Mobilising critically ill patients Flashcards
What are some complications of prolonged mobility?
- Retained secretions with impaired mucocilliary escalator and reduced tidal volumes
- Postural hypotension
- DVT
- Decreased gut motility and constipation
- Muscle shortening, wasting, and weakness
- Risk of polyneuropathy (reduced blood circulation to nerves)
- Pressure sores and skin breakdown or infection
- Low mood or depression
- Increased mortality and increased length of stay
What can mobilisation help with?
- Improving respiratory function (increasing lung volumes, optimising V/Q matching, improving airway clearance)
- Reducing risk of DVT, muscle wasting/shortening
- Increases level of consciousness and provides stimulation
- Improves cardiovascular fitness (cardiac output, manages postural hypertension)
- Decreases the length of mech vent and length of stay
What are precautions for mobilising an ill patient?
- Labile BP +/- meds
- High or arrhythmic HR
- High O2 requirements
- Mild agitation or sedation
- Haemoglobin <100g/l
- Increased BMI
- Femoral line in situ
- EVD in situ - must be drained
What are contraindications for mobilising an ill patient?
- Unstable orthopaedic injuries eg spine, pelvis
- Unstable arrhythmias or extremely high HR
- Unstable BP not meeting targets +/- high levels of meds needed to meet targets
- SpO2 <90%
- Haemoglobin <70g/l
- New skin grafts or muscle/skin flaps
- Moderate to severe agitation or sedation
- Unclamped EVD
Can a patient be mobilised if they have a stable ETT, tracheostomy tube, face mask, or nasal prongs?
Yes, if they have stable SpO2 without recent or spontaneous desats, and caution needed if patient requires FiO2 >50%
- someone must be allocated (usually the nurse) to be in charge of the airway if a patient is ventilated (ETT, trache) or the patient will be in trouble if it comes out
What should be taken into account regarding HR before mobilisation?
- Needs to be space between resting HR and max HR to allow increased HR when mobilising. eg. resting HR of 150, max HR of 160, not much allowance for increase with activity
- Not safe to mobilise: frequent arrhythmias, externally paced with no underlying rhythm, in AF with >120bpm
What are the BP limits for mobilising?
- Caution needed: systolic <100mmHg or >160mmHg
- Don’t do it: systolic <90mmHg or > 180mmHg, or needing significant meds to meet BP targets
Can people on these medications mobilise:
- positive inotropic drugs (increases contractility of heart muscle)
- increasing BP
- lowering BP
- Positive inotropic drugs (increases contractility of heart muscle): not usually
- Increasing BP: not usually (unless very low levels of medication)
- Lowering BP (yes if BP is stable and meeting targets)
Some types of mobility:
- PROM or AROM exercises
- Rolling in bed
- SOEOB
- Standing or tilt table
- Marching on the spot
- Sitting out in a chair
- Walking
Who is suitable to mobilise?
- Need medical clearance for patients with neurosurgery, LL fractures, spinal injuries
- Stable cardiorespiratory observations
- GCS - M5 or 6
Who is unsuitable to mobilise?
- Morbidly obese with inadequate manpower or equipment to assist
- Agitated and at risk of compromising their airway
- Not stable enough to mobilise
In regards to the ventilator, what direction should a patient be mobilised?
In the direction of the ventilator
What should be monitored throughout treatment?
- Mucus plugging with acute desaturation
- Pain - grimacing, increased HR, swatting, moving
- Decreasing GCS
- Bleeding - petechial haemorrhage on skin, haemoptysis
What are some activities or tasks that can be done when SOEOB (sitting on edge of bed)?
- High fives
- Kicking to a target
- Throwing a ball
When should mobilising be stopped?
- Patient is too fatigued
- Observations or behaviour outside of safe zone (eg. high or low BP/HR, low SpO2, change in sedation or agitation, risk of loss of airway)
