PT management in critical care

Question 1

Is there sufficient CV response?

Answer 1

RHR < 50% of APMHR
BP < 20% variability
ECG is normal

Question 2

Is there sufficient respiratory response

Answer 2

PaO2/FiO2 > 300
SpO2 > 90%
less than 4% decrease in SpO2
respiratory pattern is satisfactory
mechanical ventilation is maintainable

Question 3

favorable factors for mobilization

Answer 3

body temp < 38 degrees Celsius
stable Hgb and platelet count
blood glucose 3.5- 20 mmol/.L
good pt. appearance (no SOB, fatigue or chest pain)
stable ECG
no neuro or orthopedic conditions
pt. consent

Question 4

signs they are tolerating mobilization

Answer 4

appropriate incremental increase in HR
stable ECG
PaO2/FiO2 > 300, SpO2 >90% with < 4 % decrease
pt. appears unstressed

Question 5

unsure if they are tolerating

Answer 5

ectopic beats
pt. appears distressed
decrease in PaO2/FiO2
excessive increase in HR

Question 6

signs they are not tolerating mobilization

Answer 6

excessive increase in HR or BP plus signs of CV stress
increase in ectopic beats
arrhythmia plus hemodynamic instability
pt. appears distressed

Question 7

contraindications for OOB exercise

Answer 7

SpO2< 90%
HFOV ventilation
prone positioning
uncontrolled bleeding
unstable fracture
uncontrolled seizures
cardiac ischemia
pacemaker with dependent rhythm 
femoral IABP
deeply sedated
very agitated or combative
spinal precautions
ventricular rate > 150 bpm

Question 8

safe criterion for in an dOOB mobilization for FiO2 is…

Answer 8

<0.6

Question 9

what is room FiO2

Answer 9

21%`

Question 10

what are the major criteria for terminating a mobilization

Answer 10

decrease RHR
new abnormal heart rhythms
desaturation (> 4% decrease)
SBP > 180 mmHg
RR <5 or > 40 breaths/min