Acute care outcome measures/ICU meds

Question 1

AM-PAC

Answer 1

• activity measure for post-acute care AKA 6 clicks
• different forms
• BAsic mobility: PT
• physical activity - OT
• applied Cognition -SLP/nursing

Question 2

Physical Function ICU test

Answer 2

• gross assessment that can be used as an outcome measure
• measures assistance, cadence, shoulder strength and knee strength

Question 3

Richmon agitation sedation scale

Answer 3

• RASS scale
• used to measure how aware the patient is and ability to mobilize the patient
• want the patient to be alert and calm (0 score)

Question 4

Confusion assessment method of the ICU (CAM-ICU) flow sheet

Answer 4

• measures delirium (hallucination state)
• measures consciousness/delirium to mobilize
• Infections can cause delirium

Question 5

Common meds in the ICU

Ativan, Versed, Propofol, Ketamine

Answer 5

• heavy sedatives

Question 6

Common ICU meds

Fentanyl, morphine, hydromorphone

Answer 6

• Analgesias/narcotic meds

Question 7

Common ICU meds

Digitialis, mirinone, amiodorone, epinephrine, doputamine

Answer 7

• (+) inotropes used in heart failure to maintain pumping action
• help contractility

Question 8

common ICU meds

Epinephrine, norepinephrine, dopamine, doputamine

Answer 8

• vasopressors (pressors)
• powerful drugs that induce vasoconstriction to increase BP and MAP
• needs systemic vasoconstriction to get BP where it should be

Question 9

Mechanical ventilation types

Answer 9

• Oral pharyngeal tube
• nasal pharyngeal tube
• oral endotracheal tube
• tracheostomy (long term)

Question 10

Goals of mechanical ventilation

Answer 10

• decrease the work of breathing
• relief of respiratory distress symtpoms
• rest fatigued respiratory muscles
• stabilize ABGs
• improve alveolar ventilation and systemic oxygenation

Question 11

Indications for mechanical ventilation

Answer 11

• bradypnea/apnea
• tachypnea
• hypoxemia
• hypercapnia
• poor VC, respiratory muscle fatigue

Question 12

Negative pressure ventilators

Answer 12

• consiter (iron lung)
• used to treat polio
• suction container that allows chest expansion/gravity is removed from the equation
• lungs can work without resistance

Question 13

positive pressure ventilators

Answer 13

• push air into the lungs

Question 14

CPAP

Answer 14

• continuous postive airway pressure
• restrictive disorders
• provide pressure to prevent the tongue from dropping back/soft palate

Question 15

How do positive pressure ventilators work

Answer 15

• piston creates pressure
• pushes air into lungs
• when lungs reach full capacity = elastic recoil and air comes out
• control the pressure as they exhale to keep oxygen in the lung
• passes through lime soda due to making it basic since they are expiring a lot of acid
• mostly a closed system with O2 attached

Question 16

Mechanical ventilator controls/Monitors

Answer 16

• respiratory rate
• tidal volume
• FIO2: fraction of inspired oxygen
• inspiratory flow rate
• inspiratory/expiratory ratio
• PEEP (postive end expiratory pressure)

Question 17

Modes of ventilators

CMV

Answer 17

• contiuous mandatory ventilation:
• both pressure and volume varibales are controlled by vent

Question 18

modes of ventilators

assist control

Answer 18

• assist control: can be volume assist or pressure assist
• patient can have some breathing response but the machine assists
• machine controls the volume or pressure reguardless of patient effort (maintained constant)

Question 19

Modes of ventilation

• SIMV:

Answer 19

• synchronous intermittent mandatory ventilation
• triggered by patient breaths
• used for weaning
• patient breathes with the machine
• machine is triggered by patients breath
• may have spontaneous breaths but the SIMV will make sure they get what is mandatory

Question 20

Modes of ventilation

CPAP

Answer 20

• PEEP only

Question 21

Alarms

Answer 21

• alarm parameters are typicall set for patient in a resting state
• position changes, activity, coughing, suctioning, patient agitation, apnea, exercise may trigger alarm
• oxgygen/system failure alarm
• pressure alarms
• volume alarms

Question 22

weaning

Answer 22

• usually achieved in 70-80% of patients
• no intiatied until patient can maintain alveolar ventilation without vent support without excessive work of breathing
• spontaneous breathing trials aide in determing readiness
• can see how they do on SIMV also

Question 23

Risks assoicated with mechanical ventilation/long term ICU stay

Answer 23

• ventilator-assoicated pneumnia
• abnormal cough because of lack of glottal closure/imparied mucocollary transport
• laryngotracheal injury/vocal cord immobility (tube passes this area)
• respiratory muscle weakness and fatigue
• cogntive impairments

Question 24

Risks/posssible complications

for patients on a vent

Answer 24

• orthostatic hypotension
• DVT
• contractures and integumentary breakdown
• critical illness neuromyopathy
• ICU acquired weakness
• PTSD
• tracheal narrowing/stenosis (balloon that opens it up)
• vent induced lung injury: barotrauma, volutrauma

Question 25

PT interventions for ICU patients

Answer 25

• Communication stratgies
• proper positioning/posture
• airway clearance technique
• inspiratory and accessory muscle strengthening
• stretching/ROM/strength/Functional mobility
• prescribe devices - abdominal binders, LE compression wraps, wheelchairs, splints