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PT 620 Foundations 2 > PT in the Acute Care Setting/PT for Extremely Weak Pt > Flashcards

PT in the Acute Care Setting/PT for Extremely Weak Pt Flashcards

1
Q

describe the continuum of care in PT

A

ER, ICU, step down unit, discharge, acute rehabilitation, skills nursing facility, home PT, outpatient

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2
Q

the process of obtaining a history, performing a systems review, and selecting/administering tests and measures to gather data about the pt

A

examination

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3
Q

list 5 things to consider to examine when performing examination

A
  • aerobic capacity/endurance
  • CN and peripheral N integrity
  • Assistive devices
  • muscle performance (strength, power, endurance)
  • posture
    (pain, posture, prosthetics, sensory integration, ventilation, self-care, ROM, integumentary system integrity)
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4
Q

allow PT, nurses, other healthcare providers to monitor the progress of the pt over time and assess any functional changes

A

outcome measures

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5
Q

list some examples of outcome measures

A
  • Borg RPE
  • AM-PAC 6 clicks
  • FIM (functional independence measure)
  • TUG
  • 6 MWT
  • 5x STS
  • 10 MWT
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6
Q

uses 6 questions to assess the function of patients; can be used with a variety of pt populations

A

AM-PAC 6 Clicks

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7
Q

what are the 3 domains assessed in AM-PAC 6 Clicks

A

mobility
daily activities
cognation

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8
Q

used specifically for pts in the ICU; can be used to guide prescription in the ICU as well as measure function

A

FSS-ICU (functional status score of the ICU)

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9
Q

what does the FSS-ICU (functional status score of the ICU) examine

A

pt ability to:
- roll
- transfer from supine to sit
- sit edge of bed
- transfer from sit to stand and walk
(bed mobility, transfers, ambulation)

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10
Q

what do higher scores indicate on FSS-ICU (functional status score of the ICU)

A

better physical function

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11
Q

what are the 3 main types of intervention strategies

A

restorative
compensatory
preventative

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12
Q

directed towards remediating/improving the pt’s status in terms of impairments, activity limitations, participation restrictions, and recovery of function

A

restorative

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13
Q

directed toward promoting optimal function using residual abilities; the activity is adapted in order to achieve function

A

compensatory

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14
Q

directed towards minimizing potential problems and maintaining health

A

preventative

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15
Q

what are the 4 components of exercise training sessions

A
  • warm up
  • conditioning
  • cool down
  • stretching
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16
Q

how long should warm up take

A

5-10 minutes
light to moderate intensity cardiorespiratory and muscular endurance activities

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17
Q

how long should conditioning be

A

20-60 minutes
of aerobic, resistance, neuro-motor, and/or sports activities

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18
Q

how long should cool down be

A

5-10 minutes
light to moderate intensity cardiorespiratory and muscular endurance activities

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19
Q

how long should stretching be

A

10 minutes
stretching exercises should be performed after warm up and cool down phases (dynamic or static)

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20
Q

transitional phase; allows the body to adjust to the changing physiologic, biomechanical, and bioenergetics demands placed on it during the conditioning or sports phase of the exercise session; improves ROM; may reduce the risk of injury

A

warmup

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21
Q

allows for gradual recovery of HR and BP; removal of metabolic end products from the muscles used during the more intense exercise conditioning phase

A

cool down

22
Q

describe light intensity strength training

A
  • 40-50% 1 RM
  • 8-10 exercises involving the major muscle groups
  • > 1 set of 10-15 reps
  • progressive weight training or WB, stair climbing, etc.
23
Q

describe moderate intensity strength training

A
  • > or equal to 2days/week
  • 60-70% of 1 RM
  • 5-6/10
  • 8-10 exercises involving the major muscle groups
  • > 1 set of 10-15 reps
  • progressive weight training or WB, stair climbing, etc.
24
Q

describe vigorous intensity strength training

A
  • 7-8/10
  • 8-10 exercises involving the major muscle groups
  • > 1 set of 10-15 reps
  • progressive weight training or WB, stair climbing, etc.
25
Q

what decreases with age, making it important to do resistance training in older adults

A

strength

26
Q

what may need to be precede areobic training in frail adults

A

muscle strength training

27
Q

individuals with _____ need to increase muscular strength before they are physiologically capable of engaging in aerobic training

