PS201 Week 7 Cue Cards - Early Mobilisation in Acute Care

Question-and-answer flashcards covering key concepts from the lecture notes on early mobilization in the acute care setting, including definitions, indications, risks, safety checks, and a case example.

In the acute care setting, what does 'mobilization' mean?

Progressing toward locomotion—from lying supine to sitting up, sitting out of bed, sitting in a chair, and walking away from the bed.

What is the typical early mobilization sequence after major surgery?

Bed edge to chest beside the bed, then walking on the spot, walking away from the bed, and progressing to walking for more than 15 minutes.

How does early mobilization benefit oxygen transport and delivery?

By changing position from supine to upright, diaphragmatic descent and tidal volume improve, lung compliance increases, secretions are cleared more effectively, enhancing oxygen entry.

Why must physiotherapists weigh respiratory and cardiovascular reserve before mobilizing a patient?

To ensure the patient has enough reserve to meet the increased demands of exercise and avoid adverse events.

How is 'mobilization' different in orthopedics compared to acute care?

In orthopedics it often means local joint movements; in acute care it refers to progressing toward locomotion and functional movement.

Name two common pulmonary effects of immobilization.

Atelectasis and reductions in lung volumes and respiratory muscle strength.

What are some cardiovascular changes associated with immobilization?

Loss of circulating blood volume, changes in hemoglobin, reduced cardiac size, orthostatic intolerance, venous stasis, and increased risk of DVT.

Define orthostatic hypotension in the mobilization context.

A drop in systolic blood pressure of at least 20 mmHg when moving from lying to upright.

What symptoms indicate orthostatic intolerance during mobilization?

Lightheadedness, dizziness, and vision changes (potential faintness).

What is vasovagal syncope and how can it present after surgery?

A parasympathetic (vagal) response causing a sudden drop in blood pressure and potential fainting, with pallor, sweating, and blurred vision.

How should mobilization be approached to minimize risk?

Gradually: sit on the edge of the bed, stand or march near the bed, then move to a chair; stop if intolerance signs appear and have assistance ready.

Give examples of situations where bed rest is justified in the acute setting.

Spinal fractures requiring immobilization, extensive burns with grafting, after insertion of lines, or after procedures like lumbar puncture.

What did the 1944 JAMA statement say about complete bed rest?

Bed rest is highly unphysiologic and hazardous except for specific indications and should be discontinued as early as possible.

What is the long-term effect of prolonged bed rest on bones?

Decreased bone density due to lack of gravitational loading; upright activity helps prevent demineralization.

List some pulmonary and cardiovascular negative effects of immobilization.

Pulmonary: atelectasis, reduced lung volumes, reduced respiratory muscle strength. Cardiovascular: reduced blood volume, changes in hemoglobin, smaller heart size, orthostatic intolerance, venous stasis, DVT risk.

What should a physiotherapist assess before initiating mobilization?

Cardiovascular and respiratory reserve, gas diffusion, muscle strength, skeletal stability, coordination; patient readiness, concerns, expectations; environmental factors and weight-bearing status.

In the AAA repair case, what factors influence the decision to mobilize?

SpO2 95% on 6 L/min O2, BP 100/50, HR 85, epidural anesthesia, moist weak cough, poor breath sounds—these affect oxygenation and hemodynamic stability.

What are key practical safety checks before mobilizing a patient for the first time?

Current cardiovascular/respiratory status, temperature, weight-bearing restrictions, nursing input, needed assistance and equipment, and the environment.

What environmental considerations are important during mobilization?

Remove obstacles, secure or prepare gait aids, ensure bed/chair setup is safe, maintain infection control (hand hygiene), and preserve patient comfort and privacy.

What is the overarching aim of early mobilization in acute care?

To safely promote locomotion and functional recovery through careful planning, assessment, monitoring, and patient-specific risk management.

ow do orthostatic hypotension and vasovagal syncope present during mobilization, and what is their general management?

Orthostatic Hypotension: A drop in systolic blood pressure of at least 20 mmHg20 mmHg when moving from lying to upright, leading to symptoms like lightheadedness, dizziness, or vision changes/faintness.

