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Year 2: Neuromuscular II > Test 1: Lecture 5, SCI in ICU > Flashcards

Test 1: Lecture 5, SCI in ICU Flashcards

1
Q

facts about ICU with neuro pts

A

most research is about pts with TBI and CVA

better outcomes if hemodynamically stable

minimal research about SCI in ICU

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2
Q

important things to know about SCI pt in ICU when deciding whether or not to proceed

A

know labs/vitals

are they hemodynamically stable?

wait for surgical stabilization if needed

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3
Q

low hemoglobin and hematocrit put the pt at risk of what

A

anemia

bleeding out

need for transfusion

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4
Q

normal Hb values

A

male = 14-17 g/dL
female = 12-16 g/dL

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5
Q

critical Hb value

A

<6.5 g/dL

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6
Q

normal Hct values

A

male = 40-51%
female = 36-47%

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7
Q

critical value for Hct

A

<20% or >56%`

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8
Q

no exercise values for Hb and Hct

A

<8g/dL for Hb

<25% for Hct

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9
Q

light exercise values for Hb and Hct

A

8-10 g/dL for Hb

> 25% for Hct

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10
Q

resistive exercise values for Hb and Hct

A

> 10 g/dL for Hb

> 35% for Hct

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11
Q

what is the risk involved with an INR (international normalizing ratio) that is too high

A

risk of bleeding out

do not mobilize if too high

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12
Q

normal INR values

A

0.8-1.2

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13
Q

what INR value is safe for eval and regular exercise program with no increase in exercise intensity

A

<4.0

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14
Q

what INR value range indicates the pt should only do light exercise and NO resistance

A

4.0-5.0

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15
Q

what INR value range indicates that you should hold therapy

A

5.0-6.0

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16
Q

what INR value indicates pt should be on bedrest

A

> 6.0

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17
Q

what is the risk of a MAP value that is too low

A

too low means there is not enough pressure in the system to perfuse organs including the brain

risk of anoxic brain injury

do not mobilize if too low; may need pressors prior to mobility

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18
Q

normal MAP value

A

70-105 mmHg

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19
Q

low MAP value

A

<60 mmHg

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20
Q

what BP related issue is common among SCI pts

A

hypotension

especially with higher lvl injuries

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21
Q

risks of BP that is too low or too high with SCI pts

A

patient may become unresponsive if too low

if too high, (i.e. AD) they may have a stroke

position pt to increase BP if orthostatic and do not mobilize if resting BP is in HTN emergent category because exercise will just further increase BP

22
Q

HTN values for each stage (pre, stage I, stage II)

A

pre = 120-139 / 80-89

stage 1 = 140-159 / 90-99

stage 2 = 160-179 / 100-109

23
Q

HTN emergency values

A

> 180 / >110

24
Q

orthostatic hypotension indications

A

SBP drops >20 mmHg

DBP drops > 10 mmHg

25
risks if HR is too high or low
too low = unresponsive too high = cardiac event consider before mobility; know how much their HR can increase safely with mobility based on the diagnosis
26
HR values for bradychardia, normal, and tachycardia
brady = <60 normal = 60-100 tachy = >100
27
SpO2 risks for SCI pts
too low = hypoxic and risk of anoxic brain injury may need to supplement O2 to prevent desaturation with mobility
28
normal, low normal, and hypoxemia SpO2 levels
normal = 95-100% low normal = 90-95% hypoxemia = <90%
29
risks for abnormal RR
could impact gas exchange if someone is mechanically ventilated with RR of 20 at rest they do not have much reserve to tax pulmonary system; may need higher vent settings to mobilize
30
bradypnea, normal, and tachypnea values
bradypnea = <12 normal = 12-20 tachypnea = >20
31
early medical management for SCI
immobilize intubate (with minimal extension) if cervical level screen secondary injuries imaging = MRI, CT, Xray spinal stabilization and decompression
32
when is spinal stabilization sx best
first 24 hours has better outcomeds for B, C, and D
33
pharmacological management for neuroprotective and BP management benefits in SCI pts
Neuroprotective = corticosteroids (methylprednisolone) to decrease vasogenic edema, increase SC blood flow, and decrease inflammation neuroprotective needs to be given in first 8 hours; can cause harm past 48 hours vasopressors to keep BP up
34
common concomitant injuries
depends on injury mechanisms TBI fxs vertebral artery injuries integumentary compromise organ damage
35
C-collar types
Miami J Aspen Vista Halo (for upper cervical)
36
TLSO bracing types
clamshell others
37
what is an arterial line
measures arterial BP in real time goes directly into artery often in wrist but can be in femoral aa more accurate than BP cuff
38
art line considerations for mobility
heavy bleeding if pulled physician places it may limit wrist or hip movement (i.e. UE use of AD or limited hip flexion so cannot sit)
39
what is a central venous catheter
usually in neck goes down large vein through vena cava into R atrium can deliver meds directly into circulation
40
what is a PICC line
peripherally inserted into vein and goes directly to heart often used in pts who need long course of antibiotics
41
mobility considerations for PICC line/central line
they insert into heart - DO NOT PULL may cause arrthmias may cause pneumothorax often most efficient IV access points; med delivery is more challenging if pulled
42
when do pts get tracheostomy
if on vent for more than 14-21 days tube transferred from mouth to hole in neck directly into trachea
43
vent mobility considerations
vents are not portable; call RT if need to move so they can be bagged high likelihood of desaturation- watch SpO2 high risk of barotrauma if vent settings too high consider buffer room and if pt settings can be safely turned up before risk of other complications when doing mobility
44
catheter mobility considerations
hurt a lot when pulled bc of balloon and may be bleeding gravity dependent
45
how are vents controlled
either by pressure or volume
46
what is peak pressure on a vent
pressure in lungs during inhalation
47
plateau pressure on vent
pressure in lungs when air stopped moving
48
what is FiO2
fraction of inspired O2 normal RA is 21% max is 100%
49
what is flow rate
how quickly volume is being delivered (L/min)
50
what is PEEP
positive end expiratory pressure pressure required to keep alveoli open for gas exchange 5-10 range is more typical for mobility
51
how to do upright trials in ICU
progress to 1 hour upright start at 15 min and progress by 15 min each session tilt every 15 min for 2 min check virals at every position change check skin pre- post- mobility
52

Year 2: Neuromuscular II (18 decks)

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