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30 Cards in this Set
- Front
- Back
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Name three purposes of the skeletal system.
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Forms the framework of the body
Protects the internal organs Produces red blood cells Serves as a storage site for calcium Works with the muscles to cause movement |
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Define the following movements: abduction, adduction, flexion, extension, circumduction, internal rotation, supination, and pronation.
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Abduction is moving away from midline
Adduction is moving toward midline Flexion is bending, decreasing the joint angle Extension is straightening, increasing the joint angle Circumduction is moving in a circular fashion Internal rotation is turning toward midline Supination is turning upward Pronation is turning downward |
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Identify three types of muscle.
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Skeletal muscle moves the skeleton.
Smooth muscle, found in the digestive tract and other hollow structures such as the bladder and blood vessels, produces movement of food through the digestive tract, urine through the urinary tract, and blood through the circulatory system. Cardiac muscle is a unique form of muscle that possesses the ability to contract spontaneously. It is responsible for the beating of the heart. |
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How do the muscles and the nerves interact?
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The nervous system controls the movement of the musculoskeletal system. When we want to make a conscious decision to move our arm, the thought originates in the motor area of the cerebral cortex. The upper motor efferent nerves communicate with the lower motor neurons that conduct an impulse to the muscle. When the muscle receives sufficient stimuli it contracts, shortening the biceps brachii and bending the elbow. A stimulus to cause a contraction of the biceps generates a stimulus to cause relaxation in the triceps in a process known as reciprocal innervation. Movement also occurs through reflex mechanisms. Reflexes are protective mechanisms. Common reflexes include the knee jerk and corneal reflex.
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Identify the four components of body mechanics.
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Body mechanics, a term used to describe the way we move our body, includes four components: body alignment, balance, coordination, and joint mobility.
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Give at least five guidelines for good body mechanics.
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Stand in good alignment with a wide base of support.
Minimize bending and twisting. These movements cause an increase in the amount of stress on the back. Instead, face the object and bend at the hips or squat. Avoid bending at the waist. Squat to lift heavy objects from the floor. Push against the strong hip and thigh muscles to raise yourself to a standing position. When lifting or moving an object, the closer it is to the center of gravity, the greater the stability. Keep objects close to your body when you lift, move, or carry them. Use both hands and arms when you lift, move, or carry heavy objects. Raise the height of the bed and bedside table to waist level when you are working with a patient. Face objects or persons you are working with rather than twisting. When possible, keep your elbows bent when carrying an object. Use the muscles in your legs as the power for lifting. Bend your knees, keep your back straight, and lift smoothly. Repeat the same movements for setting the object down. If a ladder or stepstool is required to reach an object make sure it is stable and adequate to position your body close to the object. Do not stand on tiptoes to reach an object. Push, slide, or pull heavy objects whenever possible rather than lift them. Make sure you have a good grip on the patient or object you are moving before attempting to move the patient or object. Work with smooth and even movements. Avoid sudden or jerky motions. Assess the object or patient you are going to lift. If you have any doubt that you can do it by yourself, get help from a co-worker. |
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Identify and describe four types of exercise.
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Isometric exercises involve muscle contraction without motion. They are usually performed against an immovable surface or object. For example, when pressing the hand against the wall, the muscles of the arm contract but the wall does not move. Each position is held for 6 to 8 seconds with 5 to 10 repetitions. Isometric training is effective for developing total strength of a particular muscle or group of muscles. It is often used for rehabilitation because the exact area of muscle weakness can be isolated and strengthening can be administered at the proper joint angle. This kind of training requires no special equipment, and there is little chance of injury. Bedridden patients can use this form of exercise to maintain or regain muscle strength.
