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Examine Complex Patient 6671 > Week2 6671/6611 > Flashcards

Week2 6671/6611 Flashcards

1
Q

Moderate exercise

___ METS

A

3-6 METS

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2
Q

Congestive heart failure

S/S

A

Engorgement and distention of jugular veins

Increased fluid retention:
Weight gain
Dependent putting edema
Increased fatigue w/ activity

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3
Q

Parameters indicating lack of readiness for PT (ICU-AW)-

Pulmonary

A

SaO2 < 88% OR 10% desaturation below resting SaO2

RR > 35 breaths/min

PEEP > 10 cm H2O

FiO2 => 0.6

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4
Q

Factors affecting heart rate-

Gender

A

Males < Females

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5
Q

Medical clearance and exercise testing- screening

Low/Mod/High Risk?

A

Low:
Men < 45, Women < 55
Only 1 risk factor and no symptoms

Moderate:
Men => 45, Women =>55
2 or more risk factors

High:
Known CV, pulmonary or metabolic disorders, or s/s of CV disease (SOB at rest/mild exertion; syncope; ankle edema; palpitations)

Moderate risk and vigorous exercise or High risk = physician supervised testing

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6
Q

Becks anxiety scoring

A

0-21 low
22-35 moderate
36+ high/concerning

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7
Q

Normal adult resting breathing rate

A

10-20 breaths/min

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8
Q

Bradypnea

A

Rate < 12 breaths/min (adult)

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9
Q

Parameters indicating lack of readiness for PT (ICU-AW)

Metabolic measures

A

Glucose levels <70 or >200 mg/dL

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10
Q

Factors related to dysrhythmias (8)

A
  1. Ischemia/hypoxia of myocardium
  2. Sympathetic discharge (anxiety; exercise)
  3. Acidosis
  4. Alterations in electrolytes (decrease K+)
  5. Excessive stretch of myocardium (ie. CHF)
  6. Pharmacologic agents
  7. Sympathomimetics (caffeine; anti arrhythmia drugs; digitalis)
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11
Q

CIP/CIM (critical illness polyneuropathy/myopathy)

Pathogenesis

A

Circulatory, cellular level, and metabolic changes

Impaired O2 delivery-total body microcirculatory issues
Impaired mitochondrial function- reduced ATP, energy production
Diaphragmatic weakness from ventilation (combined sedation)
Immobility- muscle wasting

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12
Q

Pulse Assessment Scale 0-3

A

0 : absent
1 : weak, thread
2 : normal
3 : full, bounding

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13
Q

CIP/CIM (critical illness polyneuropathy/myopathy)

Dx

A 
Weaning difficultly 
Clinical presentation 
Imaging 
Labs
Tissue studies
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14
Q

CIP/CIM (critical illness polyneuropathy/myopathy)

Prognosis

A

Not great: 22% die in hospital; 33% die w/in 6 mo

Institutionalization

The younger, the better

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15
Q

Dyspnea

A

Labored or difficult breathing

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16
Q

Tachypnea

A

Rate > 20 breaths per minute (adult)

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17
Q

Do NOT mobilize the critically ill patient if…?

A
  1. Standard contraindication and precaution
  2. New onset of cardiac arrhythmias or s/s of MI
  3. New additions or adjustments to vasoactive medications
  4. Intermittent hemodialysis
  5. Intra-aortic balloon pump
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18
Q

Multi Organ Dysfunction Syndrome (MODS)

A

Progressive failure of 2 or more organ systems over 24 hours

Typically a complication of critical illness

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19
Q

Hypopnea

A

Normal respiratory rate but decreased volume

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20
Q

Factors affecting heart rate-

Environmental

A

Core temperature

Hydration

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21
Q

Medical clearance and exercise testing- Low/Mod/High Risk screening
Risk factors?

A
  1. Family hx of CV disease (before age 55 in father or first-degree male relative; before 65 in mother or first-degree female relative)
  2. Smoking (current or quit w/in 6 mo)
  3. HTN (SBP => 140; DBP => 90; or in HTN rx)
  4. Dyslipidemua (LDL > 130, HDL < 40; total cholesterol > 200)
  5. Fasting glucose => 100 on 2 separate occasions
  6. Obesity (BMI > 30)
  7. Sedentary lifestyle
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22
Q

7 sites for pulses

A
  1. Radial
  2. Brachial
  3. Carotid
  4. Femoral
  5. Temporal
  6. Popliteal
  7. Posterior tibial artery
23
Q

Factors affecting heart rate-

Age

A

Higher- infants

Lower- age >65

24
Q

Multi Organ Dysfunction Syndrome (MODS)

Medical management

A

Prevention and early detection
Pharmacologic: antibiotics, inotropic agents
Supplemental O2 and ventilation
Fluid replacement and nutritional support

Prognosis 60-90% mortality, approaching 100% with 3 or more organ involvement and sepsis plus > 65 y/o

25
Q

Parameters indicating lack of readiness for PT (ICU-AW)-

CV measures?

