Physical Therapy in The ICU: Basic Skills — Transcript

Full transcript

1. 0:00okay so today we're going to go over
2. 0:01some basic icu skills if you've never
3. 0:03spent time in a hospital these are good
4. 0:05things to practice and learn about
5. 0:06before you jump into patient care
6. 0:09so first we're going to go over how to
7. 0:11properly keep a patient
8. 0:12modest so putting their gowns on believe
9. 0:15it or not can be a tricky thing
10. 0:16and then we usually put a second gown
11. 0:18over a patient's back to help keep them
12. 0:20covered since our gowns do open in the
13. 0:22back
14. 0:23so we have our patient liza here today
15. 0:25that i'm going to demonstrate on
16. 0:27hi eliza how are you i'm will how are
17. 0:29you good
18. 0:30i'm going to help you get your gown
19. 0:31buttoned up here okay
20. 0:34so each gown has several buttons down
21. 0:37each sleeve
22. 0:38and the gown should be tied behind the
23. 0:40patient
24. 0:41one big marker to look out for is the
25. 0:44neckline on the patient so we want to
26. 0:45make sure that that's
27. 0:47in the center and then we should be able
28. 0:48to button up each of these
29. 0:51and it's really nice if the patient has
30. 0:53lines
31. 0:54to take a gown off all we need to do is
32. 0:56unbutton that and we can pull this right
33. 0:58out from underneath
34. 1:00and button it back up on top as needed
35. 1:04we're just going to button part of this
36. 1:06sleeve here
37. 1:10there also should be different size
38. 1:12gowns depending on what hospital you're
39. 1:14in so obviously this is a standard
40. 1:16patient gown if you have a bariatric
41. 1:18size
42. 1:18patient you should get them a bariatric
43. 1:21size gown so it covers more of them
44. 1:26okay so next we're going to help liza up
45. 1:29to the edge of the bed
46. 1:30and after we'll after we do that we'll
47. 1:32get make sure her backside is covered
48. 1:34before we proceed any further
49. 1:36so i'm going to use the bed to my
50. 1:38advantage these hospital
51. 1:40beds there's different models in each
52. 1:42hospital but they all should have some
53. 1:43basic functions of up and down
54. 1:45raising the head up and down etc so if
55. 1:48you look on the side panels here
56. 1:52we have some labels bed up and down
57. 1:55head up and down knees up and down etc
58. 1:58that we can use to help make sure that
59. 2:00our bodies are staying safe and we have
60. 2:02good mechanics with transfers
61. 2:04so i am going to lower this bed closer
62. 2:07to the ground for when we get up
63. 2:14and lower the knees down so she's not
64. 2:16going over a hill
65. 2:19and to lower the railing there should be
66. 2:21some sort of
67. 2:22mechanism here to unlock the railing and
68. 2:25slide it down
69. 2:26some railings go sort of in a round
70. 2:29motion to go down
71. 2:30some of them go straight down so make
72. 2:32sure to spend some time
73. 2:33checking out the beds in whatever
74. 2:35hospital setting you end up
75. 2:36in okay i am also going to sit liza's
76. 2:40head up a little bit here
77. 2:42just to make it easier for her to stand
78. 2:44up sit up on the edge of the bed
79. 2:48okay lies i'm going to have you start
80. 2:49scooting your legs this way towards the
81. 2:51edge of the bed
82. 2:55excellent i'm going to help you with
83. 2:56your trunk a little bit and we're going
84. 2:58to come up to sitting
85. 3:00excellent can you keep scooting forward
86. 3:02to get your feet down to the ground
87. 3:06good we want to make sure her feet are
88. 3:08planted on the ground
89. 3:10and we don't want to immediately walk
90. 3:11away from our patient in case she
91. 3:13doesn't have good trump control so i'm
92. 3:15keeping a hand on her
93. 3:16and getting a good feel for that
94. 3:19okay you okay sitting there for a moment
95. 3:22i'm feeling good
96. 3:23okay so next i'm going to show you how
97. 3:25to
98. 3:26prepare another gown to put over her
99. 3:29back
100. 3:30there are two different ways that we
101. 3:31like to do this
102. 3:33the first one is called making a cape
103. 3:36both of them really make a cape but
