PHTH 564 Critical Care Midterm 275
complete solutions.
PHTH 564 Critical Care Midterm 275
complete solutions.
What units within the hospital are considered to be 'critical care' units? - ANSWER - ICU (intensive care
unit)
- HAU (high acuity unit; step down from ICU)
- post- anesthetic recovery rooms
- these units have the highest staff-to-patient ratio
Provide some examples of 'active problems' (a problem that a PT can address). - ANSWER - impaired
airway clearance
- dyspnea
- decreased exercise tolerance/mobility level
- reduced lung volumes
- impaired gas exchange
- airflow limitation
- resp. muscle dysfunction
- dysfunctional breathing patterns
- pain
- MSK dysfunction (postural abnormalities, decreased compliance of the chest wall)
Provide some examples of 'inactive problems' (a problem that a PT cannot address directly; a medical
problem). - ANSWER - uncontrolled BP (would need to factor in how this would affect your Tx)
- heart arrhythmia
- heightened troponin levels
- need to work in tandem with nurses/doctors to determine if the pt is safe to mobilize, and whether
anything can be done to control/ address any of these issues
,PHTH 564 Critical Care Midterm 275
complete solutions.
Provide some examples of key information that you need to gather from the chart before working with a
patient in critical care. - ANSWER - HPC
- PMHx
- SHx
- medications
- lab results
- current stats
- medical Dx and plan
- any mobility orders, restrictions
- precautions/ contraindications to Tx
What other information can be used to get a better understanding of the patient's pathology and their
past medical history? - ANSWER - look for information about the course of the pt's admission to hospital
(not always admitted directly to critical care; how did they deteriorate on the ward before being moved
to ICU?)
- review previous admissions
- frequent admissions for the same problem?
- social history (living situation, previous level of function, supports, etc.)
What is the 'Multi Systems Approach'? What 8 systems must be considered? - ANSWER - considers each
of the major systems of the body to ensure all relevant info is obtained that may impact Ax/Tx
- consent
- central nervous (CNS)
- cardio-vascular (CVS)
- respiratory (RESP)
- Musculoskeletal (MSK)
- Mobility (Mob)
- Renal (RENAL)
- Gastro-intestinal (GI)
,PHTH 564 Critical Care Midterm 275
complete solutions.
- Haematology/ electrolytes (BLOODS)
How does obtaining consent for PT Tx in the ICU differ from gaining consent in other healthcare
settings? - ANSWER - consent to Tx in ICU is done on admission
- consent in the ICU is often implied
- consent should still be obtained from the patient whenever possible
- if an Ax or Tx has a high level or risk or is unusual for the situation, consent should be confirmed
How do you observe the function of a patient's CNS? What scales (3) are often used to quantify this? -
ANSWER - are they alert or asleep or sedated?
- orientated? are they following commands?
- are they moving? are both sides equal? are there any abnormal movements?
- Glasgow Coma Scale (eye open, verbal & motor response)
- Richmond Agitation Sedation Scale (RASS) (sedation/agitation scale)
- Behavioural Pain Scale (BPS) (facial expression, upper limb movements, compliance with mechanical
ventilation)
Explain the connection between hypoxic brain injuries and critical care. - ANSWER - patients are often
admitted to hospital/ICU for a medical reason (i.e. MI or stroke), and can often have an associated
hypoxic brain injury due to the interruption of blood flow to the brain occurring as a result of their heart
attack.
What is the ASIA scale used for in the ICU? - ANSWER - used to quantify level of function in SCI patients
and therefore the level of assist needed, especially in the acute phase post injury when their level of
function may or may not change.
Explain the importance of cognition and behaviour screening in the ICU. - ANSWER - screening for
delirium is important; the earlier we catch it the better
- 70-80% of patients have some cognitive deficit at discharge from ICU (impaired memory, depression,
impaired judgement, decreased awareness, etc.)
- good to touch base with family to check if this the patient's 'normal'
, PHTH 564 Critical Care Midterm 275
complete solutions.
What can a higher temperature be indicative of? - ANSWER - infection
- mobilizing/rehab not recommended if the patient appears acutely septic
- patients may have a lower temperature (if someone had an MI, they might be put on a protocol to
keep them hypothermic / normothermic to prevent increasing pressure in the brain)
How can you Ax the CVS? - ANSWER - heart rate (60-100; brady <60, tachy >100; can mob. from 50-130)
- rhythm (sinus or not? stable?)
- BP (80/120)
- MAP (70-110)
- medications
What are the differences in management of a hemorrhagic stroke vs. an embolic stroke? - ANSWER -
hemorrhagic = want to keep the pressure as low as possible to help stop the brain bleed
- embolic = want to increase the BP as much as possible to help shunt blood into all the little vessels in
the brain to help get past the clot/blockage
What arrhythmias should you watch out for when Ax ECGs? - ANSWER - PVCs (pre-ventricular
contractions) at the rate of more than 6 per min. or a run of 3 or more in a row require medical
attention
- more than 3 consecutive PVCs at a rate of greater than 100 bpm = V. tach.
- ventricles do not have sufficient time to fill and this, cardiac output is greatly reduced
What is the equation used to calculate MAP? - ANSWER SBP + (2xDBP)/3
- MAP > 60 is necessary to perfuse coronary arteries, brain, and kidneys.
What does central venous pressure (CVP) provide information about? - ANSWER - cardiac function (right
heart function) and the adequacy of circulating vascular volume
- normal: 2-7 mmHg if self ventilating
complete solutions.
