Vital Signs and Lab Values for Early Mobilization

Question 1

What is our role at a PT?

Answer 1

prevent decline with early mobilization

Question 2

Delayed treatment with neurologic patients can lead to barriers in recovery time and compensation: _________ neuroplasticity principle

Answer 2

time matters

Question 3

Cardiovascular systems review

Answer 3

HR, RR, and BP
Temp
Pulse Oximetry (O2)
Pain

Question 4

Heart rate/ pulse
def:
normal values:

Answer 4

movement of blood in an artery
Adult: 60 to 100 BPM

Question 5

Blood Pressure (BP) normal values:

Answer 5

120/80 mm Hg

Question 6

Acute Hypertensive Crisis is an URGENT referral. T or F

Answer 6

false: Emergency

Question 7

Another name for positional or postural hypotension

Answer 7

orthostatic hypotension

Question 8

Orthostatic Hypotension:

Answer 8

form of low blood pressure that happens when you stand up from sitting, sit up from lying down

Question 9

what is the therapeutic window?

Answer 9

spontaneous recovery and neuroplasticity have been shown greatest in patients 3-6 months post stroke

Question 10

start with ______ intensity early

Answer 10

light

Question 11

what are 3 clinical signs of orthostatic hypotension?

Answer 11

• systolic decrease/drop of 20 mmHg
• diastolic decrease/drop of 10 mmHg
• within 3 min of positional change

Question 12

hold therapy if MAP is ______ due to?

Answer 12

< 60
inadequate tissue perfusion

Question 13

one respiration =

Answer 13

one inspiration and one exhalation

Question 14

normal RR

Answer 14

12-18 respirations a minute

Question 15

terms related to observation of respiration:
- number of breaths per minute ______
- volume of air exchanged with each respiration ______
- regularity of pattern _____
- deviations from normal ______

Answer 15

• rate
• depth
• rhythm
• character

Question 16

normal body temp

Answer 16

96.8-99.3 F

Question 17

pulse ox measures _____
normal value?

Answer 17

blood oxygen levels, monitors pulse rate, and calculates HR

95-100%

Question 18

what is the most reliable indicator of pain?

Answer 18

self-report of pain
(subjective)

Question 19

what are signs of high ICP? do you mobilize when high?

Answer 19

headache, vomiting, secondary cell death
no

Question 20

what is normal ICP? severe?

Answer 20

4-15 (20) mmHg
>40

Question 21

if hemoglobin is ______ don’t ambulate

Answer 21

under 8

Question 22

what percentage of hematocrit is unsafe to ambulate pt?

Answer 22

<25%

Question 23

when do you hold therapy with abnormal INR?

Answer 23

5.0-6.0 (if too high)

Question 24

if the patient’s vitals are out of normal values do you automatically defer treatment?

Answer 24

no
consider other factors, meds, trend over 24 hours
ask! - clinic policy, patient’s feelings, nurse/MD opinion

Question 25

how can we address the challenges that neuro patients present?

Answer 25

develop standardized protocols monitor patients individually

Question 26

what are mobility goals for your patient?

Answer 26

get upright base them on level of function needed for independence based off diagnosis - what is realistic for this pt

Question 27

what is an arterial catheter and why must we as PTs be aware of this?

Answer 27

goes directly into an artery to measure BP when moving pt, if it gets pulled there will be heavy bleeding and physician will have to come to replace it

Question 28

if an art line is placed in the wrist, what may that limit? femoral artery?

Answer 28

wrist: limits UE use of AD femoral: limits hip flexion (not past 60-80) and ability to sit

Question 29

what is a bolt drain? what must you consider when wanting to move a pt with a bolt drain?

Answer 29

allows for real time measurement of ICP hole drilled into skull to measure subarachnoid pressure pt with a bolt is usually too sick to mobilize --> consider PROM & monitor ICP carefully

Question 30

what is an external ventricular drain (EVD)? what must you consider when wanting to move a pt with an EVD?

Answer 30

measures ICP, drains CSF EVDs are calibrated to pt head position --> consult with team before mobilizing

Question 31

central venous catheters (central line) and peripherally inserted central catheter (PICC) are used in __?

Answer 31

delivering medication directly into circulatory system

Question 32

what must you consider when wanting to move a pt with a central line or PICC line?

Answer 32

they insert into the heart --> DO NOT pull them may cause arrythmias and pneumothorax if pulled, medication delivery becomes very difficult

Question 33

who are ventilators used for? if on a vent for more than _______ days, pts get a tracheostomy

Answer 33

patients who cannot adequately breath on their own 14-21 days

Question 34

what should you consider when wanting to move a pt on a vent?

Answer 34

vents are not very portable --> if ambulating, call RT high likelihood of desaturation (watch SpO2) and high risk of barotrauma consider buffer room before moving as there is a risk for other complications

Question 35

what is a high flow nasal cannula and what should you consider when wanting to move this pt?

Answer 35

way to deliver high amounts of oxygen without needing to intubate consider how much they can go up on their oxygen --> if at max it could tax the cardiopulm system and if you push them too hard the next step is intubation

Question 36

what is a fecal management system? what is a foley catheter?

Answer 36

collects fecal matter into a bag urine collection * both are gravity dependent

Question 37

what needs to be taken into consideration when moving a patient with a FMS bag or catheter?

Answer 37

easy to pull and messy and painful if pulled gravity dependent --> keep below waistline

Question 38

two types of feeding tubes are nasogastric (NG) and percutaneous endoscopic gastrostomy (PEG). describe where each is placed and if they are short or long term solutions?

Answer 38

NG: through nose to stomach. short term solution PEG: directly into abdomen. long term solution. *be cautious w/ gait belts

Question 39

what must you consider when working with a pt who has a feeding tube?

Answer 39

they are likely NPO --> do NOT give food or water, they may aspirate easy to pull consider malnutrition/weightloss

Question 40

what are 3 telemetry units and their considerations for moving?

Answer 40

VS, BP cuffs, pulse ox may get noise so double check findings look for changes in response to exercise portable --> can be unplugged