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272 Cards in this Set
- Front
- Back
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How does immobility affect the heart and vessels
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venous stasis
edema Virchow's triad orthostatic hypotension thrombosis/embolus |
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define orthostatic hypotension
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prolonged bedrest inactivates baroreceptors involved with constriction and dilation of the blood vessels
causing a person who has been immobilized to be less able to maintain their blood pressure when they change positions may feel dizzy and light-headed and be unable to support his weight |
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problems with edema due to immobility
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fluid in tissue is more prone to injury
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why does immobility cause edema
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force of gravity causes blood to pool in the periphery
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what is virchow's triad
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stasis
activation of clotting and vessel injury associated with a greater chance of thrombus formation |
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what is an example of thrombus formation
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deep vein thrombosis
caused by Virchow's triad |
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what is the valsava meaneuver
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increase pressure to expel feces by contracting abdominal muscles (straining) while maintaining a closed airway (holding breath)
raises blood pressure increases risk for cardiac arythmias |
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Who should be cautioned against valsava maneuver
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pts with:
heart disease glaucoma increased intracranial pressure new surgical wound |
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what problems does immobility cause on respiratory system
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atelactasis
pneumonia - less able to cough and discard secretions |
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what problems does immobility cause on metabolism
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decreased energy needs
negative nitrogen balance anorexia |
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why does immobility cause decreased energy needs
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inactivity increases levels of serum lactic acid and decreases adenosine triphosphate concentrations
as ATP decreases the body's energy reserves do, too, which causes: metabolic rates to drop protein and glcogen synthesis decreases and fat stores increase |
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how does immobility cause integument problems
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extrenal pressure from lying in 1 position compresses capillaries in skin, obstructing skin circulation
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lack of circulation to skin causes
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skin ischemia and possibly necrosis
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how does immobility affect gastrointestinal system
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slows peristalsis causing constipation, gas, difficulty evacuating
paralytic ileus |
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what happens when peristalsis slows
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appetite diminishes
food is digested slowly causes decreased calorie intake and inability to meet proetin needs body muscle is broken down causing wasting |
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How does immobility affect geniturinary
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supine position inhibits drainage of urine from renal pelvis and bladder
urine becomes stagnant increases infection risk and kidney stone formation decrease in bladder tone - difficulty voiding in bedpan or urinal |
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who needs a mobility assessment
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any pt who has:
musculoskeletal concerns obesity confined to bed or home |
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what should be included in nursing history for immobility
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usual activity
fitness goals mobility problems underlying health problems lifetsyle external factors |
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When a patient has extremely limited activity you should assess
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ADLs - activities of daily living
IADLs - instrumental activities of daily living |
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atrophy
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decrease in size of muscle tissue due to lack of use or loss of innervation
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clonus
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spasmodic contraction of opposing muscles resulting in tremorous movement
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flacidity
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decrease or absence of muscle tone
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hemiplegia
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paralysis of one side of the body
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hypertrophy
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increase in size or bulk of a muscle or organ
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paraplegia
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paralysis of the lower portion of the trunk and both legs
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paresis
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partial or incomplete paralysis
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paresthesia
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numbness, tingling, or burning due to injury of the nerve(s) innervating the affected area
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quadriplegia
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paralysis of all 4 extremities
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spasticity
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motor disorder characterized by increased muscle tone, exagerrated tendon jerks, and clonus
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tremor
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involuntary quivering movement of a body part
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important data to include in a focused physical assessment of immobility
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vitals
height/weight BMI body alignment joint function gait muscle strength activity tolerance ***observe for pain, inflammation, and mobility limitations |
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FIM scale
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functional independence measure
used to measure multiple areas of a patient's care needs ADLs mobility problem solving memory patients are scored for baseline on admissions and the serially until discharge and later in home oroutpatient setting |
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abnormal gaits
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antalgic
propulsive scissors spastic steppage waddling |
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antalgic gait
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limp to avoid pain when bearing on weight on the affected side
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propulsive gait
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stooped, rigid posture, with head and neck bent forward; movement forward is by small, shuffling steps with involuntary acceleration also known as festinating gait
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what disease is propulsive gait common in
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Parkinson's
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scissors gait
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legs flexed slightly at hips and knees with thighs crossing in scissors like movement
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scissors gait is common in
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cerebral palsy
stroke spinal tumor |
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spastic gait
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stiff, foot dragging walk caused by one-sided, long-term, muscle contraction
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spastic gait is common in
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cerebral palsy
head trauma brain tumor |
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steppage gait
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an exaggerated motion of lifting the leg to avoid scraping the toes of a foot with foot drop - foot appears floppy with toes pointing down
