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Advanced Procedures > Mod 8: ICU & TBI > Flashcards

Mod 8: ICU & TBI Flashcards

1
Q

Prolonged effects of ICU on the body (3)

A

dec bone density in 3-6 wks
mm atrophy in big/strong mm
CT loses elasticity in days

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2
Q

tachycardia is what range?
bradycardia is?

A

> 140 bpm
<50 bpm

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3
Q

how does bedrest affect resting heart rate?
ejection fraction?

A

resting HR inc
EF dec

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4
Q

what is ventilator used for?
how effects tidal volume?

A

to breathe for pt or as supplement
dec. TV

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5
Q

example of invasive O2 delivery:
non-invasive delivery w/ vent:
non-invasive delivery w/out vent:

A

trach & endotracheal tubes
CPAP & BiPAP
nasal cannula, rebreather mask, venturi mask

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6
Q

3 peripheral lines & location

A

peripheral IV (hand, arm)
peripheral indwelling central catheter (PICC)- cubital/brachial vein
external jugular-neck

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7
Q

2 indwelling lines & location

A

central line-upper chest wall
dialysis fistula-forearm

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8
Q

3 monitor lines & purpose

A

arterial lines: for constant BP
ECG monitor: HR/rhythm
central venous pressure (CVP)- BP near vena cava

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9
Q

6 drain lines & purpose

A

catheter (Foley & suprapubic)
chest tube- drainage
J-P: for wounds
J & G- gastric surgery
ICP monitor - intracranial pressure
ventricular/lumbar drain- brain, SC, CSF

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10
Q

5 In/Out Lines

A

nasogastric feeding
Dobhoff-feeding
NG tube-drains gut
PEG- feeds directly to stomach
J-tube- into jejunum

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11
Q

Acute Care general precautions:

A

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

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12
Q

normal O2 saturation
when to not treat:
normal FiO2 values

A

> 90% norm
<85% no tx
21% & < 50% for tx

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13
Q

open vs. close injury (TBI)

A

open: direct penetration through skull
closed: no penetration through skull (concussion, hematoma, hypoxia, acc/decel)

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14
Q

epidural vs. subdural hematoma

A

epi: between skull & dura mater, arterial & fast
sub: between dura & arachnoid, venous & slow

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15
Q

anterograde vs retrograde memory

A

ant: ability to create new memory after trauma event
retro: can’t remember events prior to injury

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16
Q

which concussion classification?
no loss of consciousness
resolves within 15 min
RTS 1 wk

A

Grade 1

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17
Q

which concussion classification?
confusion > 15 min
poor concentration, retro/ant amnesia
RTS once asymptom. for 2 wks w/ rest & exertion

A

Grade 2

18
Q

which concussion classification?
any loss of consciousness
diffuse axonal injury
RTS once asymptom. for 1 mo

A

Grade 3

19
Q

3 measureable factors in Glasgow Coma Scale

A

eye opening response
verbal response
motor response

20
Q

Ranchos Los Amigos Level: ____
no response to ext stimuli
no wake/sleep cycle, purposeful movement

A

Level 1: no response

21
Q

Ranchos Los Amigos Level: ____
emerging signs of arousal
eye opening
general reflexes to stimuli but inconsistent
inappropriate/not purposeful responses

A

Level 2: Generalized Response

22
Q

Ranchos Los Amigos Level: ____
emerging awareness
withdrawal/vocal to painful stimuli
tracks object, blinks w/ light
more purposeful, appropriate responses

A

Level 3: Localized Response

23
Q

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

A

Level 4: Confused-Agitated

24
Q

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

A

Level 5: Confused-Inappropriate

25
Q

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

A

Level 6: Confused- Appropriate

26
Q

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

A

Level 7: Automatic-Appropriate

27
Q

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

A

Level 8:Purposeful-Appropriate

28
Q

Ranchos Los Amigos
Level 1:
2 & 3:
4-6:
7-8:

A

no response
dec. response
confused levels
appropriate levels

29
Q

principles of neuroplasticity

A

practice
function
specificity (appropriate skills)
repetition
intensity
time
salience/motivation- goals
age

30
Q

Contraindications to early mob w/ TBI (2)

A

elevated ICP
unstable spine

31
Q

Precautions to early mob w/ TBI (4)

A

WB restriction
skin integrity
autonomic instability (dysreflexia?)
unstable cardiovasc system/vitals
& orthopedic issues

32
Q

What is necessary in pt presentation for PT intervention w/ TBI?

A

following commands- cognition
alert & oriented to place & time
demo. insight (Ranchos Scale)

33
Q

3 phases of PT interventions w/ TBI & Ranchos levels

A

minimally conscious 1-3
structured phase 4-5
community re-entry 6-8

34
Q

spasticity: decorticate vs. decerebrate

A

corticate: UEs flex & LE ext
cerebrate: both UE & LE ext

35
Q

how to use sensory stim w/ Phase 1-3

A

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

36
Q

techniques for “structured phase” tx, Level 4&5

A

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

37
Q

the ability to select & attend to a specific stimulus while simult. suppressing others

A

attention

38
Q

how to address memory impairment in tx

A

attention first to create memory & have motor learning
aids: calendar, NB for ST memory
memory tasks integrated “remember these words”

39
Q

principles of tx for impairments of executive function

A

provide structure, feedback & routine

40
Q

spatial relations disorders:
figure ground discrimination vx. form discrimination

A

FGD: visually locate objects
FD: sort or label objects using sensory input

41
Q

Community Re-entry Tx Focus Areas (phase 6-8)

A

balance, coordination, strength
safety training
cognitive tasks w/ specificity for pt
pt & fam edu

42
Q
A

Advanced Procedures (7 decks)

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