ICU Assessment Pt. 2 Flashcards
Why do we care about electrolyte levels in patients
- Kidney function
- Cardiac function
- Nerve conduction
- Neurological status
Role of Potassium
Maintains membrane polarization (intracellular excitation) of muscle and nerve cells
Low Potassium =
High potassium =
Low: Decreased excitation in cells - depressed cardiac activity, arrhythmias, weakness including resp muscles, decreased sensation/vomiting/nausea, fatigue
High: INcrease excitation in cells - cardiac arrhythmias/arrest, diarrhea and vomiting, confusion
What does sodium do
Controls extracellular excitation and is sensitive to fluid shift. It regulate blood volume, osmotic equilibrium and pH
Low Sodium =
High sodium =
Low: Confusion, headaches, seizures, decreased blood volume/BP, swelling, pulmonary and pleural effusion, nausea and vomiting
High: Thirst, fatigue, headaches, confusion, muscle spasm and weakness, seizures and coma, thickening of secretions, tachycardia
Role of magnesium
Plays role in over 300 metabolic reactions in your body. One of its most important functions = muscle relaxation
High magnesium =
low magnesium =
High: Muscles are too relaxed, therefore low BP/HR, abnormal heart rhythms and asystole, muscle weakness, impaired breathing and respirations
low: Muscles are too excited therefore abnormal heart rhythms and tachycardia, muscle cramps, hyperactive reflexes, tremors, overall weakness
Role of calcium
An essential mineral nutrient present in every cell type. It causes neuronal stabilization and controls excitation
High calcium:
Low calcium:
High: decrease in neuromuscular excitability - resulting in headaches/stomach aches/muscle weakness/constipation/confusion
Low: increase in neuromuscular excitability
- CNS: paresthesia/seizures
- CVS: arrhythmias, arrest
- MSK: Muscle spasms and twitching
- Resp: Stridor, bronchospasm
- GI: Diarrhea due to smooth muscle excitation
What is urea
Waste from protein consumption. Depends on adequate liver and kidney function to excrete
Increased Urea =
Decreased Urea =
inc: Renal failure or hypovolemia
Dec: Malnutrition, liver failure, overhydration
What is creatine
Waste from muscle use in your body. it’s levels are an indicator of kidney function
Inc. creatine =
Dec. Creatine =
inc: Renal failure, muscle injury
Dec: Malnutrition, chronic loss of muscle bulk
Why do PTs care about renal failure
Has effects on the resp system and MSK function
- Fluid overload leads to PE and peripheral swelling (difficult to move)
- Electrolyte imbalance: acute = acidosis, which affects diaphragm contractility. Chronic = muscle weakness and myopathy
What is normal urine output? What is indicative of renal failure
1ml/kg/hour
<1/2 ml/kg/hour
Precautions after dialysis
- Low BP: If fluids removed too quickly
- Nausea: Do to changes in BP
- Cramps: rapid removal of fluid during dialysis may cause muscle cramps
- headaches: Due to changes in fluid and waste levels
- Fatigue: after and before
3 types of nutrition tubes
PEG
G-Tube
NG tube
Purpose of nutrition tubes
- Provide nutrition for Pts that can’t swallow
- Relieve abdominal bloating
- Drain GI secretion
Precautions with Nutrition tubes
- ensure feed are off 20 mins before hand on chest treatment commences. If bolus feeding try and treat pre their feeding
- Every time we turn off feeds we affect patients nutrition and blood sugar levels
- Modify your hand placement for assisted cough maneuver
- Watch you dont pull, kink, or put too much pressure on the tube when mobilising and positioning
Nutrition tube concerns
- Aspiration
- infection/septicemia
- Tube dislodgement
- bowel perforation
What is total parenteral nutrition? what are the 2 components of it
- Infusion of nutritional substances directly into the bloodstream, usually through a peripheral vein or central line
- most often 2 nutritional bags, one a mixture of essential and non-essential amino acids, the other a solution of fats and lipids
What conditions may use total parenteral nutrition
- Inadequate absorption from intestines
- gastrointestinal fistula
- bowel obstruction
- Prolonged bowel rest needed
What is a good outcome measure in ICU? Scoring?
Chelsea Critical care physical assessment tool
Closer to the middle worst off you are
10 aspects on the Chelsea Critical Care Physical Assessment Tool
- Respiratory function
- Cough
- moving within the bed
- Supine to sitting on EOB
- Dynamic sitting
- Standing balance
- Sit to stand
- Transferring from bed to chair
- Stepping
- Grip strength
Concerns with rectal tube
- The balloon can cause rectal damage - so pressures are checked regularly and it may limit at patients ability to sit for <30 mins
- if movement is causing leaking this may also limit mobility if the tube is in to prevent wound contamination
What may be causing weakness?
Muscle:
- Medications
- Undiagnosed neuromuscular disease
- SCI
- Critical illness polyneuropathy
- Loss of muscle bulk
- Electrolyte imbalance
- Systemic illness/sepsis
