152-Wk5 Mobility And Immobility Text Reading-Cecilia Bao

Front 1

Pthological influences on mobility

Back 1

-postural abnomalities
-impaired muscle development
-damage to the Central nervous system
-direct trauma to the musculoskeletal system

Front 2

Mobility

Back 2

- movement of the body as a whole, or movement of body parts in relation to one another

Front 3

bed rest

Back 3

restricts clients to bed for therapeutic reason---3% muscle strength loss per day

Front 4

systemic effects of immobility

Back 4

-metabolic change: endocrine metabolism, calcium resorption, functioning of gastrointestinal system
-respiratory changes:atelectasis and hypostasic pneumonia
-cardiovascular changes:orthostatic hypotension, increased cardiac workload, thrombus formation
-Musculoskeletal changes:reduced musle mass, musle atrophy, fall, impaired Ca metabolism and joint abnormalities (joint contracture-footdrop)

Front 5

systemic effects of immobility (cont'd)

Back 5

urinary elimination changes: urinary stasis, urinary tract infection, renal calculi, dehydration
Integumentary change:poor healing, pressure sore

Front 6

psychosocial effects of immobility

Back 6

-emotional and behavioural responses:depression, sleep-wake disturbance,
-sensory alterations,
-impaired coping
-social and family difficulties

Front 7

Developmental changes of immobility

Back 7

mostly commonly in very young children and older adults.
--infants,toddlers and preschoolers:delay gross motor skills, delayed intellectual and musculoskeletal development.
--adolescent:alter adolesent growth pattern, social isolation, lag behind in gaining independence
--adults:physiological risks, role change in family or social structure
--older adults:more physically dependent on others, more functional loss, degenerated disease, neurological trauma, chronic illness

Front 8

Nursing caring for immobilized children and older adults

Back 8

immobilized childre--plan activities that provide physical and psychosocial stimuli
immobilized older adults--develop a care plan which encourages as many self-care activities as possible, thereby, maintaining the highest level of mobility

Front 9

Assessment of mobility

Back 9

focuses on:
-ROM(Range of motion)
-gait
-exercise and activity tolerance
-body alignment

Front 10

ROM

Back 10

maximum amount of movement available at a joint in one of the four planse of the body:medial, sagittal, frontal, or transverse

Front 11

factors effect joint mobility

Back 11

ligaments, muscles, nature of the joint

Front 12

Flexion and extension:

Back 12

flexion is decreasing the angle between two adjoining bones, extension is increasing the angle between the two adjoining bones

Front 13

hyperextension

Back 13

movement of a body part beyond its normal resting extended position

Front 14

Dorsiflexion and plantar flexion

Back 14

dorsiflexion is the flexion of toes and foot upward; plantar flexion is the bending of toes and foot downward

Front 15

Abduction and adduction

Back 15

abduction is movement of an extremity away from the midline of the body, adduction is movement of an extremity toward the midline of the body

Front 16

Eversion and inversion

Back 16

eversion is the turning of a body part away from the midline, inversion is the turning of body part toward the midline

Front 17

pronation and supination

Back 17

pronation is movement of a body part so that the front or ventral surface faces downward, supination is movement of a body part so that the front or ventral surface faces upward

Front 18

Internal and external rotation

Back 18

internal rotaion is rotation of the joint inward, external rotation is rotation of the joint outward

Front 19

Circumduction

Back 19

the circular movement of a limb in a cone-shaped manner

Front 20

Assess ROM

Back 20

examine the client for stiffness, swelling, pain, limited movement and unequal movement

Front 21

Range of motion exercises

Back 21

check p&p 1195-1199

Front 22

Exercise

Back 22

-conditioning the body
-improving health
-maintaining fitness
-use as a therapy to correct a deformity or to restore the health

Front 23

Activity tolerance

Back 23

the type and amount of exercise or work that a person is able to perform

Front 24

when activity begins, monitor

Back 24

dyspnea, fatigue, chest pain, change in vital sign

Front 25

Factors affect exercise and activity tolerance

Back 25

physiological, emotional and developmental stages

Front 26

body alignment

Back 26

standing, sitting or lying down
Figure46-7,-8,-9

Front 27

physiological hazards of immobility
p1201 table46-3

Back 27

-metabolic:slowed healing, abnormal lab data, muscle atrophy, loss of subcutaneous fat
-respriratory:asymmetrical chest wall movement, dyspnea, increased breath rate, crackles, wheezes, descreased air entry
-Cardiovascular:orthostatic hypotension, increased heart rate, third heart sound, weak peripheral pulses, peripheral edema