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steppage gait is seen in
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Guillian Barre Syndrome
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waddling gait
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distinctive rolling motion in which the opposite hip drops
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waddling gait is seen in
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muscular dystrophy
developmental dysplasia of hip late pregnancy |
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nursing diagnosis that describe activity and exercise problems specifically
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activity intolerance
impaired physical mobility risk for disuse syndrome sedentary lifestyle |
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activity intolerance
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pt has insufficient physical or psychological energy to carry out daily activities
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disuse syndrome
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when a patient's prescribed or unavoidable activity creates risk for deterioration of other body systems
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specific nursing activities to promote exercise and mobility
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promoting exercise
preventing injury frome xercise positioning patients moving patients in bed transferring patients out of bed ROM exercises assisting with ambulation |
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how often is a change of position needed to prevent skin breakdown
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every 2 hours
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what kind of matress is best for immobile patients
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firm - makes it easier to turn
and supports pt's body |
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Fowler's position
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semisittingposition
head of bed elevated 45 degrees to 60 degrees promotes respiratory functioning by lowering diaphragm and allowing greatest chest expansion |
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semi-Fowler's position
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head of bed is only at 30 degrees
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high Fowler's position
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head of bed is elevated 90 degrees
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orthopneic position
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head of bed is elevated 90 degrees and overbed table with a pillow on top is positioned in front of pt
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lateral position
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side lying position with top hip and knee in front of the rest of the body
creates pressure on lower scapula, ilum, and trochanter but relieves pressure from heels and sacrum |
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lateral recumbent position
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side lying with legs in straight line
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oblique position
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alternative to lateral position
places less pressure on trochanter pt turns on side with top hip and knee flexed however top leg is placed behind the body |
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prone position
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pt lies on his abdomen with his head turned to 1 side
allows full extension of hips and knees allows secretions to drain freelyfrom mouth |
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what type of patient is the prone position helpful for
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unconscious patient
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what is the most difficult position to move an unconscious or frail patient into
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prone position
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Sim's position
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semiprone position
lower arm is positioned behind pt, and upper arm is flexed upper leg is more flexed than lower leg |
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what does Sim's position facilitate
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drainage from mouth and limits pressure on trochanter and sacrum
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Sim's position is ideal for
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administering enema
perineal procedure |
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supine position
or dorsal recumbent |
pt lies on back withhead and shoulders elevated on small pillow
spine is aligned and arms and hands comfortably rest at side |
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logrolling
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special turning technique used when pt's spine must be kept in straight alignment
moves pt as a unit |
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how many nurses are needed for log rolling
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at least 2
1 at patient's head others distributed along length of patient |
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friction reducing devices
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transfer roller
scoot sheet |
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transfer roller
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thin, low friction fabric sheets
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scoot sheet
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thin, low friction fabric sheet that is often positioned under draw sheet of patient but attached to a mechanical crank
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benefits of scoot sheet
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by turning a crank,1 person may move patient up in bed
inexepensive and widely available in units |
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how can a plastic bag help move a pt
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place plastic bag underneath draw sheet
it reduces drag and facilitates movement |
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problem with using a plastic bag to move pt
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it allows moisture to pool under pt, so should not be left in place
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transfer board
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wood or plastic device to assit with moving pts
reduces risk of injury, promotes smooth transfer |
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mechanical lift
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hydraulic device used to transfer pts
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how to use a mechanical lift
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place fabric sling under pt and attach chains or straps from sling to lifting device
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when is a mechanical lift especially useful
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when caring for obese and immobile pts
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standing assist devices
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mechanical lifts that help the patient move from a sitting to standing position or support a patient in standing position
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transfer belt
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heavy belt several inches wide that is used to facilitate transfer or provide a secure mechanism to hold patient when ambulating active range of motion
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occurs when pt independently moves his joints trhough flexion, extension, abduction, adduction, and circular rotation
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active range of motion
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movement of joints through their range of motion by another person
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PROM
passive range of motion |
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continuous passive motion
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CPM
device thatis used to gently flex and extend the knee joint |
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When is the CPM machine used
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after knee replacement or other knee procedures to allow joint to:
improve range of motion eliminate problem of stiffness prevent development of adhesions |
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what should you do if patient begins to fall
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guide pt gently to floor or chair
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what does assisting patients with ambulation include
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physical conditioning to prepare the patient for ambulation
assisting patient to walk |
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who requires physical conditioning to prepare to walk
