Intro to ICU Flashcards
What are the most common causes of being in the ICU?
-Respiratory Failure requiring mechanical ventilation, pneumonia, ARDS, Flu
- Renal Failure
- Metabolic dysfunction
- Infection > sepsis
What does ARDS stand for?
Acute respiratory distress syndrome
> fluid build up in alveoli
List 3 common surgical reasons to be in the ICU.
1) post-op pain causing difficulty breathing
2) Hypoxemia
3) Complex surgeries
Describe Guillain-Barre syndrome
The immune system attacks the PNS, can lead to rapid on set of numbness, weakness and paralysis. As a result breathing muscles are not working and mechanical ventilation is required.
List non-surgical reasons to be in the ICU.
- Trauma to the chest area, rib fractures
- Hemothorax or Pneumothorax
- Hemothorax Blood in the chest cavity (Pleural space)
- Pneumothorax air in the chest cavity
Describe the role of vasopressors post-op
Vasopressors help to increase blood pressure
- low blood pressure can also be a problem
- Remain in ICU to monitor drugs and blood pressure
What is the difference between an arterial line vs central line?
Arterial line are inserted into arteries and are used to obtain samples for ABGs
Central lines provide nutrients, fluids, and medication to the patients and are inserted into a large vein in the arm,
What does PICC stand for?
Peripherally Inserted Central Catheter.
- long term IV
- typically used for children
What does PIV stand for?
Peripheral IV
What is Vascathater used for?
Carry blood from the body to a dialysis machine
What is vac dressing used for?
negative pressure wound therapy
Why are PTs in the ICU and what is ICUAW?
ICU acquired weakness
- clinically detected weakness in patients who spend prolonged periods of time in the ICU
- makes it hard for patients to recovery
- myopathy, neuromyopathy, polyneuropathy
What is the respiratory risk of immobility?
- retained secretions
- risk of atelectasis/ pulmonary embolism, pneumonia
- dependant edema
- decreased PaO2
How much strength is lost per day in the ICU?
3-11% per day
1 day in bed = 2 weeks in rehab
What are the 3 main risks of Immobility in the ICU?
1) Pressure ulcers
2) Skeletal - bone and muscle loss
3) Deliruim
What are the 3 types of delirium and which is the hardest to detect?
Hyper, hypo and mixed
- hypo is the hardest to detect and treat
What are 3 ways delirium is similar to dementia?
- confusion / loss of cognition
- difficulty concentrating
- memory
List 5 improve outcomes for early mobility in the ICU
- decreased ventilator days
- decreased risk for pneumonia
- decreased risk of pressure ulcers
- decreased LOS
- Increased physical function at discharge
What are 3 ways delirium is different from dementia?
Delirium
- abrupt onset,
- duration days to weeks
- Reversible
Dementia
- gradual onset
- months to years
- usually unreversible
What are the steps of the early mobility ABCDEF bundle?
(A)Assess, prevent and manage pain (B) Both Spontaneous awakening and breathing trial (C) Choice of sedation (D) Delirium (E) Early Mobility (F) Family empowerment and engagement
What are the steps of PT assessment in the ICU
- Review patient chart for diagnosis and symptoms
- Review the current status of how the night went/mental state
- Review test and lab results
- determine mobility level
- Review RAAS score
Using the RAAS scale when is it safe to mobilize a patient?
Below -2 mobilizing is just patient positioning in the bed due to heavy sedation (PROM)
-1 to + 1, AROM, AAROM, Transfers, side of bed
Describe PT assessment in the ICU and the areas involved
Cardio, neuro, and respiratory status
Vital signs, heart rate, BP
- Are vitals high at rest before they start mobility or when they get moving?
- Blood pressure is a way to measure perfusion, low = organs have low perfusion
- Inotropes, vasopressors (Meds)
Respiratory Rate (15-20), Blood gasses, breath sounds, observation of accessory muscle use, heavy breathing
- Breathing pattern (symmetrical lung expansion) - Nasal prongs - O2 saturation - CXR - Pulmonary f/n test - FIOT (faction of inspired O2)
Neuro: LOC, sensation, LOC, delirium, cooperativeness, move, ability to follow directions
ROM/Strength, Bed mobility, skin integrity (pressure ulcers)
Why is positioning important in the ICU?
Optimize V/Q
- Reduce the risk of pressure ulcers
- Prone can sometimes help improve oxygenation status and hypoxia
During prone positioning, ventilation is improved due to changes in pleural pressure (PPL) and the amount of lung atelectasis present.
What is the purpose of suctioning?
To remove excess secretions from the lungs
- prevent infection
- improve airway clearance
What is a pulmonary shunt?
the alveoli of the lungs are perfused with blood as normal, but ventilation (the supply of air) fails to supply the perfused region.
In other words, the ventilation/perfusion ratio (the ratio of air reaching the alveoli to blood perfusing them) is zero.
A pulmonary shunt often occurs when the alveoli fill with fluid, causing parts of the lung to be unventilated although they are still perfused.
What are the four primary reasons for employing endotracheal intubation?
1) Upper airway obstruction
2) Inability to protect the lower airways from aspiration
3) Inability to clear secretions from the lower airways
4) Need for positive-pressure mechanical ventilatory assistance
What is the cardiovascular risk of immobility?
- decreased cardiac conditioning (0.9% per day)
- decreased venous return and stroke volume
- increased HR to maintain resting VO2
- Risk of DVT
