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CPNP > Week 12 - Acute neuological/neurosurgical patients: Cerebral haemorrhage, tumours,TBI > Flashcards

Week 12 - Acute neuological/neurosurgical patients: Cerebral haemorrhage, tumours,TBI Flashcards

1
Q

Describe the aims of the ax of acute neurological patients (8)

A
  1. Describe activity limitations
  2. establish the presence/absence of impairment
  3. establish baseline (objective measures) for monitoring improvement
  4. Determine likelihood of secondary impairment
  5. Ascertain degree to which patient can actively participate in therapy
  6. Determine a plan for intervention
  7. Recommend the most appropriate form of mobility (including level of assistance and equipment required)
  8. Work with multidisciplinary team to plan for transfer to rehabilitation/discharge
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2
Q

outline the guidelines for intervention for common impairments in acute neurological patients (3)

A
  • Graded mobilization - gradual increase amount and intensity of activities performed
  • follow medical/surgical instructions in medical record, aiming to commence graded mobilization as soon as medically stable
  • Follow acute stroke - aim for frequent but short bouts of out of bed activity (24-48 hours post)
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3
Q

Outline methods of preventing secondary impairments (contracture, pain, swelling and pressure areas) in acute neurological patients (5)

A
  1. Passive positioning in neutral positions through the day - day/night, casting/splint for severe
  2. loading bone and cartilage
  3. Electrical stimulation to prevent swelling in the hand/feet
  4. Frequent positioning changes to prevent pressure areas
  5. Task-related training that involves active stretching during the lengthening phase of action (monitor ROM)
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4
Q

Discuss the factors influencing the timing and amount of activity training performed (6)

A

Timing:

  1. ICP stable
  2. Drains removed
  3. BP <220/110 and >90/60
  4. No uncontrolled atrial fibrillation
  5. PEG or nasogastric feed ceased
  6. Read surgeon’s instructions
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5
Q

What is the % of brain injury patients with shoulder pain on admission?

A

56%

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6
Q

What are ways to prevent shoulder pain or injury? (3)

A
  1. Wearing arm sling when up walking around
  2. E-Stim
  3. Stickers and signs to be cautious of arm
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7
Q

What are ways to prevent pressure areas? (2)

A
  1. Frequently change position (turn to side, tilt table, SOOB)
  2. utilise pressure care devices
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8
Q

What is an important factor to monitor when implementing graded mobilization?

A

Monitor clinical signs of increased ICP as they may be present but not monitored

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9
Q

What is an important factor to consider when first getting patient up and out of bed?

A

Gradually monitoring blood pressure (different degrees) as postural hypotension is common and can cause patient to faint

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10
Q

What are some considerations to prepare a person for rehabilitation? (4)

A

RAFI

  1. Establish attitude of active participation
  2. Educate families and friends
  3. Promote involvement in physiotherapy
  4. Be realistic about recovery time frame (encourage but vague)
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11
Q

What % of total O2 consumption is by brain?

A

20%

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12
Q

What % of resting cardiac output is to brain?

A

15%

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13
Q

What factors affecting cerebral blood flow? (3)

A
  1. Intracranial pressure
  2. Local constriction and dilation of cerebral arterioles
  3. Mean arterial pressure at brain level
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14
Q

Define Cerebral pefusion pressure (CPP) and the equation used for it

A
  • Net pressure gradient causing blood flow to the brain

- CPP = MAP - ICP

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15
Q

What is the normal range of CPP

A

70-90 mm Hg

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16
Q

Define Intracranial pressure

A

Pressure within the intracranial compartment

17
Q

What happens when CPP drops <40?

A

Ischaemia

18
Q

What happens when CPP >90

A

Damage to blood vessels -> cerebral oedema -> brain injury

19
Q

When wanting to reduce risk of 2nd deg brain injury following TBI what levels is CPP often maintained at?

A

50-70 mm Hg

20
Q

What is the formula to find MAP?

A

DBP + 1/3 (SBP - DBP)

21
Q

What are the 2 main methods of regulating blood flow?

A
  1. Autoregulation (Based on MAP)

2. Chemicals - PaCO2, PaO2

22
Q

What range of MAP is auto-regulation effective?

A

MAP between 60-160 mmHg

23
Q

How does the respiratory system have a direct effect on cerebral blood flow and secondary brain injury?

A
  • Increase in CO2 -> vasodilation -> ICP
  • Low CO2 -> vasoconstriction = ischaemia
  • Increase in O2 -> vasoconstriction
  • decrease in O2 -> vasodilation (<60 mmHg)
24
Q

What is risk of Pneumonia due to respiratory consequences in TBI?

A

60%

25
Q

Risk of ARDS (acute respiratory distress syndrome)

A

10-30%

26
Q

What are the goals of physiotherapists for patients with acute TBI? (3)

A
  1. Respiratory impairments (gas, secretion)
  2. Other body systems (ie. musculoskeletal)
  3. Prevent 2nd deg brain injury
27
Q

What are the effects of physiotherapy techniques on ICP?

A

Effect the blood flow and oxygenation of the brain such as:

  • Increasing ICP
  • CPP usually maintained at adequate level due to increased MAP
28
Q

What are the general principles for physiotherapy Mx of patients with acute TBI in ICU?

A

consider (MWL):

Weight risks vs. benefit
liaise with medical team

Prepare (LMP):

  1. liaise with nursing staff
  2. medication prior to / during tx
  3. prep patients for intervention (meds, hyper-oxygenation if necessary)

Timing:

  1. CPP optimal stable range
  2. with other interventions - avoid quick succession

Modifications:

  1. Keep short and frequent
  2. Modify to reduce risk

Monitor:
1. Monitoring continually (ICP, CPP, HR, RR, MAP/BP/rhythm, PaO2, PaCO2, ETCO2)

29
Q

Which physiotherapy techniques shown to cause increased ICP (5)

A
  1. MHI
  2. Suctioning
  3. Vibration
  4. positioning/cervical flexion or ext.
  5. early mobilization
30
Q

What is the semi phallus position and what are the benefits?

A
  • 30 deg head up tilt

- used to maintain good CPP, max effective ventilation and minimize aspiration in non-intubated patients

31
Q

What are the effects of exercise on ICP? (3)

A
  1. Passive ROM - no significant change in ICP or CPP
  2. Active limb movement - no significant change in ICP or CPP but significant O2 consumption
  3. Resisted exercises causing valsalva manoeuvre - significant increase in ICP due to reduced venous return from head

CPNP (12 decks)

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