pt. management of patients w/SCI in the ICU Flashcards
Hemoglobin and Hematocrit
-risk:
-mobility implications
anemia, bleeding, need for transfusion
do not mobilize below if too low
Hb and Hct: critical values
hb: <6.5 g/dL
hct: <20% or >56%
Hb:
-no exercise
-light exercise
-resistive exercise
<8 g/dL
8-10 g/dL
>10 g/dL
hct:
-no exercise
-light exercise
-resistive exercise
<25%
>25%
>35%
INR: (international normalizing ratio)
-risk
-mobility implications
too high –> bleeding out
do no mobilize if too high
INR vs Activity Level:
normal activity =
<4.0 =
no resistance exercises, light exercises only =
hold exercise =
>6.0 =
.8 -1.2 (normal)
safe for eval and regular exer. program, no increase in intensity of exercise
4.0-5.0
5.0-6.0
bed rest
MAP: (mean arterial pressure)
-risk:
mobility implications:
too low means there is not enough pressure in the system to refuse organs including the brain, risk fo anoxic brain injury
do not mobilize is this is too low, may need pressors prior to mobility
resting map vs pressure
normal =
low =
70-105 mmHg
<60 mmHg
blood pressure (BP)
hypotension is common in SCI especially ________ spinal levels.
-risk
-mobility implications
higher
too low, pt. may become unresponsive, too high –> AD, pt. may stroke
position patient to increase BP if they are orthostatic, DO NOT mobilize if resting BP is in HTN emer.
Categories of BP
-normal
-preHTN
<120, <80
120-139, 80-89
Categories of BP
-HTN emer.
-orthostatic hypotension
> 180, >110
drop ≥20 , drop ≥ 10
Heart rate (HR)
-risks:
-mobility implications
too low, may become unresponsive, too high may have a cardiac event
consider HR parameters prior to mobility, know how much HR can increase safely based on Dx
resting HR vs rate (bpm)
bradycardia =
normal =
tachycardia =
<60
60 -100
>100
SpO2
-patients with _______SCI injuries. may be ventilated.
-assistance from ______ and ______ for breathing may be impacted
upper
intercostals; diaphragm
SpO2
-risks:
-mobility implications:
too low pt. might become hypoxic, risk cognitive decline and anoxic brain injury
may need supplement O2 to prevent desaturation –> stop and rest if it drops
SpO2 values:
normal =
low normal =
hypoxemia =
95-100%
90-95%
<90%
Respiratory rate (RR)
-risks:
-mobility:
could impact gas exchange
if someone is mechanically ventilated w/ RR of 20 at rest, they do not have much reserve to tax pulmonary system, may require higher vent settings to mobilize
RR: resting rate vs rate (bpm)
bradypnea =
normal =
tachypnea =
<12
12-20
>20
early medical management:
immobilize?
intubate if _______ level
screen for _______
imaging?
Sx
-common cause of SCI is _______ fx.
yes
cervical
sec. injuries
MRI, CT, Xray
spinal stabilization & decompression (first 24 hrs. has better outcomes for B, Cand D
burst
pharmacologic management: neuroprotective: corticosteroids to _______ vasogenic edema, increase SC blood flow, and decrease inflammation
-give in first ______ hours
-can cause hrm past ______ hours
-BP management: ________ to keep BP up
decrease
8 hours
48
vasopressors
Common Concomitant Injuries:
TBI
Fractures
Vertebral artery injuries & BPPV - cervical
Integ compromise - road rash
Organ damage - stabbing
Common Bracing
C collar
-miami j
-aspen vista
-halo (upper cervical)
TLSO
-clamshell
arterial line is a way to measure ___________ in real-time
goes directly into _______
often in _____ but can be found in femoral artery
more accurate than using _______
arterial blood pressure
artery
wrist
BP cuff
considerations for mobility w/arterial line:
-if pulled there will be heavy ________
-need ______ to place it on the pt.
-may limit _______ or _____ movement
bleeding
physician
wrist/hip
considerations for mobility w/arterial line:
-if line is placed at the worst it may limit the use of an _________
-If line is placed at the hip it may limit hip _____ (-)
AD
flexion (not past 60-80º
Central venous catheters:
-usually inserted in ______, goes done large vein through vena cava into right _____
-can deliver ______ through this directly into circulatory system
neck; atrium
medications
PICC
-peripherally inserted into the vein and goes directly into the ______
-often used in patients needing a longer course of _______
heart
antibiotics
central venous catheters/PICC mobility considerations:
-these insert into the heart —>
-may cause _________ or ________
-often the most efficient ______ access points
DO NOT PULL THEM
arrhythmias; pneumothorax
IV
ventilator:
-for patients who cannot adequately _____ on their own
-usually have an ____________ tube
-if on vent for more than _____-____ days pts. have to get __________
breath
endotracheal
14-21; tracheostomy
ventilator consideration for mobility:
-vents are not very _______ so for ambulation call RT
-high likelihood of desaturation: watch ________
-high risk of barotrauma if vent settings are ______
-consider how much _______room pt. has w/their vent settings and how high they can safely be turned up before there is risk of other complications.
portable
SpO2
high
buffer
Catheter: urine collection
-catheters hurt when they are pulled because of _______-
-gravity dependence
balloon
dependence
Tele, BP cuff, pulse ox
-can be portable but get an ______ from movement so double check findings
-all of these can be __________ and the patient will not _____
artifact
unplugged; die
ventilators are either controlled by ________ or _________
________ pressure in lungs during inhalation
________ pressure in lungs when air has stopped moving
________ how quickly the volume is being delivered
pressure/volume
peak pressure
plateau pressure
flow rate
fraction of inspired oxygen
normal RA is ______%
max is ______%
FiO2
21%
100%
positive end-expiratory pressure =
pressure required to keep alveoli open for gas exchange
____ -____ range is more typical for mobility
PEEP
5-10
