Test 1: Lab Values and Early Mobilization Flashcards
Benefits of acute care
prevent decline w/ early mobility
prescribe exercise programs to improve outcomes/decrease length of stay
safe DC planning
why is early mobiliztion important with neuro pts
delayed treatment can lead to barriers in recovery (use it or lose it, time matters, interference)
early mobility prevents secondary illness, pneumonia, blood clots, skin ulcers, deconditioning, and muscle atrophy
when is the “therapeutic window” for spontaneous recovery
greatest at 3-6 months
what are things you should do/check prior to starting early mobility activities
check for red flags - neuro screen
assess vital signs and lab values - monitor throughout
Confirm with interdisciplinary team - meds/24 hr stability
start with light intensity early on- FITT
what do you look at for a cardiovascular system review
Vitals:
-core vitals: (HR, RR, BP)
-temp
Non-vitals:
-pulse oximetry O2
-pain
looking at important data about current status of body and CV system and response to PA
normal values for HR/pulse
60-100 BPM for adults
can treat outside of range but check with MD
values that indicate HTN
systolic = 140 or higher
diastolic = 90 or higher
levels that indicate prehypertension
systolic = 120-139
diastolic = 80-89
hypotension value
systolic less than 100
what values define an acute HTN crisis
systolic > 180
diastolic > 110
clinical signs of orthostatic hypotension
w/i 3 min of position change
systolic drop of 20 mmHg
diastolic drop of 10 mmHg
what is mean arterial pressure
average blood pressure during a single cardiac cycle
(systolic + [diastolic x2])/3
*pressor medications increase BP to reach minimum MAP
what are normal/abnormal MAP values
MAP of 60 or greater is needed to perfuse organs
normal = 70-105 mmHg
HOLD THERAPY FOR MAP < 60
what is one respiration
one inspiration and one exhalation
normal values for RR
12-18 respirations a minute
what should you look at when observing respiration
Rate = # breaths/min
depth = volume/amount of air exchanged
rhythm = regularity of pattern
character = any deviations from normal; normal should hear no sounds
normal body temp range
96.8 to 99.3
average = 98.6
fever not super concerning in hospital since it is the body’s natural response
normal blood oxygen saturation
95-100%
hypoxemia if SpO2<90%
what is RPE
rating of perceived exertion
subjective
6-20 is traditional scale
used to determine pt’s response to exercise, determine goals, judge progress, and establish parameters of activities
what is ICP
intracranial pressure
pressure exerted by fluids such as CSF inside skull/brain
brain can herniate if too high
sign = HA, vomiting, and secondary cell death
HOLD THERAPY if high
values for normal resting ICP, mild intracranial HTN, and severe
normal = 4-15 mmHg
mild = 20-30 mmHg
severe = over 40 mmHg
what does hemoglobin measure
amount of hemoglobin in blood is an indirect measure of RBC count
(RBCs carry hemoglobin)
“under eight don’t ambulate”
what does hematocrit measure
percent of RBCs in your blood
Hb values needed for resistive exercise
> 10 g/dL
Hb values needed for light exercise
8-10 g/dL
Hb values that SHOULD NOT exercise
<8 g/dL
Hct values needed for resistive exercise
> 35%
Hct values needed for light exercise
> 25%
Hct values that SHOULD NOT exercise
<25%
what is INR
international normalizing ratio
looks at how well your blood clots
normal INR levels
0.8-1.2
INR levels to hold exercise
5.0-6.0
INR bed rest levels
> 6.0
INR levels safe for exercise w/o increase in intensity
<4.0
INR levels that indicate no resistive exercise/light exercise only
4.0-5.0
what to consider when you see abnormal vitals
what has the trend been for past 24 hours
is pt asymptomatic
any other factors involved
interventions provided by nursing that may facilitate with PT participation
benefits of early mobilization
decrease delirium by 2 days
reduce readmission
decrease death rate
reduce ventilator assisted pneumonia
reduce central line infection
reduce catheter infection
decrease overall cost
decrease medical complications
benefits/goals of getting upright
improve lung function
improve interaction with environment
weaight bearing
improved BP regulation
make it more like normal life
mobility goal
level of function needed for independence/home life
based on diagnosis/what is realistically functional for specific pt
what is an arterial catheter
“art line”
measures arterial pressure in real time
directly into artery
often in wrist but sometimes in femoral
more accurate than BP cuff
considerations regarding arterial catheter
pulled = heavy bleeding
physician needed to place it
may limit wrist/hip movement
what are bolt/external ventricular drains (EVD)
bolt
-real time measure ICP
-hole in skill
-pts with severe TBI
EVD
-measures ICP
-Drains CSF
considerations for bolt/EVD
bolt = usually too sick to mobilize; consider PROM, but weigh risk
EVDs are calibrated to pt head position; consult with team before mobilizing
what is a swan ganz catheter
“central line”
usually in neck
goes down large vein through vena cava and into R atrium
can deliver meds direct to circulation
what is a PICC line
peripherally inserted central cathether
peripherally inserted in vein and goes direct to heart
often for those who need long course of antibiotics
mobility considerations for swan ganz and PICC lines
DO NOT PULL; insert in heart
may cause arrythmias
may cause pneumothorax
med delivery is challenging if pulled
mobility considerations for ventilators/trachs
vents not portable
high likelihood of desaturation
high risk of barrotrauma if settings are too high
purpose of high flow nasal cannula
way to deliver high amounts of O2 w/o intubation
precursor to mechanical vent
nasal cannula mobility considerations
consider buffer room; are they near max settings? if so hold mobility that may tax CV system
if you push too hard, intubation is next step
Intensity and type of exercise matter
what is a fecal management system
collect fecal matter in bag
gravity dependent
often used with C-diff
what is a foley catheter
urine collection
gravity dependent
with SCI can often be an irritant causing autonomic dysreflexia
mobility considerations with urine/fecal collectors lines/tubes
FMS bags are easy to pull
catheters hurt a lot when pulled accidentally; may bleed
keep below waste
what is a nasogastric tube
through nose to stomach
feeding tube
what is PEG or percutaneous endoscopic gastrostomy
feeding tube directly to abdomen
long term solution
common in pts with lower level brain injury
feeding tube considerations for feeding tube
NPO; dont give food or water; may aspirate
easy to pull when pt is agitated
malnutrition/weight loss is a consideration
examples of telemetry units
VS, BP cuff, and pulse ox
mobility considerations with telemetry units
may get artifact or noise on signal from movement so double check findings
look for changes in exercise response
portable; can be unplugged
