Cardiology

The important aspect of this floor is to assess if the patient cardiovascular system is appropriate for the challenge of mobilization. And to monitor signs and symptoms to exercise the patient to a moderate level of exertion.

Charting

Lab values: Check the troponin level, Potassium level

Vitals trends: BP, SPO2, HR

The trend of the troponin lab value is more important than the actual number itself. Larger readings are a bad sign and progressively smaller readings may indicate the patient is stabilizing. If there is only one reading and it’s above 0.02, the patient may not be appropriate to see.

Abnormal potassium levels means the patient is at greater risk of a cardiac arrhythmia. Ask the nurse if there are doctors orders to address it before you see the patient

Cardiac Surgeries and Precautions

Open chest surgery (CABG, heart transplant, certain valve procedures)

• Updated precautions: Keep elbows close to the sides to avoid using chest muscles, logroll for bed mobility and no lifting > 5 lbs.
• Conservative precautions: No shoulder flexion past 90 degrees, pushing, pulling, or lifting > 5 lbs
  • Some hospitals still use this for all sternotomies
  • This should be used for redo sternotomies or for patients with comorbidities with delayed healing (diabetes, cancer etc)

Thoracotomies

• no restrictions
• may experience pain with shoulder flexion/abduction

Pacemaker surgery

• No pushing, pulling or lifting >5lbs, no shoulder flexion/abduction above 90 degrees on side of procedure
• Teach Adaptive technique for UB dressing and bathing

Treatments

• Take orthostatics and vitals
• Engage in warm up exercises before mobilization
• Check for loss of range of motion or sensation due to edema
• Be aware of signs and symptoms of overexertion to cue patient to rest

For patients who have received stents, it would be helpful to check on their blood flow

• Pulses, dependent rubor, sensation