ICU

Question 1

Telemetry is

Answer 1

remote monitoring of vital signs. The monitor will show at least one view of the electrocardiogram (EKG) with the heart rate, respiratory rate, the oxygen saturation (SpO2), and blood pressure

the monitor may also display the output of any other measuring devices attached to the patient, like arterial line blood pressure, pulmonary artery pressure (Table 9.3), intracranial pressure, and electroencephalogram leads

Question 1

Hemodynamic monitoring refers to

Answer 1

monitoring the functioning of the cardiovascular system. At its most basic, it is the monitoring of blood pressure and heart rate, but it may also include levels of fluid input and output, mental status, and the internal pressures and efficacy of the heart. In general, the more invasive and extensive measures taken for monitoring a patient, the more tenuous the cardiovascular status.

Question 2

Normal blood pressure ranges from

Answer 2

90 to 160 mm Hg systolic and 60 to 80 mm Hg diastolic.

Question 3

Systolic blood pressure is the

Answer 3

highest pressure of blood flow within arterial vessels that occurs during the contraction of the ventricles of the heart.

Question 4

Diastolic blood pressure is the

Answer 4

lowest pressure within arterial vessels during a ventricular cycle.

Question 5

The National Guideline Clearinghouse (n.d.-b) recommends involving rapid response team intervention for blood pressures

Answer 5

80 mm Hg or 180 mm Hg systolic and 100 mm Hg diastolic

Question 6

Orthostatic measurements are taken

Answer 6

while supine, then sitting, and last while standing at 1- and 3-minute intervals.

Question 7

A patient is considered to be orthostatic when there is

Answer 7

a drop in systolic blood pressure of 20 mm Hg, a drop in diastolic blood pressure of 10 mm Hg, or a heart rate increase of at least 20 bpm

Question 8

mean arterial pressure (MAP),

Answer 8

a measurement of the average pressure in the major arteries. It is an in- dicator of the heart’s ability to perfuse the body’s tissues, particularly organs

Question 9

Closely monitoring heart rate during therapy interventions is critical in the ICU. Normal resting heart rates are between

Answer 9

60 and 100 bpm

Question 10

What numerically is considered bradycardia, or a slow heart rate.

Answer 10

<60 bpm

Question 11

What numerically is tachycardia, or a rapid heart rate

Answer 11

A resting heart rate 100 bpm

Question 12

The clinical indicators for initiating rapid response team intervention is a heart rate

Answer 12

40 or 160, or a heart rate 140 with symptoms

Question 13

What are the symptoms that would require rapid response team intervention

Answer 13

Symptoms might include palpitations, dizziness, chest pain, shortness of breath, diaphoresis, or altered mental status.

Question 14

Cerebral perfusion pressure (CPP) is an

Answer 14

indirect measure of cerebral tissue perfusion.

Question 15

What numeric cerebral perfusion pressure (CPP) is associated with poor outcomes in patients with traumatic brain injury?

Answer 15

50 mm Hg or 70 mm Hg

Question 16

Inter cranial pressure (ICP)

Answer 16

is the amount of pressure within the cranium.

Question 17

A typical inter cranial pressure (ICP) goal is

Answer 17

20 mm Hg to 25 mm Hg (Kirkman & Smith, 2014 Zoerle et al., 2015), but the parameters may be notably different for TBI or acute hemorrhagic or ischemic stroke

Question 18

Yankauer

Answer 18

used to suction excess oral secretions

Question 19

Temporary external pacemakers are most commonly found in patients after heart surgery. Why?

Answer 19

help keep the heart rate stable

Question 20

Sepsis is a

Answer 20

systemic inflammatory response to infection.

Question 21

Secondary injury is

Answer 21

damage to the brain structures that occurs after the primary injury.

Question 22

Examples of secondary injury causes are

Answer 22

brain tissue edema, increased ICP, seizure activity, impaired airway protection and hypotensive episodes, all of which may result in decreased oxygenation or decreased perfusion of brain tissue.

Question 23

ICU-acquired weakness (ICU–AW) is defined by the American Thoracic Society (2014) as

Answer 23

generalized limb weakness developed during critical illness for which there is no explanation except the critical illness itself.

Question 24

General assessments in ICU

Answer 24

Vital signs before, during, and after the session ■■ Cognition and vision ■■ ROM ■ Basic ADLs.

