Critical Care Flashcards
Systems based approach to assessment on Critical care/ICU:
DATA BASE SUBJECTIVE (General Observation) RESPIRATORY SYSTEM: Airway Breathing CVS: Circulation CNS: Disability RENAL SYSTEM MSK: Exposure Bloods
Information gathering and general observation helps to establish:
Indications and contraindications to physiotherapy
Need to be assessing:
before/during and after any intervention to:
- To Establish if the patient has got a physiotherapy related problem
- To Determine if the patient is stable enough for selected treatment
- To Identify any deterioration and ensure appropriate action: always document next to patient to ensure no adverse change in condition and if so manage appropriately.
In database we look for:
PC/HPC/PMH/DH/SH and subjective questions/information from Notes/Staff
In subjective we assess for:
Emotional status/symptoms/pain/fatigue/specific problems
Some information can be ascertained from the nursing staff: 1) Ask nursing staff how the patient is today 2) What has happened since the last PT treatment 3)Are there any limitations to movement/handling (lines, IABP, high SCI) 4) What are the physiological parameters the medical team are working towards (Obs)
In RESPIRATORY SYSTEM we assess for
Airway & Breathing:
- Mode of ventilation/method of delivery/(ETT/Tracheostomy/Facemask) ventilator settings/oxygen delivered/mode of delivery and use of any home oxygen
(LTOT-Long Term Oxygen Therapy)/SP02/RR/ABGS/CXR/
- Previous pulmonary function tests
- Auscultation / palpation/ cough/ sputum/breathlessness/cyanosis/work and pattern of breathing Chest wall shape and expansion
In CVS we assess for:
Circulation:
- HR/Rhythm/BP and MAP/CVP/temperature/invasive cardiac monitoring (pacemaker, defibrillator)
- Ensure vigilance for signs of deterioration/loss of stability: pre, during and post treatment
In CNS we assess for:
Disability:
- Level of consciousness AVPU or GCS. Common causes of unconsciousness include profound hypoxia, hypercapnia, cerebral hypoperfusion, or the recent administration of sedatives or analgesic drugs
- Sedation score (RAS score- see over page*) if sedated (kidney failure more sedated)
- Pain score & route of analgesia- oral or intravenous (IV)
- Intra Cranial Pressure (ICP): ICP bolts?
In RENAL SYSTEM we assess for:
- Fluid input: Infusions N.B.be aware of what the drugs do as they may affect treatment options
- Fluid Output: NGTube/drains/Urine
Renal results E.G. Urea and Creatinine levels in the blood: kidneys maintain the blood creatinine and urea levels within a normal range therefore Urea and creatinine are therefore good indicators of a normal functioning kidney and an increase in the blood are indications of kidney dysfunction.
In MSK we assess for:
Exposure:
- Muscle charting/grading.
- Bony injury/fixation: #, orthopaedic surgery
- Be mindful of Skin condition: refer to tissue viability nurses
- Ex tolerance & any limitation E.G due to an injury: Is ex tol RE. MSK or C/R (O2 levels and reserve)
- Baseline i.e. PMH that may result in functional limitations /use of aids
In Bloods we assess for:
- Any other relevant Blood tests E.G. C-Reactive Protein (CRP) and White Cell Count (WCC) for signs of inflammation or infection. CRP is an acute phase reactant, a protein made by the liver that is released into the blood within a few hours after tissue injury, the start of an infection or other inflammation
- Liver function
- Clotting, i.e. platelet level and clotting times: mobilisation consideration RE: risk of bleed
General Observation includes:
- Face/colour/expression: hypoxemic (pale, clammy, cyanosis), hypercapnic, pain (facial expression)
- Position/posture/comfort
- Equipment/Attachments/drip/drains
- Skin/wounds
- Peripheries/oedema/cyanosis: unveil clothes to check, pitting oedema?, oedema - are they urinating
Common monitoring equipment in ITU includes:
- ECG (Electrocardiogram)
- Central Venous Pressure catheter (CVP)/Central lines/Jugular Venous Pressure (JVP) lines
- Arterial line (A-Line)
- Saturation Probes
- Swan Ganz Catheter/Pulmonary artery catheter
- ICP Bolts
- Intra-Aortic balloon pumps (IABP)
- Continuous Veno-Venous hemofiltration (CVVH)
- External-Ventricular Drain (EVD)
(Ventilator)
ECG measures:
Measures heart rate and rhythm. Normal values HR 50-100bpm. <50bpm (bradycardic), >100bpm (tachycardic). Always look at the HR and Rhythm before commencing treatment to establish a baseline (warning signs)
HR and rhythm are affected by:
- Physiotherapy: suctioning causes arrythmias
- Hypoxia: ischaemia of heart
- Electrolyte imbalance: seen as fluid imbalance
- Myocardial ischaemia
- Anxiety: ITU environment/treatment may cause tachycardia.