AC NLM

How soon after the onset of immobility does measurable atrophy and neuromuscular deconditioning typically begin?

Within 72 hours.

What is the leading cause of neuromuscular weakness in patients who cannot be weaned from mechanical ventilation?

Critical Illness Myopathy (CIM) or ICU Acquired Weakness (ICUAW).

Describe the pattern of weakness presentation in Critical Illness Myopathy (CIM).

Flaccid, symmetrical weakness presenting in a proximal to distal direction.

How is sensation typically affected in a patient with Critical Illness Myopathy (CIM)?

Sensation remains intact.

What change in Deep Tendon Reflexes (DTRs) is characteristic of Critical Illness Myopathy (CIM)?

DTRs are decreased or absent.

What is the effect of prolonged bed rest on resting heart rate?

It increases.

How does prolonged bed rest affect stroke volume (SV) and cardiac output (CO)?

Both SV and CO decrease.

Which cardiac structural change is associated with long-term immobility?

Myocardial thinning.

Prolonged bed rest leads to a(n) _____ in total blood volume and red blood cell mass.

Decrease

Why does hematocrit often increase during bed rest despite a drop in red blood cell mass?

There is a significant decrease in plasma volume.

List the three components of Virchow's triad that increase the risk of VTE during immobility.

Venous stasis, hypercoagulability, and blood vessel damage.

Which specific lung volumes typically decrease during prolonged bed rest?

Functional Residual Capacity (FRC), Forced Vital Capacity (FVC), and Forced Expiratory Volume in 1 second ($FEV_1$).

How does immobility affect mucociliary clearance in the respiratory system?

It decreases clearance, increasing the risk of pneumonia.

What is the estimated daily percentage decline in muscle mass for a patient who does not walk?

2 to 5 percent per day.

Which specific muscle group is most susceptible to weakness and atrophy due to immobility?

Antigravity muscles.

What skeletal condition is caused by the lack of weight-bearing during bed rest?

Disuse osteoporosis.

Prolonged immobilization can lead to _____ of the joints, characterized by the fusion of bones.

Ankylosis

Which electrolytes are typically lost from the body during prolonged bed rest?

Sodium, calcium, potassium, phosphorus, and sulfur.

How does body composition change regarding fat and lean mass during immobility?

Body fat increases while lean body mass decreases.

Describe the direction of fluid shift that occurs when a patient is in a recumbent position.

Fluid shifts from the legs to the abdomen, thorax, and head.

What happens to the levels of dopamine, noradrenaline, and serotonin during prolonged bed rest?

Levels of these neurotransmitters decrease.

How is the pain threshold affected by prolonged immobility?

The pain threshold decreases.

What neurologic risk is associated with sustained pressure on peripheral nerves during bed rest?

Compression neuropathy.

To decrease the risk of orthostatic hypotension, PTs should progressively elevate the _____.

Head of Bed (HOB)

If positional intolerance persists during mobility attempts, what equipment might a PT consider?

Lower extremity (LE) stockings or an abdominal binder.

According to the provided sources, what is the definition of a pressure injury?

Localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical device.

Which three primary factors contribute to tissue ischemia in pressure injuries?

Intense pressure, sustained pressure, and shear forces.

Stage 1 pressure injury is characterized by localized _____ of intact skin.

Non-blanchable erythema

How is a Stage 2 pressure injury defined?

Partial-thickness skin loss with exposed dermis.

What is the defining clinical feature of a Stage 3 pressure injury?

Full-thickness skin loss where adipose (fat) tissue is visible.

What structures may be visible in a Stage 4 pressure injury?

Fascia, muscle, tendon, ligament, cartilage, or bone.

What makes a pressure injury 'unstageable'?

The extent of tissue damage is obscured by slough or eschar.

Describe the appearance of a Deep Tissue Pressure Injury.

Persistent non-blanchable deep red, maroon, or purple discoloration.

Name the four high-risk areas for pressure injuries when a patient is in the supine position.

Occiput, scapula, sacrum, and calcaneus.

What are the high-risk areas for pressure injuries in the side-lying position?

Greater trochanter, medial and lateral femoral condyles, and malleoli.

Name three high-risk areas for pressure injuries when a patient is sitting.

Ischial tuberosity, sacrum, and coccyx.

List three high-risk areas for pressure injuries in the prone position.

Anterior tibia, patella, and iliac crest (or chin).

How often should a turning schedule be implemented to offload pressure in a bed-bound patient?

Every 2 hours.

How frequently should patients, especially those with SCI, be educated to perform weight shifting while sitting?

Every 15 minutes.

What type of equipment is used to provide pressure reduction for sitting patients?

Seat cushions (e.g., waffle cushions).

Why must lab results be interpreted based on the specific laboratory's reference values?

There is a lack of universal reference ranges across different facilities.

In the context of lab values, what is a 'critical value'?

A value outside the normal range to a degree that constitutes an immediate health risk.

What should a PT or PTA monitor when a patient is on anticoagulation therapy?

Signs of increased bruising and bleeding.

What is the purpose of analyzing the EMR prior to a patient exam?

To prognosticate a prioritized management strategy for mobility interventions and discharge.

What does 'clear and defensible documentation' aim to articulate?

Clinical decision making.

When determining a discharge plan, what factors must a PT synthesize regarding the patient's life context?

Pre-hospitalization status, age, and suitability of the home environment.

What is the effect of immobility on the myotendinous junction?

It becomes weakened.

How does immobility affect diuresis and natriuresis?

It alters/increases them, potentially leading to dehydration.

Which neurotransmitters are specifically mentioned as decreasing during social and sensory deprivation from bed rest?

Dopamine, noradrenaline, and serotonin.

In the side-lying position, pressure injuries are often created while attempting to offload _____ landmarks.

Supine

What is the recommended PT action if a patient demonstrates irritability or dizziness during transitional movements?

Monitor vital signs and consider utilizing bed controls to elevate the head of the bed progressively.

Besides bony prominences, what else can cause localized damage categorized as a pressure injury?

Medical or other devices (e.g., catheters).

What musculoskeletal change involves the thinning and loss of joint lubrication?

Degeneration of cartilage and synovial atrophy.

A significant limb and respiratory muscle weakness caused by sensorimotor axonal dysfunction in the ICU is known as _____.

ICU Acquired Weakness (ICUAW)

What hematological change increases the risk of blood vessel damage according to the Virchow triad?

Hypercoagulability and venous stasis.

What should PTs prioritize when a patient is physically unable to mobilize?

A repositioning schedule.

Why is it important for PTs to communicate discharge plans with the interprofessional team?

To ensure continuity of care and determine optimal equipment and follow-up needs.

How does immobility affect balance and coordination?

It causes them to decrease.

What is the primary implication of 'critical values' for a physical therapy session?

They help determine medical stability prior to initiating therapy.

The clinical presentation of 'Generalized Weakness' in the ICU often masks the beginning of _____.

Measurable atrophy