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Cardiopulm JD > Early Mobilization > Flashcards

Early Mobilization Flashcards

1
Q

Chronic critical illness patients are distinguished by a syndrome of significant, characteristic derangement of: (4)

A

Metabolism
Neuroendocrine
Neuropsychiatric
Immunologic function

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2
Q

Profound debilitation and continued multiple organ system dysfunction contributes to _____

A

PMV: prolonged mechanical ventilation

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3
Q

PMV is generally defined as….

A

The need for mechanical ventilation for LONGER THAN 21 DAYS

OR when the tracheostomy occurs (7-14 days)

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4
Q

Multiple risk factors for post ICU mortality include: (5)

A 
Age
Comorbidity
Severity of illness
Duration of ICU delirium
Sepsis
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5
Q

PICS is?

A

Post intensive care syndrome

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6
Q

PICS is the term used to describe the ________

A

Constellation of complications that endure past ICU stay

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7
Q

List 6 long term complications of ICU stay

A 
Pulmonary 
Neuromuscular
Physical Function
Psychiatric symptoms
Cognitive
QOL
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8
Q

Pulmonary long term complications include:

A

Diffusion capacity: generally mild but can persist for >5 years

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9
Q

Long term complications: Neuromuscular include:

A

CINM, disuse atrophy: can extend to over 5 years, CIP may recover more slowly than CIM

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10
Q

Long term complications: physical function:

A

ADL dysfunction: may be seen for 1-2 years

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11
Q

Long term complications: Psychiatric symptoms

A

Depression, PTSD, anxiety

Can persist for over 1 year

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12
Q

Long term complications: Cognitive

A

Impairments in memory, attention, executive function: residual effects for up to 6 years

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13
Q

Long term complications: QOL

A

Physical deficits

Improves over 1 year but can persist for over 5 years

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14
Q

ICU-AW stands for

A

Intensive care unit acquired weakness

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15
Q

_______ is clinically detected weakness in critically ill patients in whom there is no plausible etiology other than critical illness

A

ICU AW

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16
Q

ICU AW is further classified into _____, _____, or ______

A

Critical illness myopathy (CIM)
Critical illness polyneuropathy (CIP)
Critical illness neuromyopathy (CINM) Combo of CIP and CIM

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17
Q

Which one of these affects the nervous system? CIP, CIM?

A

CIP

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18
Q

CIM can be further sub-classified into what 3 categories?

A

Cachectic myopathy
Thick filament myopathy
Necrotizing myopathy

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19
Q

How do you distinguish between CIP and CIM?

A

Electrophysiological testing in involved tissues

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20
Q

What develops first? Myopathy or polyneuropathy?

A

Myopathy- earlier and more frequent

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21
Q

ICU AW is the presence of 1, 2, 5 ; and sometimes either 3 or 4. What are 1, 2 and 5?

A
  1. Weakness after onset of critical illness
  2. Weakness involves prox and distal muscles, symmetrical, flaccid and sparing the CNs. Limbs and resp. Muscles
  3. Cause of weakness NOT related to underlying critical illness
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22
Q

What can be used in place of MRC when looking at clinical features of ICU AW?

What are the values?

A

Hand dynamometry

<11 kg force for men
<7 kg force for women

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23
Q

Pathophysiologically important mechanisms for weakness include

A

Immobility
Local inflammation
Systemic inflammation

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24
Q

What causes pro-inflammatory during critical illness?

A

Cytokines shift
Increased production of reactive O2 species
Decrease in anti-oxidative defenses

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25
Q

True or false: disuse atrophy and ICU AW are the same?

A

False

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26
Q

Patients with ICU AW will demonstrate weakness ________ to detectable muscle wasting

A

PRIOR

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27
Q

Disuse atrophy can demonstrate muscle atrophy and loss of muscle strength by how much percent in the first week?

A

5%

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28
Q

What is associated with SPECIFIC structural and metabolic changes in muscle?

A

Disuse atrophy

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29
Q

There is a general shift from _____ fibers to ______ fibers with disuse atrophy

A

Slow twitch to fast twitch

30
Q

What is the term that describes the adverse effects on multiple aspects of diaphragmatic structure and function after CMV?

