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DPT 629: Cardio > Introduction to the ICU > Flashcards

Introduction to the ICU Flashcards

1
Q

t/f: there can be profound weakness and delirium w/o early mobility

A

true

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2
Q

t/f: it is now realized that early mobility in the ICU improves outcomes, decreased complications, and improves QoL after the ICU

A

true

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3
Q

what three body systems are we monitoring in the ICU?

A

cardiac system

pulmonary system

neurologic system

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4
Q

what do we monitor in the cardiac system in the ICU?

A

electrical activity of the heart

BP

right arterial pressure (RAP)

left arterial pressure (LAP)

central venous pressure (CVP)

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5
Q

how is electrical activity of the heart monitored in the ICU?

A

electrocardiogram (ECG)

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6
Q

how is BP monitored in the ICU?

A

automated cuff (noninvasive)

arterial line (invasive)

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7
Q

what pressures can be monitored with a central venous catheter (CVC)?

A

central venous pressure (CVP)
R arterial pressure (RAP)

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8
Q

what pressures can be monitored with a pulmonary artery catheter (PAC)?

A

central venous pressure (CVP)

R arterial pressure (RAP)

L arterial pressure (LAP)

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9
Q

can L arterial pressure (LAP) be measured directly?

A

no, it is measured indirectly

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10
Q

what is the only way LAP can be measured?

A

with a pulmonary artery catheter (PAC)

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11
Q

what is an arterial line?

A

a catheter going directly into an artery

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12
Q

what are the insertion sites for arterial lines?

A

radial artery

femoral artery

sometimes other sites when the radial and femoral are poor quality

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13
Q

what is the most common insertion site for arterial lines?

A

radial artery

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14
Q

what are the uses for arterial lines?

A

continuous BP monitoring

frequent ABGs

frequent clinical lab tests

drug administration

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15
Q

where does the pressure transducer have to be kept with arterial lines?

A

in line with the RA (4th intercostal space and mid axillary line)

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16
Q

is elevation in arterial pressure associated with systole or diastole?

A

systole

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17
Q

t/f: peaks and troughs with an a-line should be correlated to EKG trace

A

true

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18
Q

if the peaks of an a line trace look depressed, what may be going on?

A

you may not be getting an accurate reading and you should look at the placement of the transducer

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19
Q

if the transducer of an a line is too high, would the BP read higher or lower than normal?

A

lower BP

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20
Q

if the transducer of an a line is too low, would the BP read higher or lower than normal?

A

higher BP

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21
Q

t/f: we should avoid WB on the arm with the a line

A

true

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22
Q

can we mobilize someone with a femoral a line?

A

yes, but we need to take additional steps to ensure pt safety

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23
Q

if an a line is dislodged, what should we do?

A

elevate the limb and apply pressure to stop the bleeding bc it is a high pressure system

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24
Q

what does central venous pressure measure?

A

BP in the proximal vena cava close to the RA

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25
Q

what is normal CVP (central venous pressure)?

A

8-12 mmHg

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26
Q

why is the CVP pressure low?

A

bc it measures the low pressure side of the system (venous)

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27
Q

what does elevated CVP mean?

A

there is backflow from the R side

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28
Q

what things can cause elevated CVP?

A

fluid overload

R ventricular failure

tricuspid insufficiency

chronic L ventricular failure

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29
Q

what things can cause low CVP?

A

hypovolemia

dehydration

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30
Q

what are the insertion sites for a central venous catheter (CVC)?

A

jugular vein

subclavian vein

femoral vein

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31
Q

what are the most common insertion sites for CVC?

A

jugular vein

subclavian vein

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32
Q

where does the tip of the catheter go with a CVC?

A

proximal vena cava close to the entrance of the RA

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33
Q

what are the uses of the CVC?

A

continuous CVP monitoring

continuous RAP monitoring (indirect)

medication administration

blood sampling

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34
Q

does a CVC give us a direct or indirect measurement of RAP?

