ICU + ICU Delirium Flashcards
How much strength loss occurs in the ICU?
4-5% a day in healthy subjects
How long does it take for insulin resistance and microvascular dysfx to occur in the ICU?
5 days in healthy subjects
What are some barriers to ICU rehab?
Too sick Too sedated Too delirious PT/OT underprescribed Limited equipment and staff
What problems are associated with mechanical ventilation?
As early as 4-7 days:
- Critical illness polyneuropathy
- Critical illness myopathy
- combination of both
S/S of Critical illness polyneuropathy (CIP)
Weakness Decreased DTRs Impaired pain, temp and vibratory sense Facial weakness Cranial nerves are spared
S/S of Critical illness myopathy (CIM)
Profound weakness (esp proximal muscles) DTRs preserved or diminished Sensation is intact
S/S of Post-intensive care syndrome (PICS)
Reduced ability for ADLs Reduced capacity for ambulation (up to 5 years later!) Depression Posttraumatic stress syndrome Anxiety
Treatment for PICS
Minimize sedation
Early mobility
What are some general PT interventions for the ICU?
Strength training
ROM/Joint mobility
Endurance training
Postural re-training
Balance activities
Optimizing ventilation/secretion clearance
Progressive mobility/functional activities
What are some examples of progressive mobility exercises?
Continuous lateral rotation therapy HOB elevation/ Chair position A/PROM in bed Tilt table/tilt bed Danglining OOB to chair Ambulation
Where should a patient fall on the borg scale during ICU exercise?
3-5
What are the pulmonary requirements for being medically unstable?
O2 sat < 88%
RR > 35 breaths/min
PEEP >10 mmH2O
What are the cardiovascular requirements for being medically unstable?
Resting HR 140 bpm SBP 200 New arrhythmia developed New onset angina MAP < 65 or >120 OR > 10 mmHG lower than normal SBP or DBP for pts on renal dialysis
Is a patient medically stable if they cannot follow commands?
No
Steps to mobilize ICU patient
Look at baseline vitals
Locate all wires and tubes
Move IV pole to the side you’re getting up on
Assist pt to sitting at the side of the bed
Make sure all lines are accounted for and have slack
Go.
When should you stop or modify treatment?
O2 < 88% despited increased FiO2 Significant increased work of breathing Evidence of hemodynamic instability: decreased BP, change in EKG, chest pain HR greater than age predicted max Resp Rate > 20 bpm over resting Pt reports significant pain or failure Pt requests to stop
What is delirium?
Change in cognition and/or perception
Alteration in LOC
Inattention (perseverate)
Is delirium abrupt or gradual onset?
Abrupt
What is LOC?
Level of consciousness… may be a decreased awareness of environment
T/F: Delirium is not related to underlying psychiatric conditions
True
What are the 3 subtypes of ICU delirium?
Hyperactive
Hypoactive
Mixed
What are characteristics of hyperactive delirium?
Patient is agitated with increased motor activity, only 1% of cases
What are characteristics of hypoactive delirium?
Sleepy, inattentive, with decreased motor activity. 44% of cases
What is the most common subtype of ICU delirium?
Mixed makes up 55% of cases
How common is ICU delirium? when does it occur?
20-80% of ICU patients, usually onset at day 2 and may last 2-6 days
Which clinical tool is used to measure delirium?
Richmond Agitation Sedation Scale (RASS)
How does delirium affect patient outcomes?
2-13x increased risk of death
Assoc. w/ long term cognitive impairment
Increased length of ICU stay (8 vs 5 days)
Increased length of Hospital stay (21 vs 11 days)
How should delirium be managed?
Decrease sedation (minimize benzodiazepines and narcotics)
Improve sleep
Early mobilization
What is a valid, reliable, and quick assessment for delirium?
the CAM-ICU (confusion assessment method)
