Chapter 40 Mobility And Immobility Flashcards
What two functional systems are essential for mobility?
Musculoskeletal and nervous systems
What is mobility?
The freedom and independence in purposeful movement. Mobility refers to adapting to and having self-awareness of the environment.
What is one if the key components of reducing the complications of immobility?
Promoting venous return.
What are four types of immobility?
Temporary - knee surgery
Permanent - paraplegia
Sudden onset - fractured arm and leg
Slow onset - MS
What are the principals of body mechanics based on ?
Alignment, balance, gravity and friction.
Movement depends on which intact systems?
Skeletal
Skeletal muscle
Nervous system
What does assessment focus on regarding mobility and immobility?
Mobility ROM Gait Exercise status Activity tolerance Body alignment while sitting standing and lying.
What are some factors affecting mobility?
Alterations in muscles Injury to musculoskeletal system Poor posture Impaired CNS Health status and age.
Name two changes that occur in the integumentary system:
Increased pressure on skin
Decreased circulation to skin (ulcers)
Two changes in the respiratory system are:
- Decreased respiration movement resulting in decreased oxygen and carbon dioxide exchange.
- Stasis if secretions and decreased and weakened respiratory muscles (stele tasks and hypo static pneumonia)
Two changes to the cardiovascular system are:
Orthostatic hypotension
Less fluid volume in the circulatory system
Stasis of blood in legs
Name two changes to metabolic system:
Altered endocrine system
Changes in protein carb and fat metabolism.
Two changes to elimination system:
Genitourinary - urinary stasis
Decreased fluid intake, poor perineal car and indwelling urinary catheters
Gastrointestinal - decreased peristalsis
Constipation, then fecal impaction, then diarrhea
Two changes to Musculoskeletal system:
Decreased muscle endurance, strength and mass
Foot drop
Two changes to neurological changes:
Changes in emotional status (depression) Behavior changes (withdrawal, altered sleep)
In infants, toddlers and preschoolers what development changes are altered with immobility?
- Slower progression in gross motor skills, intellectual and musculoskeletal development.
- Body aligned with line of gravity resulting in unbalanced posture
In adolescents what development changes are altered with immobility?
Imbalanced growth spurt
Delayed development of independence
Social isolation
In adults what development changes are altered with immobility?
Alterations in every physiological system
Alterations in family and social systems
Alterations in job identity
In older adults what development changes are altered with immobility?
Alterations in balance
Steady loss of bone mass
Decreased coordination
What are the therapeutic effects of heat applications?
Increases flood flow
Increases tissue metabolism
Eases joint stiffness and pain
What are the therapeutic effects of cold applications?
Decreases inflammation Prevents swelling Reduces bleeding Reduces fever Diminishes muscle spasms Decreases pain by decreasing the velocity of nerve conduction
What are some explains of clients at risk for injury from heat/cold applications?
Very young, fair-skinned, and older (fragile skin)
Clients who are immobile (may not be able to move away when application becomes uncomfortable)
Impaired sensory perception
Name some precautions to use when heat applications are in use:
Monitor bony prominences
Avoid use over metal devices (pacemakers, prosthetic joints)
No hear to abdomen of pregnant women
No heat under client who is immobile.
When is cold applications inappropriate for clients?
Clients with cold intolerance
Vascular insufficiency
Disorders aggravated by cold (Raynaud’s phenomenon)
When using heat or cold applications make sure the providers prescription includes:
Location
Duration and frequency
Specific type (moist or dry)
Temperature to use
Heat application supplies include which two types?
Moist and Dry
Name three different types of moist heat applications:
Hot compress (towel, bath thermometer, hot water hot pack)
Hot soaks - water, bath thermometer, basin
Sitz baths
Give the different supplies used for moist cold application and dry cold application.
Moist - cold water and cold pack
Dry - ice bag, ice collar, ice glove or cold pack, cooling blanket
When using a cold or heat application then site needs to be assessed every 5-10 minutes and checked for what?
Redness or pallor Pain or burning Numbness Shivering Blisters Decreases sensation Cyanosis (cold)
Name four techniques used in promoting venous return.
Antiembolic stockings (TED) Sequential compression devices (SCDs) Intermittent pneumatic compression (IPC) Positioning techniques ROM exercises
Explain what sequential compression devices (SCD) and intermittent pneumatic compression (IPC) are:
Plastic or fabric sleeves that wrap around leg. Sleeves are then attached to electric pump that alternately inflates and deflates. The cycle is typically 10-15 seconds inflation and 45-60 seconds deflation.
What are some different ROM techniques that prevent thrombophlebitis and promote venous return?
Ankle pumps
Foot circles
Knee flexion
Do TED hose, SCDs and IPC require a prescription ?
Yes
What should immobile clients do to promote venous return?
Leg exercises
Increase fluid intake
Change position frequently
What is thrombophlebitis/deep vein thrombosis?
An inflammation of a vein (usually lower extremities) which can result in clot formation.
What are the clinical manifestations of thrombophlebitis?
Pain
Edema
Warmth
Erythema at site
What is a pulmonary embolism?
Potentially life threatening occlusion of blood flow to one or more pulmonary arteries by clot.
What are some nursing actions if a deep vein thrombosis occurs?
Notify provider
Position client in bed with leg elevated
Avoid any pressure at site
Anticipate giving anticoagulants
What are the clinical manifestations of a pulmonary embolism?
Shortness of breath Chest pain Hematemesis (coughing up blood) Decreased blood pressure Rapid pulse
What are nursing actions required of a pulmonary embolism occurs?
Prepare to give thrombolytics or anticoagulants.
To promote safe use of a cane for a client recovering from minor musculoskeletal injury or lower left extremity, which instructions should you provide?
Hold the cane on the right side
Keep two points of support on floor
Advance the weaker leg first
What is a spirometer and what does it prevent?
Apparatus for measuring the volume of air inspired and expired by the lungs. It measures ventilation.
Prevents atelectasis (collapsed lung)