A

indirect

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35
Q

what are the clinical implications of a CVC?

A

bc there is a risk of a pneumothorax, the pt must have a chest x-ray after placement to confirm placement and rule out a pneumothorax b4 they can be mobilized

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36
Q

what is another name for a pulmonary artery catheter (PAC)?

A

Swan-Ganz catheter

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37
Q

what are the insertion sites for a PAC?

A

internal jugular vein

femoral vein

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38
Q

where does the catheter tip end up in a PAC?

A

in the pulmonary artery just distal to the pulmonary valve

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39
Q

what is the pathway of a PAC?

A

vena cava–>RA–>tricuspid–> pulmonary valve–>pulmonary artery

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40
Q

what are the uses for a PAC?

A

continuous CVP monitoring

direct RAP monitoring

direct PAP monitoring

indirect LAP monitoring via PCWP

cardiac output measurement

temporary pacing of myocardium

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41
Q

does a PAC or CVC directly measure RAP?

A

PAC

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42
Q

what is the normal range for PCWP?

A

4-15 mmHg

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43
Q

what is PCWP (pulmonary capillary wedge pressure)?

A

indirect measure of pressure w/in the LV

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44
Q

after the catheter for PCWP passes through the pulmonary valve, there is a pressure monitor then a balloon and another pressure monitor, what is the purpose of this?

A

nursing can inflate the balloon to cut off pressure of that branch of the pulmonary artery to measure the difference bw the R and L side of the heart to calculate L sided pressure for an indication of L sided fxn

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45
Q

what are the uses of PCWP cath?

A

assess LV fxn

assess mitral and aortic valve dysfxn

assess pulmonary edema

assess pulmonary HTN

assess hypovolemic state

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46
Q

what are the clinical implications of a PAC?

A

pts can be mobilized with special training and protocol

PAC needs to be thoroughly secured

the transducer needs to be mid-axillary level

use the waveforms to assess accuracy of the valves

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47
Q

where do we have to keep the transducer of a PAC?

A

at mid-axillary level

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48
Q

why does a PAC need to be thoroughly secured?

A

bc if it is dislodged it could cause malignant arrhythmia, rupture of the pulmonary artery, tear of the pulmonary valve, or introduce significant risk for infection

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49
Q

what do we need to monitor with the pulmonary system in the ICU?

A

oxygenation

CO2 output

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50
Q

how do we measure oxygenation in the ICU?

A

pulse ox

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51
Q

how do we measure CO2 output in the ICU?

A

capnography

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52
Q

what is capnography?

A

measure of the end tidal CO2

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53
Q

what information does capnography give us?

A

info about the efficacy of gas exchange

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54
Q

how is capnography measured?

A

with a specialized nasal canula w/ a reservoir that measures expired CO2

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55
Q

is a side stream with capnography for ventilated or non-ventilated pts?

A

non-ventilated pts

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56
Q

is a mainstream with capnography for ventilated or non-ventilated pts?

A

ventilated pts

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57
Q

what are the normal values for CO2 expired with capnography?

A

35-45 mmHg

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58
Q

does the waveform in capnography rise or fall with expiration?

A

rises

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59
Q

does the waveform in capnography rise or fall with inspiration?

A

fall

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60
Q

why is phase one of the capnography waveform flat?

A

bc it is in dead space of the respiratory system (ie trachea) where there is very little CO2 and gas exchange

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61
Q

what is the purpose of capnography?

A

early detection of respiratory failure

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62
Q

if there is an increase in CO2 expired with capnography, are there higher or lower peaks? what does this mean?

A

higher peaks, greater risk for respiratory failure

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63
Q

what things are we monitoring in the neurologic system in the ICU?

A

ICP

CPP

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64
Q

what is the normal range for ICP (intracranial pressure)?

A

<10 mmHg

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65
Q

why does an elevation in ICP cause further damage to the brain?

