Mobility Flashcards
1
Q
How many bones are there in the skeleton?
A
206
2
Q
What is the axial skeleton?
A
The axial skeleton contains the ribs, sternum, vertebral column, and skull.
3
Q
What is the appendicular skeleton?
A
The appendicular skeleton contains the pectoral girdles, upper limbs, pelvic girdle, and lower limbs.
4
Q
What are the three types of muscle?
A
The three types of muscle are skeletal muscle, smooth muscle, and cardiac muscle.
5
Q
Why are skeletal muscles important? How many are there?
A
Skeletal muscle is critical for physical mobility. Skeletal muscles attach to bones via tendons; thus, muscle contraction causes movement of the skeletal bones. The human body contains more than 640 skeletal muscles that are under voluntary control by the nervous system.
6
Q
What do ligaments do?
A
Ligaments connect bones to other bones to form a joint. They strengthen and stabilize the joint and may limit the mobility of some joints.
7
Q
What connects bones to other bones?
A
Ligaments connect bones to other bones to form a joint. They strengthen and stabilize the joint and may limit the mobility of some joints.
8
Q
What do tendons do?
A
Tendons connect bones to muscles and carry the contractile forces from the muscle to the bone to cause movement.
9
Q
What connects bones to muscles?
A
Tendons
10
Q
What type of flexible connective tissue is found throughout the body?
A
Cartilage is a type of flexible connective tissue found throughout the body. For example, cartilage connects the ribs to the sternum, covers the epiphyses of long bones to cushion the joint, and provides structure for the nose. Cartilage is less flexible than muscle, but not as rigid as bones. Of these three types of connective tissue, cartilage is the only one that does not contain blood vessels.
11
Q
What type of connective tissue does not contain blood vessals?
A
The cartilage
12
Q
What type of tissue connects the ribs and the sternum?
A
the cartilage
13
Q
What type of tissue covers the epiphysis of the long bones to provide cusioning?
A
The cartilage
14
Q
What type of tissue gives structure to the nose?
A
Cartilage
15
Q
What are four properties of muscles (the three e’s and a c)
A
Excitability, extendibility, contractibility, and elasticity
16
Q
Excitability, extendibility, contractibility and elasticity are properties of what?
A
muscle
17
Q
What are the dangers of immobility for a patient? What medical conditions can it cause?
A
Along with exacerbating existing musculoskeletal impairment, immobility can lead to a host of other problems, including atelectasis (collapse of one or more sections of the lungs) and pneumonia; decreased gastrointestinal motility and paralytic ileus; and impaired tissue perfusion, which can predispose the patient to developing pressure injuries.
18
Q
What conditions may limit mobility?
A
Conditions that may limit mobility include pain, fatigue, respiratory disorders, cardiovascular disease, nervous system disorders, and musculoskeletal diseases or injuries.
19
Q
What are some conditions that will be exacerbated or caused by immobility?
A
Immobility may cause or affect problems with constipation, decubitus ulcers, metabolic disorders, depression, coping, or spirituality.
20
Q
Why might a nurse take special care in making sure that the home of a patient with mild to moderate severe Alzeheimer’s is free from rugs and objects that might lead to falls?
A
For example, Suttanon and colleagues (2012) identified balance and mobility impairments in patients with mild to moderately severe Alzheimer disease (AD).
21
Q
Why is it important to take folic acid during pregnancy?
A
Taking folic acid during pregnancy is known to reduce the risk of spina bifida (myelomeningocele), which can cause partial or complete loss of sensation and paralysis of the legs.
22
Q
The lack of folic acid in pregnancy is associated with what disease?
A
spina bifida (myelomeningocele)
23
Q
What genetic disorders impact mobility?
A
- muscular distrophy (MD): progressive weakness and degeneration of skeletal muscles 2. Marfan syndrome: a disorder of the connective tissues that affects the lungs, heart, blood vessals, eyes and skeleton. Causes long limbs and is associated with pain, numbness and weakness. 3. Amotrophic lateral sclerosis (ALS) a neurologic disorder that affects the neurons responsible for voluntary muscle movements. Symptoms include weaknesss, paralysis in limbs, slurred speech, trouble swallowing, muscle cramps and difficulty breathing. 4. Ellis-van Creveld Syndrome: a rare disorder that affects bone growth. It may cause a cleft lip or palate, polydactyly, tooth abnormalities or shortened arms/legs. Other disorders that may have a genetic component: rheumatoid arthritis, gout, developmental dysplasia of the hip, ankylosing spondylits, lupus
24
Q
What is Muscular Distrophy?
A
A genetic condition: muscular distrophy (MD): progressive weakness and degeneration of skeletal muscles
25
What is Marfan syndrome?
