Week 3: Intervention Planning for a Critically Ill pt in the ICU

What factors should be considered for PT intervention frequency and duration for Mr. Jones?

-In the ICU we should aim for 2x/day and 6days/week around 15 min each session

-In acute: 2x/day, 6days/week and 30 min per day until pt can perform for 1 hr

-Outpt: 2x/week for 8 weeks

What factors should be considered for Objective Factors impacting mobilization tolerance

1. HR

2. SPO2

3. RR

4. BP

5. Level of ventilation

6. MAP

7. Pt appearance

8. FIO2

9. ECG

What factors should be considered for subjective Factors impacting mobilization tolerance

1. Fatigue

2. PT judgement of medical stability

3. Pain

4. Pt readiness

5. anxiety

Restorative interventions

directed toward remediating or improving the patient's status in terms of impairments, activity limitations, participation restrictions, and recovery of function

What is the recommended frequency and duration of PT intervention in the ICU?

2x/day for 15 minutes, 6 days/week.

What is the recommended frequency and duration of PT intervention in acute care?

2x/day for 30 minutes, 6 days/week until the patient can perform for 1 hour.

What is the recommended frequency of PT intervention in outpatient care?

2x/week for 8 weeks.

What are restorative intervention strategies for Mr. Jones?

Strengthening interventions, aerobic conditioning, stretching, deep breathing exercises, functional training.

compensatory interventions

promote optimal function across the ICF without full recovery

What are compensatory intervention strategies for Mr. Jones?

Use of assistive devices, physical assistance, dynamic splints, padding for pressure areas, tilt table for orthostatic tolerance.

Preventative Interventions

Actions taken to prevent health complications.

What are preventive intervention strategies for Mr. Jones?

Education on AD use, balance training, pulmonary hygiene, early mobility.

What type of procedural interventions will improve oxygen transport and aerobic conditioning for Mr. Jones?

Walking, active assistive ROM exercises, sit to stands, stretching, EMS, functional training.

What intensity should be prescribed for active exercises for Mr. Jones?

3-5 on the BORG 10 point scale and 11-13 on the 20 point scale.

What should be monitored to determine Mr. Jones' response to mobilization?

-HR

-O2 SAT

-BP

-RR

-RPE

-Cognition

-FIO2

-ECG

-Temperature

-Sweating

-Pain

-Fatigue

-Skin color

-Anxiety

How would you progress Mr. Jones if he is tolerating mobilization?

Increase duration, reps, sets, intensity, and frequency.

What should you do if unsure about Mr. Jones' tolerance to mobilization?

Discuss with senior physical therapist and medical staff.

What signs indicate to terminate Mr. Jones' session due to intolerance?

-HR≥ 50-60% of age predicted HR max or

-BP rise or fall 20% off baseline

-Systolic should rise and diastolic should stay same or slightly rise

-ECG changes

-FIO2>.6

-PEEP≥10

-RASS -4,-5, 3,4

-Dopamine≥10

-NE≥.1

-Temperature≥38.6 or ≤36

-O2 sat drops to less than 90% or ≥4% drop from baseline

-RR>40

-Severe dyspnea, tachypnes

-Sudden fatigue or dizziness

-Line displacements

-symptomatic hypotension,

-intolerable dyspnea,

-Pt requests to stop

How would you assess the effectiveness of interventions for Mr. Jones?

Monitor physiological responses, functional improvement, and patient-reported outcomes.

What are Moveo exercises designed for?

Early weight-bearing with LE and UE exercises.

What does the DEMMI measure?

Functional ability including bed mobility, transfers, standing, and walking.

physiological response to interventions

o Heart rate and rhythm

o Blood pressure

o Respiratory rate

o SpO₂/oxygenation

o Ventilator response and tolerance

o Presence of abnormal symptoms or hemodynamic instability

functional improvement for interventions

-Progression in bed mobility

-Ability to sit at the edge of the bed

-Sit-to-stand ability

-Transfers

-Standing tolerance

-Stepping and walking distance

-Reduced need for assistance or mobility equipment

muscle strength and physical capacity improvements

-Improvement in limb strength

-Ability to perform active rather than passive movements

-improved exercise tolerance

-Improved ability to perform -repeated or progressively resisted exercises

Respiratory outcomes

-Improved secretion clearance

-Improved cough effectiveness

-Improved respiratory mechanics and oxygenation where relevant

-Reduced respiratory muscle weakness

-Improved tolerance of weaning or spontaneous breathing trials

-Progress toward liberation from mechanical ventilation when weakness or respiratory dysfunction is contributing to weaning difficulty

S5Q

-Standardized Five Questions

-Used to determine: Patient cooperation