Medically Complex/Neuro ICU

Question 1

What are the potential benefits of early mobilization in the Neuro ICU?

Answer 1

Improved physical function.
Reduction in pressure ulcers, infections, and delirium.
Decreased length of stay and mechanical ventilation duration.
Reduced anxiety and cost of care (by 15-30%).

Question 2

What are the risks associated with intense early mobilization within 24 hours of stroke onset?

Answer 2

The AVERT study showed that intense early mobilization within 24 hours of stroke symptom onset could lead to unfavorable outcomes, particularly in ischemic stroke cases.

Question 3

What are the major effects of immobility and bed rest in critically ill patients?

Answer 3

Muscle atrophy and ICU-acquired weakness.
Cognitive dysfunction and poor quality of life.
Increased risk of venous thromboembolism and infections.
Dependence on mechanical ventilation and vasopressors

Question 4

What steps should be taken to ensure safe mobility in the ICU?

Answer 4

1. Assess neurological stability
2. Evaluate vital signs and hemodynamic stability.
3. Collaborate with the healthcare team for mobility goals.
4. Consider patient-specific factors (e.g., activity orders, devices, sedation level

Question 5

What components should be assessed during a neurological exam in the Neuro ICU?

Answer 5

1. Arousal: Levels of consciousness and responsiveness.
2. Attention and Cognition: Memory, concentration, and executive functions.
3. Autonomic Nervous System: Sympathetic responses (e.g., HR, BP).
4. Motor Control: Tone, strength, and coordination

Question 6

What are signs of autonomic nervous system dysregulation in ICU patients?

Answer 6

Increased HR, RR, and BP.
Diaphoresis and hyperthermia.
Posturing or hypertonia.
Teeth grinding and paroxysmal sympathetic hyperactivity.

Question 7

What are potential safety concerns to address prior to and during mobilization?

Answer 7

New onset tachycardia, bradycardia, or arrhythmia.
New or worsening hypotension, hypertension, or orthostatic symptoms.
Oxygen saturation <88%.
Asynchrony with mechanical ventilation.
Signs of fatigue, excessive pallor, or skin flushing.

Question 8

What impairments and activity limitations should you consider when treating a patient with a large intracranial hemorrhage?

Answer 8

Impairments: Decreased strength, balance, sensation, and visual-spatial awareness.

Activity Limitations: Impaired bed mobility, transfers, ambulation, and safety awareness.

Question 9

When is early mobilization controversial for Neuro ICU?

Answer 9

<72 hours

Question 10

Time to Mobilize for Ischemic Stroke and considerations?

Answer 10

> 24 hours

considerations: cerebral perfusion, HOB changes

Question 11

Time to mobilize for SAH (subarachnoid hemorrhage) and considerations?

Answer 11

24-48 hours after ruptured aneurysm secured

considerations: EVD displacement, ICP elevation

Question 12

time to mobilize after ICH and considerations?

Answer 12

greater than or equal to 24 hours after hemorrhage stability

considerations: increases in BP

Question 13

time to mobilize after SCI and considerations?

Answer 13

24 hours post spine stabilization

considerations: orthostatic hypotension

Question 14

time to mobilize after TBI and considerations?

Answer 14

24 hours after hemorrhage stable

considerations: ICP elevation

Question 15

can patients with an EVD or lumbar drain be mobilized?

Answer 15

yes!

Question 16

what is an evd?

Answer 16

external ventricular drain

measures/assists with drainage of CSF in the head must be clamped for mobility

Question 17

what is a lumbar drain?

Answer 17

measures/assists with drainage of CSF in the low back must be clamped for mobility

Question 18

safety precautions/screens for early mobility and neurologival stability ?

Answer 18

No evidence of increased ICP >20 mm Hg
No acute or uncontrolled intracranial event
No cervical orthoracic lumbar sacral precautions (unless braced appropriately)

Question 19

what does a GCS score of 3-8 indicate?

Answer 19

severe brain injury

Question 20

what does a GCS score of 9-12 indicate?

Answer 20

moderate brain injury

Question 21

what does a GCS score of 13-15 indicate?

Answer 21

minor brain injury

Question 22

what is the lowest GCS score you can get? highest?

Answer 22

3 is the lowest, 15 is the highest

Question 23

What are the characteristics of a coma?

Answer 23

No arousal or awareness.
Eyes remain closed.
No sleep-wake cycles.
No cognitive or communication functions

basically brain dead

Question 24

What are the characteristics of a vegetative state?

Answer 24

No awareness of self or environment.
Sleep-wake cycles are present.
Reflexive responses to stimuli (e.g., head turning, random sounds/movements) may occur.

Question 25

What are the characteristics of a minimally conscious state?

Answer 25

Inconsistent but reproducible evidence of awareness.
Can localize to noxious stimuli.
May visually track objects or respond to commands sporadically.

Question 26

which reflexes are intact during coma?

Answer 26

spinal cord and brainstem

Question 27

which reflexes are intact during vegetative state?

Answer 27

spinal cord, brainstem, some arousal

Question 28

stupor vs obtunded?

Answer 28

stupor = unresponsive state from which patient can be aroused only briefly via vigorous repeated sensory stimulation

obtunded = sleepppyyyy, when aroused they exhibit decreased alertness and interest and fall back asleep

Question 29

What is dysautonomia?

Answer 29

an overactivation of the sympathetic nervous system following trauma or brain injury

Question 30

signs of dysautonomia?

Answer 30

Increased HR
Increased RR
Elevated BP
Hyperthermia and diaphoresis.
Posturing or hypertonia.
Teeth grinding

Question 31

How can dysautonomia affect mobilization in the ICU?

Answer 31

Causes unpredictable BP, HR, and RR changes.
Increases the risk of syncope or cardiovascular events during activity.
May result in patient fatigue or autonomic crises during therapy.

Question 32

What is retrograde amnesia, and how does it present?

Answer 32

Inability to recall events that occurred before the injury.
Long-term memories (e.g., childhood) may remain intact, while recent memories before the injury are lost.

Question 33

What is anterograde amnesia, and how does it present?

Answer 33

Inability to form new memories after the injury.
Patients struggle to retain new information or events but can recall past events from before the injury.

Question 34

What is post-traumatic amnesia, and how does it differ from retrograde and anterograde amnesia?

Answer 34

Time between the injury and when the patient can form continuous, ongoing memories again.

can involve both retro and anterograde amnesia

Question 35

What is explicit memory

Answer 35

semantic (general knowledge and facts)

episodic (personal experiences)

Example: Remembering the date of a historical event or your last birthday.

Question 36

What is implicit memory?

Answer 36

procedural (learning motor skills)
priming (influence of prior experiences on current actions without awareness)

Example: Typing on a keyboard or playing a musical instrument without thinking

Question 37

What is the primary difference between explicit and implicit memory?

Answer 37

Explicit Memory: Requires conscious recall and is declarative (facts/events).
Implicit Memory: Operates unconsciously and involves skills and habits (non-declarative).