ICU

Question 1

healthy person loses ___-___% of strength a day while in bed rest

Answer 1

4-5%

Question 2

Bed rest can lead to?

Answer 2

decrease strength
disuse muscle atrophy
insulin resistance
microvascular dysfunction

Question 3

insulin resistance and microvascular dysfunction occurs after _____ days in healthy subjects

Answer 3

5

Question 4

what are some barriers to ICU rehab?

Answer 4

Pts too sick

Pts too sedated

Pts too delirious

PT/OT under prescribed in ICU

Equipment limits mobility

Limited staff

Question 5

what are some problems associated with ICU stay that can occurs as early as 4-7 days post-mechanical ventilation

Answer 5

Critical illness polyneuropathy
Critical illness myopathy
Combination of both

Question 6

what is Critical Illness Polyneuropathy
(CIP)?

Answer 6

Weakness
Reduced DTRs
Impaired: pain, temperature, vibratory sense
Cranial nerves spared
Facial weakness is common

Question 7

what is critical illness myopathy? (CIM)

Answer 7

Profound weakness: especially of proximal muscles

DTRs preserved or diminished

Sensation is intact

Question 8

what is Post-intensive care syndrome
(PICS)?

Answer 8

Long term consequences of ICU

Reduced ability to perform ADLs

Reduced capacity for ambulation
up to 5 yrs post ICU (6 MWT)

Depression

Posttraumatic stress syndrome

Anxiety

Question 9

pt can have reduced capacity of ambulation that last up to _____ years?

Answer 9

5

Question 10

to minimize risk in ICU, what should be done?

Answer 10

Minimize sedation

Early mobility

Question 11

PT interventions for ICU pts include?

Answer 11

Strength training
Range of motion/joint mobility
Endurance training
Postural re-training
Balance activities
Optimizing ventilation/ secretion clearance
Progressive mobility/ functional activities

Question 12

what are examples of progressive mobility?

Answer 12

Continuous lateral rotational therapy

HOB elevation/ chair position

Bed A/PROM cycle

Tilt table/ tilt bed

Dangling

OOB to chair

Ambulation

Question 13

pt should be turned every?

Answer 13

2 hours

Question 14

intensity should be _____-___% of age predicted max HR and if it isn’t reliable then use the ____ scale with a range of ____-____

Answer 14

60-80%
Borg
3-5

Question 15

no exercise if resp rate is

Answer 15

> 35 BPM

Question 16

no exercise if oxygen saturation is below

Answer 16

88%

Question 17

no exercise if MAP is ________ or ______ mm Hg

Answer 17

120

Question 18

no exercise if SBP is ________ or _______ mm Hg

Answer 18

200

Question 19

glucose needs to be above ____ but below _____

Answer 19

70

200

Question 20

what are the steps to mobilize ICU pts?

Answer 20

Look at Baseline Vitals

Locate all, wires, tubes, etc.

Move IV pole and lines to the side you are
getting up on
usually towards the vent

Assist patient to sitting at the side of the bed
make sure that all lines are accounted for and have enough slack

Question 21

stop or modify treatment if?

Answer 21

Drop in O2 sats below 88% which is persistent despite increased FiO2
Significant increased work of breathing/accessory muscle use
Evidence of hemodynamic instability
↓BP/MAP
 Change in EKG rhythm
Chest pain
HR greater than age predicted max
Increased resp rate >20 bpm over resting
Pt reports significant pain or fatigue
Patient requests to stop