Safe Mobilisation

Question 1

What are the CV considerations for mobilisation?

Answer 1

• Heart rate
• Blood pressure
• Cardiac status

Question 2

What are the heart rate considerations for mobilisation?

Answer 2

• Normally increases supine to sitting (10bpm)
• Increases more with standing/mobs
• Aim for 50-60% max HR
• Be aware of resting HR compared to max

Question 3

What HR signs would indicate the patient needs to stop/pause mobilisation?

Answer 3

• High HR & signs of CV stress (SOB, chest pain, faint)

- If HR doesn’t increase or decreases during exercise + CV stress

Question 4

What are the blood pressure considerations for mobilisation?

Answer 4

• Normal systolic increase with exercise (up to 200)
• Diastolic stable/slight increase
• Look at patient’s pattern of BP prior to mobs
• Watch for signs of orthostatic intolerance (BP dropping with mobs)

Question 5

What are the cardiac status considerations for mobilisation?

Answer 5

Take extra care or modify if:

• Recent AMI (within 2 days) or other acute cardiac event
• Unstable angina
• Uncontrolled arrhythmia causing symptoms
• Severe symptomatic aortic stenosis (SOB, tightness in chest)
• Uncontrolled symptomatic heart failure
• Acute PE or pulmonary infarction (check with doctors)
• Suspected/known dissecting aneurysm
• Acute infection (may still be able to mob)

Question 6

What are the ECG clues to stop & reassess mobilisation?

Answer 6

• More than occasional VEB
• Runs of VT
• Atrial fibrillation (if HD compromise, i.e. dropped BP)
• New ST segment changes + symptoms

Question 7

What are the respiratory considerations for mobilisation?

Answer 7

• Oxygenation
• Hypercapnia
• Respiratory pattern

Question 8

What PaO2/FiO2 ratios are used as guidelines for mobilisation?

Answer 8

• PaO2/FiO2 >300 = safe to mobilise
• PaO2/FiO2 200-300 = marginal resp reserve (may need to increase O2)
• PaO2/FiO2 <200 = no reserve, hazardous to mobilise
• But if <300 may still be mobilised if potential benefits outweigh risks

Question 9

What is the minimum SpO2 that needs to be maintained during mobilisation?

Answer 9

> 90% - approx corresponds to PaO2 60% (below this cells die)

Question 10

How can hypercapnia affect mobilisation?

Answer 10

• Chronically elevated PaCO2 shouldn’t limit mobs

- Acute rise in PaCO2 = resp failure (can limit mobs, e.g. consciousness)

Question 11

What respiratory pattern features should be monitored during mobilisation?

Answer 11

• RR
• Abdominal rib cage/abdomen asynchrony
• Increase accessory muscle use
• Can indicate deterioration in resp function (don’t ignore)

Question 12

What are the haemoglobin considerations for mobilisation?

Answer 12

• Normally 12-18 grams/dL (male) or 11-14 (female)
• No absolute value prevents mobilisation
• Acute fall in Hb = active/recent bleeding (delay mobilisation)

Question 13

What are the platelet count considerations for mobilisation?

Answer 13

• Normally 150,000-400,000 cells/mm3
• Acute drop = active/recent bleeding
• < 20,000 = potential to increase BP, avoid mobs

Question 14

What are the white cell count considerations for mobilisation?

Answer 14

• Normally 4,300-10,800 cells/mm3
• > 11,000 or <4,300 = active infection
• Doesn’t prevent mobs but may have increased O2 demand while fighting infection

Question 15

What should be monitored while mobilising a febrile patient?

Answer 15

Fever associated with O2 consumption - monitor SpO2

Question 16

What are the blood glucose considerations for mobilisation?

Answer 16

• Normally 3.8-5.8mmol/L
• Hypoglycaemia <3.5 = lack of energy to brain
• Hyperglycaemia >20 = due to diabetes or life-threatening illness
• Either change may alter consciousness
• May need to check prior to mobs in high risk patients

Question 17

What are the neurological considerations for mobilisation?

Answer 17

• Consciousness
• Muscle strength (don’t underestimate atrophy rate)
• Neurosurgical procedures (e.g. drainage of CSF) - extra contraindications/precautions
• Care if balance issues/risk of falls

Question 18

What are the orthopaedic considerations for mobilisation?

Answer 18

• Mobilisation contraindicated in some cases (pelvic/unstable spinal fracture)
• Lower limb fracture (check WB status)
• Clarify with ortho team if unsure

Question 19

What are the skin condition considerations for mobilisation?

Answer 19

Mobilisation contraindicated in some cases:
- Split skin grafts
- Burns
- Pressure wounds
Bandaging may be required

Question 20

What are the DVT/PE considerations for mobilisation?

Answer 20

• Practice varies between hospitals
• Usually delay mobs until anti-coagulation reaches theraputic levels (check with nurses)
• Beware risks of bleeding if over-anticoagulated

Question 21

What are the nutritional considerations for mobilisation?

Answer 21

Low BMI:

• Care with bony prominences
• Avoid skin tears & pressure areas
• May have weakness & reduced exercise tolerance

High BMI:

• Bariatric equipment required
• Lifters/hoists/slide sheets

Question 22

What are the attachment considerations for mobilisation?

Answer 22

• Endotracheal (ICU) or tracheostomy tubes (ICU or wards)
• UWSD
• Dialysis tubing
• Epidurals (fine tubing)
• Rectal tubes
• IABP (intra-aortic balloon pump Do not mobilise)
• Temporary pacemakers

Question 23

What are the environment/staffing considerations for mobilisation?

Answer 23

• Environment uncluttered & free from safety hazards
• Monitoring
• Manual handling
  equipment
• Protocol/training in MH
• Respect patient privacy & dignity at all times

Question 24

What instructions & explanations should be given to patients prior to mobilisation?

Answer 24

• Explain rationale & benefits
• Explain how it will be achieved & monitored
• What the patient needs to do
• Basic components of consent should be covered