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Cardiopulm JD > PT In ICU > Flashcards

PT In ICU Flashcards

1
Q

6 types of ICU

A 
Trauma ICU
Medical ICU
Surgical ICU
Neurosurgical ICU
Cardiac Care Unit (CCU)
Neonatal ICU
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2
Q

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

A

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

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3
Q

Two ways to monitor blood pressure?

A

Non invasive blood pressure cuff

Arterial line-invasive blood pressure monitoring

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4
Q

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

A

Radial artery

Can be femoral, dorsalis pedis

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5
Q

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

A

Splinted in neutral

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6
Q

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

A

ROM and weight bearing

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7
Q

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

A

Level of R atria to be accurate

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8
Q

What does an ECG monitor?

A

heart rate and rhythm

Vary from 3-12 leads

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9
Q

Are they any mobility pxns when you have an ECG?

A

No specific mobility pxns

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10
Q

What does a swan ganz monitor?

A

Right heart, pulmonary artery/wedge pressure

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11
Q

What is a central line used for?

A

To administer meds, fluids, monitor CVP

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12
Q

Where is a swan ganz and central line inserted?

A

Into the neck

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13
Q

Where can pulse Ox be placed?

A

Fingers
Toes
Forehead
Ears

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14
Q

Reasons why pulse Ox may be innaccurate?

A

Cold hands
Moving
Poor contact btw sensor and skin
Nail polish

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15
Q

ICP can be monitored by what two ways?

A

Bolt

Ventriculostomy

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16
Q

Normal ICP should be what value?

A

Less than 15 mmHg

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17
Q

A ventriculostomy has the ability to…

A

Drain CSF from ventricle if ICP is high

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18
Q

Ventriculostomies are position dependent, true or false?

A

True

Drain must be clamped during mobilization
Must be recalibrated after session

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19
Q

Where is a lumbar drain inserted?

A

Between vertebrae into the spinal canal

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20
Q

What does a lumbar drain do?

A

Drains CSF

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21
Q

During mobilization, what must happen to the lumbar drain?

A

It must be clamped during mobilization

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22
Q

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

A

Cardiac cath

Angiogram

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23
Q

Femoral line, if sheath…. struck immobilization of ____

A

Hip

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24
Q

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

A

False.

CONTRA

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25
Q

Femoral lines can be _____ or ______

A

Arterial or venous

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26
Q

Femoral lines are commonly used for….

A

Short term dialysis

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27
Q

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

A

True

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28
Q

What does CVVHD stand for?

A

Continuous veno-venous hemodialysis

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29
Q

What patients get CVVHD?

A

Critically ill patients with CRF

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30
Q

Where does the CVVHD usually access?

A

Jugular or femoral veins

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31
Q

Mobility with CVVHD is contraindicated, true or false?

A

False. It appears feasible and safe

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32
Q

What does ECMO stand for?

A

Extracoporeal membrane oxygenation

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33
Q

Is an ECMO, patients blood is ______

_____ is removed from the blood and the ______ are oxygenated

A

Removed
CO2
RBCs

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34
Q

When is a ECMO used?

A

When convention methods for cardiac and respiratory failure are unsuccessful

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35
Q

Where is access for ECMO?

A

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

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36
Q

Can be do mobility during ECMO?

A

Studies coming out showing feasibility during ECMO

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37
Q

Where are chest tubes inserted?

A

Inserts into pleural space

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38
Q

Chest tubes are used to drain….

To prevent…

A

Fluid/blood

To prevent lung from collapsing

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39
Q

Chest tubes can be placed to…

A

Suction or water seal

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40
Q

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

A

Within slack of tubing

41
Q

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

A

Hook on walker or carry

42
Q

Endotracheal tube goes in through ____ and into _____

A

Mouth

Trachea

43
Q

Endotracheal tube is used for ______ ventilation

A

Short term

44
Q

Is it okay to mobilize patient on ET tube?

A

Yes. Do not pull the tube

45
Q

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

A

Artificial airway
Neck
Trachea

46
Q

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

A

Tracheostomy

47
Q

Be cautious when someone has a tracheostomy, because tubing…

A

May pull apart

48
Q

Can you mobilize a patient with a trach?