104. 3:39again our main landmark on these gowns
105. 3:42is
106. 3:42the neckline so if you find the neckline
107. 3:46the rest of the buttons and sleeves are
108. 3:47going to look like big floppy pieces
109. 3:50so our other landmark is going to be the
110. 3:52tie
111. 3:53on the neckline that's what goes behind
112. 3:55the back
113. 3:56so if we find the button that's closest
114. 3:59to
115. 4:00that tie and the button that's closest
116. 4:03to the neckline
117. 4:06connect those two and do the same thing
118. 4:09on the other side
119. 4:12the button that's closest to the tie
120. 4:15button that's closest to the neckline
121. 4:19now we have more of a solid piece of
122. 4:21fabric here
123. 4:23with two ties on it just like a cape so
124. 4:26we're gonna
125. 4:26throw this over eliza's back
126. 4:29and we can tie it in front
127. 4:33just like so that'll help keep her
128. 4:35covered
129. 4:36an alternative way to do this would be
130. 4:40to come
131. 4:40under the patient's arm so using those
132. 4:44same two snaps that we use the one near
133. 4:46the neckline and the one near the
134. 4:48tie we come under her arm
135. 4:52snap there
136. 4:58snap there now we don't even necessarily
137. 5:00need to tie that that is on her arms and
138. 5:02when she stands up that'll stay and
139. 5:03cover her back
140. 5:06okay okay so our next step is we're
141. 5:10going to get liza the rest of the way
142. 5:12prepared to get out of bed now that
143. 5:14we've gotten her up
144. 5:15and she's modest
145. 5:16[Music]
146. 5:18so one thing not to forget is our
147. 5:20hospital socks we don't want patients up
148. 5:23with just regular socks on or with bare
149. 5:25feet
150. 5:27a lot of patients don't like these but i
151. 5:29tell them it's hospital policy
152. 5:30we don't want them to have a fall that's
153. 5:32a lot of paperwork for us
154. 5:34i'm just going to throw these socks
155. 5:35right on we can throw them over her
156. 5:36regular socks
157. 5:40[Music]
158. 5:42perfect these have some nice non-skid
159. 5:45stuff on the bottom to help keep her
160. 5:46from slipping on these slippery floors
161. 5:49next we're going to throw a gate belt on
162. 5:53so i'm going to grab my gate belt come
163. 5:55around my patient
164. 5:56from underneath your arms here eliza
165. 6:02through get it pretty snug here
166. 6:07back through and then we can just kind
167. 6:08of tuck the tail in
168. 6:11wherever we need there are a couple
169. 6:12considerations with this in the icu
170. 6:15we need to be conscious of what lines
171. 6:17the patient have
172. 6:18has so if she had chest tubes
173. 6:22or a driveline for an lvad any sort of
174. 6:25drain
175. 6:25here in this area we'd want to be very
176. 6:28conscious of where this
177. 6:29is not hitting those we can also move it
178. 6:33up
179. 6:34into more of the armpit area especially
180. 6:36on men that works pretty well to get a
181. 6:38good hold of them
182. 6:39or to have it way down lower on their
183. 6:41hips as long as you have it nice and
184. 6:43tight so it's not riding up
185. 6:45[Music]
186. 6:46next i'm just going to show you how to
187. 6:48switch the oxygen over so
188. 6:50eliza was on let's say
189. 6:54she was on three liters per minute of
190. 6:56oxygen on the wall
191. 6:58so if we look here this is our oxygen
192. 7:00flow meter and there's just a dial here
193. 7:03that dials up and down the oxygen
194. 7:07remember that oxygen is a controlled
195. 7:10drug essentially it has to be prescribed
196. 7:12by a doctor
197. 7:14but we as therapists should have an
198. 7:16order in our chart to titrate
199. 7:18oxygen to keep levels above 90
200. 7:21usually so we can titrate this often
201. 7:24patients will need a little bit
202. 7:26more oxygen when they're up and moving
203. 7:27than they do when they're in bed
204. 7:29so that's something to keep in mind so
205. 7:32i'm going to
206. 7:33take the oxygen off the wall and put it
207. 7:35on our portable tank here so that we can
208. 7:37go walking
209. 7:39so first things first i want to make
210. 7:40sure the portable tank has enough oxygen
211. 7:43in it so there's a little