A

bc it compresses brain tissue and reduces cerebral blood flow

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66
Q

when would we want to monitor ICP in the ICU without a brain injury?

A

if a pt is mechanically ventilated

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67
Q

when do we usually monitor ICP in the ICU?

A

TBI

hypoxic brain injury

aneurysm

hemorrhage

tumor

meningitis

brain surgery

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68
Q

what does CPP measure?

A

cerebral blood flow

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69
Q

why does low CPP lead to further brain damage?

A

it decreases blood flow and oxygenation

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70
Q

CPP is calculated from what two other values?

A

MAP-ICP

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71
Q

a _____ in MAP or a _____ in ICP can cause a decrease in ICP?

A

decrease, increase

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72
Q

where is an epidural sensor placed?

A

in the epidural space

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73
Q

what is the purpose of an epidural sensor?

A

to monitor ICP

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74
Q

where is a subarachnoid bolt placed?

A

in the subarachnoid space

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75
Q

what is the purpose of a subarachnoid bolt?

A

direct ICP monitoring

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76
Q

where is an intraventricular catheter (ventriculostomy) placed?

A

in the lateral ventricle

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77
Q

what is the purpose of an intraventricular catheter (ventriculostomy)?

A

direct ICP monitoring

drainage or sampling of CSF

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78
Q

what are the clinical implications of an intraventricular catheter (ventriculostomy)?

A

the transducer must be leveled with position changes

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79
Q

what is the most reliable form of neurologic monitoring?

A

an intraventricular catheter (ventriculostomy)

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80
Q

where is a fiberoptic transducer tipped catheter placed?

A

can be in several locations

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81
Q

what is the purpose of a fiberoptic tipped catheter?

A

ICP monitoring

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82
Q

what is an EVD (extraventricular drain)?

A

a device that removes CSF from the ventricle to decrease ICP

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83
Q

is an EVD continuous or intermittent?

A

can be either

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84
Q

if an EVD is continuous, what do we have to be aware of?

A

making sure the collection bag is to gravity

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85
Q

can we mobilize pts with EVDs?

A

yes, but we need special training and protocols

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86
Q

where does the transducer have to be kept with an EVD to get an accurate reading of pressures?

A

level with the external auditory meatus

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87
Q

what are the circulatory support devices?

A

intraaortic balloon pump (IABP)

ventricular assist devices (VADs)

percutaneous VAD (pVAD)

implanted VAD (LVAD)

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88
Q

what is the purpose of an IABP?

A

to assist circulation through the body and reduce myocardial oxygen consumption

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89
Q

where is an IABP placed?

A

in the thoracic aorta via the femoral artery (and more increasingly via the subclavian artery for better mobility)

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90
Q

what is the mechanism of action of the IABP?

A

it is inflated during diastole, increasing aortic pressure distal and proximal to the balloon to increase circulation to the body and perfusion of the coronary arteries to increase oxygenation of the myocardium

it is deflated just prior to systole, decreasing pressure in the aorta and creating a vacuum effect for decreased afterload on the LV

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91
Q

how does the IABP increase circulation to the body?

A

the balloon is inflated during diastole and the increased pressure distal to the balloon increases blood flow out to the body

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92
Q

how does the IABP increase oxygenation of the myocardium?

A

when the balloon is inflated during diastole it increases pressure proximal to the balloon causing a backflow of blood to the coronary arteries to increase oxygenation of the myocardium

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93
Q

how does the IABP increase CO and decrease afterload on the LV?

A

when the balloon deflated in early systole, it decreases pressure in the aorta and creates a vacuum effect to the LV doesn’t have to work as hard to get blood out

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94
Q

what are the clinical implications of an IABP?

A

no hip flexion

can do WB w/specialty beds that assist w/transfers to standing or a tilt table

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95
Q

t/f: increasing studies are showing that mobility is safe and feasible w/IABP inserted in the L axillary or subclavian arteries

A

true

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96
Q

what is the purpose of ventricular assist devices?

