PT In ICU Flashcards by Jessica Deak

6 types of ICU

Trauma ICU
Medical ICU
Surgical ICU
Neurosurgical ICU
Cardiac Care Unit (CCU)
Neonatal ICU

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What should you be monitoring when a pt is in ICU?

Blood pressure
Cardiac function
Oxygen
Glucose (respiratory (rate CO2), temperature, ICP, CVP)

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Two ways to monitor blood pressure?

Non invasive blood pressure cuff

Arterial line-invasive blood pressure monitoring

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When you are measuring BP with an arterial line, what artery is the line inserted into?

Radial artery

Can be femoral, dorsalis pedis

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When you are measuring BP with an arterial line, how is the wrist positioned?

Splinted in neutral

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When you are measuring BP with an arterial line, what should you avoid in the wrist?

ROM and weight bearing

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When you are measuring BP with an arterial line, where should the transducer be placed?

Level of R atria to be accurate

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What does an ECG monitor?

heart rate and rhythm

Vary from 3-12 leads

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Are they any mobility pxns when you have an ECG?

No specific mobility pxns

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What does a swan ganz monitor?

Right heart, pulmonary artery/wedge pressure

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What is a central line used for?

To administer meds, fluids, monitor CVP

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Where is a swan ganz and central line inserted?

Into the neck

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Where can pulse Ox be placed?

Fingers
Toes
Forehead
Ears

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Reasons why pulse Ox may be innaccurate?

Cold hands
Moving
Poor contact btw sensor and skin
Nail polish

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ICP can be monitored by what two ways?

Bolt

Ventriculostomy

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Normal ICP should be what value?

Less than 15 mmHg

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A ventriculostomy has the ability to…

Drain CSF from ventricle if ICP is high

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Ventriculostomies are position dependent, true or false?

True

Drain must be clamped during mobilization
Must be recalibrated after session

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Where is a lumbar drain inserted?

Between vertebrae into the spinal canal

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What does a lumbar drain do?

Drains CSF

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During mobilization, what must happen to the lumbar drain?

It must be clamped during mobilization

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Femoral line- sheath may be used for procedures such as…

Cardiac cath

Angiogram

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Femoral line, if sheath…. struck immobilization of ____

Hip

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True or false: femoral line is not a contraindication to PT and we can exercise them.

False.

CONTRA

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Femoral lines can be _____ or ______

Arterial or venous

Femoral lines are commonly used for....

Short term dialysis

Make sure that the line is intact prior to and after mobilization for femoral lines

True

What does CVVHD stand for?

Continuous veno-venous hemodialysis

What patients get CVVHD?

Critically ill patients with CRF

Where does the CVVHD usually access?

Jugular or femoral veins

Mobility with CVVHD is contraindicated, true or false?

False. It appears feasible and safe

What does ECMO stand for?

Extracoporeal membrane oxygenation

Is an ECMO, patients blood is ______ | _____ is removed from the blood and the ______ are oxygenated

Removed CO2 RBCs

When is a ECMO used?

When convention methods for cardiac and respiratory failure are unsuccessful

Where is access for ECMO?

Can be VA (venoatrial) VV (venovenous) and either Femoral or jugular

Can be do mobility during ECMO?

Studies coming out showing feasibility during ECMO

Where are chest tubes inserted?

Inserts into pleural space

Chest tubes are used to drain.... | To prevent...

Fluid/blood | To prevent lung from collapsing

Chest tubes can be placed to...

Suction or water seal

If chest tube is placed to suction, can only move....

Within slack of tubing

If chest tube is placed to water seal, you can...

Hook on walker or carry

Endotracheal tube goes in through ____ and into _____

Mouth | Trachea

Endotracheal tube is used for ______ ventilation

Short term

Is it okay to mobilize patient on ET tube?

Yes. Do not pull the tube

A tracheotomy is an ________ that is made through the _____ into the ______

Artificial airway Neck Trachea

This device is used for longer term airway support (>1 week)

Tracheostomy

Be cautious when someone has a tracheostomy, because tubing...

May pull apart

Can you mobilize a patient with a trach?

Yes, be cautious, BUT IT IS SAFE

CPAP is?

Continuous positive airway pressure | HI FLOW positive pressure

CPAP can also be used for ____

Sleep apnea

A Non-rebreather mask gives you ____% O2

75-100%

Is there pressure with a non-rebreather mask?

Is there pressure with a venti-mask? | And how much % O2?

No pressure | 24-75% O2

This device has the lowest amount of oxygen delivered

Nasal Cannula

T piece: has a ______ flow of O2 Attached to _______ Has _____ attached May fall off with _______

Higher Trach Suction Mobility

Trach collar is a ______ collar that sits over the _____ site

Plastic | Trach

Are there mobility issues with a trach collar?

