(Stiller and Phillips, 2003)

Question 1

main aims of mobilisation include …

Answer 1

• optimising oxygenation by enhancing alveolar ventilation and V/Q matching
• increasing lung volume
• improving mucociliary clearance

Question 2

Mobilisatio procedure 1: where do you start?

Answer 2

Medical notes:

• Past medical history or recent symptoms of cardiovascular/respiratory dysfunction
• Medications (that may affect response to mobilisation)
• Previous level of mobility and exercise capacity (contraindications to mobilisation?)

Question 3

Mobilisation procedure 2: general observation

Answer 3

• conscious
• face-colour … cyanosis - bllue-coloured skin caused by too little oxygen in the blood
• bed position
• attachments
• skin
• peripheries

Question 4

Mobilisation procedure 3: assessment for mobilisation … LITE principles (NZ Patient Handling Guidlines, 2012)

Answer 4

• Load … risk factors (age, weight, mental state)
• Individual … capacity of carer
• Task … what needs to be done?
• Environment … staffing levels, cultural issues, resources

Question 5

Mobilisation procedure 4: sufficient cardiovascular reserve?

(if it is not sufficient, defer mobilisation or discuss with senior physiotherapist or medical staff.

Answer 5

• Resting HR < 50% age predicted max HR (220-age)
• BP < 20% recent variability
• Normal ECG (i.e. no evidence of MI or arithmia)
• No major cardiac condition present

Question 6

Mobilisation procedure 5: sufficient respiratory reseve?

Answer 6

• PaO2/FiO2 > 300
• SpO2 > 90% and SpO2 < 4% decrease
• Respiratory pattern
• Mechanical ventilation able to be maintained during treatment

Question 7

When SpO2 falls below approximately 90% there is an

increased risk of ….

Answer 7

pulmonary vasoconstriction and a resultant increase in right sided heart pressures, which may result in cardiorespiratory compromise

Question 8

Mobilisation procedure 6: are other factors favourable?

Answer 8

• Haemoglobin
• Platelet
• WCC
• Body temperature < 38
• Blood glucose
• Patient appearance … pain, fatigue, SOB, nausia
• Stable conscious state
• No other neurological contraindications
• No orthoppaedic contraindications
• No recent SSG/flap to lower limbs or trunk
• Medically stable if DVT and/or PE
• Obesity
• Consent

Question 9

Haemoglobin level should be more than ___ g/dl to mobilise.

Answer 9

> 7grams/dl

Norm: Male:13.5-18 Female:11.5-16g/dl

Question 10

WCC (White Cell Count) should be betwenn ____ and ____cells/mm3 to mobilise (the normal range)

Answer 10

4,300 - 10,800 cells/mm3 (normal range)

[if high => may indicate infection]

Question 11

Blood glucose should be between __ and __ mmol/L to mobilise.

Answer 11

3.5 - 20 mmol/L

[Norm: 3.8 - 5.8 mmol/L]

Question 12

Platelet count should be more than ___cells/mm3 to mobilise

Answer 12

> 20,000 cells/mm3 [Norm: 150,000 cells/mm3]

an acute fall in platelet count can indicate active or recent bleeding.

Question 13

Anticoagulation

Answer 13

prevents further clot formation

[if over anticoagulated, increases risk of bleeding during mobilisation]

Question 14

Tracheostomy

Answer 14

is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tracheostomy tube is usually placed through this opening to provide an airway and to remove secretions from the lungs.

Question 15

Patients who are intubated with an oral or nasal

endotracheal tube can be mobilised. T or F?

Answer 15

True

although this should be done with extreme caution due to the potential for dislodgment of the tube.

Question 16

An underwater sealed drain limits mobilisation. T or F?

Answer 16

False
An underwater sealed drain does not limit mobilisation if care is taken to ensure the tubing is not kinked or dislodged and the drain is kept below the tube’s insertion point in the thorax.

Question 17

Patients with an epidural for pain relief can be

mobilised. T or F?

Answer 17

True
once it has been ascertained that there is no motor block (ie, normal motor power in the legs) and no sympathetic block (ie, BP within normal limits).

Question 18

If a patient has arrythmia would you mobilise?

Answer 18

No.
(if the cardiovascular reserve is not sufficient, defer mobilisation or discuss with senior physiotherapist or medical staff.)

Question 19

Haemoglobin level < ___g/dl is the borderline of having transfusion
(from week 5 lab)

Answer 19

< 8 g/dl

if it continues to decrease on the following day, surgen may decide blood transfusion