A

Mean arterial pressure < 65 or > 120 mmHg
OR => 10 mmHg lower than normal SBP or DBP for pts renal dialysis

RHR <50 or >140 bpm

SBP <90 or >200 mmHg

New arrhythmia
New onset angina-Type chest pain

26
Q

S/S hypo or hyper tension

A

HA (usually occipital and present in am)

Vertigo

Flushed face

Spontaneous epistaxis (nose bleed)

Blurred vision

Nocturnal urinary frequency

27
Q

Multi Organ Dysfunction Syndrome (MODS)

Clinical presentation

A 
Low grade fever 
Tachycardia 
Dyspnea 
Systemic inflammatory response 
Altered mental status

Lungs typically first organ to fail- leading to ARDS
Followed by GI bacteremia, liver and kidney failure
Ultimately CV collapse can occur

28
Q

Vigorous exercise

___ METS or ___% VO2max

A

6 METS

> 60% VO2max

29
Q

Classic cardiac symptoms of decompensation

A

Angina
Palpitations
Dyspnea or SOB
Fatigue

30
Q

Orthostatic hypotension

Symptoms and Management

A

Lightheadedness
Rubbery legs
Feelings of syncope

Sit/Lie down
Ankle pumps
Notify medical personnel as needed
Discontinue standing activities

31
Q

Factors affecting heart rate-

Medications

A

Beta-blockers
Calcium channel blockers/Beta-receptor stimulators
Chemicals- caffeine
Hormones- thyroid

32
Q

Hyperpnea

A

Normal respiratory rate but increased volume

33
Q

Multi Organ Dysfunction Syndrome (MODS)

Physical therapy management

A

Usually only seen in critical care or burn unit

Severe protein catabolism of skeletal muscle
Lean body mass depleted
Need skin precautions and skincare

Risk often outweighs benefits
Very little in literature

34
Q

Parameters indicating lack of readiness for PT (ICU-AW)-

Lab values

A

No exercise:
Hematocrit < 25%
Hemoglobin < 8 g/dL
Platelets < 20,000/mm

If INR => 2.5-3.0 discuss w/ physician

35
Q

Dyspnea scale

A

Inhale normally and count to 15 out loud

Level 0: single breath
Level 1: requires 2 breaths 
Level 2: requires 3 breaths 
Level 3: requires 4 breaths 
Level 4: unable to count
36
Q

CIP/CIM (critical illness polyneuropathy/myopathy)

Key finding

A

Muscle weakness:
Often rapid onset;
Failure to wean from mechanical ventilation;
Motor and sensory impairment:
CIP: Symmetrical, distal and diaphragm more impacted than proximal
CIM: Symmetrical, motor only, proximal more than distal

37
Q

Critical illness and PT

Prevent and treat

A

Early rehab (in ICU- sedation must be controlled)

Focus on functional limitations, respiratory capacity and cardiac reserve

Facilitate communication

Risk vs benefit

38
Q

Classic cardiac signs of decompensation

A 
Dysrhythmias
Syncope 
Dyspnea or SOB
Dependent edema
Hemoptysis 
Cyanosis
39
Q

Hypoventilation

A

Decreased rate and volume

40
Q

Cheyne-Stokes

A

Hyperventilation followed by hypoventilation, then apnea, with cycle repeating

41
Q

Multi Organ Dysfunction Syndrome (MODS)

Causes?

A

Most commonly sepsis, but infection not required

Also caused by ARDS (Acute respiratory distress syndrome), severe inflammatory processes, shock, and traumatic injury

42
Q

BMI

A 
< 18.5 underweight
18.5-24.9 normal
25-29.9 over weight 
30-34.9 obese I
35-39.9 obese II
> 40 obese III
43
Q

Apnea

A

No breathing

44
Q

Patient with lung disease

Therapist should stop activity if?

A
  1. SaO2 decreases by 5% or more of resting value
  2. SaO2 =< 88% in patients with R side heart failure
  3. SaO2 < 80% in patients with lung disease

Patients with lung disease SaO2 < 88% use supplemental O2

45
Q

Factors affecting heart rate-

Pathology

A

Anemia
Congestive heart failure
Autonomic dysfunction (SCI, DM, Fever)

46
Q

Pulse Assessment Scale 0-4

A 
0- absent
1- markedly reduced
2- slightly reduced 
3- normal 
4- bounding
47
Q

BP- medical emergency

A

No BP
Extremely low BP
BP > 200/110 at rest

48
Q

CIP vs CIM (critical illness polyneuropathy vs myopathy)

Key distinguishing feature/ finding

A

Motor and sensory impairment:

CIP: Symmetrical, distal and diaphragm more impacted than proximal

CIM: Symmetrical, motor only, proximal more than distal

49
Q

SaO2 or SpO2 < 90%

A 
Stop performing physical activity 
Check device is on properly 
Retake measurement with pt still 
Notify medical personnel if measurement valid
Continue to monitor pt
50
Q

Orthopnea

A

Difficulty breathing while horizontal, with ease of breathing with vertical positioning

51
Q

Parameters indicating lack of readiness for PT (ICU-AW)

A
  1. Pulmonary
  2. CV
  3. Lab values
  4. Metabolic measures

If these are ok-
5. Cognition? (Able to follow directions)

52
Q

Hyperventilation

A

Increased rate and volume

53
Q

CIP/CIM (critical illness polyneuropathy/myopathy)

Prevention

A

Blood glucose control
Electrolyte and nutritional balance
Accelerated ventilation weaning

Examine Complex Patient 6671 (8 decks)

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