Marfan syndrome is a genetic condition: Marfan syndrome: a disorder of the connective tissues that affects the lungs, heart, blood vessels, eyes and skeleton. Associated with long limbs relative to the body and is associated with pain, numbness and weakness. https://www.youtube.com/watch?v=6n6Tx_bdzk8
26
What is Ellis-van Creveld Syndrome?
Ellis-van Creveld Syndrome: a rare disorder that affects bone growth. It may cause a cleft lip or palate, polydactyly, tooth abnormalities or shortened arms/legs.
27
What is spina bifida?
A birth defect in which a developing baby's spinal cord fails to develop properly.
https://www.youtube.com/watch?v=jlDZA2PNW2o
28
What is involved in the observation portion of a mobility assessment?
Observe patients as they ambulate across the room or to the examination room. Observe for balance, uneven gait, difficulty bearing weight, and use of assistive devices or furniture for balance or support. Observe for signs of pain, such as facial grimacing or guarding, or moaning or wincing with movement, bending, or weight bearing. Note any findings. Observation in the clinic or inpatient setting may be similar to that for the home setting.
29
What are questions one might ask regarding history when assessing for mobility?
History
Have you ever experienced a bone or muscle injury or problem? If so, describe it.
Have you ever taken medications to treat a bone or muscle injury or problem? If so, what were they?
Have you ever received treatments for a bone or muscle injury or problem, such as surgery, physical therapy, or alternative treatments? If so, describe them.
Has anyone in your family been diagnosed with a musculoskeletal or nervous disorder?
30
What are questions one might ask regarding current status when assessing mobility?
Current Problem
Describe the pain you are experiencing (onset, intensity, location, etiology, duration). What relieves the pain or makes it worse?
Do you have any symptoms accompanying your pain, such as swelling, muscle spasms, cognitive deficits, balance problems, numbness, stiffness, or muscle weakness?
Do your symptoms limit your ADLs, such as walking, bathing, cooking, or participating in social activities?
Are you currently taking any medications or other treatments to help decrease your symptoms?
Do you need to use assistive devices for ambulation or ADLs?
Does your condition affect your ability to sleep at night?
Has your condition ever caused you to fall?
Describe how this condition affects your relationships, your ability to work, or how you feel about yourself.
Does your condition contribute to feelings of stress? How do you cope with that stress?
If the patient is injured, ask the following questions:
Describe how the injury occurred.
How does it feel when you try to bend the joint (knee, ankle, shoulder) or use the affected area (hand/wrist, foot)?
How does it feel when you try to bear weight on the affected area (leg, foot)?
31
What lifestyle questions should a nurse ask when assessing mobility?
Lifestyle
Describe your typical dietary intake in a 24-hour period, especially your calcium intake.
Do you take vitamins or other supplements? If so, what type and how often?
Describe your physical activity in a 24-hour period.
Do you participate in a regular exercise program?
Does your job require you to do any physical labor, including lifting, bending, or twisting?
Do you smoke, drink, or use drugs? Do you feel this is contributing to your condition?
Are there any responsibilities that you may require assistance with at home, such as grocery shopping, pet care, laundry, and so forth?
Are there any barriers that you can think of that may make it difficult for you to return to your home? (For example, if the patient is non-weight-bearing, are there stairs in the home or leading into the home?)
How would you describe yourself in regard to religiosity or spirituality?
If the patient reports being religious, consider assessing for any religious beliefs behind or practices related to the injury.
Consider exploring how the patient may find comfort in spirituality.
32
Why is it important for nurses to address comfort for patients with mobility issues?
↑ Pain → ↓ activity tolerance → ↑ muscle atrophy and bone resorption.
↑ Fatigue (especially muscle fatigue) → ↓ muscle control and ↓ balance.
Patients at end of life often have ↓ mobility in general.
33
When addressing health, wellness illness and injury, the nurse is concerned with what impacts lack of movement can have?
↑ Physical activity → ↑ muscle mass/strength and bone density.
↓ Mobility → ↑ actual or perceived barrier.
34
Why would a nurse be concerned with the mood and affect when assessing mobility?
↓ Sense of self-worth or perception of life → ↑ risk of depression.
↓ Immobility → ↓ mood or affect → ↑ risk of self-harm or suicide.
35
What can a nurse do to address concerns with mood and affect?
Assess mood and affect.
Discuss signs and symptoms with healthcare providers as appropriate.
Make appropriate referrals.
Stay with patients; institute safety/suicide precautions.
36
What can a nurse do to address stress and coping with people with mobility issues?
Teach patients coping methods to counteract the stress of decreased mobility.
Encourage patients to adhere to the treatment plan to increase mobility.
Teach patients methods to reduce stress.
37
Why is it important to assess stress and coping when assessing mobility issues?
