Lecture 11: ICU and Medically Complex Patients Flashcards
she didnt actually answer this
leave the bed or chair in the lowest position w/ the wheels locked
* saftey fail if not done
know the equipment you’re going to use
confused/disoriented not a contraindication to therapy
leave call bell
restraints can be chemical as well as physcial
supplemental o2
* physcian perscribed - considered medication
* recorded as L/min
* Titration orders
* can the PT increase supplemental O2 - so can’t just go ahead and change their o2 unless there are specific titration orders based on activity level
FiO2 = fraction of inspired o2 = percentage of o2 a patient is breathing in - room air is 21% FiO2
* involved in gas exchange at the alveolar level
* can be used to assess lungs’ capacity for gas exhcange (in the ICU)
supplemental o2 and mechanical ventilation can increase to 100% FiO2
* so i think its like the % of total air thats O2 that they’re breathing in
High FiO2 - use for pts w/ low o2 levels (think spo2)
Can cause oxygen toxicity and lung damage - so the goal is to wein the pt off asap - or use the minimal amount of o2 they need
if you can maintain your spo2 w/ room air (21% O2) than your lungs are working properly. If you need extra o2, a higher percentage, your lungs are not exchanging o2 that well. Probs why they’re in the ICU
What would you use for low oxygen flow?
* what Fio2 does it have
* what L/min does it have
Nasal cannula
24-50% fio2
1-6 L/min
What would you use for moderate oxygen flow?
* what Fio2 does it have
* what L/min does it have
simple face mask
40-60%
5-10L/min
What would you use for high oxygen flow?
* what Fio2 does it have
* what L/min does it have
reservoir mask
60-90%
15 L/min
What would you use for very high oxygen flow?
* what Fio2 does it have
nasal high flow
up to 100% fio2
specialised form of pressure positive ventilation
* can be used for pts w/ sleep apnea or maintain an open airway
* fio2
CPAP
up to 100%
invasive form of pressure positive ventilation
required when a pts lungs are severely impaired
ventilator
fio2 = up to 100%
canister = used for humidification
may neeed to switch from nasal cannula to face mask because you have a mouth breather
know when you would need to switch a pt from a nasal canula to something higher duty
w/ a vent inhaled air in through throat exhaled = out through mouth
dont tell this pt to breath in through nose lol
positive pressure ventilation = you’re forcing air in to keep lungs open
* w/ ventilation can be positive or negative pressure ventilatoin
non invasive positive pressure = things like CPAP
PEEP = Positive end-expiratory pressure: alveolar pressure above atmospheric pressure that exists at end of expiration on ventilator to keep lungs open - basically just the pressure thats in your alveoli to keep them open - because when on a ventilator you’re not working to keep lungs open - were giving your lungs a break when you’re on a vent
* Improves oxygenation in pts w/ ARDS, pulmonary edema, etc
* High peep = is for critically ill, unstable O2 = what #
high peep = > 10 cm H20
also use positioning strategies, precaution for airway clearance techniques
Why do we give a PEEP and FiO2 - remember our goal is to ween pt off o2
Monitor SpO2 during mobility and interventions - i think this is just o2 sat
Healthcare team collaboration for optimal ventilation settings
* Resp therapy
Incorporate positioning, breathing ex, and mobilization techniques to optimize lung function and promote recovery
response to therapy and intervention adjustment
FiO2 > what = pts may be unstable and require minimal exertion activities
> 60%
PEEP > what = desaturation is common, barotrauma risk, unstable
PEEP > 10 cm H2O
be mindful in interventions
when a PT is on how much O2 do we add humidity in order to prevent irritation of the pulmonary mucosa
5 L/min
when the upper airway is bypassed or when flow rates exceed 10L/min, the o2 may be heated to increase its water vapor carrying capacity
* i.e., endotracheal intubation or tracheostomy - bypassing upper airway = bypasses nasal cavitity which does heating/humidification
this is for when closed mask interferes w/ coughing, talking, eating and drinking
different colors for different flow rates
pressure supported noninvasive ventilation = provides positive inspiratory and end expiratory pressure
lots more o2 than ventori mask
decision making tool for o2 therapy
because spo2 may plumet w/ activity (because their on O2) so you would want to know if you can change their % if needed
* remember O2 is a medication so we need orders from MD
mechanical ventilation is not contraindicated for pt
* as long as hemodynamically stable, receiving PEEP of 5cm H2O or less, tolerating a weaning mode of ventilation, and does not exhibit abnormal signs and symptoms in response to pre-gait activities
helps stabilize chest wall (keeps lungs open)
For normal ventilation (just us breathing) - the air is pulled into the lungs because of a negative pressure created through activation of the respiratory muscles
Mechanical ventilation = cant generate an effective negative or subatmospheric pressure
* mechanical ventilator forces air into the lungs through creation of a positive pressure greater than the atmospheric pressure that exists within the lung
On vnetilator = reduced strength of inspiratory muscles
prolonged bed rest = increased heart rate at rest
decreased total blood volume = due to not moving as much because they dont need as much blood
inspiratory muscles impacted
* meaning they arent working hard enough
* Incentive spirometer focuses the most on inspiratory muscles
An acute state of delirium, often termed ICU delirium, ICU syndrome or ICU psychosis
* state of delirium that can occur during the stay in the ICU
Disturbance in consciousness with inattention accompained by a change in cognition or perceptual disturbance that develops over a short period of time (hours to days) and fluctuates over time
* worse the longer you’re in the ICU
* flucuates over time
Relocatiton stress syndrome
ICU delirium may present as hyperactive (less common) or hypoactive, or mixed
early mobility decreases the risk of icu delrium
especially important to monitor vitals when pt is getting up - things change quickly
slowly increase HOB - helps minimize orthostatic hypotension
LE anti embolism stocking = decrease orthostatic hypotension
be aware of what mentally prolonged bed rest does to a person
mobility wise we always take the lead
therapists response and assessment of an adverse event or situation - incident report form only
* not in daily note
want catheter on working side of bed
Telemetry is the process of gathering and sending data from remote locations
invasive - may not be able to move far
medical surgical devices normally found on the med surge floor
this is a chest tube - needs to be kept upright and below so it can drain - very painful if pulled out
* dont want it to tip over because theres fluid in there
* Drains pleural space in the lungs
jackson prat drain
* used to remove fluid - done after surgical procedures
know jackson prat / chest tube - others are nice to know
central venous catheter = goes into subclavian and into the heart
babies have different lines than this
if you’re going to walk have a place to stop just incase something goes wrong
