Acute Care - Textbook CH19 Flashcards
how does an acute care stay affect patients
physical, cognitive, and emotional functioning
those in the ICU typically have to use what forms of medication
vasoactive medications
sedatives
circulatory assist devices
mechanical ventilation
define acute cardiopulmonary conditions
disease states where the pt’s oxygen transport system fails to meet immediate demands placed on it
for those with low-level functional mobility, how can an acute care stay affect them
loss of muscle strength and endurance is much more significant
– can be the difference between going home or nursing home
what are the airway clearance techniques
postural drainage
percussion
vibration
cough techniques
manual hyperinflation
airway suctioning
when should airway clearance be done? timing wise
at least 30 min after end of meal/feeding
explain how medications relate to airway clearance interventions
if pt takes pain medication, should take before
inhaled bronchodilators prior
inhaled antibiotics post-treatment
what can be used as discharge criteria for patients receiving airway clearance treatments
their independent ability to perform airway clearance
if postural drainage is used exclusively, how long should the treatments be
5-10 min, or longer if tolerated
what are signs of postural drainage intolerance
increased SOB
anxiety
nausea
dizziness
hypertension
bronchospasm
relative contraindications of postural drainage
increased ICP
hemodynamic instability
esophageal anastomosis
spinal fusion/trauma
head trauma
diaphragmatic hernia
eye surgery
relative contraindications for percussion and vibration
hemoptysis
untreated tension pneumothorax
low platelet count
hemodynamic instability
PE
subcutaneous emphysema
thoracic skin injury
when is vibration preferred over percussion
acutely ill patients with chest wall discomfort/pain
if retained secretions go untreated, what can occur
atelectasis
hypoxemia
pneumonia
respiratory failure
what makes an effective cough
1 - pt position that allows for trunk extension/flexion
2 - inspiratory phase maximization via verbal cues, positioning, arm movements
3- improvement of inspiratory holds
4 - intrathoracic/intraabdominal pressure maximization with muscle contraction
5 - pt oriented to respective timing and trunk movement for expulsion
what is the ACB
active cycle of breathing
series of maneuvers completed by the patient to emphasize secretion clearance and thoracic expansion
explain what breathing control consists of during ACB
diaphragmatic breathing at normal tidal volume for 5-10 sec
explain thoracic expansion exercises in ACB treatments
in a postural drainage position
pt performs deep inhalation with relaxed exhalation at vital capacity range
inhalation can be coupled with or without percussion on exhalation
what is the purpose of intermittent positive pressure ventilation
to aid inspiration
what does maximal insufflation-exsufflation eliminate the need for? what is the scale in which it normally ranges between
eliminates the need for deep airway suctioning
+35 to +65 cmH2O —— -35 to -60 cmH2O
for those with ARDS, what is the best position for airway clearance? why?
prone
greater volumes of ventilation
increased PaO2
what can be used to engage the diaphragm
sniffing
what can be used to increase thoracic mobility
towel roll vertically down t-spine in supine to increase anterior chest wall mobility
side-lying over towel roll to increase lateral chest wall mobility
can have UE movement in each position to further expand chest wall
what pt populations is counter-rotation effective for
those with impaired cognitive function
those unable to follow verbal cues
those with high muscular tone
explain the dichotomy of an inspiratory muscle training program
either strength or endurance
what value is associated with inspiratory muscle wekaness
max inspiratory pressure below 60 cmH2O
explain role of incentive spirometer
to practice diaphragmatic breathing
to prevent reverse atelectasis
to stimulate a cough
**** ultimately will replenish surfactant
explain the dosage related to incentive spirometry
slow, relaxed, deep breathing exercises with it 10x every hour
what is the RASS? what is its scale?
richmond agitation sedation scale
+4 to -3
will be taken prior to administering the confusion assessment method in the ICU (CAM-ICU)
what is the CAM-ICU used for
assess patient’s delirium
Level 1 Cardiac Rehabilitation Exercise HR guidelines
20-30 bpm above resting
– unless taking b-blockers, then use RPE and dyspnea scale
on a borg RPE scale, what level should warmup and cool down be at?
what is the equivalent of this number?
9-11 with peak activity being below 13
RPE level of 12-14 = 60% of max HR
RPE level of 16 = 85%
explain duration of exercise during stage 1 cardiac rehab
begin with intermittent bouts of 3-5 min
aim for 2:1 exercise-rest ratio
what is end duration goal of cardiac rehab phase 1
duration of walking time to 30-45 minutes
frequency of phase 1 cardiac rehabilitation
2-3x a day for 6-7x a week
aerobic recommendations for those with HF
– frequency
– intensity
– duration
3-5x a week
60-80% of HRR / RPE 11-14 out of 20
progressively increased to 30 upto 60min
resistance recommendations for those with HF
– frequency
– intensity
– duration
– mode
1-2 nonconsecutive days a week
40% 1RM for UE / 50% 1RM for LE
2 sets of 10-15 reps for every major muscle group
machines = loss of strength/balance
flexibility recommendations for those with HF
– frequency
– intensity
– duration
2-3x a week
to point of tightness
10-30 sec hold for static, 2-4 reps each
