Intensive Care

Question 1

General Precautions and Recommendations for Treating Patients in the ICU

Answer 1

1. Speak to the nurse assigned to the pt before initiating tm to ensure the pt is stable and that the orders haven’t changed.
2. Read the pt chart carefully before initiating tm.
3. Introduce yourself to the pt and any family in the room. Explain who you are, why you are there, and what you plan to do.
4. Check vital signs before initiating any tm.
5. Wash hands before and after treating pts.
6. Protect pts dignity and privacy.
7. Ensure that the brakes on the bed are in the locked position before moving pts.
8. Move all tubes and equipment such as catheters, IVs, and O2 tubes to the side of the bed the pt will exit to prevent pulling on the tubes.
9. Avoid raising the catheter bag above the pelvis to prevent backflow of urine.
10. Check all tubes for kinks that may impede flow.
11. Ask the nurse to detach the gastric feeding tube from the machine before PT is initiated, especially if the pt is to be moved extensively.
12. Check to determine whether an electrode has been dislodged if the ECK/EKG monitor alarm sounds.
13. Leave the pt and the room as found.
    > Make pts comfortable on completion of the PT session.
    > Raise bed rails if they were in place before.
    > Follow all specified recommendations regarding pt position change to prevent pressure ulcers.
    > Document the volume of any fluids issued to the pt during tm.
    > Inform anyone who was asked to leave the room during PT that they may return.

Question 2

PT intervention for CVA pt in the ICU

Answer 2

1. Observe the pt closely during tm for signs of changes in vital signs, as well as discoloration of lips or ears for signs of cyanosis.
2. Observe the pt closely for signs of fatigue.
3. Observe the pt closely for any signs of ↑ weakness or changes in speech which may indicate a further CVA.
4. If the pt is on a thickened diet due to swallowing problems, do NOT give water to drink.
5. Stand on the side of the bed close to the affected side to encourage pt to turn the head to their affected side.
6. Speak to the pt to explain exactly who you are and what you are going to work on.
7. Keep instructions to simple one-word commands or short sentences.
8. Be encouraging and assist as needed, but make pt do as much as possible for themselves.
9. Keep tm fairly short to prevent undue pt fatigue. Sessions may be up to 15’ at a time in the initial stages.
10. Remember that pt status post-CVA may not tolerate more than a few ex’s the 1st few days. Getting pt into a chair may be most they can tolerate in one session.
11. Ask for assistance to perform transfers, particularly for the 1st attempt.