Question 25

Additional assessments that may be encountered in the ICU include cognition, delirium, and pain assessments designed to be used with critical care patients and cognitively compromised patients.

Answer 25

Glasglow coma scale
JFK coma scale
Richmond agitation sedation scale (RASS)
behavioral pain scale
Critical- Care Pain Observation Tool (CCPOT )

Question 26

Setting short-term goals for occupational therapy with patients in the ICU may require

Answer 26

a focus on minute improvements to demonstrate progress. Critically ill patients may be too impaired to set short-term ADL goals for toilet transfers and lower body dressing. ICU goals instead may focus on components of tasks and cognitive skills rather than the whole task itself.

Question 27

Treatment planning for successful and effective interventions requires practitioners to

Answer 27

facilitate increases in skills using various meaningful activities to promote progress toward patient goals. The ICU includes the additional challenge of negotiating the physiological and psychological barriers to patient participation while under- going intense medical treatment for critical illness. Working with the team of clinicians in ICU ensures success in selecting appropriate challenges for the patient.

Question 28

Initially, daily treatments can consist of

Answer 28

active assisted and active ROM exercises, orthostatic stress challenges, and assisted participation in basic ADLs like hand or face washing and oral care.

Question 29

clinical issues seen in ICU

Answer 29

Muscle weakness
Longer use of mechanical ventilation
Longer hospital stay
Lower independent functioning
Cognitive impairments
Depression
Sensory deprivation
Decreased QOL

Question 30

Why would there be more cognitive issues in ICU

Answer 30

Light on all the time, noises that disrupt sleep, sickness, sepsis causes confusion, sensory deprivation - not sure when it’s day or night.

Question 31

Why is depression on the rise in ICU

Answer 31

sensory deprivation and overstimulation, not sure if it’s day or night.

Question 32

What are the consequences of immobility

Answer 32

The musculoskeletal system - deconditioning
Cardiovascular system
Respiratory system
Metabolic system
Integumentary system
Neuropsychology system
Gastrointestinal system

Question 33

ICU Psychosis

Answer 33

Greater risk when on mechanical ventilation
Advanced age
Pre-existing cognitive issues
Pain
Sepsis
Multiorgan involvement
Prolonged immobilization
Hypoxemia
Polypharmacy
Metabolic disorders

Question 34

Progression protocol for OT activities in the ICU

Answer 34

Level I: Bed positioning

Level II: Upright positioning

Level III: Upright positioning, OOB, seated

Level IV: Upright functional mobility

Question 35

Level 1 activities in ICU

Answer 35

Bed Positioning
Sitting with legs supported geri chair or bed
Bilateral arm & leg exercises as tolerated
Upper body ADLs

Question 36

What would progress from Level 1 to level 2

Answer 36

Vitals stable in chair for 30 min
Vitals stable with exercises of 5 min
Pain is controlled
Pt. follows commands
Pt. attends to tasks & interacts with staff
Pt. moves anti gravity or gravity eliminated arms & legs 2/5

Question 37

Level 2 activities and interventions

Answer 37

Upright, dangle feet EOB
Vision/perception, tracking tasks
Multisensory experience, orientation, & cognition tasks
Support sleep-wake cycles & routines,
Relaxation strategies

Question 38

how would a level 2 patient progress to level 3

Answer 38

Vitals are stable
Pain is controlled in sitting
Hemodynamic stability
Pt. sustains quad set for 5 seconds
If yes-have pt. stand @ EOB with walker or lift
Complete weight shifts, sides steps without knee buckling. Marches in place

Question 39

Level 3 activities in ICU

Answer 39

Upright OOB & seated in chair
Transfer to bedside chair, commode for toileting to progress to seated & sustained ADL tasks & functional transfers

Question 40

What would progress from level 3 to level 4?

Answer 40

Stable vitals with activity at chair level
Absence of persistent dizziness
Absence of knee buckling or other safety concerns

Question 41

Level 4 in ICU

Answer 41

Upright functional mobility
In room mobility related to ADLs
Occupation based cognition
Mobility & transfers related to self care
Safety emphasis
Energy conservation

Question 42

How would you progress from level 4?

Answer 42

Progress as tolerated

Question 43

Assessments in ICU

Answer 43

Genrally
vital
cognition and vision but simply from observation
A/PROM - not goniometry unless a fracture.
basic ADLs

Standardized
glasgow coma scale
intensive care delirium screening checklist
the confusion assessment method for the ICU
The behavioral pain scale