Detriments to bedrest
Orthostatic intolerance can begin in as little as __day(s) on bed rest?
A: 1-2 days
B: 1 day
C: 3-4 days
3-4 days
True or false:
You should STOP interventions when HR decreases <60 or increases >130
True
HR between 60-130 bpm is safe to start mobility
**These parameters should not be a substitute for clinical judgement**
True or false:
You must STOP mobility when systolic decreases <90 or increases >180
True
ideally want range between 90-180mmHg
**These parameters should not be a substitute for clinical judgement**
True or false:
1/4 of patients with inserted catheters will develop a LE DVT
False UE DVT
Name the pacemaker precautions:
- first 48 hours ____
- for 2 weeks precautions are ____, _____
first 48 hours: wear sling
2 weeks: no more than 10 ibs and no overhead reaching >90 degrees shoulder FL
What % of muscle strength from immobility occurs daily
A: 5.1-7%
B: 1.3-3%
C: 1.2- 2%
B: 1.3-3%
With A/PROM a ___% increase of HR can be seen already
A: 5%
B: 8%
C: 10%
10% increase in HR
HR in ICU patients well exceeds resting and most often given parameters.
Recommended to look at age predicted max 50-60% but study showed safe mobilization with resting HR 50-80% of age predicted HR max
Name 2 out of 4 reasons to not use BP cuff on an certain extremity:
Do not use on an extremity with:
1. AV fistula or graft
2. lymphedema
3. blood clot
4. masectomy/lymphadenctomy
True or false:
You can do both in bed and OOB exercises with an Endotracheal tube
True
Same with Tracheostomy
Coughing is comparable to lifting ____ibs weights over your head
A: 20 ibs
B: 30 ibs
C: 40 ibs
40 ibs
Teach bracing technique!
What % reduction in postural muscle strength after only 1 week of complete bedrest?
A: 10%
B: 12%
C: 15%
10%
True or false:
A new arrhythmia developed (including frequent ventricular ectopic beats or new onset of afib) and New onset angina type chest pain may indicate a lack of readiness for PT intervention
True
Also unstable spinal cord injury, unstable fx, active or uncontrolled GI bleed.
What is the normal range for Hgb? and what ranges can you do light exercise versus none?
Defined: iron-containing protein in red blood cells that carries O2 from the lungs to the body's tissues and organs, and transports carbon dioxide back to the lungs
Normal: Males (14-18g/dl) Females (12-16g/dl)
<8 g/dl No exercise (our guidelines we can do >6.9; coordinate after transfusion)
8-10 light exercise
> or equal to 10 resistive exercises
Chest tube precautions:
Mediastinal
Pleural
purpose: removes and prevents re-entry of air or fluid
- drainage should remain below site of insertion
- check to see if pt may or may not come off suction
-Avoid tipping (notify RN if happens)
- if tube is disconnected, notify RN and monitor vital signs if occurs
Per guidelines:
** mediastinal- OOB to chair only, no ambulation (unless order provided)
**pleural - if dislodged just cover with glove hand no pressure provided. Limit rolling to that side. If on suction needs MD order to place water seal for ambulation in hall otherwise keep in room (no restrictions on water seal)
True or false
Sternal precautions last 8-12 weeks
False: 6-8 weeks
What % of overall muscle strength can be lost in the first week of strict bedrest?
A: 20%
B: 40%
C: 50%
40%
A respiratory rate (RR) greater than ___breath/min and FiO2 greater or equal to ___ indicates a lack of readiness for PT interventions
A: > 25 RR, FiO2 > 0.6
B: >30 RR, FiO2 >0.7
C: >35 RR, FiO2 >0.6
RR >35 breaths/min
FIO2 greater or equal to 0.6
What is the normal range for hematocrit? and what ranges can you do light exercise versus none?
Defined: The % of RBCs in a whole blood sample
Normal range Males (42-52%) Females (37-47%)
<25% No exercise (our guidelines is <20% and coordinate after blood transfusion)
25-30 Light exercise
>30% resistive exercise
What is an external ventricular drain (EVD)? And do you need orders?
a temporary medical device used to drain excess cerebrospinal fluid (CSF) from brain's ventricles
Yes you do need physicians orders for any of these pts to get OOB
Neuo surgeon should provide ICP and CPP parameters (may include BP parameters)
Name some of the sternal precautions
**Extra 100 points if you can name precautions for unstable sternum**
- No lifitng more than 10ibs
- Do not reach both hands over head (do unilateral ROM over head)
- Avoid Bilateral horizontlal abduction
- No excessive pushing or pulling (and do not pull on pt's arms when assisting OOB or standing or lean too hard on fww)
- No driving for at least 3-5 weeks
*if you feel any clicking, popping, or grinding, or other movement in chest - call doctor ASAP*
Unstable sternum: limit shoulfer FL to strict 90 degrees bilaterally, limit lifting to 5ibs, no pushing pulling on bed/chair
What is PICS? (post-intensive care syndrome) and how years can the effects of it last on patients?
Answer: Triad of new or worsening physical, mental health, and cognitive impairments that persist beyond acute care hospitalization. Lasting effects up to 5 years later. (patients and caregivers affected)
- 50-100% of ICU pts will experience at least 1 physical symptom of impairment of PICS.
Example of cognitive impairments: paying attention, solving simple problems, dual task/multi step task, self-regulation.
A MAP value lower than ____mmHg
A MAP value higher than ____ mmHg
may indicate lack of readiness for PT interventions
MAP <65 (60 according to our guidelines) or >120 mmHg may lack readiness
You can begin mobility with MAP between 60-100
OR
greater or equal to 10 mmHg lower than normal SBP or DBP for pt on renal dialysis
How many hours does it take for heparin to become therapeutic?
3-5 hours
What must be done to EVD drain prior to getting OOB?
EVD must be clamped when OOB.
Name some Intracranial Pressure Precautions
and what positions can cause an increase in ICP
- HOB maintained >30 degress (or stated by MD)
- avoid increased intrathoracic pressure
- Positions that can inc ICP: trendelenburg, lateral neck FL, extreme hip FL (valsalva maneuver, pain, coughing as well)
Beware of: changes in baseline waveform bc changes can be cause by poor positioning, cerebral hypoxia or ischemia. AlSO momentary elevations of ICP (20-30 mmHg) can be noted with changes in position but if does not return to baseline activity should be stopped ASAP.
S&S of inc ICP - C/o of HA, dec LOC, dec motor response, dec pupillary size, inc BP, bradycardic, abdnormal respirations