CORRECT ANSWERS GRADED A+
What brings a patient to the ICU? - CORRECT ANSWER-Acute conditions
-Respiratory failure
-CV instability
-Neurological disorders
-Multi injuries
-Organ system failure
Complications of Bedrest: Circulation - CORRECT ANSWER--Orthostatic
hypotension
-DVT/PE
-Venous pooling d/t lack of muscle pump
Complications of Bedrest: Pulmonary - CORRECT ANSWER--Increased risk of
atelectasis d/t not ventilating a lot of alveoli
-Aspiration pneumonia d/t mucocilliary escalator not working
-Impaired gas exchange
-Reduced lung volumes
-Reduced max. O2 consumption
Complications of Bedrest: Organ Systems - CORRECT ANSWER--Altered skin
integrity
-Osteoporosis
-Urinary stasis, UTI
-Constipation
Complications of Bedrest: Other - CORRECT ANSWER--Muscle atrophy
-Joint contractures
-Sensory/perceptual abnormalities (ICU psychosis)
-ICU-acquired delirium
,What does the research say about PT/mobility in ICU patients? - CORRECT
ANSWER-Early mobilization of patients has been linked to improved outcomes &
reduced length of hospital stay
What are the ABCs of ICU Liberation? - CORRECT ANSWER-A: Assess, prevent, &
manage pain
B: Both SAT & SBT (spontaneous awakening trials, spontaneous breathing trials)
C: Choice of analgesia & sedation
D: Delirium: Assess, prevent, & manage
E: Early mobility & exercise
F: Family engagement & empowerment
Why is C: choice of analgesia & sedation so important in ICU liberation? -
CORRECT ANSWER--Choose the right medication/level of sedation; ensure that
you are just sedated enough so you're not agitated because of the tube
-Sedation can also cause delirium
***Chose drugs that are both quickly reversible but quickly acting
Why is D: Delirium so important in ICU liberation? - CORRECT ANSWER--Delirium
needs to be avoided at all costs & can greatly change patient's trajectory
-PTs have a job to "exercise" pt's brain to prevent this
Adult oxygen therapy escalation algorithm: Step 1 - CORRECT ANSWER--Start O2
at 1-5 L/min -Nasal prongs
Adult oxygen therapy escalation algorithm: Step 2 - CORRECT ANSWER-If
continued distress or SpO2 <90%:
-Face mask
-Increased O2 to 5-10 L/min
Adult oxygen therapy escalation algorithm: Step 3 - CORRECT ANSWER-If
continued distress or SpO2 <90%:
-Face mask with reservoir
,-Start O2 at 10-15 L/min & titrate to ensure bag inflates
Adult oxygen therapy escalation algorithm: Step 4 - CORRECT ANSWER-If
continued distress or SpO2 <90%:
Continue to try to find a higher level of care and consider on of the following if
available & adequate O2 supply:
-HFNO: 30-60 LPM (can also adjust FiO2)
-CPAP: 10-15 cm H20
-BIPAP:
Safety guidelines for PT in ICU - CORRECT ANSWER--Before starting, check line,
tube, drain from origin to insertion
-Always have slack on lines
-Prevent line occlusion
-Reconnect & put everything back where you found it before leaving the room
Hand hygiene in ICU - CORRECT ANSWER--Wash IN
-Wash OUT
-GLOVES
Diaphragmatic breathing - CORRECT ANSWER--Requires both "belly breathing" &
lateral costal expansion
-May increase efficiency
-May decrease work of breathing
Accessory muscle breathing - CORRECT ANSWER--Increases during exertional
activity -Increases with respiratory distress
Purpose of palpating breathing pattern - CORRECT ANSWER-Assess chest wall
expansion during breathing to compare symmetry of chest wall between R & L
side as well to compare the contribution from upper, middle, and lower chest wall
movement during breathing
, What does asymmetry in breathing pattern indicate? - CORRECT ANSWER-
Ineffective or inefficient breathing pattern
Purpose of cough exam - CORRECT ANSWER-Assess the effectiveness of a
person's cough as well as any sputum production that may indicate a medical
issue
What are the phases of cough? - CORRECT ANSWER-Stage 1: Inspiration
Stage 2: glottal closure
Stage 3: build up of intrathoracic & intraabdominal pressure
(Stage 2 & 3 happen together in a compression phase)
Stage 4: Glottal opening & expulsion
At what result does a Peak Cough Flow assessment indicate that interventions
are needed? -
CORRECT ANSWER-<270 L/min
Increased risk of ineffective cough
What PFTs/Spirometry result indicates that there might be a cough problem? -
CORRECT ANSWERVital capacity <50%
Is lung auscultation diagnostic? - CORRECT ANSWER-Kinda. No diagnosis is made
solely on lung auscultation
Limitations to Lung Ausculation - CORRECT ANSWER-Generally poor to fair inter-
rater reliability
Pros to lung auscultation - CORRECT ANSWER-Easy, quick, low cost, non-invasive,
no radiation
Bronchial lung sounds - CORRECT ANSWER-1:2
Inhalation:Exhalation
Vesicular lung sounds - CORRECT ANSWER-3:1
Inhalation:Exhalation