Mod 8: ICU & TBI Flashcards by Alyssa Donley

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

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tachycardia is what range?
bradycardia is?

> 140 bpm
<50 bpm

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how does bedrest affect resting heart rate?
ejection fraction?

resting HR inc
EF dec

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what is ventilator used for?
how effects tidal volume?

to breathe for pt or as supplement
dec. TV

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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

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3 peripheral lines & location

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

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2 indwelling lines & location

central line-upper chest wall
dialysis fistula-forearm

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3 monitor lines & purpose

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

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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

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5 In/Out Lines

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

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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

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normal O2 saturation
when to not treat:
normal FiO2 values

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

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open vs. close injury (TBI)

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

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epidural vs. subdural hematoma

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

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anterograde vs retrograde memory

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

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

Grade 1

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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