Mobility

Question 1

what are the 5 p’s in terms of identifying compartments syndrome

Answer 1

pain, paraesthesia, pallor, paralysis, pulselessness

Question 2

what is compartment syndrome

Answer 2

a limb threatening complication that occurs when there is a sudden and severe decrease in blood flow to the tissues distal to an area of injury

Question 3

what are 3 nursing interventions for compartment syndrome

Answer 3

1. keep the limb at heart level
2. pain management
3. provide education on how to recognize compartment syndrome

Question 4

what is a fat emolism

Answer 4

embolus made up of fat globules

Question 5

how does a fat embolism occur

Answer 5

fat globules diffuse from marrow into the vascular compartment which occludes small blood vessels

Question 6

what are 3 nursing interventions for fat embolism

Answer 6

1. maintain fluid and electrolyte imbalance
2. encourage exercise to prevent venous stasis
3. patient education to report S&S of a fat embolism

Question 7

what are 5 signs of a fat embolism

Answer 7

decreased spo2, tachypnea, changes in loc, cyanosis, free fat in urine

Question 8

what are 3 nursing interventions for neurovascular compromise

Answer 8

elevate limb, encourage exercise, use of compression devices

Question 9

what are 5 signs of a pe

Answer 9

dyspnea, tachypnea, hypotension, chest pain, diaphoresis

Question 10

what are 5 signs of a dvt

Answer 10

sudden onset of pain, swelling, warmth, skin discolouration, diaphoresis

Question 11

what are 5 interventions for pe and dvt

Answer 11

early ambulation, frequent ambulation, use of compressive devices, encourage fluids, administer anticoagulants as prescribed

Question 12

what are 3 signs of atelectasis

Answer 12

tachypnea, dyspnea, hypoxemia

Question 13

what are 5 signs of pneumonia

Answer 13

chest pain, tachypnea, bradycardia, coughing, sputum

Question 14

what is an acronym to remember the interventions for atelectasis and pneumonia

Answer 14

ICOUGH

Question 15

what does ICOUGH stand for

Answer 15

I: incentive spirometry
C: coughing and deep breathing
O: oral care
U: understanding (patient education
G: getting out of bed at least 3 times a day
H: head of bed elevation

Question 16

what are 5 cardiovascular complications of immobility

Answer 16

reduced cardiac capacity, loss of endurance, orthostatic hypotension, venous stasis, formation of blood clots

Question 17

what are 4 respiratory complications of immobility

Answer 17

reduced lung expansion, atelectasis, reduced gas exchange, pneumonia

Question 18

what are 4 MSK complications of immobility

Answer 18

muscle atrophy, joint contracture, bone demineralization, osteoporosis due to calcium loss

Question 19

what are 3 INTEG complications of immobility

Answer 19

hypoxemia of tissues, skin breakdown, pressure ulcers

Question 20

what are 3 GI complications of immobility

Answer 20

constipation, reduce appetite, reduced GI motility

Question 21

what are 3 GU complications of immobility

Answer 21

renal calculi, urinary stasis, infection