212. 7:45gas meter here empty to full we want to
213. 7:47make sure that there's
214. 7:48at least a thousand in there and then
215. 7:50we're gonna turn this on
216. 7:53by flipping this dial so we're gonna put
217. 7:57that on three we can hear the air coming
218. 7:59out so we know that it's on
219. 8:04then we can grab this nasal cannula here
220. 8:06right off the wall
221. 8:08[Music]
222. 8:10and put that end right there
223. 8:12[Music]
224. 8:14wise i'm going to have you remove your
225. 8:15mask so that i can put this nasal
226. 8:17cannula on you for a moment
227. 8:20we have the prongs on this nasal cannula
228. 8:22we want to make sure that they're facing
229. 8:25up and out that'll be more comfortable
230. 8:27to go on the nose
231. 8:28so we're just going to place this in her
232. 8:31nostrils
233. 8:33and around her ears and then we can
234. 8:35tighten this part here so that it stays
235. 8:37on
236. 8:38and these cover times we can have a
237. 8:40patient plate place their mask back on
238. 8:43i'll turn this off for utilize those we
239. 8:44don't have oxygen in your nose
240. 8:46we can have them put their mask back on
241. 8:48over the oxygen once that is on
242. 8:52we do have a few other options for
243. 8:54oxygen delivery i'll show you just some
244. 8:56of our common ones here
245. 8:58so this is just a simple mask if the
246. 9:00patient were on
247. 9:01six or eight liters this would be the
248. 9:03appropriate mode of delivery for that
249. 9:06just goes on and over the head
250. 9:09and if they're on more than 10 liters
251. 9:14we typically want a naughter breather
252. 9:15partial minor breather
253. 9:17this mask that has a bag so it fills up
254. 9:20a reservoir here of
255. 9:22oxygen again that just goes on over
256. 9:25their face like that
257. 9:26they all have a very similar end to just
258. 9:29go right on the iv
259. 9:30pole or on the oxygen tank right there
260. 9:35then lastly to make this portable
261. 9:39the iv pole if you had iv pumps on here
262. 9:42it needs power so it's probably plugged
263. 9:44into the wall
264. 9:46this is something that's okay for us to
265. 9:48unplug we don't need to ask nursing
266. 9:50about this
267. 9:51this is just general power everything on
268. 9:54the iv pole should have
269. 9:56battery backup on it so depending on the
270. 9:59configuration of your iv pole you can
271. 10:01kind of just loop this around
272. 10:04make sure those don't dangle and now
273. 10:07we're completely portable
274. 10:09and ready to go
275. 10:12one other thing that you'll find in all
276. 10:14your icus is your telemetry monitor
277. 10:17so different icus are going to have
278. 10:19different brands we use the phillips
279. 10:20monitors here
280. 10:22up here if they were actually connected
281. 10:23to our patient we'd have all of our ekg
282. 10:26our spo2 our blood pressures respiratory
283. 10:29rate depending on what lines they have
284. 10:31you might also have a cvp or a pap so
285. 10:33measures right heart function
286. 10:36so important buttons on here there
287. 10:38should on any monitor be some sort of
288. 10:40silence button so if there's something
289. 10:42alarming
290. 10:43as long as it's not something alarming
291. 10:45that we need to alert nursing about
292. 10:47sometimes if the patient's moving a lot
293. 10:50you might have a lot of noise on your
294. 10:52ekg lines
295. 10:54it might be but we can just press
296. 10:55silence to pause that alarm
297. 10:58another good button that's usually on
298. 11:00most um monitors is the start stop
299. 11:03button that is to take a manual blood
300. 11:04pressure
301. 11:05if they have a blood pressure cuff on
302. 11:07and the cord connected for that we can
303. 11:09press start stop
304. 11:10and that will run the cuff to get it
305. 11:12pressure there
306. 11:15in order to go walking with a patient or
307. 11:17leave the bedside
308. 11:19most hospital monitors have some sort of
309. 11:21portable
310. 11:22telemetry so these may look different
311. 11:25connect differently at each hospital but
312. 11:28we can pull this whole thing off
313. 11:30and we now have our ekg and our monitor