Front 28

physiological hazards of immobility
p1201 table46-3 (cont'd)

Back 28

-Musculoskeletal:decreased range of motion, erythema, increased diameter in calf or thigh, joint contracture, activity intolerance, muscle atrophy
-elimination:decreased urine output, cloudy or concentrated urine, decreased frequency of bowel movements, distended bladder and abdomen, decreased bowl sounds
-skin:break in skin integrity

Front 29

Impaired physical mobility (nursing diagnosis)

Back 29

used for client who has some limitation but is not completely immobile

Front 30

Risk for disuse syndrome (nursing diagnosis)

Back 30

the client who is immobile and at risk for multisystem pathophysiology because of inactivity

Front 31

joint constracutre

Back 31

an abnormal and possibly permanent condition characterized by fixation of the joint

Front 32

Urinary stasis

Back 32

renal pelvis fill before urine enters the ureters

Front 33

footdrop

Back 33

the foot is permanently fixed in plantar flexion

Front 34

what intervention is required for impaired physical mobility related to bed rest

Back 34

aimed at keeping the client as mobile as possible and encouraging the client to do self-care and ROM exercise in bed

Front 35

what intervention is required for impaired physical mobility related to pain

Back 35

assist the client with comfort measures so that the client would subsequently be more willing and able to move.
Both bed rest and pain relate situation, need to explain the importance of activity to healthy body functioning

Front 36

orthostatic hypotension

Back 36

a drop of 20mm Hg or more in systolic blood pressure and of 10mm Hg in diastolic blood pressure

Front 37

Reduce impact of immobility on metabolic system

Back 37

supply a high-protein, high-calorie diet with Vitamin B and vitamin C supplements

Front 38

Reduce impact of immobility on respiratory system

Back 38

-promoting expansion of the chest and lungs: change the position of the client at least every 2hrs, encourage the client to deep breath and cough every 1-2h, remove abdominal binders every 2 hrs.
-preventing stasis of pulmonary secretions: Chest physiotherapy (CPT)
-maitain a patent airway

Front 39

Reduce impact of immobility on cardiovascular system

Back 39

-Reduce orthostatic hypotension: changing position slowly and gradually
-Reduce cardiac workload:remind the client to breathe out while moving or being lifted up in bed
-Preventing thrombus formation:prophylaxis-leg exercises, encouragement of fluids, position change, teaching preventive measures.
IPC, SCD, medication-physician's order

Front 40

Application of SCS and TED

Back 40

p1209 box 46-9
p1210box 46-10

Front 41

Reduce impact of immobility on musculoskeletal system

Back 41

ROM exercises

Front 42

Reduce impact of immobility on elimination system

Back 42

-adequate hydration
-prevent bladder distension by assessing the frequency and amount of urinary output
-record frequency and consistency of bowel movements

Front 43

Reduce impact of immobility on integumentary system

Back 43

-positioning
-skin care
-use of therapeutic devices to relieve pressure

Front 44

risk factors may contribute to complications of immobility

Back 44

-paralysis
-impaired mobility:tractionor arthritis
-age
-impaired circulation
-level of consiousness and mental status
-skin condition

Front 45

Positioning techniques p1221

Back 45

-supported Fowler's position:head of the bed elevated 45-60 degrees and client's knees are slightly elevated without pressure, client sitting up in bed
-supine position:back-lying position
-prone position:lying chest down
-side-lying position:resting on the side with the major portion of body weight on the dependent hip and shoulder
-Sim's position:weight is placed on the anterior ilium, humerus, and clavicle

Front 46

instrumental activities of daily living (IADLs）

Back 46

Activities that are necessary to be independent in society beyond eating, grooming, tranferring and toileting. sucha s shopping, preparing meals etc.

Front 47

Measuring of crutches

Back 47

the length of the crutch should be from three to four fingerwidths from the axilla to a point 15cm lateral to the client's heel
correct position of handgrips is determined with the client upright, supporting weight by the handgrips with the elbows slightly flexed at 30 degrees

Front 48

Basic crutch stance

Back 48

the tripod position assumed before crutch walking, formed when the crutches are placed 15cm in front of or 15cm to the side of each foot, improve client's balance,

Front 49

Three-point alternating gait

Back 49

requires the client to bear all of the weight on one foot

Front 50

Two-point gait

Back 50

requires at least partial weight bearing on each foot

Front 51

swing-through gait

Back 51

used by client with paraplegia who wear weight-supporting braces on their legs

Front 52

walker

Back 52

height up to the crease of wrist, used with clients who have mild balance problem

