PCM 2 ICU Flashcards
What is a Level 1 Trauma Center?
A comprehensive regional resource that is tertiary care facility central to the trauma system
What is Intubation?
This refers to inserting a tube to establish an airway so that the patient can breath
- In most short-term trauma, respiratory failure cases that come in the emergency room the prefered method of intubation is Endotracheal Tube
What is Patient Controlled Analgesia (PCA) Pumps?
What are the side affects?
This is when the patient can control their pain medication delivery
- Only the pt should press the button
- They should not be discouraged if in pain and are asking if they can press the button
- Allergic reaction
- Nausea or vomiting
- Low BP
- Sleepiness
- Constipation
- Respiratory Distress
With patients in the ICU, what are the considerations for safe mobilization?
In the ICU, a patient may have Systemic Inflammatory Respose Syndrome (SIRS), what is this?
An exaggerated defense response of the body to a noxious stressor to localize and then eliminate the endogenous or exogenous source of the insult
With Systemic Inflammatory Response Syndrome (SIRS), what are the more common types of noxious stressors?
- Infection
- Trauma
- Surgery
- Acute inflammation
- Ischemia or reperfusion
- Malignancy
With Systemic Inflammatory Response Syndrome, how is this manifested objectively?
Any 2 of these criteria:
- Body temp >38° C (100° F) or < 36° C
(< 98.6°F) - Pulse rate > 90 beats/min
- RR > 20 breaths/min or PCO2 < 32mmHG
- Leucocyte Count > 12,000 or < 4,000/microliters or over 10% immature forms or bands
PCO2: Partical Pressure of carbon dioxide
What is Critial Illness Myopathy?
- Profound weakness > than expected for immobilization period
- Often with multiorgan dysfunction or systemic problems - especially with sepsis and ARDS
- Develops often within 4-7 days of mechanical ventilations
- Most systems rebound after ICU - neurological long term
- Physical rehab should start as soon as possible/allowed
- Activities limitations may persist for over a year
No medical treatment once it has developed
ARDS: Acute respiratroy distress syndrome
What is ICU Acquired Delirium?
Fluctuating disturbance (spectrum) of consciousness and cognition, that is a manifestation of acute brain dysfunction in critically ill patients, occurring frequently in critically ill patients in the ICU
What are the risk factors for ICU acquired delirium?
- Medications (Sedatives and analgesics)
- The environment of the ICU
-sleep deprivation / social isolation / immobilization / unfamiliar surroundings / excessive noise / sensory monotony /no diurnal light variation
What is the Treatment of ICU acquired Delirium?
Reduce precipitating factors / antipsychotic medications / proper oxygenation / pain management / early mobility
What is Post-Intensive Care Syndrome?
Health problems that remain after critical illness. They are present when the patient is in the ICU and may persist after the patient returns home. These problems can involve the patient’s body, thoughts, feelings, or mind and may affect the family members as we
- PICS may show up as critical illness myopathy; problems with thinking and judgment (cognitive dysfunctions); and/or as other mental health problems
With Disease-Specific Isolation Recommendations, what fall under Standard Precautions?
What are Contact Precautions?
Microorganisms are transferred directly from one
infected person to another or indirectly when the transfer of an
infectious agent is through an object, medical equipment, furniture surface, or person
With Disease-Specific Isolation Recommendations, what fall under Contact Precautions?
What are Droplet Precautions?
Microorganisms are transferred by direct or indirect
contact, but in contrast to contact transmission, respiratory
droplets carrying infectious pathogens transmit infection when
they travel a short distance directly from the respiratory tract of
the infected individual to the mouth, conjunctivae, or nasal
mucosa of the recipient.
With Disease-Specific Isolation Recommendations, what fall under Droplet Precautions?
Caregiver should wear mask or face shield
What are Airborn Precautions?
Microorganisms are transferred by small infectious
particles (infective over time and distance) in the respirable size
range
With Disease-Specific Isolation Recommendations, what fall under Airborne Precautions?
What is the correct way to Don PPEs?