Isotonic exercise involves movement of the joint during the muscle contraction. A classic example of an isotonic exercise is weight training with free weights. As the weight is moved throughout the range of motion, the muscle shortens and lengthens. Calisthenics, such as chin-ups, push-ups, and sit-ups, all of which use body weight as the resistance force, are also isotonic exercises. Isokinetic exercise utilizes machines that control the speed of contraction within the range of motion. Isokinetic exercise attempts to combine the best features of both isometrics and weight training by providing resistance at a constant preset speed while the muscle moves through the full range of motion. Specialized machines available at health clubs and physical therapy departments are used for this form of exercise. Aerobic exercise acquires energy from metabolic pathways that use oxygen-the amount of oxygen taken into the body meets or exceeds the amount of oxygen required to perform the activity. Aerobic exercise uses large muscle groups, can be maintained continuously, and is rhythmic in nature. It increases the heart and respiratory rate, thereby providing exercise for the cardiovascular system while simultaneously exercising the skeletal muscles Anaerobic exercise occurs when the amount of oxygen taken into the body does not meet the amount of oxygen required to perform the activity. Therefore, the muscles must obtain energy from metabolic pathways that do not use oxygen. Rapid, intense exercises, such as lifting heavy objects or sprinting, are examples of anaerobic exercise. |
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State the components of an exercise program.
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The three components of a well-rounded exercise program are flexibility, resistance training, and aerobic conditioning.
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In which age groups are you more likely to see health concerns that affect mobility?
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Health concerns that affect mobility may occur throughout the life span. Congenital problems are usually identified and treated in infancy. In contrast, degenerative problems are more likely in older adults.
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What types of disorders limit activity or mobility?
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Congenital abnormalities of the musculoskeletal system
Disorders of bone formation, integrity, metabolism, or joint mobility Disorders of the central nervous system or other body systems that produce fatigue, shortness of breath, or impaired circulation |
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What are the signs and symptoms of a fracture?
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Tenderness at the site
Loss of function Deformity of the area Swelling of the surrounding tissues Diagnosis is confirmed by x-ray. Treatment of a fracture is stabilization until the body can create enough new bone to support function. The type and severity of fracture determine whether casting or surgical repair is necessary. |
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Identify the effects of immobility on the cardiovascular, musculoskeletal, and integumentary systems.
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Cardiovascular system. Immobility increases the workload of the heart and promotes venous stasis. When you are active, the skeletal muscles of the legs assist with pumping blood back to the heart. Recall that the veins are thin-walled vessels with valves. Muscular activity propels blood toward the right side of the heart, and the valves prevent backflow of blood. Without muscular activity (immobility), blood pools in the periphery. To compensate, heart rate and stroke volume increase to maintain blood pressure. In addition to venous pooling, immobility leads to compression and injury of the small vessels in the legs and decreased clearance of coagulation factors, causing the blood to clot faster. These three changes-stasis, activation of clotting, and vessel injury-make up what is known as Virchow's Triad, a trilogy of symptoms associated with a greater chance of thrombus formation in the effected blood vessels. An immobile person is also more prone to orthostatic hypotension. Bedrest causes inactivation of the baroreceptors involved with constriction and dilation of the vessels. As a result, when a patient who has been immobilized changes position, he is unable to maintain his blood pressure. The patient complains of feeling dizzy and lightheaded and may be unable to support his own weight.
Musculoskeletal system. Inactivity causes significant wasting of the gastrocnemius, soleus, and the leg muscles that control flexion and extension of the hip, knee, and ankle. Confinement to bed leads to a 7 to 10% loss of muscle strength (atrophy) per week. Immobility also causes the joints to become stiff. The strongest muscles, usually the flexors, pull the joints in their direction leading to contractures, or joint ankylosis (fusion of the joints). Immobility affects parathyroid function, calcium metabolism, and bone formation. The result of these changes is osteoporosis, calcium depletion in the joints, and renal calculi (stones) due to increased excretion of calcium. These changes place the patient at risk for pathologic fractures with minimal trauma. Integumentary system. External pressure from lying in one position compresses capillaries in the skin, obstructing skin circulation. Lack of circulation causes tissue ischemia and possible necrosis (death). Nursing interventions include frequent turning and skin care to prevent the formation of wounds, known as pressure ulcers. |
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Why might immobility be referred to as a stressor?