No, but it is difficult to suction

What does PRVC stand for?

Pressure regulated volume control

In a PRVC, what is the vent doing?

All the work Pt may initiate breath

What is the adjustment of PRVC dependent on?

Based on compliance of lungs

What does SIMV stand for?

Synchronized intermittent mandatory ventilation

SIMV allows for _______ | It is a _____ mode

Spontaneous breathing | Weaning mode

CPAP means that the pt is breathing, and the _____ is helping Provides a _____ amount of pressure during _______

Vent Small Inspiration

PEEP stands for?

Positive expiratory end pressure

PEEP keeps the alveoli ______ and maintain greater ________

Open | Greater lung volume

PEEP: increased surface area= _______

Increase gas exchange

The higher the PEEP, the more __________

The vent is doing to help the pt breathe

FiO2 stands for what? What is it?

Fraction of inspired oxygen It is the amount of oxygen in gas exchange

Immobility: skeletal muscle strength may decline ______% per day of strict bed rest

1-1.5%

Patients who benefit from early mobility in ICU: Ability to ______ participate in therapy session ________ stable ______level within acceptable range

Minimally Hemodynamically Oxygen

Even at high intensities, bed exercises failed to counteract the negative consequences of the removal of gravitational stress, since ________ intolerance was not affected

Orthostatic

What is more important than exercise alone in minimizing the negative effects of bed rest?

Measures to counteract fluid shift directly

ICU-AW: impairment not involving the NMS may take __ months to improve

ICU-AW: impairment involving the NMS may take _____ to improve

Up to 5 years

Delirium is...

An acute decline in attention/cognition

Patient characteristic risk factors for delirium?

``` Age Alcohol Gender Living single at home Smoking ```

Chronic pathology risk factors for delirium?

Predisposing cardiac disease Predisposing cognitive impairment Predisposing pulm disease

Environment risk factors for delirium

``` Admission via ER Admission via transfer Isolation No clock No visible daylight No visit Open intensive care Physical restraints ```

Acute illness risk factors for delirium?

``` Length of stay Fever High risk of mortality Internal medicine No normal food Number of perfusion Psychoactive med Sedation TISS 28 Tubes and catheters ```

____% of patients experience mental health implication approx 4 days of delirium

____% of patients experience mild depression approx 3 months post d/c

37%

____% of patients experience PTSD over 2 years period

Effects of mobilization

``` Improved pulm function/airway clearance Improved circulation Weightshifting/pressure redistribution Improved functional status/independence Improved morale Decreased delirium/improved cognition ```

General contraindications:

``` Unstable Fx Cerebral edema with uncontrolled ICP Active bleeding Hemodynamic instability requiring high dose on pressers Oxygenation dysfunction requiring significant supplemental O2 and/or paralytic drugs Transvenous temporary pacemaker Open chest/abdomen Femoral sheath ```

True or false: Recent MI is a contraindication for PT in ICU

True

True or false: HR <40 or >130 bpm is a contraindication for PT in ICU

True

True or false: MAP >60 or <110 mmHg is a contraindication for PT in ICU

False... should be <60 and >110

True or false: O2 sat = 90% is a contraindication for PT in ICU

True

True or false: FiO2 <0.60 is a contraindication for PT in ICU

False >0.60

True or false: RR <20 is a contraindication for PT in ICU

False >40

True or false: RASS -4, -5, 3, 4 is a contraindication for PT in ICU

True

True or false: High inotrope is a contraindication for PT in ICU

True

Clinical observations that you should be looking at in the ICU

``` LOC Sweating Abn face color Pain Fatigue ```

Relative contraindications

Clinical observations stated before Unstable fractures Presence of lines that preclude mobility ICP >/= 20 cm H20

PT eval in the ICU include

``` Arousal Ability to follow commands Ability to participate in PT session Tone/spasticity Motor control/apraxia Safety awareness/impulsivity Attention/distractibility Response/tolerance treatment ```

PT Interventions: | NMES- used ____x a day on sedated patients. No atrophy on stimulated LE, ____% atrophy in control group

2x a day | 7-9%

PT interventions: | Cycle ergometry- ____ min a day passive or active cycling. At d/c, what tests/measures were shown to improve?

20 min a day | 6MWT, quad strength, SF36

ICU specific tools

Functional status score for ICU (FSS-ICU) Physical function on independence test (PFITs) John Hopkins Highest Level of Mobility (JH-HLM) Manchester Mobility Score (MMS) Acute Care Index of Function (ACIF)

ICU Outcome Measures: Assessment should be done _____ while in hospital

Weekly