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patients who have been confined to bed for more than a week
patients who have sustained major injury |
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list conditioning exercises
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quadriceps and gluteal drills (use isometric exercises)
arm exercises (trapeze bar, push-ups off mattress or chair) dangling |
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what do you use dangling for
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to prepare patient to get up in a chair, stand, or ambulate
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what are some approaches used for orthostatic problems
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antiembolism stockings with compression wraps to prevent pooling of venous blood
abdominal binders medication to control orthostatic hypotension |
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what might a patient with a spinal cord injury experiencing autonomic dysfunctions need
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high-back reclining wheelchair so back of chair can be lowered
someone may have to lift up their legs until blood pressure stabiliazes |
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list fall risk factors
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medications that cause dizziness or lethargy
patients with neurological or cognitive disorders - such as Parkinson's and Alzheimer's |
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tips to remember when assisting older adults
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observe constantly for weakness and fatigue
plan for periods of rest move patient gradually to sitting position and allow him to dangle at bedside before coming to standing position and then observe for dizziness or light headedness |
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list mechanical aids for walking
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cane
walker crutches |
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3 basic types of canes
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single-ended cane with half-circle handle
single-ended cane with straight handle multiprong canes |
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single-ended cane with a half-circle handle is ideal for
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patient who needs minimal support and is able to negotiate stairs
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single ended cane with a straight handle is ideal for
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pt with hand weakness who has good balance
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multiprong canes are good for
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pts with balance problems
they have a wide base of support |
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walkers
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lightweight metal frame device with 4 legs that provides a wide base of support as pt ambulates
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crutches
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commonly used for rehabilitation of an injured lower extremity
to limit weight bearing on legs |
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forearm support crutch is used by
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pts with permanent limitations
has handhold and forearm support |
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axillary crutches used for
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both long term and short term
support body weight in hands and arms not the axilla |
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2 point and 4 point gait are used for
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partial weightbearing
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3 point gait is used when
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weight bearing must be avoided
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swing to and swing through gait is used when
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weight bearing is permitted
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functions of the bones
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support
protection movement blood cell production mineral storage |
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mature cells are called
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osteocytes
"structure" |
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new construction
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osteoblasts
"break down for reabsorption" |
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builders are
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osteoblasts
"new bone cell sification |
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growth plate is
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spongy bone
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what provides give and movement
shaft, compact bone |
medullary cavity
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inside red and yellow bone marrow
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nutrient foramen
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covering of bone
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periosteum
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what makes up the epiphysis
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articular cartilage
epiphyseal line spongy bone articular cartilage |
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what makes up diaphysis
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medullary cavity
nutrient foramen endosteum periosteum |
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how many bones do we have
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206
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list some long bones
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femur
humorous radius |
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list some short bones
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spongy bone material
carpals & tarsals |
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list some flat bones
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2 layers compacted by spongy bone area
ribs skull scapula sternum |
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list some irregular bones
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vertebrae
sacrum mandible |
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place where 2 or more bones are joined together
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joints
functional unit of muscular skeletal unit |
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function of joints
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flexibility & movement
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list types of joints
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immovable
slightly movable freely movable |
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example of amphiarthoses joint
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sternum
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example of diarthosis joint
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wrist
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these joints move in only 1 direction
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uniaxial
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examples of uniaxial joints
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hinge (elbow)
pivot (radioulnar joint) |
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these joints move in 2 directions
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biaxial
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examples of biaxial joints
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condyloid (wrist)
saddle (thumb) |
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these joints move in multiple directions
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multiaxial
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examples of multiaxial joint
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ball and socket (shoulder)
gliding joint (fibula with tibia) |
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purpose of synovial membrane
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secrete thick fluid
reduce friction |
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bone to bone connection
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ligament
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covers ends of bones
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cartilage
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muscle to bone
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tendons
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why do injuries to tendons, ligaments, cartilage take a long time to heal
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poor blood supply
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what is a muscle made up of
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75% water
20% protein 5% organic and inorganic components |
