Activity & Immobility: Week 6

Question 1

Gait

Answer 1

The manner or style of walking, including rhythm, cadence, length of stride, and speed

Question 2

Spinal Malformations

Answer 2

Kyphosis: overexaggerated thoracic spine
Lordosis: overexaggerated lumbar spine
Scoliosis: exaggerated lateral curvature of the spine

Question 3

Atrophy vs. Hypertrophy

Answer 3

atrophy- related to decreased use, causes decreased muscle size
hypertrophy- increased or enlargement of muscle. strengthening

Question 4

Ergonomics

Answer 4

Science that focuses on factors or qualities in an object’s design/use that contribute to comfort, safety, efficiency, and ease of use

Question 5

Body Mechanics

Answer 5

Center of gravity: lower the better
Lifting: use assistive devices when appropriate
Pushing or pulling: wide base of support

Question 6

Fowler’s Bed Position

Answer 6

Head of bed at 45-60 degrees
Promotes lung expanision, useful for proceudres (NG insertion, suctioning), helps promote drainage post abdominal surgery

Question 7

High Fowler’s Bed Position

Answer 7

Head of bed between 60-90 degrees
Promotes lung expansion the most, good position to put people in acute respiratory distress, good for patients experiencing regurgitation, (lowers the diaphragm to allow for FULL lung expansion) best for patients eating in bed

Question 8

Semi-Fowler’s Bed Position

Answer 8

Head of bed between 15-45 degrees (usually 30 degrees)
Prevents regurgitation from eating/enteral feedings, helps promote lung expansion (minimally compared to flat) , most common position for patients in bed, we try never to lay patient flat because of aspiration risks for pneumonia risk, most hospitals want patients at least 30 degrees, however, for patients who have just had their groin accessed or have had some procedure or line in the groin, may be restricted to 30 degrees or lower

Question 9

Trendelenburg

Answer 9

Entire bed tilted with head of bed lower than foot of bed
Used to facilitate postural drainage and promote venous return, can be used if patient hypotensive and to shunt blood to heart/brain and out of the extremities, used more commonly in emergency situations

Question 10

Reverse Trendelenburg

Answer 10

Entire bed tilted with foot of the bed low to ground and head of bead high
Promotes gastric emptying, and prevents reflux, we use sometimes when patients have lines in their groins and cannot bend their legs so they are sitting up.

Question 11

Modified Trendelenburg

Answer 11

Patient remains flat but legs elevated above the heart

Helps with hypovolemia a bit as well, helps with venous return (fluid getting stuck in legs)

Question 12

Trapeze Bar, Mechanical Lift, Log Roll

Answer 12

Trapeze bar– allows patient to pull with upper extremities to raise trunk off the bed
Mechanical Lift- for immobilized/weak patients, make sure you know hospital policy
Log roll- for patients in spinal and cervical precautions [know procedures]

Question 13

Venous Thrombus Embolism [VTE] and/or deep vein thrombosis [DVT]

Answer 13

VTE- clot that has detached from the wall [blocking blood flow in some way]
DVT- clot within the vein obstructing blood flow

Question 14

Virchow’s Triad

Answer 14

Damage to the vessel wall
Alteration in blood flow (immobility/ bed rest)
Alterations in blood constituents (changed clotting factors, increased platelet activity)

Question 15

Pulmonary Embolism

Answer 15

Deadly complication related to VTE/DVT that has lodged in pulmonary circulation blocking gas exchanged

Question 16

Pulmonary Toilet

Answer 16

Turn, Cough, Deep Breathe
Includes positioning patient in bed
Helps prevent respiratory complications associated with immobility

Question 17

Gait Belt

Answer 17

Assistive device which helps nurses mobilize patients
Reduce chances of patient falling and decreases injury of nurses hurting themselves
Make sure you read the website related to gait belt

Question 18

Single legged versus quad cane

Answer 18

Single legged- provides support and balance for patients with MILD balance or strength impairment
Quad cane- best for unilateral weakness
Review nursing teaching points for all types of canes

Question 19

Rollator Walker

Answer 19

Walker which has either 2 or 4 wheels- commonly used short-term
Follows same rules as other walkers

Question 20

Crutch gaits

Answer 20

2-point: partial weight-bearing on both feet
3-point: all weight bearing on one-leg, affected leg not on the ground
4-point: weight-bearing on both legs, each leg moves alternately, 3 points of contact/support at all times
Swing-through: for patients with paraplegia, weight placed on supported legs then crutches step

Question 21

Lofstrand crutch

Answer 21

Forearm crutch

Usually used for longer periods of time, usually related to some type of long-term paralysis/serious weakness

Question 22

Pseudodiarrhea

Answer 22

Impacted feces become hardened and clog and then liquid stool tries to pass around it; can lead to bowel obstruction
Consequence of immobility

Question 23

Peristalsis

Answer 23

Can become decreased with immobility causing multiple other gastointestinal consequences

Question 24

Renal Calculi

Urinary Stasis

Answer 24

Another word for kidney stones
Caused by abnormal gravity associated with a person being in bed long-term, urine becomes lodged in kidneys, causing higher risks of renal calculi, UTIs, etc.

Question 25

Contractures, Foot Drop

Answer 25

Contracture: possibly permanent, abnormal fixation of the joint, caused by disuse, atrophy and shortening muscle fibers [causes decreased ROM]
Foot drop: type of foot contracture, foot permanently flexed in plantar flexion; unable to lift toes off the ground, increases risk for falls

Question 26

CVA

Answer 26

Cerebral vascular accident–> more commonly known as a stroke
Common cause of long-term immobility

Question 27

SCDs

Anti-embolic stockings

Answer 27

SCD= sequential compression device; inflates and deflates at cyclical pace, use whenever patient is not ambulating
Anti-embolic stockings- maintains external pressure on muscles of lower extremities, promotes venous return, remove at least once per shift. Appropriate use is critical.