314. 11:33all
315. 11:33here so before we go walking we
316. 11:36disconnect that from the wall
317. 11:39we can bring this over and we can set it
318. 11:42right on our iv
319. 11:43pole or we can hang it up
320. 11:47up here if you're tall enough to see
321. 11:51just somewhere where we can see it
322. 11:53because in icu it's important to be able
323. 11:55to have an eye on your patient's vitals
324. 11:57while you're up and moving so now when
325. 11:59we get up we have that with us
326. 12:01on the iv pole at all times we after our
327. 12:05session we're going to make sure that
328. 12:06this patient is settled back in bed
329. 12:08i'm going to take her geek belt off
330. 12:10because that's not comfortable
331. 12:13we already took her second gown or her
332. 12:16cape off
333. 12:17so she's not letting her wrinkles pull
334. 12:20that right through
335. 12:24so we're going to put the oxygen still
336. 12:26on here we're going to take the oxygen
337. 12:28and put it back on the wall this is a
338. 12:30really important thing to not
339. 12:32ever forget when you leave the room
340. 12:33because if you leave it on the tank
341. 12:35the tank will eventually run out of
342. 12:37oxygen and then your patient will
343. 12:38probably start to desat
344. 12:40so we're going to take this back off
345. 12:42make sure that is off
346. 12:45plug this back into the wall and turn it
347. 12:48up
348. 12:48to the appropriate three leaders that
349. 12:51she was on
350. 12:52and we'd have this on her of course next
351. 12:55we want to make sure that the iv pole is
352. 12:56plugged back into the wall that will too
353. 12:58eventually run out of battery anything
354. 13:01important in a hospital
355. 13:02should be in red plugs these are usually
356. 13:05plugs that are hooked up to
357. 13:07generators so if the power goes out
358. 13:09these will kick back on so anything
359. 13:11important
360. 13:11like medications ventilators dialysis
361. 13:15machines
362. 13:16should all be on there
363. 13:19i'm going to show quickly our patient
364. 13:21wisely here doesn't need these but
365. 13:24if your patient did have restraints on
366. 13:25before we want to make sure to put these
367. 13:27back on afterwards
368. 13:30so there's different kinds of restraints
369. 13:32at each hospital
370. 13:34they typically have some sort of velcro
371. 13:36some sort of
372. 13:38buckle fashion here and then depending
373. 13:40on your facility
374. 13:43and depending on the beds we're gonna
375. 13:46have some sort of bar
376. 13:48underneath here and you can see there's
377. 13:49even a logo here
378. 13:52that says this is where we put
379. 13:53restraints
380. 13:55so we're going to loop that through and
381. 13:57when you start at a hospital they'll
382. 13:58teach you how to do a quick release knot
383. 14:02so now liza can't move her arm very much
384. 14:05to get out of bed or anything
385. 14:07but when we need to release it all we
386. 14:09have to do is grab the tails
387. 14:11and pull and now she's free so that's a
388. 14:14specific kind of knot that's used for
389. 14:16restraints for patient safety
390. 14:19we'll take this back off here
391. 14:23another thing we want to do when a
392. 14:24patient gets back in bed is put back on
393. 14:27their scds
394. 14:29sequential compression devices these
395. 14:32help
396. 14:33move the blood around in the lower legs
397. 14:35help prevent blood clots from forming
398. 14:36when patients are flat in bed for long
399. 14:38periods of time
400. 14:41have you lift your leg up liza and these
401. 14:43just go on
402. 14:46like so they've got some velcro straps
403. 14:48again you might find
404. 14:49different brands different colors of
405. 14:51these at different hospitals
406. 14:55but they all function pretty similarly
407. 15:00there we go so we'll just
408. 15:04fasten those up and we've got our scd
409. 15:07machine right here
410. 15:12so we can take the two ends of these
411. 15:18and hook them up to our seds
412. 15:22and turn this machine on this will now
413. 15:27intermittently inflate and deflate to
414. 15:29help prevent blood from stagnating in