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COPD causes a decrease in
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mass and strength
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exercise increases
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strength and mass
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3 types of movement
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flexor
extensions rotators |
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what is the stongest type of movement
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flexor
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2 parts of neuromuscular junction
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acetylcholine
calcium |
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acetylcholine
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at muscle group
binds with receptors releases calcium shortens muscle |
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what is the
energy source of a muscle |
ATP
Adenisone triphosphate |
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what does adenisone diphosphate need to regenerate to ATP
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oxygen
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disability that is a direct result of diagnosis or trauma
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primary disability
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disability that develops as result of disease process
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secondary disability
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factors that affect mobility
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fear and/or pain
activity restrictions varying degrees of immobility from complete unconscious to partial |
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example of a therapeutic factor affecting mobility
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broken hip
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example of unavoidable factor affecting mobility
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impossible for MOBILITY per dr order
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example of voluntary factor affecting mobility
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chooses not to move
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list functions of bedrest
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conserve energy so injured part heals
prevent further damage to injured part decrease O2 required to cells |
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classifications of bedrest
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complete
partial |
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how much do you lose in every week of inactivity
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7 - 10% of strength
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a decrease in muscle mass that occurs when muscle fibers do not contract as much as they would during normal physical activity
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muscle atrophy
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occurs by calcium leaching
out of bone extra calcium will not help extra calcium in blood stream goes to joints and kidneys |
demineralization
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fibrosis
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stiff joints
involves ligaments |
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ankylosis
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frozen joints
involves ligaments |
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contracture involves
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muscles
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how are contractures fixed
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surgery
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tips for range of motion
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proper working height
uses smooth, gentle movements move joint slowly move only to the point of resistance |
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3 types of range of motion
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active self
assisted with help passive without patient |
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a decrease in the ability of the heart and its vessels to maintain function r/t immobility
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cardiovascular deconditioning
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formation of plaque and blood clots in venuous system
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pulmonary embolism
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orthostatic hypotension
systolic/diastolic |
systolic less than 20
diastolic less than 10 |
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describe process of hypotension
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immobilized patient
pooling of blood decreased blood pressure when rising dizziness body's protective mechanism increase HR to get blood to brain if that doesn't work fainting occurs regain equilibrium |
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normal pressure within vessel
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10 -15 mm Hg
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pressure in immobilized person
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20 - 30 mmHg
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occurs when venous pressure is so great it forces some of the serous part of blood out of vessel and into interstitial space surrounding vessel
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edema
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electric stockings
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TED hose
remove 20 - 30 inches daily |
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Tx for edema
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electric stockings
elevate legs do not massage - risk for thrombus |
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clot that travels from site where it was formed
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embolism
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blood clot that forms in a vessel
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thrombus
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early thrombus
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clot formation in valve pockets of deep vein
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risk factors for deep vein thrombosis
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poor blood circulation
venous injury increased blood clotting |
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cardiovascular conditioning
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heart must work harder up to 30% r/t increased blood flow to heart
heart rate increases by .5 beats/day of immobility |
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occurs when pt holds his breath when attempting to move up in bed or use bedpan (having BM)
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valsava maneuver
can cause arrythmia |
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reasons respiratory is compromised in immobilized person
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limited expansion of lungs
decreased ability to move mucous decreased space in thoracic cavity long term: restricted ventilation r/t fixed intercostal joints |
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a collapsed or airless condition of lung
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atelectasis
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cause of atelectasis
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limited ventilation
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treatment of atelectasis
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deep breathing
fluids bronchiodilators |
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prevention of atelectasis
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assessments
teaching |
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decreased energy needs lead to
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decreased metabolic rate
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increase in catabolism
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negative nitrogen balance
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end result of catabolism
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decrease in healing
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tips to prevent anorexia
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good taste to pt
smaller portions make pleasant atmosphere |
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problems immobility causes in urinary
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urinary stasis - stale, infection
renal calculi - particles incontinence urinary reflex constipation fecal impaction |
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problems immobility causes integumentary
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protein stores and fluid shifts
immobility pressure ulcers |
