Where is sodium found in the body?
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
Why is potassium important?
- 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
What are normal potassium values?
3.5-5.0 mE1/l
What are normal sodium values?
135-145 mEq/l
What are normal carbon dioxide values?
20-29 mEq/l
Measure of CO2 in blood; used to evaluate pH level and electrolyte status
What are normal glucose levels?
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
What are five core competencies of acute care?
Sound Clinical Decision Making > Safety > Skills > D/C Planning > Communication
What is clinical decision making?
- 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
Discharge Planning Acute Rehab - Red Light
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
Discharge Planning Acute Rehab - Yellow Light
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
Discharge Planning Acute Rehab - Green Light
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
What do you need to do before working with a pt in ICU that has lines or a catheter?
- 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
What do you need to do when working with a pt with a chest tube?
- 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
What do you need to do when working with someone that has a central line or pulmonary line?
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
What should you be aware of when working with someone on a ventilator?
- Note point of attachment and how secure it is
- Watch vitals
- Alarms
- Neutral head position
What is the neurologic criteria for someone to be on a ventilator?
- 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
Why would you discontinue ICU treatment?
- 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
What are general goals for OT treatment in ICU?
- 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
