Physical Therapy Interventions in the ICU Flashcards
Physical Therapy Interventions in the ICU
Goals of PT in the ICU include?
- Prevention of Secondary Complications
- Promote weaning from ventilatory support by improving strength and endurance
- Optimize oxygenation
- Restoration of Function
- Decrease Length of Stay in ICU and hospitalization
- Improve interdisciplinary progression of mobility
- Improve quality of life
Physical Therapy Interventions in the ICU
Sound clinical decision making in the ICU begins with?
Review EHR:
- PMH/current medical history/reason for admission
- Previous level of function, home environment/support system
- Current medical status/medical stability
- Medical interventions/medications/mechanical devices/supports
- Lab values
- Precautions/Contraindications
Physical Therapy Interventions in the ICU
Keys to communication include?
- PT must communicate with interdisciplinary team prior to initiating evaluation process and daily prior to intervention.
- PT must coordinate care with nursing, respiratory therapy, medical tests/interventions, physicians assessments, occupational therapy, speech/language therapy, family, patient (activity tolerance).
- PT must communicate objectively in written documentation to demonstrate patient’s ability to participate and progress with PT interventions.
Physical Therapy Interventions in the ICU
PT Tests and Measures in the ICU include?
- Arousal, attention, cognition
- Aerobic Capacity/Endurance/Activity Tolerance
- Circulation
- Integumentary Integrity
- Motor Function
- Muscle Performance
- Pain
- Range of Motion
- Ventilation and gas exchange
Physical Therapy Interventions in the ICU
The readiness of the human system for activity = ?
Arousal/Attention/Orientation/Cognition
Arousal: The readiness of the human system for activity.
Various levels of consciousness (Alert, Lethargic, Obtunded, Stupor, Coma)
Physical Therapy Interventions in the ICU
Selective awareness of the environment or responsiveness to a stimulus or task without being distracted by other stimuli = ?
Arousal/Attention/Orientation/Cognition
Attention: Selective awareness of the environment or responsiveness to a stimulus or task without being distracted by other stimuli.
Physical Therapy Interventions in the ICU
Patient’s awareness of time, person, place, situation = ?
Arousal/Attention/Orientation/Cognition
Orientation: Patient’s awareness of time, person, place, situation.
- Ox4
Physical Therapy Interventions in the ICU
Defined as the process of knowing and includes both awareness and judgment = ?
Arousal/Attention/Orientation/Cognition
Cognition: Defined as the process of knowing and includes both awareness and judgment (Mini-Mental exam, MoCA, any documentation of poor judgment during PT intervention)
Physical Therapy Interventions in the ICU
- Ventilator asynchrony
- Increased O2 consumption
- Inadvertent removal of devices, IV’s and catheters
- PTSD
Are examples of ?
Risks of UNDER-sedation:
- Ventilator asynchrony
- Increased O2 consumption
- Inadvertent removal of devices, IV’s and catheters
- PTSD
Physical Therapy Interventions in the ICU
- Pneumonia/lung injury
- Neuromuscular dysfunction (CIP) and (CIM)
- Delirium
Are examples of ?
Risks of OVER-sedation:
- Pneumonia/lung injury
- Neuromuscular dysfunction (CIP) and (CIM)
- Delirium
Physical Therapy Interventions in the ICU
(CIP) = ?
and
(CIM) = ?
Critical Illness Polyneuropathy (CIP) and
Critical Illness Myopathy (CIM):
Overlapping syndromes of diffuse, symmetric, flaccid muscle weakness occurring in critically ill patients
- Skeletal Muscles and Respiratory
The cause is unknown but thought to be a manifestation of a systemic inflammatory response related to critical illness
- 33-57% of patients in ICU>7 days develop CIP/CIM
- only 50% progress to full recovery
- timeline: weeks to months
Main Risk Factors
- Sepsis
- Systemic inflammatory response syndrome (SIRS)
- Multi-organ failure
Physical Therapy Interventions in the ICU
Disturbance of consciousness and cognition that develops over a short period of time (hours to days) and fluctuates over time = ?
ICU Delirium: Delirium-National Center for Biotechnology Information (NCBI) defines delirium as a disturbance of consciousness and cognition that develops over a short period of time (hours to days) and fluctuates over time
May be caused by hypoxemia, chemical changes in the brain, medications, infections, severe pain, withdrawal from alcohol/nicotine/sedatives/pain meds, severe medical illness
It is suggested that 60-80% of ventilated patients and 20-50% of non-ventilated patients in ICU develop some level of delirium
Up to 50% of critically ill patients showed cognitive impairment 1 year after illness
Physical Therapy Interventions in the ICU
Delirium Management in ICU, PAD = ?
Manage “PAD”
- Pain
- Agitation
- Delirium
Sedation Vacations
Discontinue mechanical ventilation as soon as possible
Initiate mobility as soon as possible
Minimize sleep disruption
Physical Therapy Interventions in the ICU
Tests for Arousal/Attention = ?
- National Institute of Health Stroke Scale (NIHSS)
- Richmond Agitation-Sedation Scale (RASS)
- Glascow Coma Scale
Physical Therapy Interventions in the ICU
National Institutes of Health Stroke Scale (NIHSS) = ?
- Assessment tool that systematically assesses and quantitatively measures stroke-related neurologic deficit
- Can be performed by a physician, RN, or PT (Evaluator must complete training and competency testing)
- Valid for predicting lesion size and can help determine stroke severity
- Predicts patient outcomes
- Scoring: 0 (no deficits) to 42 (most severe deficits)
- Requires 10 minutes to complete
Physical Therapy Interventions in the ICU
Describe the Richmond Agitation Sedation Scale (RASS)
Physical Therapy Interventions in the ICU
Describe the Glasgow Coma Scale (GCS)