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problems immobility causes in neurosensory and psychosocial
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decreased stimulation
altered role personality changes |
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prolonged immobilization in infants and children causes
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delays in social, motor, and intellectual development
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prolonged immobilization in adolescents
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posture habits
lose peer connection loss of identity |
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prolonged immobility in older adult
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loss of independence
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assessment for mobility
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baseline assessment
activities of daily living cardiovascular vitals before & after respiratory Vitals integumentary breakdown |
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baseline assessment for mobility includes
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gait
ROM recent trauma physical exam |
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Activity should be stopped immediately IF
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heart rate increases more than 20 bpm above baseline
pulse weakens heart rhythm changes from regular to irregular chest pain occurs pt experiences SOB blood pressure change of 10mmHg diastolic dyspnea irregular respiratory rhythm |
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how can you tell if activity is within safe limits
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pt's respiratory rate returns to baseline levels within 3-4 minutes after activity
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metabolic mobility nursing diagnosis
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fluid volume deficit r/t anorexia secondary to immobility
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cardiovascular mobility nursing diagnosis
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alterations in cardiac output r/t immobility
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musculoskeletal mobility nursing diagnosis
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activity intolerance r/t sedentary lifestyle
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integumentary mobility nursing diagnosis
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potential impairment of skin integirty r/t immobility, poor nutrtion and incontinence
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good body mechanics promotes
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musculoskeletal functioning
decreases energy required to move and maintain balance decreases risk of energy optimal balance maximumbody function in whatever position the body assumes enhances lung expansion promotes efficient circulatory, renal, GI |
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poor aligment does what
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detracts from person's appearance
can adversely affect an individual's health |
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posture reflects
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mood
self esteem person's personality |
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what leads to body becoming unstable and unbalanced
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line of gravity and center of gravity lie outside base of support
closer line of gravity is to edge of base of support the more precarios balance is |
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what does weight do to a person's center of gravity
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whenever a person lifts or carries an object, the weight alters the person's center of gravity which is displaced in the direction of the weight
to counter balance the body moves in direction away from weight |
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usual posture of infants
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horizontal rather than upright
abdomen rounded and prominent extremities generally flexed and inwardly rotated feet usually inverted but may be passively everted |
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toddlers body alignment
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marked lumbar lordosis and protruding abdomen
slight outward rotation of hips and eversion of feet |
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preschoolers body alignment
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protrusion of abdomen less exaggerated
extremities more proportionate to trunk |
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schoolage body alignment
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legs have straightened
toes point straight ahead should perform scoliosis screening |
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adolescent body alignment
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significant changes in proportions and contour
differentiation of male/female characteristics |
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older adult body alignment
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tend to have some contracture of flexor muscles
may show kyphosis with disappearance of earlier lumbar lordosis osteosporosis common |
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what causes a dowager's hump possibly
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osteosporosis which can cause compression fractures of vertebraes resulting in forward leaning, stooped position - dowager's hump
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2 movements to avoid due to potential causing of back injury
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twisting of lumbarthoracic spine
acute flexion of back and hips while keeping knees straight |
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lifting
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movement against gravity
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pivoting
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body is turned to avoid twisting
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procedure for pivoting
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foot ahead of the other
raise heels slowly weight is on balls of feet pivot about 90 degrees |
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compression fracture may lead to
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kyphosis
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1 of the leading causes of accidental death in US
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falls
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25% of falls occur in
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elderly
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list factors increasing potential for falls
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unfamiliar surroundings
strangeness of diagnostic test; surgery immobilization causing weakness pain loss of independence and control over one's activities drugs contributing to dizziness - sedatives, etc. elimination dysfunction confusion |
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consequences of poor body mechanics
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physical stresses to back
strain sprain |
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5 most common work-related back injuries among hospital nurses
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lifting pt in bed 48%
helping pt out of bed 30% moving a bed 27% lifting pt to stretcher 22% carrying equipment weighing more than 30 lbs |
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areas of assessment for mobility
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history
exam diagnostic tests |
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exam should include
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level of weakness
pain obesity meds IV present cast present |
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diagnostic tests for mobility
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X-ray
blood testing |
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blood testing can show
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Rickett's in children
osteomalacia in adults phosphorous levels - elevated with bone tumors |
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assessment of body alignment includes inspection in what 3 ways
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standing
sitting lying |
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purpose of assessing alignment-ambulation
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identify normal changes resulting from growth and development
ID poor posture and learning needs to maintain good posture |
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factors contributing to poor posture
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esteem
fatigue |
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pelvic tilt
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pelvis is tucked under normally - this is absent when alignment is poor
