Body Positions and Mobilization Flashcards
What factors can lead to deconditioning?
Hospitilization: enforced bed rest, effects of illness, effects of medical treatment
Aging process: cardiopulm changes, muscle changes, comorbid conditions
Factors lead to deconditioned state due to the removal of gravitational and exercise stress
- threaten O2 transport/step in transport pathway
- lead to functional decline
What are 3 common pulmonary diseases involving increased fluid?
Pleural effusion: fluid around lungs in pleural space compresses lungs
Atelectasis: fluid/junk in the lungs
Ascites: abdominal fluid/swelling under diaphragm that decreases breathing in supine
What are the norm ranges for ABGs?
pH: 7.35-7.45
PaCO2: 35-45
HCO3: 22-26
-Respiratory problems: CO2 will be abnormal
Partially compensated bicarb will change to neutralize/add H ions
-Metabolic problems: HCO3 will be abnormal
Partially compensated CO2 will change to help neutralize
What are normal PO2 levels (partial pressure of oxygen)
Normal: 80-100
Hypoxemic if
What are the 3 types of atelectasis?
- Resorption: obstruction of airway results in resorption of oxygen trapped in dependent alveoli
- no impairment of blood flow through alveolar walls - Compression: pleural cavity partially/completely full of fluids
- tumors, blood, air. ex: pleural effusions - Contraction: local fibrotic changes in lung or pleura
- prevents full expansion. ex: pulmonary fibrosis
What is the difference in support of a venture mask vs. a nasal canula?
Venture mask goes up to 15L
Nasal canula goes up to 6 L only
What are normal hemodynamic responses to an assesment/objective exam?
RR: gravitational stress of EOB should increase ventilation and decrease RR
HR: if rapidly increase with symptoms means can’t keep up with BP drop
ECG: afib if 100 fast, uncontrolled with symptoms meaning decreased CO and BP
What are the factors involved in selecting an exercise program?
- Specificity: optimal improvement training stimulus SIMILAR to goals
- Overload: stimulus GREATER than what pt accustomed to
- Adaptation window: current abilities/amount of PREVIOUS training determines rate of improvement
- Mode: goal driven equipment use, aerobic/resistant, assitive devices
- Intensity: RPE, METS, peak HR%, rate-pressure product (angina threshold)
- Frequency: how often? determined by METS
- Duration: include warm up and cool down
- Progression: based on risk assessment, tests and procedures, and response to exercise
When determining frequency of exercise per week what is the criteria based on MET levels?
3 METS: 2-3/ day
3-5 METS: 1-2/day
>5 METS: 3-5/week for 20-30 min
7 METS: 5-7/week for 30-40 min
What is the Progressive Activity Plan for Phase 1 Rehab?
Day 1: CCU
- MET level 1-2
- Activity: bed rest, oob-chair, bedside commode
Day 2: step-down unit
- MET level 2-3
- Activity: CCU activities, emphasize self-care, sitting warm ups, walking in room
Day 3
- MET level 2-3
- Activity: OOB as tolerated, standing warm ups, walk 5-10 mins in hall 2-3xday
Day 4
- MET level 3-4
- Activity: shower with seat, standing warm ups, walk 5-10 min in hall 3-4xday, one flight of stairs or treadmill walk
What are guidelines for EARLY mobility in Phase 1 rehab?
Toilet: bedpan, commode, urinal
1-2 METS; HR increase 5-15bpm
Bathing: bed bath, tub, shower
2-3 METS; HR increase 10-20bpm
Walking: flat surface 2 mph 2-2.5 METS 2.5mph 2.5-2.9 METS 3mph 3-3.3 METS HR increase 5-15 bpm for all
UE exercise: standing
Arms 2.6-3.1 METS
Trunk 2-2.2 METS
HR increase 10-20bpm
Leg exercises
2.5-4.5 METS; 15-25bpm
Stairs: 12 steps
Down 2.5 METS; 10bpm
Up 4.0 METS 10-25 bpm
Treatment possibilities for Ventilatory Pump Dysfunctions
- Position and mobility to increase O2 transport
- Correct biomechanics
- Breathing inhibition techniques: biofeedback, tactile cues to accessory muscles
- Facilitation techniques: pursed lip, diaphragm, sniff, segmental, air stack
- Airway clearing techniques
- Supplemental oxygen
- Exercise retraining