PHTH 564 Critical Care Midterm 275
complete solutions.
What units within the hospital are considered to be 'critical care' units? - ANSWER - ICU (intensive care
unit)
- HAU (high acuity unit; step down from ICU)
- post- anesthetic recovery rooms
- these units have the highest staff-to-patient ratio
Provide some examples of 'active problems' (a problem that a PT can address). - ANSWER - impaired
airway clearance
- dyspnea
- decreased exercise tolerance/mobility level
- reduced lung volumes
- impaired gas exchange
- airflow limitation
- resp. muscle dysfunction
- dysfunctional breathing patterns
- pain
- MSK dysfunction (postural abnormalities, decreased compliance of the chest wall)
Provide some examples of 'inactive problems' (a problem that a PT cannot address directly; a medical
problem). - ANSWER - uncontrolled BP (would need to factor in how this would affect your Tx)
- heart arrhythmia
- heightened troponin levels
- need to work in tandem with nurses/doctors to determine if the pt is safe to mobilize, and whether
anything can be done to control/ address any of these issues
,PHTH 564 Critical Care Midterm 275
complete solutions.
Provide some examples of key information that you need to gather from the chart before working with a
patient in critical care. - ANSWER - HPC
- PMHx
- SHx
- medications
- lab results
- current stats
- medical Dx and plan
- any mobility orders, restrictions
- precautions/ contraindications to Tx
What other information can be used to get a better understanding of the patient's pathology and their
past medical history? - ANSWER - look for information about the course of the pt's admission to hospital
(not always admitted directly to critical care; how did they deteriorate on the ward before being moved
to ICU?)
- review previous admissions
- frequent admissions for the same problem?
- social history (living situation, previous level of function, supports, etc.)
What is the 'Multi Systems Approach'? What 8 systems must be considered? - ANSWER - considers each
of the major systems of the body to ensure all relevant info is obtained that may impact Ax/Tx
- consent
- central nervous (CNS)
- cardio-vascular (CVS)
- respiratory (RESP)
- Musculoskeletal (MSK)
- Mobility (Mob)
- Renal (RENAL)
- Gastro-intestinal (GI)
,PHTH 564 Critical Care Midterm 275
complete solutions.
- Haematology/ electrolytes (BLOODS)
How does obtaining consent for PT Tx in the ICU differ from gaining consent in other healthcare
settings? - ANSWER - consent to Tx in ICU is done on admission
- consent in the ICU is often implied
- consent should still be obtained from the patient whenever possible
- if an Ax or Tx has a high level or risk or is unusual for the situation, consent should be confirmed
How do you observe the function of a patient's CNS? What scales (3) are often used to quantify this? -
ANSWER - are they alert or asleep or sedated?
- orientated? are they following commands?
- are they moving? are both sides equal? are there any abnormal movements?
- Glasgow Coma Scale (eye open, verbal & motor response)
- Richmond Agitation Sedation Scale (RASS) (sedation/agitation scale)
- Behavioural Pain Scale (BPS) (facial expression, upper limb movements, compliance with mechanical
ventilation)
Explain the connection between hypoxic brain injuries and critical care. - ANSWER - patients are often
admitted to hospital/ICU for a medical reason (i.e. MI or stroke), and can often have an associated
hypoxic brain injury due to the interruption of blood flow to the brain occurring as a result of their heart
attack.
What is the ASIA scale used for in the ICU? - ANSWER - used to quantify level of function in SCI patients
and therefore the level of assist needed, especially in the acute phase post injury when their level of
function may or may not change.
Explain the importance of cognition and behaviour screening in the ICU. - ANSWER - screening for
delirium is important; the earlier we catch it the better
- 70-80% of patients have some cognitive deficit at discharge from ICU (impaired memory, depression,
impaired judgement, decreased awareness, etc.)
- good to touch base with family to check if this the patient's 'normal'
, PHTH 564 Critical Care Midterm 275
complete solutions.
What can a higher temperature be indicative of? - ANSWER - infection
- mobilizing/rehab not recommended if the patient appears acutely septic
- patients may have a lower temperature (if someone had an MI, they might be put on a protocol to
keep them hypothermic / normothermic to prevent increasing pressure in the brain)
How can you Ax the CVS? - ANSWER - heart rate (60-100; brady <60, tachy >100; can mob. from 50-130)
- rhythm (sinus or not? stable?)
- BP (80/120)
- MAP (70-110)
- medications
What are the differences in management of a hemorrhagic stroke vs. an embolic stroke? - ANSWER -
hemorrhagic = want to keep the pressure as low as possible to help stop the brain bleed
- embolic = want to increase the BP as much as possible to help shunt blood into all the little vessels in
the brain to help get past the clot/blockage
What arrhythmias should you watch out for when Ax ECGs? - ANSWER - PVCs (pre-ventricular
contractions) at the rate of more than 6 per min. or a run of 3 or more in a row require medical
attention
- more than 3 consecutive PVCs at a rate of greater than 100 bpm = V. tach.
- ventricles do not have sufficient time to fill and this, cardiac output is greatly reduced
What is the equation used to calculate MAP? - ANSWER SBP + (2xDBP)/3
- MAP > 60 is necessary to perfuse coronary arteries, brain, and kidneys.
What does central venous pressure (CVP) provide information about? - ANSWER - cardiac function (right
heart function) and the adequacy of circulating vascular volume
- normal: 2-7 mmHg if self ventilating
