OT and acute care

Monitoring your clients in acute care

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Another post in my series for OTs working in acute care

Cheat sheet for OTs: Monitoring medical status

There are many tools available to an OT who works in a medical setting. These tools can help make clinical decisions about intervention.  Here are the most accessible ones…

HEART RATE

How fast is the heart beating? The pre-OT session values tells us who is appropriate for higher demanding activities;  post-OT session values tells us how well your client tolerated the OT session.

NORMAL resting values (proceed with occupational therapy interventions):

  • 50-100 (age and medicationss will impact resting heart rate)

Resting HR values that may be a reason to MODIFY occupational therapy interventions:

  • RHR >100 (except for special cases such as heart transplant patients – safest bet is to get medical OK before working with patients with HR >100)

HR values that are a CONCERN. You should stop OT intervention and notify medical staff:

  • >120 resting heart rate associated with other symptoms that are not expected;
  • Drop of >15 beats per minute with activity;
  • Cardiac patients who have an increase to >125 BPM with minimal exertion

BLOOD PRESSURE

How is the heart keeping up with the body’s demands? You want to know if the pressure in the chambers of the heart responds normally to activity and returns to normal after activity, in particular, diastolic numbers.

NORMAL resting BP values (proceed with occupational therapy interventions):

  • <135 Systolic
  • <85 Diastolic

BP values that may be a reason to MODIFY occupational therapy interventions:

  • >150 Systolic (at rest) or <90 (at rest)
  • >90 Diastolic (at rest)
  • Remember that beta-blockers lead to lower BP response
  • >200 Systolic (with activity)
  • >100 Diastolic (with activity)
  • Systolic drop >10 from rest

BP values that are a CONCERN. You should stop OT intervention and notify medical staff (some of these values might be expected, it is always better to have an MD order if you are going to work with someone with these values):

  • >200 Systolic (at rest)
  • >110 Diastolic (at rest)
  • <80 with symptoms
  • >210 Systolic (with activity)
  • >110 Diastolic (with activity)
  • Systolic drop >15 from rest

BLOOD O2 SATURATION

Oxygen levels tell us how well the blood is carrying oxygen to provide fuel for activity.

NORMAL resting O2 values (proceed as planned with occupational therapy interventions):  

  • 93-94%

Resting O2 values that may indicate a reason to MODIFY or hold therapy:

  • <90% at rest; however, some clients are at these levels at baseline, make sure you get medical clearance prior to working with them in any strenuous activities

O2 values that are a CONCERN. You should stop OT intervention and notify medical staff:

  • Drop of greater than 4% with activity;
  • O2 values <88% with activity.

RESPIRATORY RATE

Tells us how well a client is tolerating activity (or not!).  An increase in RR is normal with activity that is moderate to strenuous.  An increase in RR that is not expected is a problem.

NORMAL resting values (proceed with occupational therapy interventions):

  • 12-20 breaths per minute (will depend on age, meds, etc.)

RR that may be a reason to MODIFY occupational therapy interventions:

  • >25 BPM <12 BPM
  • Mild dyspnea at rest
  • Moderate dyspnea with activity

When respiratory rate is a CONCERN. You should stop OT intervention and notify medical staff:

  • Moderate dyspnea at rest
  • Severe SOB with activity

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