A

to unload a failing ventricle and directly help the ventricle pump blood

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97
Q

what is the percutaneous VAD on the market rn?

A

Impella

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98
Q

is the Impella (pVAD) temporary or long-term?

A

temporary

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99
Q

who would have a pVAD?

A

a pt we expect to improve

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100
Q

do pts leave the ICU with an Impella (pVAD)?

A

nope

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101
Q

how does the Impella (pVAD) work?

A

is has an axial flow rotary pump in the mitral valve/LV that spins and creates a vacuum effect, sucking blood from the LV through the device and into the aorta

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102
Q

where is the Impella (pVAD) inserted?

A

into the femoral or axillary artery

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103
Q

the Impella (pVAD) pumps blood from ____ to _____

A

the LV, aorta

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104
Q

what is the implanted VAD on the market rn?

A

Heartmate III

105
Q

is the Heartmate III temporary or long term?

A

long term

106
Q

will people leave the ICU with a Heartmate III?

A

yes, they can and will even go home with them

107
Q

what is the indication for a Heartmate III?

A

end stage HF

108
Q

what is the least common reason for a Heartmate III?

A

bridge to recovery

109
Q

which reason for using the Heartmate III involves an expectation that heart fxn will improve and the pt will no longer need the LVAD?

A

bridge to recovery

110
Q

which reason to use the Heartmate III involves using it until they find a suitable organ for the pt?

A

bridge to transplant

111
Q

what is the most common reason for getting a Heartmate III?

A

destination therapy

112
Q

what is destination therapy with the Heartmate III?

A

permanent placement of the device with no plans for transplantation to prolong life and improve QoL in pts with end stage HF

113
Q

which reason for getting the Heartmate III is not common at all and uses the device when deciding if a pts is or is not a good candidate for a transplant?

A

bridge to decision

114
Q

how is the Heartmate III inserted?

A

via sternotomy

115
Q

what is a clinical implication of a pt with a Heartmate III?

A

bc it is done via sternotomy, we have to follow sternal precautions

116
Q

t/f: the Heartmate III provides augmentation of CO (cardiac output)

A

true

117
Q

where is the Heartmate III implanted?

A

directly into the apex of the heart through the LV wall

118
Q

how does the Heartmate III work?

A

if drains blood directly from the LV and brings it around the heart through an artificial vessel to a hole made in the aorta

119
Q

the Heartmate III takes blood directly from the ____ to the _____

A

LV, aorta

120
Q

t/f: pts with a Heartmate III may or may not have any natural heart fxns

A

true

121
Q

t/f: the controller box attached to the Heartmate III must be battery powered or wall powered at all time

A

true

122
Q

what are the forms of ventilatory support?

A

noninvasive positive pressure ventilation

artificial airways

tracheostomy tube

123
Q

is there a need for an artificial airway with non-invasive positive pressure ventilation?

A

nope

124
Q

what is noninvasive positive pressure ventilation?

A

mechanical ventilation using a mask instead of an artificial airway

125
Q

is noninvasive positive pressure ventilation for long term or short term ventilatory support?

A

short term ventilatory support

126
Q

t/f: pts must be breathing spontaneously to be on noninvasive positive pressure ventilation

A

true

127
Q

t/f: the pt drives inspiration and expiration with non-invasive positive pressure ventilation

A

true

128
Q

how is the efficacy of noninvasive positive pressure ventilation monitored?

A

via ABGs

129
Q

what is continuous positive airway pressure (CPAP)?

A

a form of noninvasive positive pressure ventilation where there is a constant stream of compressed air during inspiration and expiration to splint open airways

130
Q

what is the purpose of CPAP?

A

to splint open airways

131
Q

what is CPAP used for in the ICU?

A

respiratory failure

132
Q

what is the gold stand for treatment of sleep apnea?

