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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
Parameters indicating lack of readiness for PT (ICU-AW)- | CV measures?
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
S/S hypo or hyper tension
HA (usually occipital and present in am) Vertigo Flushed face Spontaneous epistaxis (nose bleed) Blurred vision Nocturnal urinary frequency
27
Multi Organ Dysfunction Syndrome (MODS) | Clinical presentation
``` 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
Vigorous exercise | ___ METS or ___% VO2max
6 METS | > 60% VO2max
29
Classic cardiac symptoms of decompensation
Angina Palpitations Dyspnea or SOB Fatigue
30
Orthostatic hypotension | Symptoms and Management
Lightheadedness Rubbery legs Feelings of syncope Sit/Lie down Ankle pumps Notify medical personnel as needed Discontinue standing activities
31
Factors affecting heart rate- | Medications
Beta-blockers Calcium channel blockers/Beta-receptor stimulators Chemicals- caffeine Hormones- thyroid
32
Hyperpnea
Normal respiratory rate but increased volume
33
Multi Organ Dysfunction Syndrome (MODS) | Physical therapy management
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
Parameters indicating lack of readiness for PT (ICU-AW)- | Lab values
No exercise: Hematocrit < 25% Hemoglobin < 8 g/dL Platelets < 20,000/mm If INR => 2.5-3.0 discuss w/ physician
35
Dyspnea scale
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
CIP/CIM (critical illness polyneuropathy/myopathy) | Key finding
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
Critical illness and PT | Prevent and treat
Early rehab (in ICU- sedation must be controlled) Focus on functional limitations, respiratory capacity and cardiac reserve Facilitate communication Risk vs benefit
38
Classic cardiac signs of decompensation
``` Dysrhythmias Syncope Dyspnea or SOB Dependent edema Hemoptysis Cyanosis ```
39
Hypoventilation
Decreased rate and volume
40
Cheyne-Stokes
Hyperventilation followed by hypoventilation, then apnea, with cycle repeating
41
Multi Organ Dysfunction Syndrome (MODS) | Causes?
Most commonly sepsis, but infection not required Also caused by ARDS (Acute respiratory distress syndrome), severe inflammatory processes, shock, and traumatic injury
42
BMI
``` < 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
Apnea
No breathing
44
Patient with lung disease | Therapist should stop activity if?
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
Factors affecting heart rate- | Pathology
Anemia Congestive heart failure Autonomic dysfunction (SCI, DM, Fever)
46
Pulse Assessment Scale 0-4
``` 0- absent 1- markedly reduced 2- slightly reduced 3- normal 4- bounding ```
47
BP- medical emergency
No BP Extremely low BP BP > 200/110 at rest
48
CIP vs CIM (critical illness polyneuropathy vs myopathy) | Key distinguishing feature/ finding
Motor and sensory impairment: CIP: Symmetrical, distal and diaphragm more impacted than proximal CIM: Symmetrical, motor only, proximal more than distal
49
SaO2 or SpO2 < 90%
``` 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
Orthopnea
Difficulty breathing while horizontal, with ease of breathing with vertical positioning
51
Parameters indicating lack of readiness for PT (ICU-AW)
1. Pulmonary 2. CV 3. Lab values 4. Metabolic measures If these are ok- 5. Cognition? (Able to follow directions)
52
Hyperventilation
Increased rate and volume
53
CIP/CIM (critical illness polyneuropathy/myopathy) | Prevention
Blood glucose control Electrolyte and nutritional balance Accelerated ventilation weaning

Examine Complex Patient 6671 (8 decks)

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