2.2 Body Positioning and Mobilization of the Deconditioned Patient Flashcards
Why is body positioning important?
heart function lung function bone density GI mobility ect...
Aerobic deconditioning is the function of what 2 principle mechanism?
1) removal of gravitational stress
2) removal of exercise stress
Results from
- threats to O2 transport
- dysfunction of one or more steps of O2 transport
If a patient hasn’t been seen for PT in days and in the hospital what should we be thinking?
Any complications?
Very decreased aerobic capacity!
If PaO2 drops on curve can be detrimental. T/F.
True. Think O2 dissociation curve!!
How can BiPAP help with someone that is getting worsened respiratory acidosis?
bi-level positive airway pressure
forces airways to stay open to Ventilate better!
Thoracentesis and ascites procedures
US to find space of fluids and drains it…
What position is better for pleurel effusion patients?
Sitting up for diaphragm to be better position.
Types of Atelectasis
1) Resorption
2) Compression
3) Contraction
Resorption Atelectasis
Completes OBSTRUCTION of an airway –> reabsorption of the O2 trapped in the dependent alveoli, w/o impairment of blood flow through the affected alveolar walls
Compression Atelectasis
Results when the pleural cavity is partially or completely filled by fluid exudate, tumor, blood, or air
Contraction Atelectasis
Local or generalized fibrotic changes in the lung or pleura prevent full expansion
Decreased lung compliance, collapse, disease state…
Key exam Q’s?
Cough? SOB? Chest discomfort? PLOF? Activities since admin? Life-space assessment? DASI?
What should we think about before entering?
Red flags? Clinical presentation of referring dx? Most recent CXR Most recent lab values Review of vital signs over the past 12-24 hours
What should you look for with a patient laying in bed?
Venturi mask - Increase lung expansion
Breathing pattern, distressed, tachypnic, skin color, edema
Hypothesis of Key Impairments
Hospitalization reconditioning
Decreased aerobic capacity (O2 transportation)
Increased work of breathing and O2 demand
Generalized weakness/strength/power deficits
ROM
Pain
What does the MRC Sum Scale look at?
Objective way to demonstrate how weak the patient is in the ICU
Would O2 improve after exercise?
It should after resting!
What are 3 principles of exercise rx?
1) Specificity of training
2) Overload
3) Adaptation window
Examples of specificity of training?
Change height of bed and challenge it…
Examples of overload?
Walk 45’ today and tomorrow work further…
Examples of adaptation?
Larger improves quickly, room of improvement
Deep slow breathes effects/improves… IS
Atelectasis!
With sitting at the bed METS?
1-2
*Understand METS
What are some ways we can measure intensity?
% park HR Max HR (calculation) RPP, rate pressure product (angina threshold) RPE METS
Stairs is considered what MET?
4/5
Duration?
Minutes to get training effect? Increase this as tolerated!!
Always warm up and cool down - prevent hypotension and prepares heart!
What do we have to promote if a patient is bedridden??
WB!!!
Goals should include:
OOB Aerobic conditioning Functional strength/power training Functional mobility Pt/Family education
Its w/ ventilatory pump dysfunction difficult thoracic expansion treatment or pathological?
Pursed-lip breathing Diaphragmatic Sniffing Segmental and lateral costal breathing/expansion or manual technique Air stacking Biomechanics Breathing inhibition techniques Airway clearance techniques Supplemental O2 Exercise, retraining!
Treatments
Sitting EOB
Posture - support under feet
Deep breathing/ventilation: facilitate inspiration
Trunk extension
Shoulder flexion, abduction, ER
Looking up
Deep breathing/ventilation: facilitate expiration
Trunk flexion
Shoulder extension, adduction, IR
Looking down
If a patient can’t breath what should we work on first?!
BREATHE
