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Year 2: Neuromuscular > Test 1: Lab Values and Early Mobilization > Flashcards

Test 1: Lab Values and Early Mobilization Flashcards

1
Q

Benefits of acute care

A

prevent decline w/ early mobility

prescribe exercise programs to improve outcomes/decrease length of stay

safe DC planning

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2
Q

why is early mobiliztion important with neuro pts

A

delayed treatment can lead to barriers in recovery (use it or lose it, time matters, interference)

early mobility prevents secondary illness, pneumonia, blood clots, skin ulcers, deconditioning, and muscle atrophy

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3
Q

when is the “therapeutic window” for spontaneous recovery

A

greatest at 3-6 months

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4
Q

what are things you should do/check prior to starting early mobility activities

A

check for red flags - neuro screen

assess vital signs and lab values - monitor throughout

Confirm with interdisciplinary team - meds/24 hr stability

start with light intensity early on- FITT

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5
Q

what do you look at for a cardiovascular system review

A

Vitals:
-core vitals: (HR, RR, BP)
-temp

Non-vitals:
-pulse oximetry O2
-pain

looking at important data about current status of body and CV system and response to PA

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6
Q

normal values for HR/pulse

A

60-100 BPM for adults

can treat outside of range but check with MD

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7
Q

values that indicate HTN

A

systolic = 140 or higher
diastolic = 90 or higher

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8
Q

levels that indicate prehypertension

A

systolic = 120-139
diastolic = 80-89

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9
Q

hypotension value

A

systolic less than 100

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10
Q

what values define an acute HTN crisis

A

systolic > 180
diastolic > 110

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11
Q

clinical signs of orthostatic hypotension

A

w/i 3 min of position change

systolic drop of 20 mmHg

diastolic drop of 10 mmHg

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12
Q

what is mean arterial pressure

A

average blood pressure during a single cardiac cycle

(systolic + [diastolic x2])/3

*pressor medications increase BP to reach minimum MAP

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13
Q

what are normal/abnormal MAP values

A

MAP of 60 or greater is needed to perfuse organs

normal = 70-105 mmHg

HOLD THERAPY FOR MAP < 60

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14
Q

what is one respiration

A

one inspiration and one exhalation

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15
Q

normal values for RR

A

12-18 respirations a minute

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16
Q

what should you look at when observing respiration

A

Rate = # breaths/min
depth = volume/amount of air exchanged
rhythm = regularity of pattern
character = any deviations from normal; normal should hear no sounds

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17
Q

normal body temp range

A

96.8 to 99.3

average = 98.6

fever not super concerning in hospital since it is the body’s natural response

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18
Q

normal blood oxygen saturation

A

95-100%

hypoxemia if SpO2<90%

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19
Q

what is RPE

A

rating of perceived exertion

subjective

6-20 is traditional scale

used to determine pt’s response to exercise, determine goals, judge progress, and establish parameters of activities

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20
Q

what is ICP

A

intracranial pressure

pressure exerted by fluids such as CSF inside skull/brain

brain can herniate if too high

sign = HA, vomiting, and secondary cell death

HOLD THERAPY if high

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21
Q

values for normal resting ICP, mild intracranial HTN, and severe

A

normal = 4-15 mmHg

mild = 20-30 mmHg

severe = over 40 mmHg

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22
Q

what does hemoglobin measure

A

amount of hemoglobin in blood is an indirect measure of RBC count

(RBCs carry hemoglobin)

“under eight don’t ambulate”

