Treating the Critically Ill in Acute Care & the ICU Effective - - PowerPoint PPT Presentation
Treating the Critically Ill in Acute Care & the ICU Effective protocols for assessment, early mobility, treatment, discharge and documentation 1 Objectives Obj es & Ag Agenda enda Announcements Plan for the day: Resources!! Staying
Effective protocols for assessment, early mobility, treatment, discharge and documentation
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Announcements Plan for the day:
Staying between the lines and labs Evaluations‐ more than the FIM ICU & CCU Critically ill Acute Discharge prep and carry‐over
Resources!!
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Therapy must communicate for safe early mobility and to minimize risks from immobility and delirium.
a time
patients, and families working on common goals (De La Fuente‐Martos
et al, 2018).
management (both passive and active) in contrast to therapy role for mobility outside of transfers (Brock et al, 2018).
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Syndrome
(ICU‐AW) results in…
than a third of our ICU patients (Petrucci, 2018).
Ventilator Days: Post extubation dysphagia
months and years following hospitalization (Hashem et al, 2016).
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What bedrest means to the human body. Results of 24 hours
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instability
determinate upon 5‐10 minutes of positional tolerance
(Ahrens et al, 2005)
Respirations >35
management.
referrals, resources
(Castro et al, 2015).
was not a reported factor as a barrier with implementation of therapy services early in care (Hickmann et al,
2016).
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Hashem, M, D., Nelliot, A., & Needham, D, M. (2016). Early mobilization and rehabilitation in the ICU: Moving back to the future. Respiratory Care, 61(7), 971‐9.
ASHA Wire reports: “Studies show that difficulty communicating is the most commonly distressing symptom of mechanically ventilated patients.” (Holden, 2017)
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Intercranial Pressure Probe Ventilator EKG Monitor I.V Pump Swan Line EEG Box Feeding Pump through Nasogastric Tube Electroencephal
Compression Boots Foley Catheter Pulse Ox.
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11 PICC Line Vein Catheter Tip
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Cephalic Vein Cephalic Vein
Median Cubital Vein Accessory Cephalic Vein
Basillic Veins Basillic Veins Median Antebrachial Vein Basillic Vein Cephalic Vein Digital Dorsal Veins Dorsal Venous Network Dorsal Metacarpal Veins
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Nephrostomy (Side View)
Nephrostomy Catheter Drainage Bag Bladder Kidney Ureter
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critical‐care
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Bladder Spine Suprapubic Catheter Abdominal Wall Removable Trocar Cannula
(minimally at the onset of each new task), and post‐treatment.
92%)_ indicating need for incorporation
pre activity/exercise to promote
retention for improved safety with ______. (p.63)
treatment was modified/withheld/graded down due to __risk of/improvement of___
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the ICU, CCU, and Acute Care Setting
Responsiveness (p.48)
Agitation Sedation Scale)
Assessment Method)
professionals/overview
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enjoyment*(p.34‐37)
Category (p.46)
Index (p.40)
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tool)
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all levels and imperative to minimize complications.
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Disruption
breathing and awakening trials
appropriate sedation
management
mobilization
inclusion
(Medtronic, 2018)
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femoris CSA. Adding FES did not show differences.” (Woo et al,
p.16, 2018).
decrease both LOS as well as inflammatory responses within patients leading to positive outcomes (Winkelman, 2012).
both respiratory and orthostatic patient stability (Brock et al, 2018).
the importance of a transdisciplinary approach especially as interventions grade up by day and with changes to med/surgical units.
approach to interventions 31
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initially presents in the cognitive realm there are profound ties to to mobility & mobility plays a significant role in the resolution of
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Access at www.icudelirium.org
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Passive, Active, and Manual resistive interventions (Hickmann et al, 2017). Leg press and ergometry (3‐4 watts)‐ how to modify, make it work for your patients Tilt tables and Standing Music: Triggers physiologic relaxation responses in patients (Pertucci, 2018). Family Involvement as a global initiative Delirium: Neurocognitive stimulation, virtual reality interventions
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http://troymedia.com/2017/02/03/change‐the‐way‐we‐view‐exercise‐for‐frail‐and‐critically‐ill‐patients/ https://www.youtube.com/watch?v=GrxooU9WI9k https://www.youtube.com/watch?v=yLpe_DwsqFE https://www.youtube.com/watch?v=0C‐I9vhfO4o
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effects that enhance ventilation, circulation and muscle metabolism.” (Cowan et al, 2017).
care culture.
assist in creating a culture of mobility.” (Saunders, 2015).
suffer from delirium (2017). While there is increased focus in the ICU and CCU settings on cognition, as practitioners we need to continue this focus throughout our acute care interventions.
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(Salzman, 2017)
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modulation: “…music therapy may consist of calming, soft tones of 60‐80 beats per minute for at least 15‐ 30 minutes at least twice daily during the pre‐ and postoperative periods.”
(Paulson & Coto, 2018). Music
interventions are found to reduce reduce opioid utilization.
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approach the return to mobility and how are we documenting skill? Loss impacts the changes our patients are experiencing.
and Flaherty (2016) emphasize the three roles of
education specialists, consultants, and rehabilitators.
https://www.baltimoresun.com/health/bs‐hs‐picu‐up‐20161103‐story.html https://www.youtube.com/watch?v=ylkMyBCehck
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Patient's Mobility Goal for the Following Day:
DATE: /
exercises
Le Let's G s Get M Moving ng
______ ______Phase 2 Phase 3 Phase 4 Phase 1
Patie tient a t and Family ily M Mobility lity Goal:___ _______ _______ ___
Pati tient N t Name
Distance: Distance: Distance: Distance:
DATE: / DATE: / DATE: /
Mobility Goal: Mobility
Goal:
Mobility Goal:
AM PM Eve AM PM Eve AM PM Eve AM PM Eve AM PM Eve AM PM Eve AM PM Eve AM PM Eve AM PM Eve AM PM Eve AM PM Eve AM PM Eve
Initial in box completed by person assisting with activity
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to trigger meaning and value in collaborating disciplines and utilize AOTAs guide for OT in Acute Care
(Smith, 2017).
between acute and community practitioners
(Falvey et al 2016)
assessment is vital for minimizing the risk of reassessment‐ Speak‐up!
intervention positively impact psychological, physiological (activity tolerance, strength, balance), and fiscal factors following hospitalization
(Johnson et al, 2017).
patient hand‐off. (p.27) 44
impacting treatment initiation prior to treatment…
“Mobility and Rehabilitation Guidelines”
level including both physical and cognitive complexities.
for _______ impacting _(task/activity)_.
treatment _________ was attempted this session with ___(outcome)____.
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*Remember to consider cueing needs
for cognitive and physical assist in physical tasks as well as ADLS
____________
actively directing _________ on ________
will initiate/trial/implement __________
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network.org
all.org
atomyvideos.html
muir.com/resources/
.nih.gov
ns.com
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