A

CPAP

133
Q

t/f: the mask for CPAP must be tight fitting to work

A

true

134
Q

why don’t many pts like CPAP?

A

bc they don’t like the pressure of the tight face mask

135
Q

what is bilevel positive airway pressure (BiPAP)?

A

a form of noninvasive positive pressure ventilation that delivers high pressure during inspiration and low pressure during expiration for those who can’t tolerate CPAP or have a harder time getting air out

136
Q

why would a pt use BiPAP over CPAP?

A

they can’t tolerate CPAP

they have a harder time getting air out

137
Q

what are airway adjuncts?

A

artificial airways that make sure airways stay patent w/ventilation

138
Q

what do airway adjuncts do?

A

provide a conduit for oxygenation, ventilation, and suctioning

139
Q

what two artificial airways cannot be attached to mechanical ventilation but can be attached to bag masks?

A

oropharyngeal and nasopharyngeal airways

140
Q

what is the purpose of naso/oropharyngeal airways?

A

maintanence of airways patency

141
Q

what is an oropharyngeal airway?

A

artificial airways that goes through the mouth to the pharynx in fully sedated pts

142
Q

why are oro/nasopharyngeal airways used in fully sedated pts?

A

bc of where they end, they can induce a gag reflex

143
Q

what is a nasopharyngeal airway?

A

an artificial airways through the nose to the pharynx in fully sedated pts

144
Q

what is an endotracheal tube (ETT)?

A

an oral or nasal artificial airways that does past the pharynx into the trachea just b4 the bifurcation

145
Q

what is the purpose of having a balloon on the end of an ETT?

A

to secure it in place and make sure no air escapes if it attached to mechanical ventilation

146
Q

can an ETT be attached to mechanical ventilation?

A

yes

147
Q

what is a tracheostomy?

A

a surgically creates airway opening over the trachea below the vocal cords

148
Q

what is a tracheostomy tube?

A

an artificial airways inserted into the trachea via a tracheostomy

149
Q

if a tracheostomy is planned, why would a PEG tube be placed for nutrition?

A

bc the tracheostomy tube compresses the esophagus, so the pt won’t be able to eat

150
Q

why is a tracheostomy tube used?

A

when other forms of ventilation via other airways adjuncts fails

when there is a need for mechanical ventilation for a prolonged period

151
Q

what is mechanical ventilation?

A

can invasive unit that delivers positive pressure through an artificial airway

152
Q

t/f: breaths can be machine or pt driven with mechanical ventilation

A

true

153
Q

with mechanical ventilation, during _____ positive pressure pushes air into the lungs causing lung and chest wall expansion

A

inspiration

154
Q

with mechanical ventilation, during _____, air delivery stops and passive recoil of the lungs and chest wall pushes air out

A

expiration

155
Q

what are the adjustable parameters of mechanical ventilation?

A

mode

FiO2

PEEP

TV

RR

156
Q

what is the purpose of PEEP in mechanical ventilation?

A

to splint airways open, prevent alveolar collapse, and improve functional residual volumes

157
Q

what is the downside of PEEP?

A

if it is too high, it can cause damage to the lungs

158
Q

what is tidal volume (TV)?

A

how much air goes in/out of the lungs

159
Q

what are the 4 modes of mechanical ventilation?

A

controlled mechanical ventilation

assist/control (AC)

synchronized intermittent mandatory ventilation (SIMV)

pressure support ventilation (PSV)

160
Q

what is the most invasive mode of mechanical ventilation?

A

controlled mechanical ventilation

161
Q

what is controlled mechanical ventilation?

A

a mode of mechanical ventilation where the pt is usually fully sedated and the machine controls all parameters

162
Q

what is assist/control (AC) ventilation?

A

a mode of mechanical ventilation where the pt triggers the breaths and if the pt doesn’t trigger a breath in a specified time, the machine delivers TV

163
Q

what is synchronized intermittent manditory ventilation (SIMV)?

