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Clinical Integrations 1 > Chapters 7-10 > Flashcards

Chapters 7-10 Flashcards

1
Q

Critical Illness Definition

A

-ICU acquired weakness (ICU-AW), critical illness polyneuropathy (CIP, CIPN), critical illness myopathy (CIM), Post-ICU Syndrome (PICS)
-Mechanical Ventilation: failure to wean
-Sepsis
-Multi-system organ dysfunction
-multi-trauma

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2
Q

CIP/CIM Pathogenesis

A

Circulatory, cellular level, and metabolic changes
-impaired oxygen delivery- total body microcirculatory issues
-impaired mitochondrial function- reduced ATP, energy production
-diaphragmatic weakness from ventilation (combined sedation)
-immobility- muscle wasting

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3
Q

Key Findings for CIP

A

-muscle weakness: often rapid onset, failure to wean from mechanical ventilation
-motor and sensory impairment: symmetrical, distal, and diaphragm more impacted than proximal

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4
Q

Key Findings for CIM

A

-muscle weakness: often rapid onset, failure to wean from mechanical ventilation
-motor and sensory impairment: symmetrical, motor only, proximal more than distal

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5
Q

Medical Management of CIP/CIM

A

-dx.: weaning difficulty, clinical presentation, imaging, labs, tissue studies
-prevention: blood glucose control, electrolyte and nutritional balance, accelerated ventilator weaning
-tx.: limited
-px.: not great (22% die in hospital, 33% die within 6 months), institutionalization, the younger the better

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6
Q

Critical Illness and PT

A

Prevent and Treat
-early rehab (in ICU- sedation must be controlled)
-focus on functional limitations, respiratory capacity, and cardiac reserve
-facilitate communication
-risk vs. benefit

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7
Q

Multiple Organ Dysfunction Syndrome (MODS) Definition

A

Progressive failure of more than 2 organ systems over 24 hours
**typically a complication of critical illness

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8
Q

Causes of MODS

A

-most commonly caused by sepsis, but infection not required
-also caused by ARDS, severe inflammatory processes, shock, and traumatic injury

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9
Q

MODS Clinical Presentation

A

-low grade fever
-tachycardia
-dyspnea
-systemic inflammatory response
-altered mental status
-lungs typically first organ to fail leading to ARDS
-followed by GI bacteremia, liver, and kidney failure
-ultimately CV collapse can occur

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10
Q

MODS Medical Management

A

-prevention and early detection
-pharmacologic: anti-biotics, inotropic agents
-supplemental oxygen and ventilation
-fluid replacement and nutritional support

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11
Q

MODS Prognosis

A

60-90% mortality approaching 100% with 3 or more organ involvement and sepsis plus >65 y/o

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12
Q

MODS PT Management

A

-usually only seen in critical care or a burn unit
-severe protein catabolism of skeletal muscle (lean body mass depleted, need skin precautions and skin care)
-risk often outweighs benefit
-very little in the literature about MODS

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13
Q

Symptoms assoc. w/ GABA (inhibitory)

A

-Sedative effects on brain, feelings of pleasure, calmness, sleepiness
-mood lability, impaired judgement/motor control/attn./memory, slurred speech, incoordination, unsteady gait, nystagmus, depressed reflexes, generalized muscle weakness

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14
Q

Symptoms assoc. w/ Glutamate (excitatory)

A

-excitement, energy
-restlessness, irritability, headache, insomnia, GI disturbances, muscle twitches, dyskinesia, dystonia, tachycardia/arrhythmia, enhanced pain perception, pupillary dilation, anxiety, BP and respiratory alterations

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15
Q

Withdrawal Symptoms

A

Hyperactive SNS, tachycardia, sweating, tremor, nausea/vomiting, hallucinations, anxiety, headache, marked fatigue, irritability, chills, diarrhea, insomnia, seizures, difficulty concentrating, depressed mood

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16
Q

Clinical Institute Withdrawal of Alcohol Scale (CIWA)

A

-monitor alcohol withdrawal symptoms
-score >0 = pt. is still detoxing, hold PT
-score =0 = PT intervention may be appropriate to address impairments

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17
Q

Clinical Presentation of Metabolic Acidosis

A

-Tachypnea, tachycardia, decreased appetite, weakness/muscle twitching, malaise, nausea & vomiting, diarrhea, headache
-severe cases: myocardial depression, hypotension, compensatory hyperventilation, stupor, unconsciousness, coma, death

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18
Q

Diabetic ketoacidosis

A

breath with fruity odor

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19
Q

Methanol Ingestion

A

Visual changes

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20
Q

Salicylate Overdose

A

Tinnitus and vertigo

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21
Q

Results of Chronic Metabolic Acidosis

A

-Protein catabolism: depletion of skeletal muscle, impaired strength, physical performance, cardio fitness, decreased bone integrity, peripheral tissues
-more rapid development of exertional fatigue in patients with comorbidities

22
Q

PT Implications for Metabolic Acidosis

A

Interventions facilitating adequate ventilation (freq. turning, coughing, and deep breathing exercises); pt. educ (combat fear of movement related to fatigue; exercise reduces fatigue); Wolf’s law (WB exercise for bone integrity)

23
Q

Pathogenesis of Metabolic Alkalosis: Phase 1

A

Generation phase: bicarbonate accumulates
-GI loss of acid via vomiting
-kidney- due to volume depletion, kidneys retain bicarbonate

24
Q

Pathogenesis of Metabolic Alkalosis: Part 2

A

Maintenance phase: kidneys do not effectively excrete excess bicarbonate
-volume contraction
-chloride depletion
-decreased glomerular filtration
-hypokalemia

