Intensive care chap 13 Flashcards
1
Q
OBJECTIVES
Provide an overview of the intensive care unit
A
FYI
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
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!
4
Q
intensivist
A
Physician specializing in ICU
Able to react quickly
Does not necessarily know pt well
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
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
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
8
Q
normal pulse ox
A
95%
9
Q
ECG
A
Monitor heart rate and rhythm
Alarm goes off if rate/rhythm is outside of set range
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
11
Q
Intravenous infusion
A
- Plastic or metal needle
- Secured with tape
- Flush with saline
- Avoid pulling
- Call nurse if alarm goes off
12
Q
Lower extremity compression
A
- Lower extremity compression
13
Q
Mechanical Ventilator
A
- Deliver a mixture of oxygen and air
- Use for pts who cannot breath well enough to exchange air
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
15
Q
Post surgical drains
A
- Drains excess blood
- May use a Hemovac
- Keep below level of entry of tube
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
