Vital Signs and Lab Values for Early Mobilization Flashcards
What is our role at a PT?
prevent decline with early mobilization
Delayed treatment with neurologic patients can lead to barriers in recovery time and compensation: _________ neuroplasticity principle
time matters
Cardiovascular systems review
HR, RR, and BP
Temp
Pulse Oximetry (O2)
Pain
Heart rate/ pulse
def:
normal values:
movement of blood in an artery
Adult: 60 to 100 BPM
Blood Pressure (BP) normal values:
120/80 mm Hg
Acute Hypertensive Crisis is an URGENT referral. T or F
false: Emergency
Another name for positional or postural hypotension
orthostatic hypotension
Orthostatic Hypotension:
form of low blood pressure that happens when you stand up from sitting, sit up from lying down
what is the therapeutic window?
spontaneous recovery and neuroplasticity have been shown greatest in patients 3-6 months post stroke
start with ______ intensity early
light
what are 3 clinical signs of orthostatic hypotension?
- systolic decrease/drop of 20 mmHg
- diastolic decrease/drop of 10 mmHg
- within 3 min of positional change
hold therapy if MAP is ______ due to?
< 60
inadequate tissue perfusion
one respiration =
one inspiration and one exhalation
normal RR
12-18 respirations a minute
terms related to observation of respiration:
- number of breaths per minute ______
- volume of air exchanged with each respiration ______
- regularity of pattern _____
- deviations from normal ______
- rate
- depth
- rhythm
- character
normal body temp
96.8-99.3 F
pulse ox measures _____
normal value?
blood oxygen levels, monitors pulse rate, and calculates HR
95-100%
what is the most reliable indicator of pain?
self-report of pain
(subjective)
what are signs of high ICP? do you mobilize when high?
headache, vomiting, secondary cell death
no
what is normal ICP? severe?
4-15 (20) mmHg
>40
if hemoglobin is ______ don’t ambulate
under 8
what percentage of hematocrit is unsafe to ambulate pt?
<25%
when do you hold therapy with abnormal INR?
5.0-6.0 (if too high)
if the patient’s vitals are out of normal values do you automatically defer treatment?
no
consider other factors, meds, trend over 24 hours
ask! - clinic policy, patient’s feelings, nurse/MD opinion
how can we address the challenges that neuro patients present?
develop standardized protocols
monitor patients individually
what are mobility goals for your patient?
get upright
base them on level of function needed for independence
based off diagnosis - what is realistic for this pt
what is an arterial catheter and why must we as PTs be aware of this?
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
if an art line is placed in the wrist, what may that limit?
femoral artery?
wrist: limits UE use of AD
femoral: limits hip flexion (not past 60-80) and ability to sit
what is a bolt drain? what must you consider when wanting to move a pt with a bolt drain?
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
what is an external ventricular drain (EVD)?
what must you consider when wanting to move a pt with an EVD?
measures ICP, drains CSF
EVDs are calibrated to pt head position –> consult with team before mobilizing
central venous catheters (central line) and peripherally inserted central catheter (PICC) are used in __?
delivering medication directly into circulatory system
what must you consider when wanting to move a pt with a central line or PICC line?
they insert into the heart –> DO NOT pull them
may cause arrythmias and pneumothorax
if pulled, medication delivery becomes very difficult
who are ventilators used for? if on a vent for more than _______ days, pts get a tracheostomy
patients who cannot adequately breath on their own
14-21 days
what should you consider when wanting to move a pt on a vent?
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
what is a high flow nasal cannula and what should you consider when wanting to move this pt?
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
what is a fecal management system? what is a foley catheter?
collects fecal matter into a bag
urine collection
* both are gravity dependent
what needs to be taken into consideration when moving a patient with a FMS bag or catheter?
easy to pull and messy and painful if pulled
gravity dependent –> keep below waistline
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?
NG:
through nose to stomach. short term solution
PEG:
directly into abdomen. long term solution. *be cautious w/ gait belts
what must you consider when working with a pt who has a feeding tube?
they are likely NPO –> do NOT give food or water, they may aspirate
easy to pull
consider malnutrition/weightloss
what are 3 telemetry units and their considerations for moving?
VS, BP cuffs, pulse ox
may get noise so double check findings
look for changes in response to exercise
portable –> can be unplugged
