Mobilization and Exercises Flashcards
What are some ways to get acutely ill patients up without over taxing them?
Arousal, mobilization, breathing, exercises, bagging, postural drainage, coughing, suctioning
Give a goal of mobilization and what position it is best performed in.
Goal: Use exercise to optimize O2 transport
Best performed in upright to facilitate gravitational and exercise stimulus
What is the goal of exercise?
Optimize oxygen transport
Know the 17 things that bed rest can cause
Its entirely too much for one notecard
Why does bed rest cause resting tachycardia?
Pressure on thoracic wall because of position and visceral encroachment
How long does it take for atrophy of the muscles to occur? Peak forces of type I & II fibers decreases how much?
Atrophy occurs in 4 hours
Type I: 24% Type II: 27%
A decrease of the sympathetic system causes?
Abnormal vascular tone
What intensity of work for how long is needed to keep the negative effects at bay?
6.0 METS for 1 hour per day
What are the two types of beds and how do they work?
- Kinetic: moves M/L, keeps mucus moving in lungs, pt may become dependent on passive motion (disadvantage)
- Tilt Table: Retrains orthostatic hypotension pt, legs dep and not moving-> blood pooling (dis)
What 4 complications indicate the need for bed rest?
- Venous Problems: elevate legs (may not control edema)
- Orthopedic insult: vertebral fx, traumatic femur fx, used to decrease pain post-ax
- Acute Back injury: mostly with herniations or ruptures
- Pregnancy
T/F: High intensity and moderate intensity have the same effect in preventing orthostatic intolerance.
False: High upright interval exercises are more effective
(Isometric/Isotonic) exercises maintain VO2 and muscle integrity better.
Isometric exercises
What vitals should be constantly monitored when you are exercising a patient?
BP, HR, RR, RPE, METS, RPP
What is the formula for rate pressure product?
HR x Systolic BP
What 7 things should you check before getting a patient up for exercise?
- Pt should be rested
- Not eaten heavily
- Attentive and aroused as much as possible
- Minimal pain and distress
- Time visit with meds (30 min after taking)
- Equipment properly situated
- Assistant properly situated
Your goal is to have the patient do what?
As much of the movements as possible
What are the three parts of exercising your patient?
Warmup
Steady state activity
Cool Down
Usually _____ and ________ frequent leads to cumulative adaptive responses to prepare for D/C.
Shorter and more frequent
T/F: The more acutely ill the patient, the more you monitor them.
True
What are the long term effects of exercise on the cardiopulmonary system?
Decreased: Submaximal minute ventilation
Increased: Respiratory muscle strength and endurance, collateral ventilation, pulmonary vascularization
Give some long term effects on the cardiovascular system from exercising.
Increased: Myocardial mm. mass and efficiency, efficiency of thermo regulation.
Exercise induced bradycardia
Decreased: SV at rest and submax work rates; RHR and BP; Submax HR, BP, RPP; Submax RPE and breathlessness; orthostatic intolerance in upright position
The hematological system gets what long term effects with exercise?
Increased: Circulating BV, # of RBC
Optimize hematocrit and cholesterol
Decreased: blood lipids
What is increased with the CNS during long term exercising?
Increased sense of well being and concentration.
The neuromuscular system receives what benefits from exercise?
Increased: Efficiency of postural reflexes assoc. with type of exercise and reflex control, movement efficiency and economy.
Enhanced neuromotor control
Exercise causes what to occur in the MS system?
Increased: mm vascularization, myoglobin, muscle metabolic enzymes, glycogen storage capacity capacity, biomechanical efficiency, movement economy, mm strength and endurance, ligament tensile strength.
Muscle hypertrophy and Maintenance of bone density
Which system has an increase in efficiency of hormone production and degradation to support exercise?
Endocrine system
The immunological system has what benefit from exercise?
Increased resistance to infection
Give the long term effects of exercise on the integumentary system.
Increased: Efficiency of skin as heat exchanger, sweating efficiency, and healing
Decreased: skin abrasions and breakdown
Exercise programs for your patient should include what 5 components?
Mode, intensity, frequency, duration, and progression
Give some general advantages of long term exercise.
Improved O2 transport (VO2max, DO2), platelet adhesives and blood viscosity optimized, maintained BP, bone marrow production influenced, adrenergic responses more sensitive, glucose response normalized, WBC increased (immune system boost), Increased PNS function
Decreased: HR and SV, sympathetic function
Exercise does not change the submax VO2 but what else might it change?
Physiologic response to exercise load
What is the patients response to resistance exercise?
CV response to exercise is diminished, Peak responses diminished, Faster recovery time, Increased arterial wall resistance increases pulse pressure.
What exercises can increase your patients respiratory fitness?
Pursed lip breathing, anything that works the diaphragm
What is the difference in UE and LE exercise?
UE: you need to decrease the THR by 10 points less than the LE
Males will have a different score for which exercise?
Leg ergometry
Exercise tests should be _____ to the work the patient will be doing.
Specific
Problems from contraindications will arise faster in acute or chronic patients?
Acute
Review all the absolute and relative contraindications!!
KNOW ALL THE THINGS! :)
Exercise prescriptions should include what 4 components?
Individualized, Intensity, Motivation, and Monitoring
How much time should you recommend a patient get in physical activity every day? Can these include lifestyle activities?
1 hour per day
Can include lifestyle activities
Is moderate exercise the same for obese and normal weight patients?
No
Resistance exercises should include what?
2-3 days per week, 8-10 major muscle groups, UE intensity- 30-40% and LE 50-60% or tolerated wt for 8-10 reps
Which patients are especially at risk for hypotension and need to adhere to the cool down phase?
Pts on alpha or calcium channel blockers, or on vasodilators
What is the contraindicated BP amount for exercise?
200/110
Exercise does not change the submax VO2 but what else might it change?
Physiologic response to exercise load
What is the patients response to resistance exercise?
CV response to exercise is diminished, Peak responses diminished, Faster recovery time, Increased arterial wall resistance increases pulse pressure.
What exercises can increase your patients respiratory fitness?
Pursed lip breathing, anything that works the diaphragm
What is the difference in UE and LE exercise?
UE: you need to decrease the THR by 10 points less than the LE
Males will have a different score for which exercise?
Leg ergometry
Exercise tests should be _____ to the work the patient will be doing.
Specific
Problems from contraindications will arise faster in acute or chronic patients?
Acute
Review all the absolute and relative contraindications!!
KNOW ALL THE THINGS! :)
Exercise prescriptions should include what 4 components?
Individualized, Intensity, Motivation, and Monitoring
How much time should you recommend a patient get in physical activity every day? Can these include lifestyle activities?
1 hour per day
Can include lifestyle activities
Is moderate exercise the same for obese and normal weight patients?
No
Resistance exercises should include what?
2-3 days per week, 8-10 major muscle groups, UE intensity- 30-40% and LE 50-60% or tolerated wt for 8-10 reps
Which patients are especially at risk for hypotension and need to adhere to the cool down phase?
Pts on alpha or calcium channel blockers, or on vasodilators
What is the contraindicated BP amount for exercise?
200/110