A

Yes, be cautious, BUT IT IS SAFE

49
Q

CPAP is?

A

Continuous positive airway pressure

HI FLOW positive pressure

50
Q

CPAP can also be used for ____

A

Sleep apnea

51
Q

A Non-rebreather mask gives you ____% O2

52
Q

Is there pressure with a non-rebreather mask?

53
Q

Is there pressure with a venti-mask?

And how much % O2?

A

No pressure

24-75% O2

54
Q

This device has the lowest amount of oxygen delivered

A

Nasal Cannula

55
Q

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

A

Higher
Trach
Suction
Mobility

56
Q

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

A

Plastic

Trach

57
Q

Are there mobility issues with a trach collar?

A

No, but it is difficult to suction

58
Q

What does PRVC stand for?

A

Pressure regulated volume control

59
Q

In a PRVC, what is the vent doing?

A

All the work

Pt may initiate breath

60
Q

What is the adjustment of PRVC dependent on?

A

Based on compliance of lungs

61
Q

What does SIMV stand for?

A

Synchronized intermittent mandatory ventilation

62
Q

SIMV allows for _______

It is a _____ mode

A

Spontaneous breathing

Weaning mode

63
Q

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

A

Vent
Small
Inspiration

64
Q

PEEP stands for?

A

Positive expiratory end pressure

65
Q

PEEP keeps the alveoli ______ and maintain greater ________

A

Open

Greater lung volume

66
Q

PEEP: increased surface area= _______

A

Increase gas exchange

67
Q

The higher the PEEP, the more __________

A

The vent is doing to help the pt breathe

68
Q

FiO2 stands for what?

What is it?

A

Fraction of inspired oxygen

It is the amount of oxygen in gas exchange

69
Q

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

70
Q

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

A

Minimally
Hemodynamically
Oxygen

71
Q

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

A

Orthostatic

72
Q

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

A

Measures to counteract fluid shift directly

73
Q

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

74
Q

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

A

Up to 5 years

75
Q

Delirium is…

A

An acute decline in attention/cognition

76
Q

Patient characteristic risk factors for delirium?

A 
Age
Alcohol
Gender
Living single at home
Smoking
77
Q

Chronic pathology risk factors for delirium?

A

Predisposing cardiac disease
Predisposing cognitive impairment
Predisposing pulm disease

78
Q

Environment risk factors for delirium

A 
Admission via ER
Admission via transfer
Isolation
No clock
No visible daylight
No visit
Open intensive care
Physical restraints
79
Q

Acute illness risk factors for delirium?

A 
Length of stay
Fever
High risk of mortality
Internal medicine
No normal food
Number of perfusion
Psychoactive med
Sedation
TISS 28
Tubes and catheters
80
Q

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

81
Q

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

82
Q

____% of patients experience PTSD over 2 years period

83
Q

Effects of mobilization

A 
Improved pulm function/airway clearance
Improved circulation
Weightshifting/pressure redistribution
Improved functional status/independence
Improved morale
Decreased delirium/improved cognition
84
Q

General contraindications:

A 
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
85
Q

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

86
Q

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

87
Q

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

A

False… should be <60 and >110

88
Q

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

89
Q

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

A

False >0.60

90
Q

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

91
Q

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

92
Q

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

93
Q

Clinical observations that you should be looking at in the ICU

A 
LOC
Sweating
Abn face color
Pain
Fatigue
94
Q

Relative contraindications

A

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

95
Q

PT eval in the ICU include

A 
Arousal
Ability to follow commands
Ability to participate in PT session
Tone/spasticity
Motor control/apraxia
Safety awareness/impulsivity
Attention/distractibility
Response/tolerance treatment
96
Q

PT Interventions:

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

A

2x a day

7-9%

97
Q

PT interventions:

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

A

20 min a day

6MWT, quad strength, SF36

98
Q

ICU specific tools

A

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)

99
Q

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

Cardiopulm JD (12 decks)

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