Week 1/2 Flashcards
hemodynamic stability vs hemodynamic instability
stability - stable blood flow
instability - abnormal or unstable blood flow
what does A + O x 4 mean?
alert and oriented x 4 (person, place, time, situation)
What is PUSH test? What are the parameters?
Pressure Ulcer Scale for Healing
- surface area of the wound
- wound exudate
- type of wound tissue
What are Braden and Norton scales used for?
to predict the likelihood a patient will develop a pressure ulcer
What are the 4 main types of infection control precautions?
- contact
- droplet
- airborne
- neutropenic
contact precaution PPE
gloves and gown
ex: MRSA, VRE, norovirus, C-Diff, chicken pox
what must be done with enteric precautions?
hand washing with soap and water
- all equipment must be cleaned using chlorine-based disinfectant
ex: C-Diff, norovirus, and rotovirus
droplet precaution PPE
face mask and goggles
- most likely need gown and gloves as well
airborne precautions PPE
respirator or N95
- isolation room w/ negative pressure
ex: TB, measles, chicken pox (via coughing and sneezing)
neutropenic precautions
< 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
AM-PAC 6 scoring and cut off score
looks at activity impairments and independence
scored 1-4 with 1 meaning unable and 4 meaning independent
> 17 means discharge (want high score)
DEMMI score
looks at mobility
higher score means better mobility (raw score out of 19 and interval score out of 100)
PFITs scoring
looks at physical function (marching)
0-12 with higher score meaning increased independence
FSS-ICU scoring
- 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
CPAx scoring
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
Perme ICU Mobility Score
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
ACIF scoring
acute care index of function - has wheelchair component
score of < 0.4 indicated need for more therapy after ICU D/C
What is considered orthostatic hypotension?
systolic drop of 20 mm/Hg and diastolic drop of 10 mm/Hg accompanied by 10-20% increased HR
what changes in muscle fibers during bed rest?
Type IIB (fast twitch for force) more affected than type I (slow twitch for endurance) and type IIA (intermediate fibers)
stages of pressure sores
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)
how often should repositioning occur? what are the most common areas for pressure sores?
at least every 2 hours
- heels, sacrum, and spine
DTR differences between CIP (critical illness polyneuropathy) and CIM (critical illness myopathy)
CIP - decreased DTRs
CIM - DTRs may be preserved or diminished
Which muscles are most affected with steroid induced myopathy?
proximal muscles
- atrophy of type 2 muscles
pulmonary measures indicated patient is not ready for PT
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%)
CV measurements needed for PT
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
What outcome measure has a wheelchair component?
Acute Care Index of Function (ACIF)
Acute hypercapnia or hypoexmia will lead to what?
altered consciousness
acute hypercapnia - increase in CO2
Low complexity
- no personal factors/comorbidities
- addressing 1-2 elements
- STABLE
Moderate complexity
- 1-2 personal factors and/or comorbidities
- addressing a total of 3 or more elements
- evolving condition
High complexity
- 3 or more personal factors and/or comorbidities
- addressing a total of 4 or more elements
- unstable
Adaptations to decreased loading occurs _________ of immobility
within days
Atrophy occurs greatest in _________ muscles than __________ muscles
antigravity muscles (quads)
antagonist muscles (hamstrings)
___ strength somewhat spared in comparison to ___ atrophy
UE
LE
What position enhances atrophy during immobilization?
Immobilization in shortened position
- immobilization in lengthened/stretched position may decrease loss of muscle fiber proteins
________ metabolism enzymes decreased while ________ pathway enzymes spared during bed rest.
Aerobic
Anaerobic
leads to early fatigue and reduced mitochondria which leads to impaired endurance capacity
Lab values indicating lack of readiness for PT
HCT < 25%
Hgb < 8 g/dl
Platelets < 20,000
Platelets INR > 2.4-3.0
What strength is associated with increased risk of mortality and loss of independence?
grip strength
- woman < 7kg and men < 11 kg = ICU-acquired weakness
Activities measured with AM-PAC
- turning over in bed
- supine to sit
- bed to chair
- sit to stand
- walk in room
- 3-5 steps w/ rail
