Acute Care Special Conditions

Question 1

For every day spent in the hospital, it takes ____ days for a patient to recover

Answer 1

3

Question 2

For every day spent in critical care, it takes ____ days to recover

Answer 2

5 to 7

Question 3

With longer stays, ____ develops

Answer 3

ICU delirum

A state of extreme confusion, fatigue, anxiety, and hallucinations as a result of the stress endured by the patient during a critical care stay (can lead to long-term depression and post-traumatic stress disorder)

Question 4

____ is a frequent and long-lasting complication of survivors of critical illness

Answer 4

Functional disability

• Older patients and patients who survive respiratory and/or circulatory failure
• Often face neuromuscular and neuropsychological difficulties

Question 5

Among patients who require prolonged mechanical ventilation, up to ____ have functional limitations after discharge from the hospital

Answer 5

65%

Question 6

One study found that mechanically ventilated patients who received early mobilization were almost ____ as likely to have died or been re-hospitalized a year later

Answer 6

half

Question 7

physical and occupational therapy initiated at the inception of respiratory failure was associated with fewer days on mechanical ventilation and a near ____ of functional independence at hospital discharge (8)

Answer 7

doubling

Question 8

Early progressive mobility is not only safe and feasible, but also associated with decreased ____, ICU acquired pneumonias, number of days on a ventilator, ICU induced delirium, and cost of care

Answer 8

hospital length of stay

Question 9

What two things are early progressive mobility associated with?

Answer 9

Improvements in functional outcomes and quality of lifes

Question 10

Early mobilization appears to decrease the incidence of ICU-acquired weakness, improve the functional capacity, and increase the number of ventilator-free days and the discharged-to-home rate for patients with a critical illness in the ____ setting

Answer 10

ICU

Question 11

____ for the ICUto provide the best accuracy for making a timely recommendation for discharge home in patients who had an ICU admission

Answer 11

Functional Status Score

• Consists of 5 functional tasks (rolling, supine to sit, sit to stand, sitting on edge of bed, and walking)
• Each task is scored from 0-7 (with total score of 0-35)
• A Functional Status Score at ICU discharge (discharge from ICU to the floor) of 19 or higher predicted discharge to home with a sensitivity of 82.9% and specificity of 73.6%

Question 12

When should PT intervene in the ICU?

Answer 12

Question 13

Potential body/structure effects of criticall illness

Answer 13

Question 14

____ = ICU-Acquired Weakness = profound weakness greater than might be expected to result from prolonged bedrest and accompanied by dysfunction of multiple organ systems

Answer 14

• ICU-Acquired Weakness = profound weakness greater than might be expected to result from prolonged bedrest and accompanied by dysfunction of multiple organ systems
• Activity limitations can persist months to years after hospitalization

Question 15

When to begin PT in the ICU

Answer 15

starting physical rehabilitation as soon as they have sufficient medical stability to accommodate the increased vascular and oxygen demands that accompany the physical examination and intervention

Question 16

Parameters indicating a lack of readiness for physical therapy interventions in the critical care setting

Answer 16

Question 17

Physical Rehabilitation ICU-Acquired Weakness
Outcome Measurement Approaches

Answer 17

Question 18

Physical Function Intensive Care Test (PFIT)

Answer 18

Includes 5 items:
* Amount of assistance for sit-to-stand transfers
* Strength for shoulder flexion
* Strength for knee extension
* Marching in place
* Upper extremity endurance (arm elevation to 90 degrees of shoulder flexion)

Scores Range from:
* 0 (able to perform strength testing only with a maximal score of 2/5 for shoulder and knee) to 10 (performance without any difficulty)

Provides an objective measure of endurance in addition to typical strength and functional assessments

Specific to ICU as these pts can’t do 6 MWT

Question 19

Richmond Agitation Sedation Scale

Answer 19

+2 to -2 are ideal for PT

Question 20

Physical therapy intervention techniques

Answer 20

Question 21

Critical Care Physical Therapy Session

Answer 21

Requires a systematic approach:
* Notify nursing staff when entering and leaving
* Examine patient vital signs and ventilator settings
* Scan environment systematically; visually following lines and tubes from beginning to end
– Ask questions / check with nursing staff if unsure
* Visualize the mobility activity
– Set up the environment to minimize stress to the patient and having to move / rearrange lines during the activity (create slack for lines / hold in one hand)
– Get help if needed
* Keep the patient informed and monitor responses
* Inspect all lines, tubes, safety devices, and monitors before leaving

Ask patients if they have had PT before. Explain PTs role in recovery.