rehabilitation, exercise and early mobilisation in critical care

Question 1

classification of critical are in context- level 0 and level level 1

Answer 1

0- patients whose needs can be met through normal ward care in an acute hospital
1- patients at risk of their condition deteriorating, or those recently recited from higher levels of care, whose needs can be met on an acute ward with additional advice and support from the critical care team

Question 2

classification of critical are in context- level 2

Answer 2

patients requiring more detailed observations or intervention including support for a single failing organ system or post-operative care and those stepping down from higher levels of care

Question 3

classification of critical are in context- level 3

Answer 3

patients requiring advanced respiratory support alone, or basic respiratory support together with support of at-least 2 organ systems. this includes all complex patients requiring support for multi-organ failure

Question 4

handling unconscious patients

Answer 4

create identity- ask family members, treat them as people not patient

Question 5

physio in critical are

Answer 5

common complications associated with prolonged ICU stay inside- deconditioning, muscle weakness, dyspnoea, depression and anxiety, reduced health related QOL
Management of respiratory problems including intubation avoidance and weaning from ventilator, emotional problems and communication, deconditioning and related complications

Question 6

goal of respiratory PT

Answer 6

Optimise oxygen transport, improve ventilation/perfusion, improve lung volume, reduced WOB, enhance mucocillary clearance

Question 7

goal of respiratory PT

Answer 7

Optimise oxygen transport, improve ventilation/perfusion, improve lung volume, reduced WOB, enhance mucocillary clearance

Question 8

physical problems from ICU

Answer 8

weakness, walking distance, fitness, lack of stamina, SOB, leg weakness, tiredness, aches and pains, muscle pain

Question 9

mobilisations

Answer 9

joint mobs- mannual therapy techniques used to modulate pain and treat joint dysfunction that limited ROM, assess altered mechanics of the joint
secretions- the movement of respiratory secretions from distal to more prox airways
include rolling, PROM, sitting

Question 10

the steps in oxygen transport pathway

Answer 10

ventilation of the alveoli, diffusion of O2 across the alveolar capillary membrane, perfusion of the lungs, biomechanical reaction of oxygen within the blood, affinity of oxygen with hb, CO, integrity of the peripheral circulation, oxygen extraction at tissue level

Question 11

why do we want to mobilise the critically ill

Answer 11

maintaining and improving cardiopulmonary status remain a central objective for physio on critical care

Question 12

exercise mobilisation rehab

Answer 12

exercise to describe aspects of our management such as bed exercises, walking on spot
mobilisation to describe aspects of our management such as walking, sitting out
rehabilitation- includes physical, functional, communication, social, spiritual, nutritional and psychological aspects

Question 13

barriers to early rehab

Answer 13

stability of patient, staffing and collaboration, deep sedation, attention to hard ware, level of arousal

Question 14

aim of early rehab

Answer 14

ventilation, central and peripheral perfusion, circulation, muscle metabolism, alertness,

Question 15

why do we want to mobilise

Answer 15

pain and discomfort, tethered/ restricted, immobile because of illness because of illness and the environment, atrophy of postural muscle resulting in inability to sit/stand independently, lack of proprioceptive feedback and movement, anti gravity muscles of the back/ knee extensors and calf muscles, disuse atrophy, aerobic conditioning, risk of contractors

Question 16

strategies and intervention for rehab in ICU- movements

Answer 16

PROM- assess joint range and patient comfort and use of accessory mobilisations, active assisted, functional exercise, strengthening or resisted exercise, transfers, stepping in place- MOTS, stepping practice and gait re-ed, increase exercise tolerance

Question 17

strategies and intervention for rehab in ICU- positioning

Answer 17

positioning- passive/ active assisted, cardiac chair, sit in multi function chair, working in standing- balance/ posture/ endurance/ ability to transfer weight

Question 18

barriers to early rehab

Answer 18

unit culture- mobility low on on the list of priorities, the presence of unnecessary lines, the use of sedation
lack of resource- poor communication amongst staff and lack of accountability, mobilising patients is resource intensive/ safety parameters
prioritising and leadership= lack of staff/skilled staff, increased effort and burden of load, lack of equipment

Question 19

facilitators to early rehab- organisational change

Answer 19

making daily mobility to the standard of care, PT makes a daily routine and sets goals combined with functional activities, use of dedicated mobility

Question 20

facilitators to early rehab- leadership

Answer 20

MDT planning and strong leadership, involve patient families in early phase rehab

Question 21

facilitators to early rehab- resources

Answer 21

prioritising of mobility from all staff, accept a degree of risk, have adequate equipment, training is vitally important