Permissive Hypertension, Hypoperfusion, and Early Poststroke Mobility
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The past 10 years of acute stroke interventions have been revolutionary, including the use of poststroke blood pressure management to influence recovery. There has been a recent focus on early mobility of patients with acute stroke and blood pressure control. “Permissive hypertension” has crept into our practice considerations with a variety of parameters in the literature, forcing each entity to choose their own risk/reward answer to patient mobility questions. New American Heart Association/American Stroke Association guidelines allow some direction for blood pressure management at rest, but therapists may be responsible for mobility decisions and may feel pressured into high-risk situations to evaluate and treat their patients. A multidisciplinary, multi-site panel will discuss current stroke literature highlighting permissive hypertension, the hazards of hypoperfusion, and early patient mobility. Speakers, including a comprehensive stroke coordinator, will present a well-rounded view of critical reasoning for best patient care and the importance of communication illustrated by case studies. Presenters will examine legal, ethical, and practical concerns regarding risk of mobility and poststroke blood pressure control. Therapists will take away crucial information regarding early blood pressure control and tips for communicating concerns.
Learning Objectives:
- Explain protective reasoning for blood pressure control and the effects on vulnerable neurologic tissue in the acute poststroke phase.
- Identify blood pressure control statements from the guidelines for the early management of patients with acute ischemic stroke from the from the American Heart Association/American Stroke Association and differing views from other organizations for mobility.
- Recognize signs and symptoms of hyper/hypotension dysfunction in patients with an acute stroke and apply critical reasoning for mobility treatment strategies.
- Incorporate team-based communication for conflict resolution and safe progression of mobility of patients with labile blood pressure.
Kimberly Lemmons
PT, DPT, CSRS
Kimberly is a Board-Certified Clinical Specialist of Neurologic Physical Therapy with experience throughout the continuum of patient recovery. Her passion for neurology began with the creation of a hospital-based out-patient spinal cord injury treatment program. Currently, her clinical focus is on neurologic recovery in acute care. As a specialist, Dr. Lemmons has been a representative of therapy services to several interdisciplinary stroke councils at Primary and Comprehensive Stroke Centers. She enjoys leading educational opportunities for interprofessional knowledge exchanges. She is active member of the APTA and has been a credentialed clinical instructor for more than 10 years. Dr. Lemmons also lectures regularly at the University of North Texas Health Science Center. Her areas of community outreach include local stroke support groups and presenting safe mobility techniques with the Alzheimer's Association. Dr. Lemmons is currently involved in research for post-stroke recovery in acute care. She graduated with her Masters of Physical Therapy from California State University, Northridge and her Doctorate of Physical Therapy from University of Tennessee, Chattanooga.
Lara A Firrone
PT, NCS
Lara holds a BS in Psychology from Memphis State/University of Memphis and a BS in PT from University of Tennessee Health Science Center Memphis. She is a Neurological Clinical Specialist, initial in 2006 and renewed in 2016. She is a member of the APTA including the sections/academies for Acute Care and Neurology. She holds a certificate for CAPS, certified aging in place specialist via the National Home Builders Association and completed an executive certificate in Home Modification from University of Southern California Leonard Davis School of Gerontology. She wrote a section in a chapter in the textbook Pathology: Implications for the Physical Therapist, 4th ed by Goodman and Fuller. She practices at Methodist LeBonheur Healthcare University Hospital with primary role of staff PT for the stroke unit, including creating evidence based practice training and competencies for the rehab department. She also provides to MLH lectures and educational support related to care of the patient with neurological deficits, including dementia and Parkinson. She has done outreach with MLH and AARP for stroke and aging in place.
Katrina Key
PT, DPT
Katrina has been practicing in acute care for over 10 years at a Level 2 trauma hospital. She has extensive experience in progression of the ICU patient for a variety of diagnoses including neurologic, cardiac, and multi-trauma. Her clinical focus is on evidence-based practices and optimal care of the medically complex patient. She was integral in the inclusion of therapy services during Patient Care Rounds in multiple ICU settings and other programs including Safe Patient Handling and bariatric programs. Her impact extends to correct patient care equipment utilization and multiple opportunities of interdisciplinary presentations for staff education, especially in the care of the ICU patient. Her professional certifications include Neuro-IFRAH and McKenzie A and B. Katrina is also a certified clinical instructor and enjoys taking on students for acute care experiences. Prior to her physical therapy career, she received her Masters in Education from Drury University with an emphasis in Physical Education. She has taught Integrated Sciences at the high school level and Kinesiology while coaching women's basketball at Midland Community College.
James Ryan
RN
James is a licensed Advanced Practice Registered Nurse with a Master of Science in Nursing from the University of Southern Alabama and a board-certified Adult/Geriatric Clinical Nurse Specialist. He is also certified in Stroke by American Nurses Credentialing Center. He is the Stroke Program Coordinator at a high-volume Joint Commission Comprehensive Stroke Center in Fort Worth, Texas where he partners with other healthcare professionals to improve the care for Stroke patients and families. After having seen his Grandfather and Aunt both recover from Strokes in the home, he is aware of the impact Stroke has on the person and the whole family.
Course Instructions
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- Click the Take Quiz button to complete the assessment. Learners will have 3 attempts to pass and must answer at least 70% of questions correctly.
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