A

a mode of mechanical ventilation where the machine delivers a fixed # of breaths ina fixed TV

the pt can breathe spontaneously in bw

164
Q

what is the least supportive mode of mechanical ventilation?

A

pressure support ventilation (PSV)

165
Q

what is pressure support ventilation (PSV)?

A

a mode of mechanical ventilation where the pt breathes spontaneously and determines the TV

the machine delivers positive pressure during inspiration

can be added to other modes

166
Q

what are possible complications of mechanical ventilation?

A

ventilator associated pneumonia

ventilator induced injury

ventilator induced diaphragm dysfxn

elevated ICP

elevated CVP

167
Q

why does ventilator associated pneumonia occur?

A

bc mechanical ventilation bypasses the body’s natural defenses against airborne pathogens

not all lung areas are equally ventilated so some areas become breeding grounds for bacteria

168
Q

why does ventilator induced injury occur?

A

bc of the cyclical opening and closing of the alveoli bc of the different mechanics of breathing naturally vs on a vent

excessive PEEP or TV

169
Q

what is ventilator induced diaphragm dysfxn?

A

atrophy/contractile dysfxn that causes weakness or low muscle endurance of the diaphragm

170
Q

what are common pulmonary effects of ICU admission?

A

ventilator associated pneumonia

ventilator induced lung injury

ventilator induced diaphragm dysfxn

171
Q

what are common psychiatric effects of ICU admission?

A

delirium

altered arousal

depression

anxiety

172
Q

what is a common neuromuscular effect of ICU admission?

A

ICU acquired weakness

173
Q

what are common nutritional effects of ICU admission?

A

cachexia

malnutrition

174
Q

ICU delirium occurs in what % of ppl admitted to the ICU?

A

20-80%

175
Q

what is ICU delirium?

A

cognitive impairments specific to the time period of being hospitalized

176
Q

what is ICU delirium associated with?

A

self extubation

removal of catheters

failed extubation

prolonged hospitalization

177
Q

t/f: ICU delirium can be hyperactive, hypoactive, or mixed

A

true

178
Q

what is the assessment tool for ICU delirium?

A

CAM-ICU tool

179
Q

what is the diagnostic criteria for ICU delirium with the CAM-ICU?

A

pt has to have feature 1 and 2 and either 3 or 4

180
Q

what is feature one of the CAM-ICU?

A

acute onset or fluctuating course

181
Q

what is feature two of the CAM-ICU?

A

inattention

182
Q

how does the CAM-ICU test for inattention?

A

have the pt squeeze your hand when you say a certain letter when calling out a series of letters

183
Q

what is considered an error in feature two of the CAM-ICU?

A

if the pt squeezes your hand when the letter was not said

if the pt does not squeeze your hand when the letter is said

184
Q

how many errors in feature two of the CAM-ICU is considered a (+) result?

A

more than 2 errors

185
Q

what is feature three of the CAM-ICU?

A

altered level of consciousness

186
Q

what is a (+) for feature three of the CAM-ICU?

A

RASS is anything but 0

187
Q

what is feature four of the CAM-ICU?

A

disorganized thinking

188
Q

how is disorganized thinking tested in the CAM-ICU?

A

a series of yes or no questions

189
Q

how many errors in feature 4 of the CAM-ICU is considered a (+) result?

A

more than 1 error

190
Q

what is the definition of arousal?

A

state of responsiveness to stimulation or physiologic readiness for activity

191
Q

what can affect arousal in the ICU?

A

use of sedating meds

delirium

neurologic injury

192
Q

how is arousal measured in the ICU?

A

the Richmond Agitation-Sedation Score (RASS)

193
Q

what is a 0 on the RASS?

A

pt is alert and calm

spontaneously pays attention

194
Q

anything above a zero on the RASS requires that we do what?

A

look at the pt

195
Q

what is +1 on the RASS?

