Quiz #4 (critical care) prep

Question 1

In addition to the neuromuscular and musculoskeletal systems, critical illness has the potential to affect what?

Answer 1

multiple other systems, b/c of the systemic inflammatory response associated with critical illness.

Question 2

What is ICU-aquired weakness?

Answer 2

profound weakness greater than what might be expected from prolonged bed rest

Question 3

When patients are admitted to the ICU with one of these three conditions the medical staff need to be need to be aware of developing ICU-aquired weakness. What are the three conditions?

Answer 3

sepsis
ARDS
patients on mechanical ventilation for as little at 4-7 days

Question 4

When reading literature what three terms are used to describe ICU-aquired weakness?

Answer 4

critical illness myopathy (CIM)
critical illness polyneuropathy (CIP)
critical illness polyneuromyopathy (CIPNM or CINM)

Question 5

Can ICU-aquired weakness be diagnosed?

Answer 5

no

Question 6

If you suspect a patient is acquiring ICU-weakness what valid and reliable (objective) measure can be used to predict if your patient is acquiring ICU-weakness?

Answer 6

Medical Research Council (MRC) sum score

Question 7

What is the Medical Research Council (MRC) sum score and what score is equivalent to a MMT of 4/5?

Answer 7

the MRC is a test of muscle strength (0-5):
shoulder abduction
elbow flexion
wrist extension
hip flexion
knee extension
ankle dorsiflexion

Question 8

What does 0-5 represent in the MRC scoring system?

Answer 8

5- normal strength/power
4- active movement against gravity with resistance
3- active movement against gravity
2- active movement with gravity eliminated
1- flicker/trace muscle contraction
0- no active muscle contraction

Question 9

What can a clinician due to improve their ability to diagnose ICU-aquired weakness at a earlier time?

Answer 9

perform a neuromuscular examination while sedative agents are stopped

Question 10

Why is it important to know if or when a patient in the ICU is on sedative medications?

Answer 10

b/c sedative agents can mask symptoms or delay the identification of ICU-aquired weakness

Question 11

Why would it be important for the prescribing physician to consider to limit the dose or frequency of sedative agents to patients in the ICU?

Answer 11

b/c daily interruptions of sedative agents and/or limiting the administration and dosing of sedative agents improve the outcome of patients who are critically ill.

Question 12

What does Schweickert et al report shortens duration of ICU-associated delirium and therefore can lead to shorter length of stay in both ICU and hospitals?

Answer 12

sedation vacation combined with early physical rehabilitation

Question 13

The nurse is not sure if your next patient is able to tolerate physical therapy treatment because the patient is not always able to interact when when engage them, the nurse says you can try. What can you use to determine if the patient is appropriate for treatment?

Answer 13

Richmond Agitation Sedation Scale (RASS) - can be used to determine a patients ability to interact.

Question 14

What RASS score does you patient need to have in order for you to treat them?

Answer 14

-2 - +2

(-5 (unarousable) to +4 (combative)

Question 15

What is CIP?

Answer 15

critical illness polyneuropathy - impaired neuromuscular system including:

• weakness
• reduced DTR’s
• impaired pain, temp., and vibration sense
• CN’s ok but facial weakness is common

Question 16

What is CIM?

Answer 16

critical illness myopathy -

• profound weakness, esp in proximal muscles
• DTR’s may be preserved or diminished
• sensation remains intact

Question 17

Your patients nerve conduction study results came back today and the study found that your patient affected muscles have a reduced ability to recruit motor units. What can you determine from this?

Answer 17

The patient has CIP

Question 18

Your first day in the ICU you perform a LQS and find your new patient has muscle weakness, positive sharp/dull, positive 2pt sense, and impaired DTR’s. You can determine what?

Answer 18

The patient has CIP

Question 19

Your ICU patient has results from a recent nerve conduction study from Dr. Voorhees showing prolonged durations of compound muscle action potential amplitudes which reflects a slowed muscle fiber conduction velocity. Dr. Voorhees asked you what condition they have?

Answer 19

The patient has CIM

Question 20

What is one way to differentiate CIM from CIP when performing your neuro screening?

Answer 20

test the patients sensation - sharp dull/temp/vibration

Question 21

What are 3 common “patient education” topics that are given to patients if their functional capabilities have changed?

Answer 21

• pacing of activities
• safety awareness and preventing falls
• compensatory strategies to increase efficiency of movements

Question 22

What are 4 common techniques you can use if your patient has respiratory weakness and is having a difficult time being weaned from a mechanical ventilator?

Answer 22

• costophrenic assisted cough
• pursed-lip breathing
• diaphragmatic breathing
• scoop technique

Question 23

What are the two approaches a physical therapist can use to structure the order of interventions for progressing exercise with the patient?

Answer 23

• begin with easiest exercises and progress to more demanding (fatiguing patient with easy task may make it impossible to complete complex tasks)
• begin with the most demanding tasks first

Question 24

What is the CAM-ICU test?

Answer 24

test using non-verbal tasks, including picture recognition, vigilance levels, and response to simple questions and demands. (evidence of delirium)