Week 12.2 - Safe mobilisation of scutely ill patients Flashcards
List the general considerations that must be made when mobilising an acutely ill patient
Cardiovascular
Respiratory
Heamatological and metaboli
Subjective
How does the cardiovascular consideration, Heart rate affect physio treatment
HR will increase when SOOB and mobilising. If it increases to much and signs of CV stress (SOB, chest pain, faint, clammy) - may need to pause
If it decreases or doesn’t Increase and there is CV stress - CEASE mobilisation
What do we have to consider about BP when mobilisation
What for signs of Orthostatic Intolerance
remember the effect of inotropes
If BP drops significantly during treatment - cease or modify mobilisation
Look at cardiac status. List potentially things that you should take care with or modify your treatment for
Recent AMI - within 2 days Unstable Angina Uncontrolled Arrythimia Severe symptomatic sternoisis Uncontrolled symptomatic heart failure Acute PE or pulmonary infarction Suspected/ known dissecting aneurysm Acute infections
Should you be monitoring ECG’s when you are mobilisation a patient? Isn’t that the nurses job?
Yes you should be monitoring. Monitor for more than the occasional VEB Runs of VT Atrial fibrillation New ST segment changes and symptoms
What are the levels of PAo2/ FiO@ ratio you should be thinking about for mobilisation
If > 300 - safe to mobilise
200-300 - marginal respiratory reserve , be careful
<200 - no reserve, hazardous to mobilise
monitor SpO2 during and after mobilisation aswell
Should a Chronic Hympercapnic person be mobilised
Yes! DOn’t need to worry about their PaCO2. Maybe still monitor if you can
What should you do if you go in and the patient has an acute rise in PaCo2?
THis is respiratory failure. This will liit mobilisation as it can alter the consciousness
Does Respiratory pattern affect treatment including mobilisation
can should seterioration of respiratory function. Don’t ignore this. Look at patient and respond to visual clues
Do Hb levels affect mobilisation?
No absolute value prevents. If there is an acute fall in Hb probably and acute or recent bleeding and you should delay mobilisation
Do Platelet counts affect mobiliation
if < 20000 potential increase in BP as a reult, therefore avoid mobilisation.
If there is an acute drop means there is active or recent bleeding so should delay mobilisation
Does WBC could affect mobiliation?
No, just note well that there may be an increase demand in O2 demand while fighting infection
What affect does fever have on physiotherpay treatment
You can still mobilise etc just remember that as the temperature increase so does the consumption of O2
How does blood glucose levels affect mobilisation
Check blood glucose levels in at risk patients before mobiliation. If too hypoglycemic it can cause unconsciousness
If too much not good for diabetes and may cause loss of consciousness too
What should you take into accoun on a neurological basis
Consciousness, muscle strength, neurological procedures, contraindications/ precautions to be aware of
Care if the have balance issues
