Bed, Rest, Deconditioning & Hospital Acquired Weakness: pt. 2 Flashcards

1
Q

what is CIP

A
  • critical illness polyneuropathy
  • ICU neuropathy
  • caused by prolonged ventilator dependence
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2
Q

what do u see with critical illness polyneuropathy

A
impaired neuromuscular system 
weakness
decreased DTRs
impaired pain
temp/vibratory sense
facial weakness
CNs spared
abnormal conduction studies
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3
Q

if CIP is present what should it raise a concern for

A

acute inflammatory demyelinating polyneurpoathy or traumatic neuropathies

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4
Q

what is critical illness myopathy (CIM)

A

profound weakness - proximal muscles
DTRs may be preserved or diminished
sensation in tact
overall reduction in force generation of unhealthy muscle fibers

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5
Q

CIPNM strength of muscle groups: what strength grade is shoulder abduction

A

5 = normal muscle strength/power

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6
Q

CIPNM strength of muscle groups: what strength grade is elbow flexion

A

4 = active movement against gravity with resistance

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7
Q

CIPNM strength of muscle groups: what strength grade is wrist extension

A

3 = active movement against gravity

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8
Q

CIPNM strength of muscle groups: what strength grade is hip flexion

A

2 = active movement with gravity eliminated

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9
Q

CIPNM strength of muscle groups: what strength grade is knee extension

A

1 = flicker/trace muscle contraction

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10
Q

CIPNM strength of muscle groups: what strength grade is ankle dorsiflexion

A

0 = no active muscle contraction

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11
Q

steroid induced myopathy occurs how

A
  • acutely or from chronic glucocorticoid maintenance therapy
  • steroids induce muscle catabolism and myocyte apoptosis –> atrophy of type 2 muscle fibers
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12
Q

which muscles are most affected with steroid induced myopathy

A

proximal muscles

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13
Q

who is at an increased risk with steroid induced myopathy

A

elderly
inactive
those with cancer
nutritional depletion

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14
Q

what worsens steroid induced myopathy

A

fasting and inactivity

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15
Q

can weakness improve with steroid induced myopathy

A

yes, when steroids are reduced but full recovery takes a long time

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16
Q

what is rhabdomyolysis and what does it involve

A
  • muscle injury that involved myoglobinuria, electrolyte abnormalities and acute kidney injury
  • injury to myocyte membrane that results in increased intracellular Ca+ concentrations
17
Q

what is increased when you have rhabdo and what occurs do to that elevation

A
  • elevated intracellular Ca+

- causes pathologic interaction of actin and myosin = muscle destruction and fiber necrosis

18
Q

what is rhabdo associated with in the hospital

A

muscle compression

static positioning

19
Q

what are common manifestations for rhabdo

A
myalgia
pimenturia 
elevated CK
acute renal failure
muscle weakness
20
Q

if u have ICU-acquired weakness, what can the PT do

A
  • begin activities upon achieving medical stability to allow for increased vascular and oxygen demands of PT eval and treatment
21
Q
what pulmonary measures would indicate a pt not ready for PT interventions:
SaO2: 
RR:
PEEP:
FIO2:
A
  • <88% or pt experiences a 10% oxygen desaturation below resting
  • > 35 breaths/min
  • > 10 cm H2O
  • greater than or equal to 0.6
22
Q
what lab values would indicate a pt not ready for PT interventions: 
HCT:
HGB:
platelets:
platelets anticoag INR:
A
  • <25% no exercise
  • <8 g/dl no exercise
  • <20,000 no exercise
  • > 2.4-3.0 discuss with MD
23
Q

what CV measures would indicate a pt not ready for PT interventions:
MAP:
resting HR:
systolic:

A
  • <65 or >120; OR greater than or equal to 10 lower than normal systolic or diastolic pressure for pt receiving renal dialysis
  • <50 or >140
  • <90 or >200
  • new arrhythmia developed
  • new onset angina-type chest pain
24
Q

what metabolic measures would indicate a pt not ready for PT interventions:
glucose:

A
  • <70 or >200
25
what is response dependent management
delivery of O2 must equate to the consumption of O2 by the body
26
what are the important respiratory/cardiac values for proceeding with interventions
FIO2 PEEP MAP
27
PEEP
positive end expiratory pressure pressure required to prevent alveolar collapse at end of expiration range from 0-24 cm H2O
28
MAP
mean arterial pressure | measures amount of pressure required to maintain tissue perfusion
29
the ability to maintain hemodynamic stability determines what for PT
ability to treat and degree of pt interaction
30
what is the grip strength measure for men and women that would indicate ICU acquired weakness
men: < 11 kg women: < 7 kg
31
what do u measure to determine ICU acquired weakness in pts
strength DTRs respiratory status sensory status
32
what outcome measures are useful for early mobility
``` FIM PFIT FSS-ICU ACIF AM-PAC 6 CLICKS ```
33
what activities do we measure for post acute care status
``` turning over in bed supine to sit bed to chair sit to stand walk in room 3-5 steps w rail ```