4) Mobilization & Exercise Implications for CPPT

Question 1

Physical Activity

Answer 1

Any bodily movement produced by muscle contractions that causes a substantial increase of energy expenditure

Question 2

Exercise

Answer 2

Physical activity that consists of planned, structured, & repetitive movements done to improve or maintain components of physical fitness in sub-acute/chronic pt’s

Question 3

Mobilization

Answer 3

Therapeutic & prescriptive application of low-intensity exercise to manage acute CP dysfunction

Question 4

Who is mobilization usually done for?

Answer 4

Acutely ill pt’s

Question 5

What is the goal of mobilization?

Answer 5

Optimize O2 transport

Question 6

What position should mobilization be done in & why?

Answer 6

Mobilization should be done in an upright position bc it will help to optimize hemodynamics & fluid shifts.

Question 7

Which two types of tx yield health benefits?

Answer 7

Physical Activity & Exercise

Question 8

True or False: Mobilization is used to elicit gravitational & exercise stimuli?

Answer 8

True

Question 9

Examples of mobilization

Answer 9

Bed Mobility
Standing
Amb to bathroom
etc

Question 10

What do acute CP/CV pathologies indirectly compromise & why?

Answer 10

Fxnl capacity–>In the acute stage, the PT is probably reclined & the body naturally wants to do the least amount of movement.

Question 11

What does recumbancy & immobilization cause?

Answer 11

Further dysfunction of the O2 transport system

Question 12

Mobilization & exercise require extra metabolic demands in what pt population?

Answer 12

Pt’s w/compromised O2 transport capacity

Question 13

Why are hospitalized pt’s hypermetabolic?

Answer 13

Bc they have incr body temp, healing, work of breathing, & response to routine interventions

Question 14

What type of exercises are essential for CP PT pt’s?

Answer 14

Relaxation

Question 15

What are the factors that contribute to incr metabolic demands & O2 consumption?

Answer 15

• Fever
• Thermoregulatory challenges
• Healing & repair
• Infection
• Interventions
• Feeding
• Being physically handled
• Body Positioning
• Noxious stimuli(Needles)
• Social Contact
• Anxiety
• Pain/Discomfort
• Agitation
• Noises
• Disrupted circadian rhythms

Question 16

What should you use to determine a saftey margin?

Answer 16

VO2

Question 17

When does anaerobiosis occur & why?

Answer 17

*Occurs when pt’s O2 transport system can’t meet the required metabolic demands–>Serum lactic acid levels are high so pt goes into metabolic acidosis

Question 18

5 Effects of Rhythmic Lung Movement During Physical Activity

Answer 18

1) Incr VA by incr TV
2) Facilitates lymphatic flow & drainage
3) Improved mucocilliary transport & mucous clearance
4) Minimizes bacterial colonization in the AW
5) Stims surfactant production & distribution

Question 19

What does undergoing gravitational & exercise stress do for the O2 transport system?

Answer 19

Enhances biochem, physical, & mechanical efficiency of the transport pathway

Question 20

Things to think about:

Answer 20

• Prescription
• Acute physiologic effects
• Monitor signs & sx’s
• Mobilization stimuli
• Conditions that benefit from mobilization

Question 21

True or False: small amounts of movement can provide sufficient CP stress & be beneficial

Answer 21

True

Question 22

What should ventilatory strategies be combined with?

Answer 22

Coughing exercises

Question 23

What should coughing exercises be combined with?

Answer 23

Ventilatory strategies

Question 24

Exercise intensity should do what w/out doing what?

Answer 24

Incr TV w/out causing desaturation, hemodynamic instability, or respiratory distress

Question 25

What are extrinsic factors related to?

Answer 25

Pt’s care

Question 26

What are intrinsic factors related to?

Answer 26

The pt

Question 27

Steps of CP Mobilization

Answer 27

1) Is all factors contributing to deficits in O2 transport
2) Determine if mobilization & exercise are indicated & which ones will address the pt’s deficits
3) Match appropriate mobilization/exercises w/pt’s O3 transport capacity
4) Set the intensity w/in therapeutic but safe limits
5) Combine various body positions, especially upright
6) Set the duration of the sessions based on the pt’s physical response
7) Repeat mobilization as often as possible
8) Incr intensity as appropriate

Question 28

Examples of mobilization stimuli

Answer 28

• Ambulation
• Cycle Ergometer
• ADL’s
• Standing
• Transfers
• Dangling
• Bed Exercises

Question 29

Supplemental devices for the pt:

Answer 29

• Ad’s
• W/c
• Weights
• Pulleys
• Therabands
• Grab Bars
• Trapeze

Question 30

Supplemental devices for the PT:

Answer 30

*Gait belts & mechanical transfer lift

Question 31

Conditions that benefit from acute exercise:

Answer 31

• Atelectasis
• Pulmonary Consolidation
• Pulmonary Infiltrates
• Pneumonia
• Bronchiolitis
• Alveolitis
• Acute lung injury & pulmonary edema
• Hemothorax
• Pneumothorax
• CP insufficiency
• CP sequelae of surgery/immobility
• Pleural effusions

Question 32

Benefits of Mobilization

Answer 32

• Maintain muscle mass
• Improve exercise tol
• Maintain fxn
• Counter the effects of bedrest
• FRC
• CO
• DVT risk
• Secretion removal

Question 33

Benefits of early mobilization:

Answer 33

• Postural hypotension
• Maintain density
• Improved consciousness, reaction time, & mental fan
• Improved sleep
• Maintain balance responses
• Constipation
• Skin breakdown