415. 15:31the legs
416. 15:33now before we leave the room we also
417. 15:35want to make sure that the patient has
418. 15:37their call light
419. 15:38never ever leave this where it can't be
420. 15:41reached by the patient
421. 15:43that puts them at risk of falls if they
422. 15:44need something and they don't know how
423. 15:46to call for help they're more likely to
424. 15:47try to climb out of bed
425. 15:49so we want this nice and close to the
426. 15:51patient where they can reach it
427. 15:53we want to make sure that they
428. 15:54understand how to use it
429. 15:56so especially patients with some
430. 15:57delirium or cognitive
431. 16:00deficits we want to make sure we review
432. 16:02with them that this big red button
433. 16:03is how you call for the nurse most call
434. 16:06lights will also work the lights
435. 16:08the tv other things like that
436. 16:12and we want to make sure our patient's
437. 16:14comfortable
438. 16:16we ask them if they want a blanket maybe
439. 16:19get some more pillows
440. 16:22tuck them in nice and tidy
441. 16:23[Music]
442. 16:31okay eliza is there anything else you
443. 16:33need right now are you comfortable
444. 16:34yep i'm good to go okay thank you
445. 16:38okay so we're going to enter an icu room
446. 16:40now
447. 16:41a couple things to point out outside the
448. 16:42room there should be gloves to dawn
449. 16:45before you don gloves you always want to
450. 16:48use some hand sanitizer
451. 16:50or wash your hands in a nearby sink make
452. 16:51sure your hands are clean
453. 16:54so we're going to come into the room
454. 16:55here i'll just point out a few things
455. 16:57that we'll notice
456. 16:58we've got a chair set up here for the
457. 17:00patient
458. 17:01here's our iv pole with their pumps they
459. 17:04are not currently on this patient
460. 17:06is not on any drips at the moment
461. 17:09again we've got our oxygen flow meter
462. 17:11there may or may not be a humidifier
463. 17:14associated with that flow meter that's
464. 17:17just to provide some humidity so the air
465. 17:19doesn't dry their nose out so much
466. 17:25patients should have a tray table with
467. 17:27their various things on it including
468. 17:28their incentive spirometer which we want
469. 17:30to teach them how to use
470. 17:32help prevent atelectasis pneumonia
471. 17:36we've got other patient belongings
472. 17:38usually lots of stacks of pillows
473. 17:41sharps container more gloves within the
474. 17:44room
475. 17:45always in case you need them without
476. 17:47leaving the room
477. 17:48a computer that you can check your chart
478. 17:51if you need anything
479. 17:54we've got our telemetry monitor here you
480. 17:56can see that his is hooked up so we're
481. 17:58looking at our ekg
482. 18:00our spo2 respiratory rate and he's got a
483. 18:02blood pressure cuff on
484. 18:06a couple other things to know we usually
485. 18:08have a tank of oxygen in the room
486. 18:11and an ambu bag and some airways just in
487. 18:14case of an emergency those are always
488. 18:16stocked in every icu room
489. 18:19other things stocked maybe on shelves or
490. 18:21in drawers
491. 18:24got things in drawers like alcohol pads
492. 18:28flushes that the nurses use to flush
493. 18:30medications
494. 18:32cleaning wipes if needed
495. 18:35any other patient supplies including
496. 18:38bandages
497. 18:40etc
498. 18:46if you have a sink usually there is a
499. 18:50patient closet of some sort with the
500. 18:52lines in it
501. 18:54sink and toilet oftentimes in an icu the
502. 18:56toilet is in the middle of the room
503. 18:58instead of having
504. 18:59a closed bathroom which is unfortunate
505. 19:02but we do want to keep an eye on
506. 19:03patients while they're up
507. 19:07so overall as we come into the room we
508. 19:10can just scan and see what we need we
509. 19:12realize we have the chair set up already
510. 19:14i spot some socks over here we've got
511. 19:16plenty of pillows
512. 19:18we know we've got a full oxygen tank
513. 19:20over there
514. 19:22anything we might need to get this
515. 19:23patient up and moving