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Immobility might be referred to as a stressor because it triggers the release of epinephrine and norepinephrine, thyroid hormones, adrenocorticotropic hormone (ACTH) from the pituitary gland, and aldosterone from the kidneys. These changes in hormone levels are the same as the stress response, letting us see that immobility can be a stress in itself.
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What are three effects of immobility on the GI system?
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Immobility slows peristalsis, which often leads to constipation, gas, and difficulty evacuating stool from the rectum. In extreme circumstances, a paralytic ileus (cessation of peristalsis) may occur. With peristalsis slowed, appetite diminishes and food that is consumed is digested slowly. The net effect is usually decreased caloric intake and inability to meet the protein demands of the body. Body muscle is broken down as a fuel source, and further wasting occurs.
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What changes in mood might be seen with immobility?
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Patients who are in bed for long periods of time can suffer depression, anxiety, hostility, sleep disturbances and changes in their ability to perform self care activities, as well as disorientation and apathy.
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Describe a focused assessment for a patient experiencing mobility concerns.
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The focused assessment includes gathering a nursing history and performing a physical examination.
A nursing history focused on activity and exercise assesses past and current activity, as well as future plans. The history addresses the following topics: Usual activity Fitness goals Mobility concerns Underlying health concerns Lifestyle External Factors A physical examination focused on activity and exercise assesses the musculoskeletal system and activity tolerance. Important data include vital signs, height, weight, body mass index, body alignment, joint function, gait, and activity tolerance. |
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Identify the assessment methods (inspection, palpation, percussion, and auscultation) used when performing a physical examination focused on mobility concerns.
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The assessment methods used when performing a physical examination focused on mobility concerns include inspection, palpation, and auscultation (of joint movement, crepitus, etc.).
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Describe the following positions: Fowler's, lateral, prone, Sims', and supine.
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Fowler's position is a semi-sitting position. The head of the bed is elevated 45º to 60º.
Lateral position is a side-lying position with the top hip and knee flexed and placed in front of the rest of the body. Prone position is a position where the patient lies on his stomach, with his head turned to one side. Sims' position is a semiprone position. The lower arm is positioned behind the patient and the upper arm is flexed. The upper leg is more flexed than the lower leg. Supine position, also known as the dorsal recumbent position, is where the patient is placed on his back with the head and shoulders elevated on a small pillow. The spine is aligned and the arms and hands comfortably rest at the side. |
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What is the advantage of the oblique position versus the lateral position?
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The oblique position is an alternative to the lateral position that places less pressure on the trochanter. The patient turns on the side with the top hip and knee flexed, but the top leg is placed behind the body.
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Identify and describe six positioning devices.
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An adjustable bed, sometimes known as a hospital bed, assumes a variety of positions. The head can be elevated or lowered below the level of the feet, and the foot of the bed can be elevated. Often the bed breaks or "gatches" at the knee to prevent the patient from sliding down when the head is elevated. The height of the bed is also adjustable.
Pillows expand the weight-bearing area by molding to the body and are the most common device used to assist with positioning. Pillows provide support and elevate body parts. A trapeze bar is a triangular shaped bar that is attached to an overhead bed frame. The patient can use the base of the triangle as a grip bar to move up in bed, turn, pull up in preparation for getting out of bed, or pull up to get on and off the bedpan. A footboard is a device placed at the end of the bed that prevents plantar flexion. A foot cradle is a metal or plastic device that is secured at the foot of the bed to prevent bedding from constricting the movement of the lower extremities. Sandbags are small fabric bags filled with sand. They are used in the same manner as pillows, however they provide firm support. Trochanter rolls are made from tightly rolled towels or foam pads. They are usually 12 to 18 inches in length. The rolls are placed adjacent to the hips and thighs to prevent external rotation of the hips. Splints may be premanufactured or fashioned from rolled wash clothes. The purpose of a splint is to hold the wrist and hand in a natural position and prevent claw-hand deformities. |
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What are three uses for siderails?
