Activity Flashcards
what is the primary cause of musculoskeletal disorders among nurses?
patient handling
-over half of nurses have chronic back pain
who is most at risk for musculoskeletal disorders due to patient handling?
CNA’s
RN’s rank 8th for occupations at risk for injury
what percentage of nursing back injuries were preventable?
89%
what variables lead to back injuries?
-manual lifting
-uncoordinated lifts
-exceeding recommended lift weight limits
-using outdated techniques
-transferring or repositioning uncooperative or confused patients
what are the proper body mechanics of lifting?
-close to object
-face direction of movement
-slide, roll, push, pull instead of lift
-broad support base
-flex knees, straight back
-strong core
-low center of gravity
-longest and strongest bones for power
-use weight of your body by rocking
safe patient transfer?
-assess pt capabilities to assist in moving
-ensure enough staff available
-remove clutter (clear path)
-decide on equipment
-plan transfer
do not put the patient in Trendelenburg (puts all organs in to thoracic cavity)
Ask questions:
ROM, arm/leg strength, walking ability
lifting guidelines?
35 lbs MAX per person
if over 35 lbs, use assistive devices
*need more ppl if pt confused, combative, on the floor, etc
assist devices example?
-sling lift
-stand scale (good for knee replacement)
effects of immobility: increases what?
cardiac workload
venous thrombosis risk
urinary stasis
contractures risk
skin breakdown risk
bone loss
work of breathing
sense of powerlessness
effects of immobility: decreases what?
respiration depth
respiration rate
bladder muscle tone
muscle size, tone, strength
endurance, stability, coordination
sensory stimulation
immobility effects specifically in elderly?
rapidly deteriorates muscle mass in older/frail pt with little muscle mass to begin with
*~2wks for young healthy pt
low mobility in hospitalized patients conclusion?
low mobility and bed rest are common in hospitalized pts and are important predictors of adverse outcomes
activity assessments?
-activity orders
-muscle mass, tone, strength
-joint structure and function
-strength and endurance
-mobility probs (fractures/breaks, strokes, amputations, resp probs, heart probs)
-physical health probs
-mental health probs
-fall risk assessment
-meds (sedatives, antihypertensives, opioids)
-nutrition deficiences
AMPAC 6 CLICKS
how much difficulty…
1. turning over in bed
2. sitting down on and standing up from chair w/ arms
3. moving from lying on back to sitting on side of bed
1: unable, 2: a lot, 3: a little, 4: none
how much help from someone else…
4. moving to and from bed to a chair (including wheelchair)
5. to walk in hospital room?
6. climb 3-5 steps w/o railing
1: total, 2: a lot, 3: a little, 4: none
what is AMPAC used with? what are the values?
JH-HLM
AMPAC 6-7 = JH 2
AMPAC 8-9 = JH 3
AMPAC 10-15 = JH 4
AMPAC 16-17 = JH 5
AMPAC 18-21 = JH 6
AMPAC 22-23 = JH 7
AMPAC 24 = JH 8
what is JH-HLM?
daily mobility score
1. lying in bed
2. bed activities/dependent transfer
3. sit at bed edge
4. move to chair/commode
5. standing (1+ mins)
6. walk 10+ steps
7. walk 25+ feet
8. walk 250+ feet
who does not have to move?
physiologically unstable
EKG changes/cardiac enzymes
INR >5, PTT >100
unresponsive to verbal stimuli
spinal trauma/unable fractures
femoral sheath
thrombolytic admin
safety and activity interventions?
- ambulating
- PROM/AROM: passive and active range of motion
- position changes (necessary to reduce pressure on capillary beds (tissue death) causes skin breakdown)
- trapeze bars/side rails
-physical therapy consults
-turning systems
-avoiding knee gatching (end of bed pushed up- pressure causing DVT and PE)
-log rolling
-specialty beds
what is Fowler’s?
head of bed elevated 45-60 degrees
what is low Fowler’s?
HOB elevated 15-30 degrees
what is semi Fowler’s?
HOB elevated to 30-45 degrees
what is high Fowler’s?
HOB elevated 90+ degrees
what is Fowler’s important for?
reducing aspiration risk, slipping in bed, tube feedings
what is orthopneic?
sit up 90 degrees and on pillows (tripod position)
*for COPD- expands lungs for better ventilation
what is prone position?
lying face down
*increases blood flow to anterior surfaces which increases oxygenation perfusion
what is lateral position?
lying on side
*place pillows everywhere there is a bony prominence
what is SIM’s position?
on side, arm back, one leg slightly elevated on pillow
*frequently used in OB and maternity
what is lithotomy position?
stirrups/legs up
*for pelvic procedures
trendelenburg?
feet elevated, bed straight
reverse trendelenburg?
head elevated, bed straight
protective positioning?
-pillows
-pressure reducing mattress
-support boots
-hand rolls
-trochanter rolls
*maintain body parts in normal anatomical position
what is Bloom’s taxonomy?
remember
understand
apply
analyze
evaluate
create
what is a trochanter roll for?
add support to avoid hips externally rotating
what is log rolling?
maintaining spinal alignment while turning/moving pt
what should you offload to prevent pressure injuries? (most common site due to constant pressure)
sacrum
other common sites?
heels, back of head, elbows, etc
what are support boots for?
to maintain plantar flexion
prevents foot drop by keeping foot in anatomical alignment
*foot board also prevents foot drop
which side should you stand on when assisting with ambulating?
stand on WEAK side
walkers adjusted to?
height/level of patient’s hip
cane use?
hold cane on strong side
1. advance cane
2. advance weak leg
3. advance strong leg
*creates tripod strength
axillary crutches duration?
long term
forearm crutches duration?
short term