Vasovagal Syncope: A parasympathetic (vagal) response causing a sudden drop in blood pressure and heart rate, often leading to fainting, accompanied by pallor, sweating, and blurred vision, particularly post-surgery.

Management: Mobilize gradually (e.g., sit on bed edge, then stand/march near bed, then move to a chair). If signs of intolerance (lightheadedness, dizziness, pallor, sweating) appear, stop immediately, have the patient rest, sit down, or return to supine position with assistance.

Summarise historical bed-rest practices and the evolution to current recommendations

Historically, prolonged bed rest often for up to 2 months2 months was common post-surgery. However, the 1944 JAMA statement declared bed rest 'highly unphysiologic and hazardous'. Recommendations evolved, first shortening elective bed rest to 2 weeks2 weeks (e.g., after myocardial infarction) and now aiming for early mobilization within 12 hours12 hours post-operatively for many conditions. Current practice emphasizes minimizing bed rest as soon as safely possible.

identify key components of a safe mobilisation plan for a post-operative patient.

1. Data to Collect (Assessment):

   • Patient Status: Review current vitals (SpO2, BP, HR, temperature), pain levels, and respiratory status (e.g., cough effectiveness, breath sounds).

   • Medical Context: Identify weight-bearing restrictions, surgical precautions, presence of lines/drains, epidural status, and nursing input.

   • Patient Readiness: Assess cognitive function, patient concerns, and expectations.

   • Physiotherapist Assessment: Evaluate cardiovascular/respiratory reserve, gas diffusion, muscle strength, skeletal stability, and coordination.

2. Gradual Progression:

   • Begin by sitting on the edge of the bed (with feet supported if possible).

   • Progress to standing or marching near the bed.

   • Move to a chair for increasing periods.

   • Initiate ambulation (walking) gradually, increasing distance and duration.

   • Continuously monitor for signs of intolerance (e.g., lightheadedness, dizziness, pallor).

3. Safety Measures:

   • Assistance: Ensure adequate personnel are present (e.g., a second person if needed).

   • Environment: Clear obstacles, secure bed/chair brakes, prepare gait aids, and maintain infection control.

   • Monitoring: Vigilantly observe for signs of orthostatic hypotension or vasovagal syncope.

   • Response to Intolerance: If signs appear, immediately stop mobilisation, have the patient rest, sit down, or safely return to a supine position with assistance.

Define early mobilization in acute care and distinguish it from orthopedic interpretations.

In acute care, early mobilization refers to initiating a progression towards locomotion (from supine to sitting, standing, and walking) as soon as safely possible, often within hours post-operatively. In contrast, mobilization in orthopedics frequently refers to specific, local joint movements, such as range of motion exercises for a joint, rather than general functional progression towards ambulation of the whole patient.

What are the day-1 mobilization targets in oesophagogastrostomy protocols and according to the 2017 Australian survey findings?

Oesophagogastrostomy Protocol (Day 1): Patients should aim for sitting in a chair for 2 hours2 hours, standing on the spot for 5 minutes5 minutes, and walking for 20 meters20 meters.

2017 Australian Survey Findings (Median Day 1 Targets for post-operative patients):

• Sitting out of bed: 60 minutes60 minutes

• Standing from bed: 5 minutes5 minutes

• Walking distance: 30 meters30 meters

Explain the physiological impact of sitting up and upright positions on diaphragmatic excursion and tidal volume, and their significance for oxygen delivery.

When moving from a supine to an upright or sitting position, gravity assists the diaphragm's descent by pooling abdominal contents inferiorly, allowing for greater diaphragmatic excursion. This increased range of motion allows for more complete lung expansion, leading to an improved tidal volume (the amount of air inhaled or exhaled in a normal breath). The larger tidal volume and better lung expansion enhance gas exchange efficiency, increase lung compliance, and facilitate more effective clearance of respiratory secretions. Consequently, more oxygen can enter the bloodstream, improving overall oxygen transport and delivery to tissues, which is crucial for patient recovery and preventing pulmonary complications.