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Acute > Week 1/2 > Flashcards

Week 1/2 Flashcards

1
Q

hemodynamic stability vs hemodynamic instability

A

stability - stable blood flow

instability - abnormal or unstable blood flow

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2
Q

what does A + O x 4 mean?

A

alert and oriented x 4 (person, place, time, situation)

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3
Q

What is PUSH test? What are the parameters?

A

Pressure Ulcer Scale for Healing

  • surface area of the wound
  • wound exudate
  • type of wound tissue
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4
Q

What are Braden and Norton scales used for?

A

to predict the likelihood a patient will develop a pressure ulcer

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5
Q

What are the 4 main types of infection control precautions?

A
  • contact
  • droplet
  • airborne
  • neutropenic
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6
Q

contact precaution PPE

A

gloves and gown

ex: MRSA, VRE, norovirus, C-Diff, chicken pox

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7
Q

what must be done with enteric precautions?

A

hand washing with soap and water
- all equipment must be cleaned using chlorine-based disinfectant

ex: C-Diff, norovirus, and rotovirus

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8
Q

droplet precaution PPE

A

face mask and goggles

- most likely need gown and gloves as well

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9
Q

airborne precautions PPE

A

respirator or N95
- isolation room w/ negative pressure

ex: TB, measles, chicken pox (via coughing and sneezing)

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10
Q

neutropenic precautions

A

< 15000 mmm^3

  • wash hands and equipment before touching patient
  • mask for patient and provider
  • diet restrictions, no tap water/ice from vending
  • no fresh flowers
  • visitation restrictions and no visitors who are ill
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11
Q

AM-PAC 6 scoring and cut off score

A

looks at activity impairments and independence
scored 1-4 with 1 meaning unable and 4 meaning independent

> 17 means discharge (want high score)

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12
Q

DEMMI score

A

looks at mobility

higher score means better mobility (raw score out of 19 and interval score out of 100)

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13
Q

PFITs scoring

A

looks at physical function (marching)

0-12 with higher score meaning increased independence

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14
Q

FSS-ICU scoring

A
  • predictive of discharge location when measured at time of ICU discharge
    looks at functional mobility and amount of assist needed

21-28 = home
10-20 = IP rehab
< 9 = SNF

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15
Q

CPAx scoring

A

measures physical function in the ICU

0-5 (dependent-independent)
higher score means more independence w/ max 50
- higher scores associated w/ shorter hospital stays

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16
Q

Perme ICU Mobility Score

A

Higher the score, the more independent the patient is (out of 32)

assesses mobility status of patients in ICU
- ID mobility barriers and need for assistance

17
Q

ACIF scoring

A

acute care index of function - has wheelchair component

score of < 0.4 indicated need for more therapy after ICU D/C

18
Q

What is considered orthostatic hypotension?

A

systolic drop of 20 mm/Hg and diastolic drop of 10 mm/Hg accompanied by 10-20% increased HR

19
Q

what changes in muscle fibers during bed rest?

A

Type IIB (fast twitch for force) more affected than type I (slow twitch for endurance) and type IIA (intermediate fibers)

20
Q

stages of pressure sores

A

Stage 1 – skin is still intact but feels like mashed potatoes
Stage 2 – broken the dermis
Stage 3 – into the subcutaneous (partial thickness)
Stage 4 – into muscle and bone (full thickness)
- If they have bone showing, you can assume that they have osteomyelitis (bone infection)

21
Q

how often should repositioning occur? what are the most common areas for pressure sores?

A

at least every 2 hours

  • heels, sacrum, and spine
22
Q

DTR differences between CIP (critical illness polyneuropathy) and CIM (critical illness myopathy)

A

CIP - decreased DTRs

CIM - DTRs may be preserved or diminished

23
Q

Which muscles are most affected with steroid induced myopathy?

A

proximal muscles

- atrophy of type 2 muscles

24
Q

pulmonary measures indicated patient is not ready for PT

A

SaO2: <88% or patient experiences a 10% oxygen desaturation below resting SaO2
Respiratory rate: >35 breaths/min
PEEP: >10 cm H2O
FIO2: ≥0.6 (60%)

25
Q

CV measurements needed for PT

A

Mean arterial pressure: <65 or >120 mm Hg or ≥10 mm Hg lower than normal systolic or diastolic blood pressure for patients receiving renal dialysis
Resting heart rate: <50 or >140 bpm
Systolic blood pressure: <90 or >200 mm Hg
New arrhythmia developed (including frequent ventricular ectopic beats or new onset atrial fibrillation)
New onset angina-type chest pain

26
Q

What outcome measure has a wheelchair component?

A

Acute Care Index of Function (ACIF)

27
Q

Acute hypercapnia or hypoexmia will lead to what?

A

altered consciousness

acute hypercapnia - increase in CO2

28
Q

Low complexity

A
  • no personal factors/comorbidities
  • addressing 1-2 elements
  • STABLE
29
Q

Moderate complexity

A
  • 1-2 personal factors and/or comorbidities
  • addressing a total of 3 or more elements
  • evolving condition
30
Q

High complexity

A
  • 3 or more personal factors and/or comorbidities
  • addressing a total of 4 or more elements
  • unstable
31
Q

Adaptations to decreased loading occurs _________ of immobility

A

within days

32
Q

Atrophy occurs greatest in _________ muscles than __________ muscles

A

antigravity muscles (quads)

antagonist muscles (hamstrings)

33
Q

___ strength somewhat spared in comparison to ___ atrophy

A

UE

LE

34
Q

What position enhances atrophy during immobilization?

A

Immobilization in shortened position

  • immobilization in lengthened/stretched position may decrease loss of muscle fiber proteins
35
Q

________ metabolism enzymes decreased while ________ pathway enzymes spared during bed rest.

A

Aerobic

Anaerobic

leads to early fatigue and reduced mitochondria which leads to impaired endurance capacity

36
Q

Lab values indicating lack of readiness for PT

A

HCT < 25%
Hgb < 8 g/dl
Platelets < 20,000
Platelets INR > 2.4-3.0

37
Q

What strength is associated with increased risk of mortality and loss of independence?

A

grip strength

- woman < 7kg and men < 11 kg = ICU-acquired weakness

38
Q

Activities measured with AM-PAC

A
  • turning over in bed
  • supine to sit
  • bed to chair
  • sit to stand
  • walk in room
  • 3-5 steps w/ rail

Acute (14 decks)

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