After a pt has had surgery it is very important that we get them up and mobilize them as fast as possible. However after surgery some pts are given an epidural to relieve pain. This presents a problem for physios because it often causes low BP in theses pts.
In my first week on the general surgery ward I was helping my supervisor mobilise a Day 1 post-op pt who had an epidural. After speaking with the nurse we decided that we would attempt to get the pt out of bed and walk them a few metres to the shower. Before we started the nurse took the pts obs and everything was WNL except their BP was only 106/70. After discussing it with my supervisor we decided that we would still get the pt up and that we would just take it slowly and monitor for any signs of dizziness or light headedness. I assisted the pt to move from supine lying to SOEB and once there asked about dizziness. The pt replied that her pain levels had increased but that they felt no dizziness. After sitting and dangling their legs for a few minutes we decided to attempt to stand up. We managed to stand the pt up and the pt still reported that they did not feel light headed or dizzy. The pt then marched on the spot a few times and then with my supervisor guarding the patient and me standing nearby pulling the oxygen bottle we started to take a few steps towards the bathroom. At this point the pt started complaining of feeling very nauseous and faint. As I was walking in front of the pt I had to climb over all the pts attachments to get to the chair which was a few metres behind the pt. The pt didn’t pass out however they came very close but once they sat back down they felt fine.
This situation highlights the importance of setting up your treatment area because it would have been much easier if we had a chair closer or if I had been following behind with the oxygen bottle so I wouldn’t have had to climb over the attachments and risk pulling them out, to get to the chair. It also enforces how important it is to have 2 therapists with a day 1 pt because they can go from feeling good to feeling sick in a few seconds.
In this case where the pts BP is borderline it is a tough decision as to whether or not the advantages of early mobilization outweigh the risks. In this situation we decided to proceed with the treatment and although we constantly questioned the pt regarding symptoms of dizziness, it was nausea that made the pt feel faint in the end. This also shows how important it is to question the patient about all different symptoms.
When pts BP is that low what have other people been told to do; bed exercises or get the pt up?
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The main thing thats stopped me from getting pt's out of bed has been low hb and then I just do bed ex's and DBEs. With low BP, depending on how low and what the trend has been like and whats normal for the pt, I've mostly been told to see how they go sitting over the edge of the bed, followed by marching on the spot and if thats all going well then going for a short walk, monitoring symptoms and pulling a commode behind in case they start feeling light headed and dizzy. On a surgery ward this may mean you need 3 people if you have too many attachments to deal with. So basically the same as what you had to do.
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