ICU Neurologic Patients Flashcards
Identify: Acute inflammatory demyelinating polyradiculopathy.
GBS
Describe how GBS presents:
Bilateral, ascending paresthesia and weakness.
Three phases of GBS:
Progression
Plateau
Recovery
Two primary treatments for GBS:
Plasmapharesis (plasma exchange)
Intravenous immunoglobulin (IVIg)
Equally effective
When is ICU level care needed for GBS?
If respiratory failure occurs
During the progressive phase of GBS, what does PT do?
Mostly monitoring
Positioning and splinting (skin breakdown, loss of ROM)
Nerve glides (pain management)
What should be avoided during the progressive phase of GBS?
Strength training!
Mobilizing out of bed
During the plateau phase of GBS, what does PT do?
Slowly initiate AAROM and AROM
Continue stretching, positioning, and nerve glides
Progress upright tolerance slowly and monitor hemodynamic response.
During the recovery stage of GBS, what does PT do?
Progress strengthening activities (low resistance, high sets, concentric exercises)
Functional activities as tolerated
Avoid NM fatigue
Monitor daily for relapse
What are main types of brain injuries?
Primary and secondary
Three outcome measures typically used to determine severity of Brain injury
Rancho, Glasgow, JFK
Rancho level 1:
No response
Rancho level 2:
Generalized response
Rancho level 3:
Localized response
Rancho level 4:
Confused-agitated response
Rancho level 5:
Confused-inappropriate response
Rancho level 6:
Confused-appropriate response
Rancho level 7:
Automatic-appropriate response
Rancho level 8:
Purposeful-appropriate response
Normal intracranial pressure range:
4-15 mmHg
Identify 5 positions that increase intracranial pressure:
Trendelenburg
Lateral neck flexion
Extreme hip flexion
Valsalva and coughing
Noxious stimulation/pain
Identify 3 mat activities appropriate for Rancho 3:
- PNF
- Prone -> prone on elbows -> quadruped
- Facilitate head and trunk control
Identify the Rancho level
- Confused and frightened
- Does not understand feelings or events
- Recognize family and friends inconsistently
- Difficulty concentrating and following directions
- Overreacts by hitting, screaming, thrashing
- Focused on basic needs
- Inappropriate
Rancho 4: Confused and agitated
PT treatment focus and goal for Rancho 4:
- Focus: Decrease confusion and agitation
- Goal: Provide patient sense of safety
Identify
Temporary suppression of reflexes below the level of the lesion.
Spinal shock
During the 1st treatment after a spinal cord injury, what 3 things should be done?
- Don TED hose, ace wrapes and abdominal binder
- TLSO, cervical collar
- Gradually raise HOB until in seated position. Monitor HR, BP, O2 sats every 20-30 degrees.
What timeframe is the goal to get a stroke patient to the hospital after symptom onset?
ASAP, but within 3 hours is the goal.
Why is a head CT done first for a stroke patient?
To rule out a hemorrhage
What are the most common sources of emboli?
3
- Vascular
- Cardiac
- Infection
4 cardiac pathologies that can lead to an embolus:
- A-fib
- MI
- Patent foramen ovale (PFO)
- Valve incompetence
1 example of an infection that can lead to an embolus:
Endocarditis
Define Penumbra
Ischemic but still viable cerebral tissue
2 parts of the stroke bed:
- Core (dead)
- Penumbra
3 endovascular treatments for an ischemic stroke
- IV thrombolytic agent
- Intra-arterial fibrinolysis
- Mechanical thrombectomy
tPA and TNKase are examples of what?
Thrombolytics
What is required after treatment with thrombolytic agents
24 hours bedrest
Goal glucose control is __-__ mg/dl after a stroke.
140-180
Is higher or lower BP preferred post-stroke?
Higher to perfuse penumbra. May allow up to 200 mmHg.
3 impacts of exercise that are relevant to stroke pt implications:
- Increases body temperature
- Decreases blood glucose
- Increases BP
2 classifications of a subarachnoid hemorrhage:
- Aneurysmal
- Non-aneurysmal
Define an aneurysm
Bulging out that occurs at a site of weakness in vessel wall.
80% of subarachnoid hemorrhage strokes are caused by _______.
an aneurysm rupturing
During acute stages of stroke how long should PT sessions be?
Short. 2-15 minutes is ideal
Three locations aneurysmal subarachnoid hemorrhage typically occur:
- Anterior communicatin artery
- Middle cerebral artery
- Posterior communicating artery
2 classic features of SAH
- Severe HA
- Sudden onset
3 clinical features of SAH
- Nausea and vomiting
- Reduced consciousness
- Meningism
Two ways to definitively diagnose a SAH
- CT angiography
- Digital subtraction angiography
Identify
CSF obstructed by clot, leading to increased pressure on the brain
Hydrocephalus
4 types of treatment for aneurysm:
- Coiling
- Clipping
- Coiling and stenting
- Stenting
5 secondary complications of aneurysmal SAH
- Hydrocephalus
- Re-bleeding
- Vasospasm
- Delayed cerebral ischemia
- Electrolye disturbances