25
Risk Factors for Metabolic Alkalosis
1. Acid loss: hypokalemia, diuretic therapy, steroids, vomiting, NG suctioning 2. Excessive HCO3 intake: peptic ulcer/GERD/excessive antacid use, overcorrection of acidosis, large blood volume transfusion 3. Excessive HCO3 resorption: hyperaldosteronism, Cushing disease
26
Medical Mgmt. of Metabolic Alkalosis
-treat the underlying cause -correct electrolyte imbalances: administer KCl, hypocalemia, hypocalcemia
27
Presentation of Metabolic Alkalosis
-Muscle weakness, irritability, restlessness, confusion, nausea & vomiting, diarrhea, muscle twitching -severe cases: seizures, hypotonia, cardiac arrhythmias, respiratory paralysis, comatose
28
Virus
sub-cellular organism made up of only a RNA or DNA covered with proteins ex.) influenza, herpes, hepatitis, some types of meningitis and pneumonia, cold
29
Bacteria
single-celled microorganism with well-defined cell walls that can grow independently on artificial media without the need for other cells ex.) stretococcus, staphylococcis, C-diff, E. Coli
30
Fungi
Single-celled or multicellular organism, any group of spore-producing organism feeding on organic matter ex.) yeast= thrush, diaper rash, athlete's foot
31
2 Forms of Fungi
1. True pathogen- causes infection in a healthy person 2. Opportunistic pathogen- causes infections in immunocompromised persons
32
Parasites
Organism that live on or in a host and gets its food from or at the expense of the host ex.) pinworms, trichomoniasis, toxoplasmosis, giardiasis, cryptospriodiosis, malaria
33
Prions
Infectious agent composed entirely of protein material that can fold in multiple structurally distinct ways leading to disease that is similar to viral infection ex.) Creutzfeldt-Jakob disease, "mad cow" disease (vCJD)
34
Sepsis
-life-threatening complication of infection occurring when the immune reaction to infection triggers an inflammatory response throughout the body -inflammation can trigger cascade of changes that damages multiple organ systems leading to failure
35
Healthcare-Acquired Infections (HAI)
Infection acquired in a hospital or other healthcare setting (E. coli, Staph Aureus, pseudomonas, candida albicans, enterococcus faecalis)
36
Common sites for HAI
Urinary tract, surgical wounds, joints, lower respiratory tract
37
Standard Precautions
Used for all patient care -hand hygiene -use PPE when expectation of possible exposure to infectious materials -properly handle and clean/disinfect pt. care equipment and devices properly -ensure healthcare worker safety including proper handling of needles and other sharps
38
Contact Precautions
direct or indirect contact with a patient and their environment including a person's room, objects in contact with the patient that has an infection with an organism transmitted fecal/orally (C. Diff), wound and skin infections, multidrug resistant bacteria (MRSA) **PPE: gloves & gown; mask & eye protection if contact with body secretions
39
Droplet Precautions
infections transmittable through air droplets by coughing, sneezing, talking, and close contact with an infected person's breathing (influenza) **PPE: surgical mask & eye protection
40
Airborne Precautions
required for a patient with anthrax, TB, measles, or other pathogens transmitted through air flow that are 5 micrometers or smaller **PPE: gloves, gown, approved N95 respirator mask properly fitted
41
5 Moments for Hand Hygiene
1. Before pt. contact 2. Before aseptic procedure 3. After body fluid exposure risk 4. After patient contact 5. After contact with patient environment
42
Stages of Sepsis
1. Sepsis 2. Severe Sepsis 3. Septic Shock
43
Sepsis Presentation
pt. must exhibit at least 2 of the following symptoms in addition to having confirmed infection or traumatic insult -body temp >101º F or below 96.8ºF -HR >90bpm -RR>20 breaths per minute
44
Severe Sepsis Presentation
exhibits at least one of the following s/s indicating possible organ failure -significant decreased urine output -abrupt mental status change -decreased platelet count -difficulty breathing -abnormal heart pumping function -abdominal pain
45
Septic Shock Presentation
pt. exhibits all s/s severe sepsis plus extreme hypotension that does not respond adequately to fluid resuscitation
46
Risk Factors for Sepsis
-advanced or very young age -immunocompromise, immunosuppression -hospitalization (ICU) -presence of wounds or injuries -presence of invasive devices -antibiotic-resistant bacteria -co-morbidities (COPD, CHF, DM, cancer, PNA, HAI)
47
Stages of HIV/AIDS
1. Acute Infection 2. Asymptomatic HIV 3. Symptomatic HIV disease 4. Acquired Immunodeficiency Syndrome (AIDS)
48
1. Acute Infection
-1-6 weeks after exposure -transient period of flu-like symptoms -viral load is increasing rapidly -antibody testing negative (seroconversion)
49
2. Asymptomatic HIV
-1-20 yrs. -CD4 count: >500 cells/mm3 -positive antibody test -clinically healthy (generalized lymphadenopathy)
50
3. Symptomatic HIV disease
-variable time frame -CD4 count: 200-500 cells/mm3 -neurologic symptoms (HIV encephalopathy) -lymphadenopathy -non-specific symptoms (diarrhea, weight loss, fatigue, fever, & night sweats)
51
4. Acquired Immunodeficiency Syndrome
-variable timeframe -CD4 count <200 cells/mm3 -increased risk of opportunistic infection (P. carinii pneumonia, CMV, malignancy), autoimmune condition, or malignancy

Clinical Integrations 1 (2 decks)

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