ICUAW

Question 1

What is muscles/limbs are affected by ICUAW ?

Answer 1

symmetrically ( bilaterally?) starting proximal and moving to distal
respiratory muscles (especially diaphragm)

Question 2

ICUAW characterized by 3 things

Answer 2

1. Reduced muscle tone
2. DTRs may be normal or may be reduced
3. Greatly reduced muscle mass

Question 3

how may ICUAW occur

Answer 3

1. polyneuropathy,
2. myopathy, or
   3.muscle atrophy

Question 4

pt. population

Answer 4

those who aren’t moving, chronic or severe diagnoses ( IE- sepsis) corticosteroids, and diabetes

Question 5

3 strategies for ICUAW pts.

Answer 5

1. use shorter less intense sessions
2. adjust head with it raised at first, then lower it, eventually working on EOBS
3. If available, use mechanical lift to get patient into bedside chair to start short periods (< 2h rs) OOB

Question 6

CIP (Critical Illness Polyneuropathy ) - what is it

Answer 6

Main contributor to persistent disability
just nerve damage = distal and symmetrical

Question 7

CIP (Critical Illness Polyneuropathy ) - how may pts present

Answer 7

1. weak
2. decreased DTRS
3. impaired sensation to pain, temp, and vibration

Question 8

How may Critical Illness Myopathy (CIM) present

Answer 8

1. flaccid all over the place
2. DTRs may or may not be there
3. sensation still there

Question 9

What is Critical Illness Polyneuromyopathy (CIPNM)

Answer 9

like CIP
pt. may have muscle and nerve damage

Question 10

How is ICUAW Diagnosed?what is the most commonly used measure

Answer 10

Assessment of peripheral muscle strength
** Medical Research Council (MRC) sum score ( pt. has to be alert and follow direction)

Question 11

outcome measures for ICUAW dx

Answer 11

Scored Physical Function in Intensive Care Test (PFIT)
FSS-ICU
CPAx
6-minute walk test

Question 12

Hand-held dynamometry what it does? limitation

Answer 12

measures handgrip and quadriceps strength
limited value to determine global muscle strength

Question 13

CIPM scoring for muscle strength and 2 cutoff scores
what are the muscle groups tested?

Answer 13

<48 shows significant weakness
<36 shows severe weakness,

Question 14

How are diagnoses typically ruled out by

Answer 14

use muscle strength testing
* Limited methods to assess respiratory muscle strength

Question 15

5 Risk factors for ICUAW

Answer 15

1.Higher severity of illness
2. Sepsis ->high lactate level
3. Multiple organ failure
4. **Longer duration on mechanical ventilation
5. Longer length of stay in the ICU

Question 16

super important risk factor for ICUAW

Answer 16

= prolonged ventilation
may lead to diaphragmatic dysfunction and not being able to get off ventilation ( poor weaning)

Question 17

What are predictors of prolonged mechanical ventilation?

Answer 17

Limb and respiratory muscle weakness
One-year mortality higher in weak patients (MRC sum score < 48)

Question 18

Key consideration with PT and ICUAW

Answer 18

Create a culture of mobility
may just bring patient to side of bed or raise HOB - something is better than nothing

Question 19

Link PT intervention time with what 2 things

Answer 19

1. Length of stay
2. discharge plans
   outcome measures –> determine discharge

Question 20

Systems affected by bed rest

Answer 20

Question 21

Orthostatic Hypotension characterized by what drops in systolic and diastolic BP by what % ? increase in HR by what %

Answer 21

more than 20 mm Hg systolic
10 mm Hg diastolic accompanied 10-20% increased HR

Question 22

OH PT treatments -4 things

Answer 22

1. get them moving ASAP
2. LE exercises to improve circulation
3. compression stockings
4. tilt table if they’re disable or have been immobilized for a while

Question 23

True or False - Reconditioning takes much longer than deconditioning

Answer 23

True
you dont use it you lose

Question 24

Decreased FRC can lead to

Answer 24

shunting and atelectasis
causes increase airway resistance

Question 25

Decreased RV and TV can lead

Answer 25

increased resting respiratory rate

Question 26

Virchow Triad- 3 factors

Answer 26

venous TE ( like a clot)
1. Venous stasis
2. Hypercoagulability
3. Blood vessel damage

Question 27

Looking for a DVT- site and clinical signs - are they reliable

Answer 27

site = gastroc / soleus
signs are usually unreliable but they’re
= Pain and calf tenderness, swelling, redness, positive Homan’s sign

Question 28

DVT PT treatment

Answer 28

1. get em moving
2. legs up
3. comprezzion

Question 29

osteoporosis PT consideration

Answer 29

shows importance of closed-chain exercises and WB upright activities!

Question 30

Decubitus Ulcer cause, KEY intervention

Answer 30

leison caused by constant pressure ( usually by bony landmarks)
damage to underlying tissue
KEY intervention = PREVENTION

Question 31

Ileus - what is it and key intervention

Answer 31

GI issue w/o obstruction
early mobilization

Question 32

Neurlogical conditions -
3 PT considerations

Answer 32

1. lights on
2. shades up
3. raise head of bed
   delirium common problem

Question 33

Delirium
what is it
triad
key consideration

Answer 33

umbrella of cognitive symptoms
= inattention , decreases awareness and perception
DELIRIUM ACCELERATES COGNITIVE IMPAIRMENT

Question 34

Gist of Response-dependent management

Answer 34

assessing the patient’s status from moment to moment
ensure they are hemodynamically stable and their body handle PT

Question 35

Response-dependent management

Answer 35

Delivery of O2 must equate to the consumption of O2 by the body

Question 36

Interventions should be —- -based ? end goal?

Answer 36

function based
end goal: enable patient to return home or at least to a lower level of care