Bed, Rest, Deconditioning & Hospital Acquired Weakness: pt. 2 Flashcards
what is CIP
- critical illness polyneuropathy
- ICU neuropathy
- caused by prolonged ventilator dependence
what do u see with critical illness polyneuropathy
impaired neuromuscular system weakness decreased DTRs impaired pain temp/vibratory sense facial weakness CNs spared abnormal conduction studies
if CIP is present what should it raise a concern for
acute inflammatory demyelinating polyneurpoathy or traumatic neuropathies
what is critical illness myopathy (CIM)
profound weakness - proximal muscles
DTRs may be preserved or diminished
sensation in tact
overall reduction in force generation of unhealthy muscle fibers
CIPNM strength of muscle groups: what strength grade is shoulder abduction
5 = normal muscle strength/power
CIPNM strength of muscle groups: what strength grade is elbow flexion
4 = active movement against gravity with resistance
CIPNM strength of muscle groups: what strength grade is wrist extension
3 = active movement against gravity
CIPNM strength of muscle groups: what strength grade is hip flexion
2 = active movement with gravity eliminated
CIPNM strength of muscle groups: what strength grade is knee extension
1 = flicker/trace muscle contraction
CIPNM strength of muscle groups: what strength grade is ankle dorsiflexion
0 = no active muscle contraction
steroid induced myopathy occurs how
- acutely or from chronic glucocorticoid maintenance therapy
- steroids induce muscle catabolism and myocyte apoptosis –> atrophy of type 2 muscle fibers
which muscles are most affected with steroid induced myopathy
proximal muscles
who is at an increased risk with steroid induced myopathy
elderly
inactive
those with cancer
nutritional depletion
what worsens steroid induced myopathy
fasting and inactivity
can weakness improve with steroid induced myopathy
yes, when steroids are reduced but full recovery takes a long time
what is rhabdomyolysis and what does it involve
- muscle injury that involved myoglobinuria, electrolyte abnormalities and acute kidney injury
- injury to myocyte membrane that results in increased intracellular Ca+ concentrations
what is increased when you have rhabdo and what occurs do to that elevation
- elevated intracellular Ca+
- causes pathologic interaction of actin and myosin = muscle destruction and fiber necrosis
what is rhabdo associated with in the hospital
muscle compression
static positioning
what are common manifestations for rhabdo
myalgia pimenturia elevated CK acute renal failure muscle weakness
if u have ICU-acquired weakness, what can the PT do
- begin activities upon achieving medical stability to allow for increased vascular and oxygen demands of PT eval and treatment
what pulmonary measures would indicate a pt not ready for PT interventions: SaO2: RR: PEEP: FIO2:
- <88% or pt experiences a 10% oxygen desaturation below resting
- > 35 breaths/min
- > 10 cm H2O
- greater than or equal to 0.6
what lab values would indicate a pt not ready for PT interventions: HCT: HGB: platelets: platelets anticoag INR:
- <25% no exercise
- <8 g/dl no exercise
- <20,000 no exercise
- > 2.4-3.0 discuss with MD
what CV measures would indicate a pt not ready for PT interventions:
MAP:
resting HR:
systolic:
- <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
what metabolic measures would indicate a pt not ready for PT interventions:
glucose:
- <70 or >200
what is response dependent management
delivery of O2 must equate to the consumption of O2 by the body
what are the important respiratory/cardiac values for proceeding with interventions
FIO2
PEEP
MAP
PEEP
positive end expiratory pressure
pressure required to prevent alveolar collapse at end of expiration
range from 0-24 cm H2O
MAP
mean arterial pressure
measures amount of pressure required to maintain tissue perfusion
the ability to maintain hemodynamic stability determines what for PT
ability to treat and degree of pt interaction
what is the grip strength measure for men and women that would indicate ICU acquired weakness
men: < 11 kg
women: < 7 kg
what do u measure to determine ICU acquired weakness in pts
strength
DTRs
respiratory status
sensory status
what outcome measures are useful for early mobility
FIM PFIT FSS-ICU ACIF AM-PAC 6 CLICKS
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
