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Malcolm

Malcolm is a 62-year-old man with diabetes. He is 6′3″ tall and 32 kg overweight. Malcolm underwent a quintuple bypass surgery 2 days ago and is in the cardiac care unit (CCU). He has required assistance of the nursing staff to stand and transfer to a bedside chair. His vital signs are stable, and he is ready to begin postsurgical cardiac rehabilitation, including getting out of bed into a chair and attempting ambulation for short distances. What needs to be assessed before beginning the intervention? What might you expect to see and hear upon entering the CCU? What may require special attention during Malcolm's treatment? Will you need help? How might you feel about this session? What may Malcolm be feeling about this session?

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Introduction

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The environment in which health care takes place can have a significant effect on the practice of patient care. In addition to the more common hospital setting, patient care techniques may be performed in homes, independent and assisted living facilities, skilled nursing facilities, hospices, outpatient clinics, schools, adult day care settings, group homes, and community clinics. The settings can vary from those with extremely limited resources to very complex and highly technical environments. Because of its complexity and the vulnerability of its patients, the critical care environment is often the most intimidating setting for the new practitioner.

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Critical Care Environments

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Critical care combines the expertise of multiple health-care professionals caring for patients in acute, life-threatening situations caused by trauma or illness. Critical care practice may take place at the scene of an accident, in the emergency department or surgical suite, or in a variety of intensive care units (ICUs). For the therapist, the most common site at which patient care techniques are practiced is the hospital-based ICU. ICUs, also called critical care units (CCUs), provide medical assistance to critically ill patients and may specialize in a specific kind of care, such as cardiac, respiratory, trauma, or neonatal care.

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Despite the critical status of the patient's condition, mobility tasks are often called for in intensive care. In fact, depending on the patient's medical condition, patient mobility techniques may be essential to the patient's optimal recovery.1 The ICU, however, poses special challenges for patient mobility tasks such as positioning, bed mobility, transfers, and ambulation. Many of the medical factors that hinder a patient's ability to perform mobility tasks, including pain, neuromuscular impairments, and side effects of medications, are magnified in the critical care environment.

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Furthermore, during these times of life-changing, and even life-threatening, illnesses and injuries, there are even fewer opportunities for patients to be surrounded by familiar, meaningful objects and supportive family and close friends. The stresses of bright lights, unfamiliar noises, round-the-clock activity, and disrupted sleep patterns can have adverse effects on a patient's psychological well-being. Sometimes these stresses are enough to result in ICU delirium, also called “ICU syndrome” ...

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