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Fundamentals of disease > Intensive care chap 13 > Flashcards

Intensive care chap 13 Flashcards

1
Q

OBJECTIVES

Provide an overview of the intensive care unit

A

FYI

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2
Q
  • Must be able to adapt
  • Many comorbidities
  • High risk of morbidity and mortality
  • Diagnoses will include:
    • MI, COPD, PVD, CHF
  • Work closely with PT
  • Be aware of lab values
    • Should understand values that determine pt should not have therapy
A

ICU

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3
Q

entering the ICU

A

Observe all equipment
Use universal precautions
Be aware of any extra (barrier) precautions
Introduce self
Careful to schedule at appropriate time….be flexible!

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4
Q

intensivist

A

Physician specializing in ICU
Able to react quickly
Does not necessarily know pt well

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5
Q
  • Intra-arterial lines
  • Auto blood pressure monitors
  • EKG monitors
  • Intracranial pressure monitor,
  • IV infusion
  • LE compression stockings
  • Mechanical ventilator
  • Oxygen
  • Postsurgical drains
  • Pulse oximeter
  • Suction devices
  • catheters
A

equipment

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6
Q
  • Get to know the ICU nurse
  • Check with nurse before starting therapy
  • Read chart
  • Observe equipment
  • Explain to pt/family who you are
  • Check vitals
  • Wash hands
  • Follow universal precautions
  • close curtain/door to maintain privacy
  • Move mobile equipment
  • Make sure oxygen tubing is long enough
  • Lock breaks on bed
  • USE GAIT BELT
  • Use good shoes/socks for ambulating and transfers
  • Make sure pt is covered
  • move equipment and tubes to same side of bed as getting pt up, check if ECG needs to be kept on
  • Keep catheter bag below bladder
  • Watch for kinks
  • Have nurse detach gastric tube
  • Watch IV
  • If alarms sound, check with nurse
  • Leave pt and room as found
  • Make sure pt is comfortable, call light, phone and TV control need to be easily accessed
  • RAISE BED RAILS
  • Appropriate positioning to avoid pressure ulcers
A

General precautions and recommendations

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7
Q

equipment used in ICU

A
  • Arterial lines/intra-arterial lines
    • Insert in Radial A., Axillary A., femoral A., Pedal A.
    • Line is rigid
    • Constant measuring of blood pressure
  • Blood Pressure
    • Checked frequently
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8
Q

normal pulse ox

A

95%

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9
Q

ECG

A

Monitor heart rate and rhythm
Alarm goes off if rate/rhythm is outside of set range

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10
Q

Intracranial Pressure Monitor

A
  • Probe is placed in subarachnoid space and is attached to monitor
  • Normal ICP 5-15 mmHg
  • Therapy activities may increase ICP
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11
Q

Intravenous infusion

A
  • Plastic or metal needle
  • Secured with tape
  • Flush with saline
  • Avoid pulling
  • Call nurse if alarm goes off
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12
Q

Lower extremity compression

A
  • Lower extremity compression
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13
Q

Mechanical Ventilator

A
  • Deliver a mixture of oxygen and air
  • Use for pts who cannot breath well enough to exchange air
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14
Q

Oxygen

A
  • Helps to maintain normal oxygen saturation
  • Will have valve at wall that adjusts O2
  • Mask or nasal cannula
  • May have orders to adjust oxygen during therapy
  • Report if pt is cyanotic or labored breathing
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15
Q

Post surgical drains

A
  • Drains excess blood
  • May use a Hemovac
    • Keep below level of entry of tube
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16
Q

Pulse oximeter

A
  • Measures oxygen saturation
  • Small portable ones can be used during ambulation
  • Normal saturation 95-100%
  • Below 94%=hypoxic
  • Know the level considered safe by the physician
17
Q

Suctioning device

A
  • Usually used with tracheotomy
  • PTA will not perform this
  • Can use through nose or mouth
18
Q

Urinary catheter

A
  • Wash hands
  • Don’t raise above level of insertion
19
Q

why ICU

A
  • Monitoring post surgically
    • Stabilize vital signs
    • Electrolyte imbalances
    • wounds
  • Can move to step down unit
    • More medically stable
20
Q

NPO

A

restriction

Nothing by mouth

pt could asperate

21
Q

physical therapy interventions

A
  • Challenging
  • How stable?
  • How much can you push?
  • Fatigue or depression?
22
Q

burns

A
  • Pulmonary PT, wound care, positioning, ROM, bed mobility, transfers, ambulation
  • Wear gloves, gown
  • Pressure relief beds
  • Minimize hand contact with burned tissue
  • Positioning is essential
  • Wound care
  • Whirlpool
23
Q

cva

stroke

A
  • May start bed mobility, ROM, transfers
  • Ambulation
  • Educate family on ROM exercises
  • Watch for changes in vital signs, fatigue, increase in weakness or decline in speech
  • Know restrictions on liquids
  • Stand to affected side
  • Explain treatment
  • Instructions need to be kept simple
  • Keep treatments short
  • Allow pt to do as much as possible
  • Avoid discussion about prognosis
24
Q

end stage renal failure

A
  • Will fatigue easily
  • Be aware of fluid restrictions
  • Avoid pressure ulcers
  • Vital signs, cyanosis
  • Keep treatment short
25
Q

myocardial infarct

heart attack

A
  • Monitor vital signs
  • Caution with transfers
  • BP must remain within acceptable limits

careful because they tend to hold their breath

26
Q

near drowning

A
  • Have to be aware of level of consciousness
  • Avoid overstimulation of pt
  • Explain everything
  • Monitor pt during therapy
  • May have to do many short visits
27
Q

surgery

A

Postural drainage, bed mobility, ROM, transfers, ambulation

28
Q

trauma

A
  • Fractures are considered after bleeding and other major trauma
  • Halo with cervical fractures
  • Breathing exercises
  • Bed mobility and strengthening
  • Specialized assistive devices
  • Be careful of weight bearing status
  • Coordinate therapy with other needs
  • Careful of fatigue
29
Q

Traumatic Brain Injury

A
  • May be unconscious or semi-conscious
  • Will require extensive monitoring
  • Be aware of cognitive level
  • do not overstimulate
  • Explain everything
  • Watch for any response if in coma
  • Involve family
30
Q

Pressure Ulcers

A
  • PT, PTA actively involved in preventing ulcers and educating others
  • Change positions every 2 hours
  • Respect turning schedule
  • Pressure relief devices

be aware of wearing schedule for devices.

31
Q

rLegal and Ethical Issues

A
  • End of life rights and right to refuse treatment
  • Be accurate in your notes
  • Compassion for dying patients and grieving family
  • Keep talking to the patient
32
Q

Pediatric Intensive care

A
  • Be confident
  • Child might be frightened
  • NICU: help enhance normal development
33
Q
A

Fundamentals of disease (19 decks)

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