152-Wk5 Mobility, Assisted Ambulation, And Passive Range Of Motion - Janelle Ryma

Front 1

What is human mobility?

Back 1

movement of the body as a whole and the movement of body parts in relation to one another

Front 2

What are the benefits of mobility and exercise regarding the cardiovascular system?

Back 2

- increased blood flow

- heart strengthening

- increased venous return

- decreased resting heart rate

Front 3

What are the benefits of mobility and exercise regarding the pulmonary system?

Back 3

- increased oxygen carried to tissues

- easier breathing

- deeper breathing (increased diaphragm mobility)

Front 4

What are the benefits of mobility and exercise regarding the metabolic system?

Back 4

- increased basal metabolic rate

- increased metabolism of glucose and fatty acids

- increased heat and energy production

- increased motility

Front 5

What are the benefits of mobility and exercise regarding the musculoskeletal system?

Back 5

- increased range of motion

- increased muscle mass

- increased bone density

- increased muscle tone

Front 6

What are the benefits of mobility and exercise regarding activity tolerance?

Back 6

- increased tolerance to exercise and activity

- decreased fatigue

Front 7

What are the benefits of mobility and exercise regarding psychosocial factors?

Back 7

- more efficient response to stress

- decreased depression

Front 8

What amount of physical activity is required to remain healthy?

Back 8

adding up 60 minutes of activities a day in periods of at least 10 minutes each

Front 9

What percentage of Canadians are inactive?

Back 9

52%

Front 10

What are the effects of immobility on the respiratory system?

Back 10

- Decreased expansion of chest and lungs (shift in body fluid distribution)

- Stagnant secretions accumulating in bronchi and lungs = bacterial growth and pneumonia development

- Ineffective cough reflex = increased possibility of airway obstruction

Front 11

What are the effects of immobility on the cardiovascular system?

Back 11

- Orthostatic hypotension

- Thrombosis formation

- Venous stasis

- Damage to the vein walls = clot formation

Front 12

What are the effects of immobility on the musculoskeletal system?

Back 12

- Muscle wasting or loss of muscle mass

- Muscle atrophy, decreased muscle tone/strength/stability

- Decreased bone density leading to osteoporosis

- Joint contracture

Front 13

What are the effects of immobility on the integumentary system?

Back 13

- Pressure ulcers

Front 14

What are the effects of immobility on elimination?

Back 14

- Urinary stasis leading to UTIs

- Constipation

- Incontinence

- Kidney problems

Front 15

What are the effects of immobility on metabolism?

Back 15

- Metabolic rate disruption

- Imbalances of macronutrients, fluids, electrolytes, and calcium

- GI disturbances

Front 16

What are the effects of immobility on psychosocial factors?

Back 16

- Emotional and behavioral changes

- Sensory alterations

- Impaired ability to cope

- Changes in social behavior and interactions

- Concerns regarding role changes, loss of independence, altered self-concept, finances, family responsibilities, and future health can contribute to:
o Depression, feelings of isolation and loss
o Hopelessness, withdrawal
o Frustration, irritability, anger
o Anxiety
o Decreased coping skills, unreasonable dependence on others
o Disruption of normal sleep patterns
o Lack of appetite

- Psychological effects can influence: cardiac status,
nutritional intake, and recovery

Front 17

What are the developmental effects of immobility on infants and children?

Back 17

- developmental milestons not reached

- delayed/impaired speech

- impaired socialization

- decreased intellectual development

Front 18

What are the developmental effects of immobility on adolescents?

Back 18

- obesity

- social isolation

Front 19

What are the developmental effects of immobility on older adults?

Back 19

- loss of muscle strength

- decreased bone density

- increased risk of falls

- social isolation

Front 20

What 5 areas are addressed in the Management of Mobility?

Back 20

1.Health Promotion
2. Disease and Injury Prevention
3. Diagnosis and Treatment
4. Rehabilitative Care
5. Supportive Care

Front 21

What role can a nurse play in health promotion regarding mobility?

Back 21

- educate

- encourage

- fit and demonstrate how to use aids

- reorientate to health services

- incorporate family support

Front 22

Identify areas that currently require health promotion activities.

Back 22

- diabetes

- obesity

- osteoporosis

- fall prevention

- sports injury prevention

Front 23

What role can a nurse play in disease and injury prevention regarding mobility?

Back 23

- educate on safety

- implement a targetted intervention plan

- provide positive feedback

Front 24

What role can a nurse play in disease and injury prevention regarding immobility?

Back 24

- assess the client and environment

- increase or sustain current level of mobility

Front 25

What 3 levels exist in diagnosis and treatment of immobility?

Back 25

1. Primary Care (ex. First Aid - use of RICE)
2. Secondary Care (ex. seeing a specialist for nerve damage)
3. Tertiary Care (ex. ventilation of an immobile patient)

Front 26

What are the focuses of rehabilitative care?

Back 26

- initial focus is on prevention of complications from illness or injury
- once client has stabilized, the focus is on returning the client to previous level of functioning or assisting at their new level of functioning

Front 27

What role does the nurse play in rehabilitative care regarding mobility?

Back 27

- repositioning at least q2h

- reassurance and communication

- ROM and PROM exercises

- encourage use of aids

- encourage optimal use of ADLs

Front 28

What are the focuses of supportive care?

Back 28

- involves working with a client with chronic or progressive illness/disability

- focuses on providing support for the client in an institutional setting (long-term care), the community (adult day care setting), or their home (home care)

Front 29

What is the purpose of assisted ambulation?