A

restless

anxious, apprehensive, movts NOT aggressive

196
Q

what is +2 on the RASS?

A

agitated

frequent nonpurposeful movt, fights ventilation

197
Q

what is +3 on the RASS?

A

very agitated

aggressive, pulls lines and tubes

198
Q

what is +4 on the RASS?

A

combative

violent

danger to self and staff

199
Q

anything below a zero on the RASS, we have to do what?

A

talk to and touch the pt

200
Q

what is -1 on the RASS?

A

drowsy

not fully alert, but has sustained awakening to voice

eye opening and contact >10 sec

201
Q

what is -2 on the RASS?

A

light sedation

briefly awakens to voice

eye opening and contact <10 sec

202
Q

what is -3 on the RASS?

A

moderate sedation

movt/eye opening to voice (no eye contact)

203
Q

what is -4 on the RASS?

A

deep sedation

no response to voice

movt/eye opening to physical stimulation (chest rub)

204
Q

what is -5 on the RASS?

A

unarousable

no response to voice or physical stimulation

205
Q

what is ICU acquired weakness?

A

an overarhcing term for profound neuromuscular weakness that occurs during an ICU admission

acute, diffuse, flaccid paralysis

206
Q

t/f: ICU acquired weakness is deconditioning from being ill

A

false

207
Q

t/f: there is no alterations in muscle tone with ICU acquired weakness, muscles are just globally weak

A

true

208
Q

what three illnesses are included under ICU acquired weakness?

A

critical illness neuropathy

critical illness myopathy

mixed critical illness neuropathy and myopathy

209
Q

how is ICU acquired weakness assessed in the ICU?

A

Medical Research Council Examination (MRC)

210
Q

what movts are assessed with the MRC exam?

A

shoulder abd

hip flex

knee ext

wrist ext

DF

211
Q

why are specific movts used in the MRC?

A

they include major muscle groups affected in the ICU

they are easy to perform in supine

they include actions at the major jts of the body

212
Q

how is the MRC exam scored?

A

like an MMT without any (+) or (-)

213
Q

what is the MRC score to dx ICU acquired weakness?

A

<48/60

214
Q

critical illness myopathy causes necrosis of what type of muscle fibers?

A

type 2 muscle fibers

215
Q

t/f: sensory fxns are spared in critical illness myopathy

A

true

216
Q

critical illness myopathy is associated with what?

A

meds

liver/lung transplant

hepatic failure

acidosis (metabolic or respiratory)

217
Q

what is a key difference bw critical illness myopathy and polyneuropathy?

A

myopathy will affect proximal b4 distal

neuropathy will affect distal b4 proximal

218
Q

does critical illness myopathy affect small or large muscle groups first?

A

large muscle groups b4 small muscle groups

219
Q

what is critical illness polyneuropathy?

A

axonal neuropathy (damage to axons)

220
Q

what does critical illness polyneuropathy cause?

A

flaccid tetraplegia

hyporeflexia

muscle atrophy

distal sensory imbalances

221
Q

what is critical illness polyneuropathy associated with?

A

intense inflammatory states (sepsis, multiorgan failure)

222
Q

how does critical illness affect nutrition?

A

it puts the body in hypermetabolic and hypercatabolic states that deplete the body tissue stores and protein elements leading to decreased protein synthesis, enhanced protein breakdown, and malnutrition

223
Q

what is hypermetabolism?

A

increased energy needs

224
Q

what is hypercatabolism?

A

increased breakdown of energy stores

225
Q

what does malnutrition cause?

A

muscle wasting

reduced muscle strength and endurance

increased infection rates

reduced pulmonary fxn

increased mortality

226
Q

what is the ABCDEF bundle?

A

an approach to care designed to maximize active pt and family engagement in care

227
Q

what does the A in the ABCDEF bundle stand for?

A

assess, prevent, and manage pain

228
Q

what does the B in the ABCDEF bundle stand for?