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23
Q

what does hematocrit measure

A

percent of RBCs in your blood

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24
Q

Hb values needed for resistive exercise

A

> 10 g/dL

25
Q

Hb values needed for light exercise

A

8-10 g/dL

26
Q

Hb values that SHOULD NOT exercise

A

<8 g/dL

27
Q

Hct values needed for resistive exercise

A

> 35%

28
Q

Hct values needed for light exercise

A

> 25%

29
Q

Hct values that SHOULD NOT exercise

A

<25%

30
Q

what is INR

A

international normalizing ratio

looks at how well your blood clots

31
Q

normal INR levels

A

0.8-1.2

32
Q

INR levels to hold exercise

A

5.0-6.0

33
Q

INR bed rest levels

A

> 6.0

34
Q

INR levels safe for exercise w/o increase in intensity

A

<4.0

35
Q

INR levels that indicate no resistive exercise/light exercise only

A

4.0-5.0

36
Q

what to consider when you see abnormal vitals

A

what has the trend been for past 24 hours

is pt asymptomatic

any other factors involved

interventions provided by nursing that may facilitate with PT participation

37
Q

benefits of early mobilization

A

decrease delirium by 2 days
reduce readmission
decrease death rate
reduce ventilator assisted pneumonia
reduce central line infection
reduce catheter infection
decrease overall cost
decrease medical complications

38
Q

benefits/goals of getting upright

A

improve lung function
improve interaction with environment
weaight bearing
improved BP regulation
make it more like normal life

39
Q

mobility goal

A

level of function needed for independence/home life

based on diagnosis/what is realistically functional for specific pt

40
Q

what is an arterial catheter

A

“art line”
measures arterial pressure in real time
directly into artery
often in wrist but sometimes in femoral
more accurate than BP cuff

41
Q

considerations regarding arterial catheter

A

pulled = heavy bleeding

physician needed to place it

may limit wrist/hip movement

42
Q

what are bolt/external ventricular drains (EVD)

A

bolt
-real time measure ICP
-hole in skill
-pts with severe TBI

EVD
-measures ICP
-Drains CSF

43
Q

considerations for bolt/EVD

A

bolt = usually too sick to mobilize; consider PROM, but weigh risk

EVDs are calibrated to pt head position; consult with team before mobilizing

44
Q

what is a swan ganz catheter

A

“central line”
usually in neck

goes down large vein through vena cava and into R atrium

can deliver meds direct to circulation

45
Q

what is a PICC line

A

peripherally inserted central cathether

peripherally inserted in vein and goes direct to heart

often for those who need long course of antibiotics

46
Q

mobility considerations for swan ganz and PICC lines

A

DO NOT PULL; insert in heart

may cause arrythmias

may cause pneumothorax

med delivery is challenging if pulled

47
Q

mobility considerations for ventilators/trachs

A

vents not portable

high likelihood of desaturation

high risk of barrotrauma if settings are too high

48
Q

purpose of high flow nasal cannula

A

way to deliver high amounts of O2 w/o intubation

precursor to mechanical vent

49
Q

nasal cannula mobility considerations

A

consider buffer room; are they near max settings? if so hold mobility that may tax CV system

if you push too hard, intubation is next step

Intensity and type of exercise matter

50
Q

what is a fecal management system

A

collect fecal matter in bag

gravity dependent

often used with C-diff

51
Q

what is a foley catheter

A

urine collection

gravity dependent

with SCI can often be an irritant causing autonomic dysreflexia

52
Q

mobility considerations with urine/fecal collectors lines/tubes

A

FMS bags are easy to pull

catheters hurt a lot when pulled accidentally; may bleed

keep below waste

53
Q

what is a nasogastric tube

A

through nose to stomach

feeding tube

54
Q

what is PEG or percutaneous endoscopic gastrostomy

A

feeding tube directly to abdomen

long term solution

common in pts with lower level brain injury

55
Q

feeding tube considerations for feeding tube

A

NPO; dont give food or water; may aspirate

easy to pull when pt is agitated

malnutrition/weight loss is a consideration

56
Q

examples of telemetry units

A

VS, BP cuff, and pulse ox

57
Q

mobility considerations with telemetry units

A

may get artifact or noise on signal from movement so double check findings

look for changes in exercise response

portable; can be unplugged

58
Q
A

Year 2: Neuromuscular (20 decks)

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