Back 29

- to improve functional mobility by compensating for neuromuscular and skeletal problems (Balance, Strength,
Pain on weight bearing, Lower limb amputation, Postural instability)

- to enhance body functions

- to assist healing of fractures and other musculoskeletal problems

Front 30

What are 3 Gait Patterns of Weightbearing?

Back 30

1. FWB = Full Weight Bearing

2. NWB = Non Weight Bearing

3. PWB = Partial Weight Bearing

Front 31

What does WBAT stand for?

Back 31

weight bearing as tolerated

Front 32

What 3 terms describe touching the foot to the floor for balance?

Back 32

1. Feather WB
2. Shadow WB
3. Touch WB

Front 33

List 4 support devices.

Back 33

1. Parallel bars
2. Walkers
3. Crutches
4. Canes

Front 34

List 3 types of crutches.

Back 34

1. Axillary
2. Loughstrand or Forearm
3. Trough

Front 35

List 3 types of canes.

Back 35

1. Simple
2. Quadruped
3. Walkane

Front 36

List 4 support device accessories.

Back 36

1. Axillary pads
2. Crutch tips
3. Platform
4. Ice picks

Front 37

What must you consider when fitting crutches or canes?

Back 37

- Correct shoes

- Stand straight with crutches 5-8” to side

- Shoulders not elevated or depressed

- Arm hanging relaxed, elbow straight

- Crutch pads in place

- Crutch height

- Handgrip at distal wrist crease

Front 38

What are the 5 points of instructions on crutch/cane use?

Back 38

1. Verbal description
2. Demonstration
3. Verbal rehearsal
4. Observation of other clients
5. Trying it out

Front 39

How should a person use crutches going UP the stairs?

Back 39

- strong leg leads

- crutches always stay with injured side

Front 40

How should a person use crutches going DOWN the stairs?

Back 40

- injured leg leads

- crutches always stay on injured side

Front 41

What is guarding and how do nurses carry it out?

Back 41

- process of protecting a client from falling

- use safety belt and client’s shoulder as points of control

- stand to one side of client, holding belt at back, other hand in front on anterior shoulder (with crutches--near top of crutch)

Front 42

What are 3 instructions for using a walker?

Back 42

1. Increases the base of support

2. Height – same as crutch hand piece

3. Move walker ahead, then walk into it

Front 43

What are 3 common errors when using a walker?

Back 43

1. Pulling up on the walker

2. Moving walker too far forward

3. Stepping too close to the front of the walker

Front 44

What are 2 instructions for using a cane?

Back 44

1. Height – same method as for the crutch hand piece

2. Hold in opposite hand to problem lower limb (distributes weight)

Front 45

What are 4 benefits to assisted ambulation?

Back 45

1.Getting people up and moving is a VERY important part of their care


2. Minimizes ‘down time’

3. Improves client’s level of physical activity

4. Increases independence or decreases dependence

Front 46

Define full range of motion (FROM).

Back 46

extent of anatomical motion available at a joint

Front 47

Define active range of motion (AROM).

Back 47

movement of a body segment by voluntary muscle contraction

Front 48

Define active assisted range of motion (AAROM).

Back 48

movement produced by a combo of voluntary movement plus the assistance of an external force such as you

Front 49

Define passive range of motion (PROM).

Back 49

- involves NO voluntary muscle contraction

- movement is produced entirely by an external force

Front 50

Give examples of an external force.

Back 50

- Another part of the person’s body (eg an arm)

- A passive ROM machine

- Another person

Front 51

What happens when a joint is taken through its available range of motion?

Back 51

A number of structures are lengthened:
- Joint capsule
- Ligaments
- Muscles
- Blood vessels
- Nerves
- Skin

Synovial fluid is moved

Front 52

What is an indication of PROM and when might it occur?

Back 52

- the client is unable to move the body segment
- may happen with: paralysis, coma, post-operative, when AROM or AAROM is too painful

Front 53

What is the goal and benefit of PROM?

Back 53

to prevent or reduce complications arising from immobility

Front 54

What are some complications arising from immobility?

Back 54

- Joint capsule adhesions

- Decreased muscle extensibility

- Discomfort arising from immobility

Front 55

What are some limitations of PROM?

Back 55

- Will not increase ROM or muscle extensibility because you do not force movement beyond that which is readily available

- Will not increase muscle strength

Front 56

How can you incorporate active and passive ROM in daily care?

Back 56

- Be aware of client’s ROM limits and affect on function

- Encourage full active range using muscular activity with functional tasks (bridging, moving in bed, quads in sitting)

- Add gentle assist to reach end of range (shoulder elevation, hip and knee bending)

Front 57

What are 7 precautions to take when incorporating ROM into daily care?

Back 57

1. Know ‘normal’

2. Be aware of times when movement would delay tissue healing (bone fracture, recent tendon repair, recent skin graft)

3. History of subluxation or dislocation

4. Do not move joints at fast speeds or hastily

5. Pain may cause involuntary muscle spasm

6. Know what the client’s available range is

7. With spasticity (increased muscle tone due to central nervous system insult) the muscle resists movement;
Move slowly, pause and hold the position when resistance is great (or has increased) then continue if relaxation has occurred

Front 58

What are 10 general guidelines for application of PROM?

Back 58

1. Subjective Evaluation/History
2. Explanation and Consent
3. Prepare the environment
4. Prepare the client-comfortable position
5. Prepare self
6. Handling with firm, comfortable grip
7. Movement (pain-free, limb alignment, adequate support, non-forced)
8. Move slow
9. One rep better than none
10. Monitor response

Front 59

What are the benefits of encouraging independent functional activity?

Back 59

range, strength and function are maintained or improved