Mod 8: ICU & TBI Flashcards
Prolonged effects of ICU on the body (3)
dec bone density in 3-6 wks
mm atrophy in big/strong mm
CT loses elasticity in days
tachycardia is what range?
bradycardia is?
> 140 bpm
<50 bpm
how does bedrest affect resting heart rate?
ejection fraction?
resting HR inc
EF dec
what is ventilator used for?
how effects tidal volume?
to breathe for pt or as supplement
dec. TV
example of invasive O2 delivery:
non-invasive delivery w/ vent:
non-invasive delivery w/out vent:
trach & endotracheal tubes
CPAP & BiPAP
nasal cannula, rebreather mask, venturi mask
3 peripheral lines & location
peripheral IV (hand, arm)
peripheral indwelling central catheter (PICC)- cubital/brachial vein
external jugular-neck
2 indwelling lines & location
central line-upper chest wall
dialysis fistula-forearm
3 monitor lines & purpose
arterial lines: for constant BP
ECG monitor: HR/rhythm
central venous pressure (CVP)- BP near vena cava
6 drain lines & purpose
catheter (Foley & suprapubic)
chest tube- drainage
J-P: for wounds
J & G- gastric surgery
ICP monitor - intracranial pressure
ventricular/lumbar drain- brain, SC, CSF
5 In/Out Lines
nasogastric feeding
Dobhoff-feeding
NG tube-drains gut
PEG- feeds directly to stomach
J-tube- into jejunum
Acute Care general precautions:
universal precautions & PPE
survey surroundings & prepare room for tx
check vitals & monitor throughout
explain plan for tx
don’t pull out lines/tubing
tube collectors in dependent position
normal O2 saturation
when to not treat:
normal FiO2 values
> 90% norm
<85% no tx
21% & < 50% for tx
open vs. close injury (TBI)
open: direct penetration through skull
closed: no penetration through skull (concussion, hematoma, hypoxia, acc/decel)
epidural vs. subdural hematoma
epi: between skull & dura mater, arterial & fast
sub: between dura & arachnoid, venous & slow
anterograde vs retrograde memory
ant: ability to create new memory after trauma event
retro: can’t remember events prior to injury
which concussion classification?
no loss of consciousness
resolves within 15 min
RTS 1 wk
Grade 1
which concussion classification?
confusion > 15 min
poor concentration, retro/ant amnesia
RTS once asymptom. for 2 wks w/ rest & exertion
Grade 2
which concussion classification?
any loss of consciousness
diffuse axonal injury
RTS once asymptom. for 1 mo
Grade 3
3 measureable factors in Glasgow Coma Scale
eye opening response
verbal response
motor response
Ranchos Los Amigos Level: ____
no response to ext stimuli
no wake/sleep cycle, purposeful movement
Level 1: no response
Ranchos Los Amigos Level: ____
emerging signs of arousal
eye opening
general reflexes to stimuli but inconsistent
inappropriate/not purposeful responses
Level 2: Generalized Response
Ranchos Los Amigos Level: ____
emerging awareness
withdrawal/vocal to painful stimuli
tracks object, blinks w/ light
more purposeful, appropriate responses
Level 3: Localized Response
Ranchos Los Amigos Level: ____
confused, disoriented, heightened state
hyper alert, restless & hypersensitive to stimuli
aggressive, combative, paranoid
limited concentration/attention
perceptual distortions
no ST/LT recall
uncooperative, incoherent verbal
Level 4: Confused-Agitated
Ranchos Los Amigos Level: ____
confused, disoriented, agitated
distractible & need redirection to task
impaired memory
brain more organized
respond to simple commands
converse on social auto level
Level 5: Confused-Inappropriate
Ranchos Los Amigos Level: ____
inconsistent orientation
early awareness
consistently follow simple directions
goal directed behavior but need ext cues
max A for new learning
retrograde mem > anterograde mem
Level 6: Confused- Appropriate
Ranchos Los Amigos Level: ____
poor social cues, lacks insight/judgment
learn familiar task in closed environment on short term
need help w/ motor planning
egocentric
Level 7: Automatic-Appropriate
Ranchos Los Amigos Level: ____
multi task in all environments
needs breaks for attention/conc. endurance
more consistent social behavior
recall/integrate memory
some periods of depression, irritable when stressed
Level 8:Purposeful-Appropriate
Ranchos Los Amigos
Level 1:
2 & 3:
4-6:
7-8:
no response
dec. response
confused levels
appropriate levels
principles of neuroplasticity
practice
function
specificity (appropriate skills)
repetition
intensity
time
salience/motivation- goals
age
Contraindications to early mob w/ TBI (2)
elevated ICP
unstable spine
Precautions to early mob w/ TBI (4)
WB restriction
skin integrity
autonomic instability (dysreflexia?)
unstable cardiovasc system/vitals
& orthopedic issues
What is necessary in pt presentation for PT intervention w/ TBI?
following commands- cognition
alert & oriented to place & time
demo. insight (Ranchos Scale)
3 phases of PT interventions w/ TBI & Ranchos levels
minimally conscious 1-3
structured phase 4-5
community re-entry 6-8
spasticity: decorticate vs. decerebrate
corticate: UEs flex & LE ext
cerebrate: both UE & LE ext
how to use sensory stim w/ Phase 1-3
orient pt to time, place, surroundings
<15 min stimulation, 8-10x day
sensory input to reorient N.S.
ex: music, photo, perfume, lotion, ROM
look for appropriate responses
techniques for “structured phase” tx, Level 4&5
no new learning, simple exercises
cognitive activities
participation > accuracy
controlled/closed environment
co-treat for safety; restraints
one new stimuli at a time (low-stim enviroment)
use redirection
the ability to select & attend to a specific stimulus while simult. suppressing others
attention
how to address memory impairment in tx
attention first to create memory & have motor learning
aids: calendar, NB for ST memory
memory tasks integrated “remember these words”
principles of tx for impairments of executive function
provide structure, feedback & routine
spatial relations disorders:
figure ground discrimination vx. form discrimination
FGD: visually locate objects
FD: sort or label objects using sensory input
Community Re-entry Tx Focus Areas (phase 6-8)
balance, coordination, strength
safety training
cognitive tasks w/ specificity for pt
pt & fam edu