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postural scoliosis can be caused by
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crossing of legs causing a C shape of lumbar thoracic spine
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how to assess for pts capabilities & limitations for movement
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rising from lying position - rise w/o support from arms (if muscle weakness may roll to side and push up with arms)
rising from chair - normally can do w/o rising arms moving in bed - supine to lateral, lateral to lateral, supine to prone, supine to sitting |
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assessing gait
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arms swing appropriately
trunk is steady and upright head erect gaze straight ahead vertebral column upright heel strikes ground before toe feet dorsiflexed in swing phase arm opposite swing through foot moves forward at same time |
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planning care for pts at risk
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use assessment data and nursing dx to identify goals of care
id assistance pt needs give guidance teach new techniques physician usually orders specific body positions after surgery or trauma to musculoskeletal system |
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general goals for alignment & ambulation
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maintain and restore proper body alignment
prevent muscle contractures improve body mechanics in daily life prevent back injuries and falls |
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pts activity order contains
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data essential for planning nursing interventions in body alignment
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never lift more than
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35% of body weight
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rigid piece that transmits or modifies motion or force
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lever
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what is the lever in the body
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bones
can lift more weight when they use lever bent elbow |
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fixed point about which a lever moves
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fulcrum
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fulcrum in the body is
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joint
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the energy or power required to accomplish movement
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force
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in the body the force is supplied by the
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muscles
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force that opposes motion of an object as it is slid across surface of another object
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friction
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what creates more friction - pulling or pushing, or rolling
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pushing creates most
rolling creates the least |
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an ordinary person can lift only about how much without risk of back strain
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20 lbs
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in infants curvature develops in stages. when does anterior cervical curvature develop
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3 -4 mos
lifting head |
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when does anterior lumbar curvature develop
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12 - 18 mos
when walking |
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nutritional effects of immobility
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anorexia
negative nitrogen balance hypoproteinemia |
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neurosensory effects of immobility
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numbness
nerve damage sensory deprivation |
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6 types of joints
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pivot
hinge gliding ball and socket saddle conyloid |
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calcium is needed for
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bone and teeth strength
blood clotting muscle strength |
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phosphorous needed for
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bone and teeth strength
cell membrane metabolism conversion of food into energy |
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calcitonin
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regulates blood calcium levels works with parathyroid dormone
too much in blood - releases it |
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parathyroid hormone
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works with calcitonin to regulate blood calcium levels
pulls calcium into blood stream |
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growth hormone
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building and maintenance of bone tissue
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insulin
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building and maintenance of bone tissue
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gluccocorticoids
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bone growth
calcium and phosphorous absorption |
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sex hormones
estrogen testosterone |
estrogen - osteoblastic activity
testosterone - bone mass |
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thyroxine
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protein synthesis
increases rate of bone growth |
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4 lifting measures
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position of weight
height of object body position maximum weight |
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steps to proper lifting
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assess basic 4 lifting measures to determine if you need help
lift object correctly from below center of gravity lift object correctly from shelf above center of gravity |
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how to lift from below center of gravity
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come close to object to be moved
enlarge base of support by placing feet slightly apart lower center of gravity to object to be lifted maintain proper alignment of head and neck with vertebrae |
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how to lift object safely from shelf above center of gravity
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use safe, stable step stool
stand as close to shelf as possible quickly trasnfer weight of object from shelf to arms and over base of support |
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tips for preventing back injuries
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become consciously aware of posture and body mechanics
make conscious effort to improve posture and mechanics minimize lordosis use firm mattress exercise regularly to maintain overall physical condition avoid exercises that cause pain unless physically fit avoid activities that require excessive arching of spine and spinal rotation |
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nursing intervention for mobility - integumentray
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fluids
repositioning |
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nursing interventions for musculoskeletal
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ROM
protein encourage independence |
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nursing intervenetions cardiovacular
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frequent assessments
TED hose |
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nursing interventions for respiratory
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increase fluids
respiratory tx teaching turn deep breathing cough |
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metabolic/nutrition interventions
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smaller portions
education supplements pleasant foods |
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elimination nursing interventions
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fluids
reposition privacy |
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neurosensory interventions
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stimulation
visiting interests puzzles |
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psychosocial interventions
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encourage visits
go for walks ADLs encourage dressing set down and talk w/ pt |
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developmental interventions
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age appropriate toys
interaction with peers reading WII |
