Mobility

Question 0

Stretching or tearing of ligaments; most common are of ankles and knees; may involve swelling, pain and bruising

Answer 0

Sprain

Question 1

What does RICE stand for, referring to sprains and strains?

Answer 1

Rest, Ice, Compression, Elevation

Question 2

Stretching or tearing of a muscle or tendon; may cause pain, swelling, and muscle spasms; most commonly occur to lower back and hamstrings

Answer 2

Strain

Question 3

What are some major complications immobility can lead to?

Answer 3

Atelectasis, pneumonia, decreased gastrointestinal motility, paralytic ileus, or impaired tissue perfusion.

Could also lead to atrophy and contractures, pressure ulcers, orthostatic intolerance, deep vein thrombosis, kidney stones, psychological affects of feeling powerlessness and possible reduce self-esteem.

Question 4

Techniques used for physical assessment of mobility:

Answer 4

Examination should be head to toe and proximal to distal.

• Inspection
• Palpation
• Measurement of muscle mass
• Range of motion (ROM)

Question 5

Physical assessment also includes assessing the clients neurovascular status through use of the 5 P’s neurovascular assessment, what are the 5 P’s?

Answer 5

Pain– Assess for pain using a 0 to 10 pain scale
Pulses – Compare bilaterally
Pallor – Could indicate blood loss and coolness to extremity
Parestethsia– Decreased sensation causing complaint of burning, tingling, numbness; could indicate neural damage
Paralysis/paresis– Assess mobility distal to affected body part; could indicate nerve damage

Question 6

How do you assess muscle strength?

Answer 6

Assess bilaterally. Be aware of clients history (certain diseases can affect mobility of muscles). Find out which side is dominant (strength is expected to be greater on the side). Provide resistance against muscles to test client’s strength. Use muscle grading scale to score them 0-5.

Question 7

Using muscle grading scale if a patient can do full range of motion against full resistance they would get a score of _____.

Answer 7

5

Question 8

Using muscle grading scale if a patient can do full range of motion against some resistance, they would receive a score of _____.

Answer 8

4

Question 9

Using muscle grading scale, if the patient can do full range of motion against gravity, they would receive a score of ____.

Answer 9

3

Question 10

Using muscle grading scale, if a patient can only do passive range of motion, they would receive a score of ____.

Answer 10

2

Question 11

Using muscle grading scale, if the patient can feel contraction of muscles, but there is no movement of the limb, they would receive a score of _____.

Answer 11

1

Question 12

Using muscle grading scale, if a patient has no visible contraction; paralysis, they would receive a score of _____.

Answer 12

0

Question 13

What test would you use to look for carpal tunnel by holding wrist in acute flexion for 60 seconds?

Answer 13

Phalen’s test

No tingling, numbness, or pain should be felt for a normal finding.
Numbness, tingling, or pain may indicate carpal tunnel syndrome.

Question 14

Which test would you use to look for fluid of the knee by applying downward pressure on the knee while pushing patella backward against femur?

Answer 14

Ballottement test

The patella should not move for a normal finding.
Increased fluid will cause a tapping sound as the patella displaces the fluid and hits the femur.

Question 15

What test would you use to look for a meniscus injury by having the client lay down and asking them to turn flexed knee toward center of body. Stabilizing knee and applying pressure on the lower leg?

Answer 15

McMurray’s test

No pain or clicking should be present for normal finding.
Pain, locking, or popping may indicate a meniscus injury

Question 16

___________ is an example of ______________ method of rehabilitative nursing which is defined as interventions used to help an individual maintain their regular mobility.

Answer 16

Exercise, Preservative

Question 17

Interventions specifically designed for those with decreased mobility are _____________ methods of rehabilitative nursing.

Answer 17

Restorative – purpose is to assist client in obtaining level of mobility that was present prior to them getting ill.

Examples include ambulation with assistive devices

Question 18

Importance of exercise

Answer 18

Promotes proper alignment
Prevent contractures
Stimulates circulation
Prevents pressure ulcers
Prevents thrombophlebitis
Reduces joint pain and stiffness
Increases flexibility and endurance
Prevents edema and promotes lung expansion