A

sarcopenia

28
Q

describe moderate intensity aerobic training

A
  • > or equal to 5 days/week
  • 40-60% HRR
  • 30-60 minutes, at least 10 minute bouts, 150-300 minutes per week
  • any modality that does not impose excessive orthopedic stress (walking, aquatics, stationary bike)
29
Q

describe vigorous intensity aerobic training

A
  • > or equal to 3 days/week
  • 60-90% HRR
  • 20-30 minutes/day, at least 10 minute bouts, 75-100 minutes/week
  • any modality that does not impose excessive orthopedic stress (walking, aquatics, stationary bike)
30
Q

describe FIIT for balance training

A
  • > or equal to 2-3 days/week
  • to the point of feeling tightness or slight discomfort
  • hold stretch for 30-60 seconds
  • progressively difficult postures that gradually reduce BOS, dynamic movements that perturb the COG, stressing postural muscles, reducing sensory input, tai chi
31
Q

describe neuromotor exercise training and what is it effective in doing

A
  • combines balance, agility, and proprioceptive training
  • effective in reducing and preventing falls
32
Q

pts who have been on prolonged bed rest and pts in the ICU are especially prone to what

A

neuromuscular dysfunction and ICU acquired weakness

33
Q

describe the weakness pattern with best rest induced weakness

A

symmetry
LE > UE weakness
antigravity muscles most affected

34
Q

describe severity of bed rest induced weakness

A

weakness is proportional to duration of bed rest

35
Q

are DTR present or absent in bed rest induced weakness

A

present

36
Q

describe weakness pattern of ICU acquired weakness

A

symmetric
extremity weakness
respiratory muscle involvement

37
Q

describe the severity of ICU acquired weakness

A

weakness is disproportionate to duration of bed rest

38
Q

are DTRs present or diminished in ICU acquired weakness

A

diminished

39
Q

what do you have to assess with ICU acquired weakness

A

tone, motor control, strength and sensation

40
Q

what outcome measure can be used to assess ICU acquired weakness

A

functional status score for ICU (FSS ICU)

41
Q

interventions used on severely weak pt

A
  • progressive mobilization
  • strengthening
  • aerobic endurance
  • balance
  • flexibility
42
Q

initiated based on pt’s tolerance and response to activity, vitals and neurological status must be monitored continuously, consider orthostatic hypotension

A

progressive mobilization for severely weak pt

43
Q

list some pros and cons for NMES

A

Strengths: can be used in sedated pts, can be done in supine, single person implementation, provides “something”

Limitations: completely non-volitional, current can be impaired by things such as obesity or edema, limited therapist time (takes time to set up), no outcomes beyond ICU awakening

44
Q

what type of training will pts respond better to

A

interval training better than long periods of activity

45
Q

used to prevent contractures/pressure ulcers, does not prevent muscle atrophy, positioning pts in muscle shortening positions should be avoided especially in pts that cannot move themselves

A

passive ROM

46
Q

what position helps to correct orthostatic intolerance

A

exercises in upright positions

47
Q

what is ICU acquired weakness associated with

A

increased mortality

48
Q

what are the 3 subcategories of ICU acquired weakness

A
  • critical illness myopathy
  • critical illness polyneurophy
  • critical illness neuromyopathy
49
Q

what is the best form of management for ICU acquired weakness and what helps to improve prognosis

A
  • prevention is the best form of management
  • early mobilization improves prognosis
50
Q

what are complications of ICU acquired weakness

A
  • increased time on ventilator
  • increased time in ICU
  • increased hospital length of stay
51
Q

general indications for stopping exercise

A
  • onset of angina/angina-like sx
  • drop in SBP >10 mmHg with increase in work rate
  • SBP decreases below the value obtained in same position prior to testing
  • excessive rise in BP (systolic > 250 and/or diastolic > 115)
  • SOB, wheezing, leg cramps, claudication
  • signs of poor perfusion (light headed, confusion, ataxia, pallor, cyanosis, nausea, cold or clammy skin)
    failure of HR to increase with increased exercise intensity
  • noticeable change in heart rhythm by palpation or auscultation
  • subject requests to stop
  • physical or verbal manifestations of severe fatigue
  • failure of testing equipment

PT 620 Foundations 2 (9 decks)

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