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Barriers to Mobility

Physiotherapy Tech In-Service Training

Ash Brownett

on 14 July 2015

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Transcript of Barriers to Mobility

Barriers To Mobilising Patients
By Ash Brownett | Physiotherapy Technical Instructor
Hb - Haemogolobin
C - Reactive Protein (CRP)
Blood pH
Potassium (K+)
White Blood Cells
Blood Pressure
Oxygen Saturation (SpO2)
Respiratory Rate - Most Important Observation
Heart Rate
Blood Glucose Measuring (BM)



Red Blood Cells
Other Considerations To Think About
Confusion Levels - Acute Delirium
Attachments - Drips, Drains, Lines
Analgesia - Effective Pain Relief
Portable Oxygen
Walking Aids
Parkinson's - Medication on Time
These are your immune system cells
Normal range is 4-11 x10^9/L
5 different types; Neutrophils, Lymphocytes, Eosinophils, Monocytes and Basophils.
If raised indicate infection or Leukaemias.
Neutorphils indicate Bacterial infection
Lymphocytes indicate Viral infections
Eosinophils - seen in parasitic infections
Steroid use will lower numbers of WBCs
Normal levels are between 3.5 and 5.0 mmol/L
Hyperkalaemia is >6.5 mmol/L and is a medical emergency as it can lead to myocardial hyperexcitation, and can lead to ventricular fibrilation and cardiac arrest! Caused by Renal Failure and damaged cells

Hypokalaemia is <2.5 mmol/L this can also cause arrhythmias and muscle weakness, cramps and light headedness. Due to vomiting and diarrhoea
International Normalised Ratio
This is a measure of how well your blood clots, it is used routinely with patients on anticoagulants such as Warfarin, Heparin, Aspirin etc.
Normal range: 0.9-1.2
If 2 or above indicates treatment required for anti-coagulation.
If 3 or above will have a serious delay in clotting time.
This is just one of several test to identify anti-coagulation abilities.
Blood pH has to be kept between a very narrow range.
Normal range: 7.35 - 7.45 (Slightly Alkaline)

Components in the blood adjust the pH, especially the blood gas carbon dioxide.
Increased levels of CO2 results in acidosis (<7.35)
Decreased levels of CO2 or increased levels in the base HCO3 results in metabolic alkalosis (>7.45).
Very important to regulate for all enzymes in the body.
Made up of Troponin I and Troponin T
Most sensitive and specific markers of myocardial damage indicating heart attack.
Released by necrotic cardiac tissue.
Initial rise within 4-6 hours.
Remains elevated for 10-14 days.
Normal levels: Troponin T < 0.1ug/L
Any raise indicates cardiac damage
Use along side Creatine Kinase to diagnose.
Platelets are responsible for clotting and stopping of bleeding.
Normal range: 150-400 x10^9/L
<50 x10^9/L can result in bruising very easily
<20 x10^9/L can results in spontaneous bleeding and if severe inter-cranial haemorrhage.
Too many platelets lead to inappropriate clotting (DVT/PE).
If patient remains still for too long platelets tend to clump together.
Useful in monitoring inflammation and infection
Normal levels: <8mg/L
Mild inflammation levels: 10-50mg/L
Active bacterial infection: 50-200mg/L
Severe infection or Trauma: >200mg/L

For monitoring infections CRP should be used along side white blood cell results although these may take > 48 hours to show and increase.
To test the quality of red blood cells a Full Blood count is requested and is made up of several tests
MCV: Mean Cell Volume - (size of RBC)
Haematocrit: Measures proportion of RBC in sample
Hb: Haemoglobin concentration in blood
MCH: Mean corpuscular Hb, amount of Hb in each RBC
Red blood cells last ~120 days, removed by spleen.
Normal RBC level: 2-3 x10^13
Lower indicated anaemia, higher indicates leukemia
Oxygen carrying component in red blood cell
Normal levels in Men: 13.8 to 18.0 g/dL Normal levels in Women: 12.1 to 15.1 g/dL The measurement of Hb can be affected by either dehydration or hyperhydration.
Albumin test can indicate hydration status.
Low Hb will cause anaemia and can have symptoms of shortness of breath, fatigue, feeling dizzy and syncope.
D - Dimer
Will be present if there is any inappropriate clotting.
The bigger the number the bigger the clot.
May be raised in pregnancy and post surgery.
If not raised can exclude inappropriate clotting.
Not specific for DVT/PE so other clinical investigations are required.
Normal levels: < or =250 ng/mL
BSc Biomedical Science (Hons) | Trauma and Orthopaedic Team
Blood pressure is made up of two numbers, Systolic (larger number)and Diastolic (smaller number)
Systolic is the more important number as it indicates the push from the left ventricle of the heart.
A Systolic BP below 100mmHg is classed as hypotension.
If mobilised there is a risk of syncope.
Other signs and symptoms include feeling dizzy, especially in postural changes, e.g. lying to standing, cold extremities and feeling tired.
A systolic BP of > 160mmHg is classed as Hypertension, less of a problem for mobilising but will increase risks of heart attack and stroke.
Heart rate has a wide range of normal depending on numerous factors.
Tachycardia is classed as a resting heart rate of >100bpm
Bradycardia is classed as a resting heart rate of < 60bpm
The heart rate can also be irregular or regular.
Atrial Fibrillation is an irregular pattern of contraction.
If a patient is in fast AF (irregular >120bpm) DO NOT MOBILISE the patient as you don't want to increase the heart rate any further.
It can lead to Ventricular Tachycardia and other heart rhythms that can be fatal or required defibrillation.
Normal range > 95% on room air
For COPD patients - aim for 88-92%.
If a patient desaturates below 95% SpO2 then oxygen may be given to ensure hypoxia does not develop. (Remember to record amount of oxygen)
It is important to keep COPD patients within a lower range of oxygen as if given too much they will start to retain CO2.
Temperature fluctuates throughout the day and night
Normal values are between 36.0 degrees C and 37.8 degrees C.
It is normally at is highest during our working day and at the lowest half way through our sleep.
Anything above 37.8 degrees C would be classed as pyrexia (hyperthermia).
Anything below 36 degrees C would be considered hypothermia.
Respiratory rate is the number of breaths taken within a minute.
Normal rate is between 12-20 breaths per minute
An increased respiratory rate is termed tachypnea >20 bpm
A lower than normal respiratory rate is termed bradypnea. < 12 bpm

It is one of the most poorly recorded observations in hospitals.
BUT it is the most important of all the observations in patient monitoring as it can indicate early on if your patient is becoming unwell.
It is the first observation to show any change in the acutely unwell patient. All other observations, HR, BP etc. have compensatory systems built in, so takes more time to show any changes.
The normal blood glucose level in humans is about 4 mmol/LThe body, when operating normally, restores the blood sugar level to a range of about 4.4 to 6.1 mmol/L. Shortly after eating the blood glucose level may rise temporarily up to 7.8 mmol/L.

Hypoglycaemiaia is < 3.5 mmol/L although symptoms are not normally seen until < 2.0 mmol/L. Symptoms include confusion, fatigue, seizures, unconsciousness and if untreated death.
Hyperglycaemia is >7.0 mmol/L, in the acute setting there are no severe problems, but long term can lead to damage to organs, eyes, and neuropathies in hands and feet.
Any Questions?
Basic Observations
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