pt. management of patients w/SCI in the ICU

Question 1

Hemoglobin and Hematocrit
-risk:
-mobility implications

Answer 1

anemia, bleeding, need for transfusion
do not mobilize below if too low

Question 2

Hb and Hct: critical values

Answer 2

hb: <6.5 g/dL
hct: <20% or >56%

Question 2

Hb:
-no exercise
-light exercise
-resistive exercise

Answer 2

<8 g/dL
8-10 g/dL
>10 g/dL

Question 3

hct:
-no exercise
-light exercise
-resistive exercise

Answer 3

<25%
>25%
>35%

Question 4

INR: (international normalizing ratio)
-risk
-mobility implications

Answer 4

too high –> bleeding out
do no mobilize if too high

Question 5

INR vs Activity Level:
normal activity =
<4.0 =
no resistance exercises, light exercises only =
hold exercise =
>6.0 =

Answer 5

.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

Question 6

MAP: (mean arterial pressure)
-risk:
mobility implications:

Answer 6

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

Question 7

resting map vs pressure
normal =
low =

Answer 7

70-105 mmHg
<60 mmHg

Question 8

blood pressure (BP)
hypotension is common in SCI especially ________ spinal levels.
-risk
-mobility implications

Answer 8

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.

Question 9

Categories of BP
-normal
-preHTN

Answer 9

<120, <80
120-139, 80-89

Question 10

Categories of BP
-HTN emer.
-orthostatic hypotension

Answer 10

> 180, >110
drop ≥20 , drop ≥ 10

Question 11

Heart rate (HR)
-risks:
-mobility implications

Answer 11

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

Question 12

resting HR vs rate (bpm)
bradycardia =
normal =
tachycardia =

Answer 12

<60
60 -100
>100

Question 13

SpO2
-patients with _______SCI injuries. may be ventilated.
-assistance from ______ and ______ for breathing may be impacted

Answer 13

upper
intercostals; diaphragm

Question 14

SpO2
-risks:
-mobility implications:

Answer 14

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

Question 15

SpO2 values:
normal =
low normal =
hypoxemia =

Answer 15

95-100%
90-95%
<90%

Question 16

Respiratory rate (RR)
-risks:
-mobility:

Answer 16

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

Question 17

RR: resting rate vs rate (bpm)
bradypnea =
normal =
tachypnea =

Answer 17

<12
12-20
>20

Question 18

early medical management:
immobilize?
intubate if _______ level
screen for _______
imaging?
Sx
-common cause of SCI is _______ fx.

Answer 18

yes
cervical
sec. injuries
MRI, CT, Xray
spinal stabilization & decompression (first 24 hrs. has better outcomes for B, Cand D
burst

Question 19

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

Answer 19

decrease
8 hours
48
vasopressors

Question 20

Common Concomitant Injuries:

Answer 20

TBI
Fractures
Vertebral artery injuries & BPPV - cervical
Integ compromise - road rash
Organ damage - stabbing

Question 21

Common Bracing

Answer 21

C collar
-miami j
-aspen vista
-halo (upper cervical)

TLSO
-clamshell

Question 22

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 _______

Answer 22

arterial blood pressure
artery
wrist
BP cuff

Question 23

considerations for mobility w/arterial line:
-if pulled there will be heavy ________
-need ______ to place it on the pt.
-may limit _______ or _____ movement

Answer 23

bleeding
physician
wrist/hip

Question 24

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 _____ (-)

Answer 24

AD
flexion (not past 60-80º

Question 25

Central venous catheters:
-usually inserted in ______, goes done large vein through vena cava into right _____
-can deliver ______ through this directly into circulatory system

Answer 25

neck; atrium
medications

Question 26

PICC
-peripherally inserted into the vein and goes directly into the ______
-often used in patients needing a longer course of _______

Answer 26

heart
antibiotics

Question 27

central venous catheters/PICC mobility considerations:
-these insert into the heart —>
-may cause _________ or ________
-often the most efficient ______ access points

Answer 27

DO NOT PULL THEM
arrhythmias; pneumothorax
IV

Question 28

ventilator:
-for patients who cannot adequately _____ on their own
-usually have an ____________ tube
-if on vent for more than _____-____ days pts. have to get __________

Answer 28

breath
endotracheal
14-21; tracheostomy

Question 29

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.

Answer 29

portable
SpO2
high
buffer

Question 30

Catheter: urine collection
-catheters hurt when they are pulled because of _______-
-gravity dependence

Answer 30

balloon
dependence

Question 31

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 _____

Answer 31

artifact
unplugged; die

Question 32

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

Answer 32

pressure/volume
peak pressure
plateau pressure
flow rate

Question 33

fraction of inspired oxygen
normal RA is ______%
max is ______%

Answer 33

FiO2
21%
100%

Question 34

positive end-expiratory pressure =
pressure required to keep alveoli open for gas exchange
____ -____ range is more typical for mobility

Answer 34

PEEP
5-10