Front 53

canes

Back 53

cane length is equal to the distance between the floor and the crease at their wrist when they are standing tall with their arm straight down at their side. -Single straight-legged cane is used to support and balance a client with decreased leg strength. cane is kept on the stronger side of the body
-the quad cane provide the most support, used when partial or significant leg paralysis or some hemiplegia is present

Front 54

heparin therapy in prophylaxis of DVT

Back 54

5000 units given subcutaneously 2 hrs before surgery and repeated every 8-12 hrs until the client is fully mobile or discharged

Front 55

Pillow

Back 55

provide support, elevate body parts, splint incisional areas, reduce postoperative pain during activity or coughing and deep breathing

Front 56

wedge

Back 56

maintian the legs in abduction after total hip replacement surgery

Front 57

foot boot

Back 57

maintain feet in dorsiflexions

Front 58

trochanter roll

Back 58

prevents external rotation of the hips when a client is in a supine position

Front 59

sandbags

Back 59

immobilize an extremity or maintain body alignment

Front 60

hand rolls

Back 60

maintain thumb in slight abduction and in opposition to the fingers to prevent contractures
most often used for clients whose arms are paralyzed or who are unconscious

Front 61

Hand-wrist splints

Back 61

maintain proper alignment of the thumb(slightly abduction) and the wrist (slightly extention)

Front 62

Trapeze bar

Back 62

allow the client to use their upper extremities to raise their trunk off the bed, to assist in transfer from bed to wheelchair, or to perform arm exercises

Front 63

ligament, tendons, cartilaginous tissue

Back 63

Ligaments are elastic and provide joint flexibility and support,bind joints together and connect bone and cartilage. Tendons are fibrous bands of tissue that connect muscle to bone. Cartilaginous tissue is nonvascular supporting connective tissue located in the joints, thorax, trachea, larynx, nose, and ear.

Front 64

Types of joints

Back 64

The hip joint, with a ball-and-socket structure, is a synovial joint that moves freely.
A synostotic joint is bone joined by bone.
A cartilaginous joint is a synchondrodial joint with little movement.
A synovial joint is a syndesmodial joint, in which two bony surfaces are united by a ligament.

Front 65

Immobility leads to the release of calcium from bone into the bloodstream

Back 65

may cause hypercalcemia

Front 66

the most significant hazard of restricted mobility

Back 66

Deep vein thrombosis

Front 67

How to use walker

Back 67

-hold the handgrips on the upper bars, moves the walker forward
-take a step with the weaker or painful leg
-take a step with the unaffected leg
-walk to instead of beyond the walker

Front 68

How to use crutch to ascend the stairs

Back 68

-1. Hold onto the hand rail with 1 hand. Hold both crutches under your opposite arm. Crutches should be in the middle of the step, away from the edge.
-unaffected leg on stairs, weight transferred to the unaffected leg
-weak leg on stairs, aligned with the crutches

Remember, the "good" leg goes up first and the crutches move with the "bad" leg

Front 69

How to use crutch to descend the stairs

Back 69

-Hold onto the hand rail with 1 hand. Hold both crutches under your opposite arm. Crutches should be in the middle of the step, away from the edge.
-Put your crutches down on the
next step.
-Step down with your weaker leg
-Step down with your stronger leg.

Remember the "bad" leg goes down first and the crutches move with the "bad" leg

Front 70

How to sit with crutches

Back 70

-hold both crutches by one hand(unaffected side)
-grasp arm of chair with free hand, stick the weak leg out, lower the body into chair

Front 71

How to use a cane

Back 71

-cane is kept on the stronger side of the body
-place the cane forward
-weaker leg move forward to the cane
-stronger leg is then advanced past the cane

Front 72

How to walk with crutches

Back 72

1. Begin in the tripod position, remembering to keep all your weight on your “good” (weight-bearing) foot.
2. Advance both crutches and the affected foot/leg.
3. Move the “good” weight-bearing foot/leg forward (beyond the crutches).
4. Advance both crutches, and then the affected foot/leg.
5. Repeat steps #3 and #4.

Front 73

To stand up with crutch

Back 73

-Move toward the edge of your chair.
-Hold both crutches on the side that you hurt with your hand holding tightly onto the handgrips.
-Press down on the handgrips with one hand and press down on the seat or arm of the chair with your other hand so you can push yourself up.
- Use a crutch on each side and check to make sure you are standing in a good position.