Special Enviornments

What is the ICU?

intensive care unit

What is the ICU used for?

where critical patient care techniques are practiced in hospitals

Who do PTs work with in the ICU to get a patient, still on a ventilator, up and walking?

respiratory therapists

What is ICU delirium?

a disturbance of consciousness and cognition that develops in the ICU causing confusion, disorientation, and impaired memory/judgment

What is ICU acquired weakness (ICUAW)?

long-term effects on strength, function and quality of life from being in the ICU

What are some steps to encourage early mobility safely and effectively?

-interdisciplinary communication

-create mobility plan

-check with nursing staff

-communicate with patient

-scan the room for safety

-check vital signs/ventilator settings

-check all lines

-visualize planned activity

-move equipment and get assistance

-apply giat belt

-group lines together

-engage the patient in mobility while monitoring them closely

-end the activity safely

What are some critical care devices that you should look out for?

-nutrition

-waste excretion

-circulation

-respiration

-neural function

-suction/drainage

If an arterial line is dislodged during a therapy session, what should you do?

apply pressure to stop the bleeding and notify the nurse immediately

What the main 3 functions of devices?

-send substances into the body

-take substance out of the body

-monitor function/level in the body

What is a nasoenteral tube?

feeding tube is inserted through the nose into the small bowel

What is a nasogastric tube?

feeding tube inserted through the nose into the stomach

What is an enterostomy tube?

feeding tube inserted through small surgical opening in abdomen

What is indwelling (foley) urinary catheter?

tube inserted into bladder through urethra to drain it; drain urine before activity

What is a condom catheter?

tubing connected to a condom to drain urine; male patients

How long after being fed through a tube should they be positioned upright?What about pediatric patients?

30 mins; 1 hour

What is a PEG tube?

percutaneous endoscopic gastrostomy tube - feeding tube

What is an external wicker catheter?

externally applied device for women to collect urine; female patients

What are the surgically inserted catheters?

suprapubic catheter, urostomy, and nephrostomy; keep insertion site dry and avoid placing gait belt there

What is a colostomy/ileostomy bag?

bag for collecting feces; keep bag attachment secure and dry

What is rectal tube?

tube inserted to rectum and attached to drain fecal matter; easily dislodged

The more central a line is, the more ____ its disturbance.

critical

How do you give optimal cardiovascular care?

collaborate with a nurse

What are cardiac leads?

wires connected to monitor heart activity; alarm may sound if dislodged

What is a temporary transvenous pacemaker?

regulates heartbeat; limits mobility and can be life-threatening if disconnected

What is a peripherally inserted central venous line (PICC)?

catheter inserted into vein in upper arm for long-term medications/fluids

What is an intravenous (IV) line?

administers drugs and fluids in vein of forearm, back of hand, neck, leg, or foot

What should you avoid on the arm that has an IV?

blood pressure cuff

If IV insertion site is swollen or red what should you do?

notify nursing staff

What is a tunneled central venous catheter (Hickman/Broviac)?

implanted IV catheter into jugular vein for long-term use

What is an implantable intravascular device (Port-A-Cath, MediPort)?

port placed under the skin and attached to a catheter for long-term administration of medications/fluids

What is an arterial line?

thin catheter inserted into an artery that measure arterial blood pressure; can be used to draw blood/deliver medications

What will alter the transducer readings of an arterial line?

changes in bed height

Femoral insertion of an arterial line causes what?

hip flexion ROM restricted to 60-80 degrees

What is pulmonary artery catheterization?

catheter that directly monitors cardiac output

What is intraosseous (IO) venous access?

accesses systemic circulation through bone barrow cavity

What is a left ventricular assist device (LVAD)?

mechanical pump attached directly to the left heart ventricle

What is a pulse oximeter?

external device that indirectly measures O2 saturation level

What is a blood pressure (BP) cuff?

inflatable cuff to restrict blood flow for indirect BP measurement

What is the sequential compression device (SCD)?

pumps up and deflates to encourage circulation and reduce pooling of blood

What is a endotracheal tube?

breathing tube inserted through mouth into trachea

What is a tracheostomy tube?

breathing tube inserted through neck to trachea

What are the types of O2 masks?

nasal cannula (1-2 L of O2), non-rebreather mask (higher flow), reservoir mask

What is a nebulizer?

handheld or attached respiratory tube for medications

What is a ventilator?

machine-assisted breathing device connected to tracheal tubing; check for changes in insertion level before/after activity

What is an intracranial pressure monitor?

small catheter connects sensor in epidural space to transducer that measures pressure within brain

What is a ventricular shunt (ventriculoatrial)?

tube surgically placed into ventricle of brain to remove excess cerebrospinal fluid from brain to jugular vein or abdomen

What is a patient-controlled analgesia (PCA) device?

push button for patient to deliver main medication through IV via electronic pump

What is Yankauer suction?

rigid suction tube with hook-shaped end to wall suction unti

What is a Jackson-Pratt drain?

tubing from surgical site of suction bulb that drains/collects fluid from surgical site

What is postoperative surgical drain (hemovac)?

tubing from surgical site to collect fluid

What is a chest tube?

large-bore tube inserted into chest cavity to drain excess fluid or maintain pulmonary inflation

Make sure to provide opportunity for what kind of mobility training?

meaningful and realistic

After a patient has been discharged, why might the PT go to their home?

to make sure their home environment is safe for thme

How can you prevent falls in the home?

-good lighting

-removing obstacles

-removing loose rugs

Always respect that you are a what in the patients home?

guest

How many people in the US experience homelessness on any given night?

600,000

What is home insecurity?

homelessness

What are other treatment environments?

-emergency departments (room)

-schools

-group homes

-hospice

What should you do to prepare for an emergency?

-stay up-to-date on training

-know policies/procedures and equipment location

What should you do during an emergency?

-check for safety and patient condition

-call for help

-care for patient

What should you do after an emergency?

-notify and document

What kind of approaches yield the best patient outcomes?

team approaches