A

Ventilator induced diaphragmatic dysfunction (VIDD)

31
Q

As few as ____hours of CMV can result in diaphragmatic atrophy

A

6-18 hours

32
Q

_______ will also decrease diaphragm strength by oxidative stress (reactive oxygen species ROS)

A

Hyperglycemia

33
Q

Hyperglycemia decreases _____ which is one of the key proteins involved in regulation of cross bridge cycling

A

Troponin T

34
Q

Increased ________, decreased ________, and increased ________ causes the muscle atrophy

A

Increased proteolysis
Decreased protein synthesis
Increased apoptosis

35
Q

Hypermetabolic stresses of critical illness with result in significant ______ loss in the form of ______

A

Protein loss

Amino acids

36
Q

Muscle exhibits a syndrome of _________ where it is unable to use the supply of AA available

A

Anabolic resistance

37
Q

Critically ill patients commonly receive less than ___% of their goal nutritional intake during their ICU stay

38
Q

Bioenergetic failure is reduced ____________ and ATP formation leads to _________ and increased ________

A

Reduced glucose uptake
Mitochondrial dysfunction
Free radial production

39
Q

Muscle atrophy occurs with approximately a ____% decrease in muscle fiber area per day with the greatest atrophy in the contractile myosin filaments and relative preservation of other structural proteins.

The muscle protein loss can approach _____% per day

40
Q

ICU AW will affect the ____ and _____ muscles and space the _____ muscles

A

Limb
Trunk/respiratory

Facial

41
Q

name some risk factors for ICU AW

A 
Sepsis
Multi organ failure
Muscle immob
HYPERglycemia
Corticosteroids
Neuromuscular blockers
Increased duration or SIRS (systemic inflammatory response syndrome)
Mechanical vent for greater than 1 week
42
Q

Recognized brain dysfunction complicating critical illness and constitutes a major challenge to ICU practioners

43
Q

Characterized by acute disturbances of consciousness accompanied by:
Inattention
Disorganized thinking
Perceptual disturbances that fluctuate over a short period of time

44
Q

Delirium is an important factor in ______time even with light sedation

A

Ventilation

45
Q

Three types of delirium:

A

Hypoactive: lethargy and inattenton
Hyperactive: agitated and combative
Mixed

46
Q

What does the ABCDE Bundle of Optimal Management consist of?

A

Awakening and Breathing trial coordination
Choice of sedatives
Daily delirium monitoring
Early mobility and Exercise

47
Q

Positions that reduce dyspnea:

A

Upright
Lean forward
Fixation of arms

48
Q

What is the OPTIMAL position to reduce dyspnea:

A

Sitting and leaning forward with the arms resting on the thighs

49
Q

Sitting and leaning forward for COPD patients ______ intra abdominal pressure, causing the curvature of the diaphragm to ______

A

Increases

Increase

50
Q

Fixing the arms ______ the load on the diaphragm

51
Q

Safe exercise parameters for HR

A

Between 40-130 bpm

52
Q

Safe exercise parameters for RR

A

Between 5-40 b/min

53
Q

Safe exercise parameters for SPO2

54
Q

Safe exercise parameters for MAP

A

Between 65-110 mmHg

55
Q

Safe exercise parameters for SBP

56
Q

Safe exercise parameters for RPE

A

Between 10 and 15

57
Q

Should you do activity with development of arrythmia, angina, or complaint of distress or fatigue?

58
Q

Green circle means:

A

Low risk of adverse event

59
Q

Yellow triangle means:

A

Potential risk and consequences of an adverse event are higher than green, but may be outweighed by the potential benefits of mobilization

60
Q

What does a red octagon mean?

A

Significant potential risk or consequences of an adverse effect

61
Q

If percutaneous oxygen saturation is <90%, then….

A

NO OUT OF BED EXERCISES

62
Q

Graded mobilization program: Phase 1

Description:

A

CANNOT FOLLOW SIMPLE DAMANDS

63
Q

Graded mobilization program: Phase 1

Treatment suggestions

A

PROM, sitting in chair

3x/day for 20 min

64
Q

Graded mobilization program: Phase 1

Criteria for next phase

A

Able to follow simple commands

65
Q

Graded mobilization program: Phase 2

Description

A

Follow simple commands, requires max assistance to stand or unable to stand

66
Q

Graded mobilization program: Phase 2

Treatment suggestions

A

AA/AROM UE and LE
Bed mobility
Assisted sitting balance activities
Mobile leg press

67
Q

Graded mobilization program: Phase 2

Criteria for next phase

A

Requires min-mod assistance to stand and can support majority of BW

68
Q

Graded mobilization program: Phase 3

Description

A

Still weak
Requires min to mod assistance
Can support majority or BW

69
Q

Graded mobilization program: Phase 3

Treatment suggestions

A

Progress standing with hydraulic assist platform walker
Transfer training to chair
Preaumbulation training with walker
Gait training

70
Q

Graded mobilization program: Phase 3

Criteria for next phase

A

Requires min assist to ambulate >10 ft with a walker

71
Q

Graded mobilization program: Phase 4

Description

A

Able to transfer and ambulate >10 ft with a walker and min or no assistance

72
Q

Graded mobilization program: Phase 4

Treatment suggestions

A

Progressive walking and gait training
High level balance activities
Endurance
Start HEP

Cardiopulm JD (12 decks)

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