ICUAW Flashcards
What is muscles/limbs are affected by ICUAW ?
symmetrically ( bilaterally?) starting proximal and moving to distal
respiratory muscles (especially diaphragm)
ICUAW characterized by 3 things
- Reduced muscle tone
- DTRs may be normal or may be reduced
- Greatly reduced muscle mass
how may ICUAW occur
- polyneuropathy,
- myopathy, or
3.muscle atrophy
pt. population
those who aren’t moving, chronic or severe diagnoses ( IE- sepsis) corticosteroids, and diabetes
3 strategies for ICUAW pts.
- use shorter less intense sessions
- adjust head with it raised at first, then lower it, eventually working on EOBS
- If available, use mechanical lift to get patient into bedside chair to start short periods (< 2h rs) OOB
CIP (Critical Illness Polyneuropathy ) - what is it
Main contributor to persistent disability
just nerve damage = distal and symmetrical
CIP (Critical Illness Polyneuropathy ) - how may pts present
- weak
- decreased DTRS
- impaired sensation to pain, temp, and vibration
How may Critical Illness Myopathy (CIM) present
- flaccid all over the place
- DTRs may or may not be there
- sensation still there
What is Critical Illness Polyneuromyopathy (CIPNM)
like CIP
pt. may have muscle and nerve damage
How is ICUAW Diagnosed?what is the most commonly used measure
Assessment of peripheral muscle strength
** Medical Research Council (MRC) sum score ( pt. has to be alert and follow direction)
outcome measures for ICUAW dx
Scored Physical Function in Intensive Care Test (PFIT)
FSS-ICU
CPAx
6-minute walk test
Hand-held dynamometry what it does? limitation
measures handgrip and quadriceps strength
limited value to determine global muscle strength
CIPM scoring for muscle strength and 2 cutoff scores
what are the muscle groups tested?
<48 shows significant weakness
<36 shows severe weakness,
How are diagnoses typically ruled out by
use muscle strength testing
* Limited methods to assess respiratory muscle strength
5 Risk factors for ICUAW
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
super important risk factor for ICUAW
= prolonged ventilation
may lead to diaphragmatic dysfunction and not being able to get off ventilation ( poor weaning)
What are predictors of prolonged mechanical ventilation?
Limb and respiratory muscle weakness
One-year mortality higher in weak patients (MRC sum score < 48)
Key consideration with PT and ICUAW
Create a culture of mobility
may just bring patient to side of bed or raise HOB - something is better than nothing
Link PT intervention time with what 2 things
- Length of stay
- discharge plans
outcome measures –> determine discharge
Systems affected by bed rest
Orthostatic Hypotension characterized by what drops in systolic and diastolic BP by what % ? increase in HR by what %
more than 20 mm Hg systolic
10 mm Hg diastolic accompanied 10-20% increased HR
OH PT treatments -4 things
- get them moving ASAP
- LE exercises to improve circulation
- compression stockings
- tilt table if they’re disable or have been immobilized for a while
True or False - Reconditioning takes much longer than deconditioning
True
you dont use it you lose
Decreased FRC can lead to
shunting and atelectasis
causes increase airway resistance
Decreased RV and TV can lead
increased resting respiratory rate
Virchow Triad- 3 factors
venous TE ( like a clot)
1. Venous stasis
2. Hypercoagulability
3. Blood vessel damage
Looking for a DVT- site and clinical signs - are they reliable
site = gastroc / soleus
signs are usually unreliable but they’re
= Pain and calf tenderness, swelling, redness, positive Homan’s sign
DVT PT treatment
- get em moving
- legs up
- comprezzion
osteoporosis PT consideration
shows importance of closed-chain exercises and WB upright activities!
Decubitus Ulcer cause, KEY intervention
leison caused by constant pressure ( usually by bony landmarks)
damage to underlying tissue
KEY intervention = PREVENTION
Ileus - what is it and key intervention
GI issue w/o obstruction
early mobilization
Neurlogical conditions -
3 PT considerations
- lights on
- shades up
- raise head of bed
delirium common problem
Delirium
what is it
triad
key consideration
umbrella of cognitive symptoms
= inattention , decreases awareness and perception
DELIRIUM ACCELERATES COGNITIVE IMPAIRMENT
Gist of Response-dependent management
assessing the patient’s status from moment to moment
ensure they are hemodynamically stable and their body handle PT
Response-dependent management
Delivery of O2 must equate to the consumption of O2 by the body
Interventions should be —- -based ? end goal?
function based
end goal: enable patient to return home or at least to a lower level of care