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Ensure patient safety
Provide a grip for the patient who is able to reposition himself in bed Act as a form of restraint |
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What criteria determine whether your patient should be logrolled when he is repositioned?
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Logrolling is a special turning technique used when the patient needs to maintain the spine in straight alignment.
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How often should you turn and reposition a patient?
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Patients should be turned at least every 2 hours to protect their skin and prevent problems associated with immobility. Turning is often done at the same time the patient is moved up in bed.
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Identify the most appropriate device for the following activities: Transferring an obese patient from a bed to a stretcher
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A transfer board should be used when transferring an obese patient from a bed to a stretcher.
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Assisting an immobile patient to a recliner chair
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A mechanical lift should be used when assisting an immobile patient to a recliner chair.
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Helping a weak patient from a bed to a chair
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A transfer belt should be used when helping a weak patient from a bed to a chair.
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Identify four principles to be followed when performing PROM.(passive Range of Motion)
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Explain to the patient the purpose of PROM. You also wish to teach family members and caregivers about the importance of range-of-motion exercises and enlist their help in exercising the patient when they visit.
Observe the patient as you perform PROM. You may need to perform PROM in several short segments when the patient easily fatigues. Support the patient's limb above and below the joint that is to be exercised. Move the joint in a slow, smooth rhythmic manner. Avoid fast movements as they may cause muscle spasm. Use Table 31-3 (in Volume 1) as a guide to move each joint through the range of motion it is able to attain. Never force a joint. Some patients may have limited range of motion. Move each joint until there is resistance, not pain. Perform PROM at least twice daily. Move each joint through its range of motion three to five times with each session. Consider incorporating PROM into care activities, for example, while bathing or turning the patient. Return the joint to a neutral position when exercise is complete. Encourage active exercise whenever possible. |
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Describe activities that can promote a patient's readiness for ambulation.
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Quadriceps and Gluteal Drills. The quadriceps muscle group and the gluteal muscles are the largest muscles of the body. When practicing good body mechanics, you use these muscles to lift objects to protect your back. Patients who have been confined to bed can perform isometric muscles in bed to facilitate the transition to ambulation. Ask the patient to tighten her thigh muscles by pushing downward with her knees and flexing her feet. Hold the position for a count of five and then relax. Repeat this process two to three times per hour during the waking hours. To exercise the gluteal muscles, ask the patient to pinch her buttocks together. Repeat this exercise when the patient exercises the quadriceps muscles. Instruct the patient not to hold her breath as she exercises.
Arm Exercises. The arm muscles are used when getting out of bed and for crutch walking. To prepare the patient for ambulation, install a trapeze bar. The trapeze bar exercises the biceps muscles. To exercise the triceps muscles ask the patient to lift his upper body off the mattress by firmly pressing down with the palms. Push-ups can also be done from a seated position at the side of the bed or from a stationary chair or wheelchair. Dangling. Dangling is a seated position at the side of the bed. The patient can rest his feet on the floor or a footstool. This position readies the patient to get up in a chair, to stand, or to ambulate. Patients who have been bedridden frequently become lightheaded or develop orthostatic hypotension when first getting up. Dangling allows the patient to experience being upright with limited risk of falling. As a result, patients should not be moved further unless they are comfortable and stable in the dangling position. Daily Activities. Encourage your patient to be active in bed and get out of bed into the chair prior to attempting to walk. Performing ADLs exercises many of the muscle groups used in ambulation. Getting up to the chair readies the patient for an upright posture and is an important predictor of success with ambulation. |
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What action should you take if a patient begins to fall when ambulating?
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If the patient begins to fall, do not attempt to hold the patient up independently. Instead, do the following:
Protect the patient as you guide him to a seated or lying position. Create a wide base of support and project the hip closest to the patient forward. Assist the patient to slide down your leg as you call for help. Protect the patient's head as his body descends. |
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Identify five crutch gaits.
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Two-point and four-point gaits are used for partial weight bearing.
Three-point gait is used for non-weight bearing. Swing-to and swing-through are used when weight bearing is permitted. |