A

both spontaneous awakening trials (SAT) and spontaneous breathing trials (SBT)

229
Q

what does the C in the ABCDEF bundle stand for?

A

choice of analgesia and sedation

230
Q

what does the D in the ABCDEF bundle stand for?

A

delirium (assess, prevent, and manage)

231
Q

what does the E in the ABCDEF bundle stand for?

A

early mobility and exercise

232
Q

what does the F in the ABCDEF bundle stand for?

A

family engagement and empowerment

233
Q

what is a good definition of early mobility?

A

any active exercises where the pt can assist w/the activity suing their own muscles strength and control

234
Q

t/f: early mobility is generally applied to ppl receiving mechanical ventilation and other life support machines

A

true

235
Q

early mobility starts how many days after intubation?

A

1-4 days after intubation

236
Q

t/f: early mobility programs are broadly safe and feasible

A

true

237
Q

are adverse events common in early mobility programs?

A

no

238
Q

what are some temporary and non-life threatening adverse events that may arise with early mobility?

A

temporary desaturation

techypnea

HR changes

loss of devices (pulling Foley or IV out)

postural hypotension (OH)

239
Q

what CV signs are we monitoring in the ICU for safe early mobility?

A

HR 50-150 bpm

MAP 65-120 mmHg

vasopressor dose is stable or decreasing with appropriate BP/MAP

240
Q

what do vasopressors do?

A

elevate HR

241
Q

what pulmonary signs are we looking for in the ICU for safe early mobility?

A

RR <35 breaths/min

SpO2 >90%

PEEP less than or equal to 10 cmH2O

FiO2<0.7

242
Q

what neurologic signs are we looking for in the ICU for safe early mobility?

A

RASS -1 to +1

following simple commands

243
Q

what are some improvements associated with early mobility programs?

A

shorter ICU LOS

shorter hospital LOS

increased return to fxnal independence

shorter duration of delirium

increased ventilator free days

improved fxnal independence at hospital d/c

244
Q

t/f: there are many different protocols for earl mobility

A

true

245
Q

is a pt at level one in mobility fully conscious and participating in therapy?

A

no, they are completely unconscious and unable to participate

246
Q

when is skilled therapy needed in early mobility levels?

A

level 2

247
Q

what early mobility activities are involved in level 1?

A

preventative measures (PROM, position changes every 2 hours, using HOB to achieve sitting, passive transfer)

248
Q

to progress to level 3, pts must have what MMT scores in the UEs?

A

at least 3/5

249
Q

to progress to level 4, pts must have what MMT scores in the LEs?

A

at least 3/5

250
Q

what early mobility is involved in level 2?

A

all of level 1 activities

resistive exercises, sitting EOB, passive transfers

251
Q

what early mobility is involved in level 3?

A

all level 1 and 2 activities

active transfers, standing actively with asssitance as needed

252
Q

what level is full participation in early mobility?

A

level 4

253
Q

what early mobility is involved in level 4?

A

all level 1, 2, and 3 activities

ambulation (marches, walking in hall/room), commode use

254
Q

what are some low level activities for early mobility?

A

sitting EOB

seated ADls

sitting balance

dependent transfers using Hoyer lift

tilt table

supine exercises

255
Q

what are some supine low level exercises?

A

AAROM

AROM

light weights

resistance bands

cycle ergometry

Moveo

NMES

256
Q

what are some mid level activities for early mobility?

A

sitting balance activities with less support and more dynamic

active transfers

standing balance

STS machine

257
Q

what are some higher level activities for early mobility?

A

standing ADLs

marching

ambulation

standing ther ex

258
Q

how do we know what level of activity a patient can handle in early mobility programs?

A

monitor their face and VSs

259
Q

what are some ICU specific outcome measures?

A

physical fxn intensive care test scored

ICU mobility scale

fxnal status for the ICU

DPT 629: Cardio (11 decks)

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