Safe Mobilisation Flashcards
What are the CV considerations for mobilisation?
- Heart rate
- Blood pressure
- Cardiac status
What are the heart rate considerations for mobilisation?
- 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
What HR signs would indicate the patient needs to stop/pause mobilisation?
- High HR & signs of CV stress (SOB, chest pain, faint)
- If HR doesn’t increase or decreases during exercise + CV stress
What are the blood pressure considerations for mobilisation?
- 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)
What are the cardiac status considerations for mobilisation?
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)
What are the ECG clues to stop & reassess mobilisation?
- More than occasional VEB
- Runs of VT
- Atrial fibrillation (if HD compromise, i.e. dropped BP)
- New ST segment changes + symptoms
What are the respiratory considerations for mobilisation?
- Oxygenation
- Hypercapnia
- Respiratory pattern
What PaO2/FiO2 ratios are used as guidelines for mobilisation?
- 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
What is the minimum SpO2 that needs to be maintained during mobilisation?
> 90% - approx corresponds to PaO2 60% (below this cells die)
How can hypercapnia affect mobilisation?
- Chronically elevated PaCO2 shouldn’t limit mobs
- Acute rise in PaCO2 = resp failure (can limit mobs, e.g. consciousness)
What respiratory pattern features should be monitored during mobilisation?
- RR
- Abdominal rib cage/abdomen asynchrony
- Increase accessory muscle use
- Can indicate deterioration in resp function (don’t ignore)
What are the haemoglobin considerations for mobilisation?
- Normally 12-18 grams/dL (male) or 11-14 (female)
- No absolute value prevents mobilisation
- Acute fall in Hb = active/recent bleeding (delay mobilisation)
What are the platelet count considerations for mobilisation?
- Normally 150,000-400,000 cells/mm3
- Acute drop = active/recent bleeding
- < 20,000 = potential to increase BP, avoid mobs
What are the white cell count considerations for mobilisation?
- 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
What should be monitored while mobilising a febrile patient?
Fever associated with O2 consumption - monitor SpO2
What are the blood glucose considerations for mobilisation?
- 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
What are the neurological considerations for mobilisation?
- 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
What are the orthopaedic considerations for mobilisation?
- Mobilisation contraindicated in some cases (pelvic/unstable spinal fracture)
- Lower limb fracture (check WB status)
- Clarify with ortho team if unsure
What are the skin condition considerations for mobilisation?
Mobilisation contraindicated in some cases: - Split skin grafts - Burns - Pressure wounds Bandaging may be required
What are the DVT/PE considerations for mobilisation?
- Practice varies between hospitals
- Usually delay mobs until anti-coagulation reaches theraputic levels (check with nurses)
- Beware risks of bleeding if over-anticoagulated
What are the nutritional considerations for mobilisation?
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
What are the attachment considerations for mobilisation?
- 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
What are the environment/staffing considerations for mobilisation?
- Environment uncluttered & free from safety hazards
- Monitoring
- Manual handling
equipment - Protocol/training in MH
- Respect patient privacy & dignity at all times
What instructions & explanations should be given to patients prior to mobilisation?
- Explain rationale & benefits
- Explain how it will be achieved & monitored
- What the patient needs to do
- Basic components of consent should be covered