- Hand hygiene
- Apply gown, making sure it covers all your outer garments. Pull the sleeves to the wrist and tie the gown securely at the neck and waist
- Apply either a surgical mask or a fitted respirator around mouth and nose
- Press the metal tab on the mask against your nose for a secure fit
- If eyewear or gogges are needed, fit them snufly around face and eyes
- Apply clean gloves that are unpowdered, gloves should be latex free
What is the correct way to Doff PPEs?
- Remove gloves, grasp the outside with the opposite hand and peel off
- Remove eye protection by using the “Clean” headband at the back or earpieces
- Remove your gown
- Remove mask or respirator
- Wash hands for medical aspesis
What are common exercise and mobilizations options in the ICU with an unconscious patient?
PROM, positioning and family education
What are common exercise and mobilizations options in the ICU with the patient in bed?
Active extremity movement, bed mobility, contemporary exercise
What are common exercise and mobilizations options in the ICU with a patinet sitting at the edge of bed?
May practice static sitting or dynamic sitting (complete exercise or ADL activity)
What are common exercise and mobilizations options in the ICU with transfers?
Transfer to bedside chair
What are common exercise and mobilizations options in the ICU with those with Advanced mobility?
Standing exercise or gait
What are the Goals of PT interventions in the ICU?
- Minimize or prevent adverse effects of immobility and inactivity
- Help each person become functionally independent
- Begin information intake and ideas regarding discharge planning
With Contemporary Treatments in the ICU, what patients may be able to do Supine Cycle Ergometry?
Those patients who are mechanically ventilated and in neurocritical care unit with external ventricular drains
What can the Supine Cycle Ergometry Imporve and Decrease?
Improve:
- Recovery of functional exercise capacity
- Muscle force at discharge
- Self-perceived functional status
- Ability to live independently
Decrease:
- Duration of mechanical ventilation
- Incidience of ICU-AW5
- ICU stays
With Conteporary Treatments in the ICU, what may Neuromuscular Electrical Stimulation help improve?
The rate in regaining muscle strength in ICU, but still with functional disability after discharge
What is Orthostatic Hypotension?
What are the Sx?
(Hemodynamic Event)
Decrease in systolic blood pressure decrease of at least 20 mm Hg or a diastolic blood pressure decrease of at least 10mm Hg within three minutes of standing.
- Lightheadedness
- Dizziness
- Blurry vision
- Weakness
- Fainting (syncope)
- Confusion
- Nausea
With a person in the ICU, why might a patient exerperince Orthostatic Hypotension?
- Immobilized in a recumbent position for an extended time.
- Older adults
- On antihypertensive medications
- Decreased ability to return venous blood to the heart (SCI)
- Hypotensive
What should be the initial response with a person that had Orthostatic Hypotension?
- Press the call light or ask for help of nurse if can hear/see you.
- Place the patient in a supine position with the head slightly lower than the lower extremities. If respiration is impaired, it may be necessary to place the patient supine with the body flat or with the head and chest elevated slightly.
- Have the patient remain quiet and avoid exertion.
- Further treatment needed
What is the Treatment fo Orthostatic Hypotension?
Compression
- Wrap the patient’s lower extremities from the feet to the groin with elastic compression bandages
- Apply an abdominal binder or corset
- Apply elastic hose (half or full length)
Muscle Pumping
- Instruct the patient to perform active ankle dorsiflexion plantar flexion exercises (“ankle pumps”)
- Alternate knee-to-chest exercises in supine and/or sitting
Titrate the Vascular System
- Allow the patient to accommodate to the upright position gradually by slowly elevating the head of the bed to various levels; or use a tilt table to elevate the patient by increments.
In the ICU a patient may exerience Shock, what is this?
- Shock is an acute circulatory failure threatening multiple organ systems
- Low blood pressure and subsequent poor perfusion.
- The main types of shock are hypovolemic (trauma), cardiogenic (heart attack), and distributive shock (septicemia).
- Shock must be managed rapidly by identifying and treating acute, reversible causes
What are the PT considerations of the those patients with Shock?
- Vitals: Pay attention to trends
- Medications: Vasoactive Drugs
-Dopamine, Norepinephrine, Epinephrine, Vasopressin
-Low, moderate, high level of support
