4) Mobilization & Exercise Implications for CPPT Flashcards
Physical Activity
Any bodily movement produced by muscle contractions that causes a substantial increase of energy expenditure
Exercise
Physical activity that consists of planned, structured, & repetitive movements done to improve or maintain components of physical fitness in sub-acute/chronic pt’s
Mobilization
Therapeutic & prescriptive application of low-intensity exercise to manage acute CP dysfunction
Who is mobilization usually done for?
Acutely ill pt’s
What is the goal of mobilization?
Optimize O2 transport
What position should mobilization be done in & why?
Mobilization should be done in an upright position bc it will help to optimize hemodynamics & fluid shifts.
Which two types of tx yield health benefits?
Physical Activity & Exercise
True or False: Mobilization is used to elicit gravitational & exercise stimuli?
True
Examples of mobilization
Bed Mobility
Standing
Amb to bathroom
etc
What do acute CP/CV pathologies indirectly compromise & why?
Fxnl capacity–>In the acute stage, the PT is probably reclined & the body naturally wants to do the least amount of movement.
What does recumbancy & immobilization cause?
Further dysfunction of the O2 transport system
Mobilization & exercise require extra metabolic demands in what pt population?
Pt’s w/compromised O2 transport capacity
Why are hospitalized pt’s hypermetabolic?
Bc they have incr body temp, healing, work of breathing, & response to routine interventions
What type of exercises are essential for CP PT pt’s?
Relaxation
What are the factors that contribute to incr metabolic demands & O2 consumption?
- 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
What should you use to determine a saftey margin?
VO2
When does anaerobiosis occur & why?
*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
5 Effects of Rhythmic Lung Movement During Physical Activity
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
What does undergoing gravitational & exercise stress do for the O2 transport system?
Enhances biochem, physical, & mechanical efficiency of the transport pathway
Things to think about:
- Prescription
- Acute physiologic effects
- Monitor signs & sx’s
- Mobilization stimuli
- Conditions that benefit from mobilization
True or False: small amounts of movement can provide sufficient CP stress & be beneficial
True
What should ventilatory strategies be combined with?
Coughing exercises
What should coughing exercises be combined with?
Ventilatory strategies
Exercise intensity should do what w/out doing what?
Incr TV w/out causing desaturation, hemodynamic instability, or respiratory distress
What are extrinsic factors related to?
Pt’s care
What are intrinsic factors related to?
The pt
Steps of CP Mobilization
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
Examples of mobilization stimuli
- Ambulation
- Cycle Ergometer
- ADL’s
- Standing
- Transfers
- Dangling
- Bed Exercises
Supplemental devices for the pt:
- Ad’s
- W/c
- Weights
- Pulleys
- Therabands
- Grab Bars
- Trapeze
Supplemental devices for the PT:
*Gait belts & mechanical transfer lift
Conditions that benefit from acute exercise:
- Atelectasis
- Pulmonary Consolidation
- Pulmonary Infiltrates
- Pneumonia
- Bronchiolitis
- Alveolitis
- Acute lung injury & pulmonary edema
- Hemothorax
- Pneumothorax
- CP insufficiency
- CP sequelae of surgery/immobility
- Pleural effusions
Benefits of Mobilization
- Maintain muscle mass
- Improve exercise tol
- Maintain fxn
- Counter the effects of bedrest
- FRC
- CO
- DVT risk
- Secretion removal
Benefits of early mobilization:
- Postural hypotension
- Maintain density
- Improved consciousness, reaction time, & mental fan
- Improved sleep
- Maintain balance responses
- Constipation
- Skin breakdown