↓ Mobility → ↑ stress → difficulty coping.
38
What are 5 Ps of Neurovascular Assessment?
pain, pulses, pallor, paresthesia and paralysis(paresis)
39
What do you ask when assessing for paresthesia?
One asks about numbness, sensation, pins and needles.
40
What is paresthesia?
Definition. Paresthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. The sensation, which happens without warning, is usually painless and described as tingling or numbness, skin crawling, or itching.
41
What does one call a burning or prickling sensation in the arms, legs and feet (or other parts of body)? It is described as tingling, numbness, skin crawling or itching?
Paresthesia
42
Why is coolness at an injury site along with a pallor of coolness worrying?
It may be a manifestation of decreased arterial supply to the area.
43
What is a nurse assessing when assessing pallor?
Observe skin color in the injured or affected extremity and in the skin in general. General pallor may indicate severe loss of blood, whereas pallor and coolness of the injured extremity indicates decreased arterial supply. In contrast, warmth and cyanosis may indicate venous stasis.
44
What might paresthesia indicate?
The presence of paresthesia (changes in sensation, such as burning, tingling, or numbness) indicates neural damage or involvement.
45
What does a nurse assess when examining for paresis and paralysis?
For the patient with a fracture, assess the patient’s ability to move body parts distal to the fracture, such as fingers and toes. Inability to move indicates paralysis, whereas muscle weakness indicates paresis. Paralysis or paresis may indicate nerve or tendon damage.
46
How does one assess for paralysis and paresis?
Assess the patient's ability to move parts of the body distal to the fracture, such as fingers and toes. Muscle weakness indicates paresis; lack of movement, paralysis. They may indicate nerve or tendon damage.
47
How does one assess pulses?
Compare distal pulses between the injured or affected extremity and the unaffected extremity. Lack of distal pulse may indicate compartment syndrome or arterial compromise.
48
What would a lack of a pulse distil to the injury possibly indicate?
Compare distal pulses between the injured or affected extremity and the unaffected extremity. Lack of distal pulse may indicate compartment syndrome or arterial compromise.
49
What blood tests are used to assess for musculal/skeletal disorders?
1. Alkaline phosphatase (ALP) 2. Calcitonin/parathyroid hormone (PTH) 3. Calcium (Ca) 4. Creatine kinase (CK) 5. GH Growth Hormone 6. Human leukocyte antigen-B27 (HLA-B27) 7. Phosphorus (P) 8. Rheumatoid factor (RF) 9. Uric Acid.
50
Why would an ALP (Alkaline phosphatase) test be performed to assess for muscular skeletal disorders?
ALP is produced by bone and other organs. Increased ALP may indicate bone disease, bone fracture, bone tumors, osteomalacia, Paget disease, or rickets. Decreased ALP may indicate Wilson disease.
51
Why would an Calcitonin/parathyroid hormone (PTH) test be performed to assess for muscular skeletal disorders?
Calcitonin and parathyroid hormone (PTH) have opposite actions in the regulation of blood calcium levels, which is vital for bone and muscle strength and function. Increased calcitonin may indicate a thyroid tumor. PTH may be increased in osteoporosis that does not respond to therapy. Increased PTH may suggest kidney disease, parathyroid gland tumors, lack of calcium, or vitamin D disorders.
52
Why would a Calcium test be performed to assess for muscular skeletal disorders?
Increased blood Ca levels could indicate the presence of metastatic bone tumors, Paget disease, bone fractures, or hyperparathyroidism. Decreased blood Ca levels could indicate hypoparathyroidism, osteomalacia, or vitamin D deficiency.
53
What is osteomalacia?
Softening of bones generally due to severe vitamin d deficiency.
54
What is Paget's disease?
Paget's disease of bone
Also called: PDB, osteitis deformans: A disease that disrupts the replacement of old bone tissue with new bone tissue.
Paget's disease of bone most commonly occurs in the pelvis, skull, spine, and legs. Risk factors include increasing age and a family history of the condition. Over time, affected bones may become fragile and misshapen.
This condition can be symptomless for a long period of time. When symptoms do occur, they may include bone deformities, broken bones, and pain in the affected area.
Treatment involves medications that reduce the breakdown of bone.
55
What is Wilson's disease?
Wilson's disease is a very rare inherited disorder that causes too much copper to accumulate in the organs.
In Wilson's disease, copper isn't eliminated properly and instead accumulates, possibly to a life-threatening level. Symptoms typically begin between the ages of 12 and 23.
Symptoms include swelling, fatigue, abdominal pain, and uncontrolled or poorly coordinated movements.
Treatment often includes medications that can prompt the organs to release copper into the bloodstream. Once it's in the bloodstream, it can then be eliminated from the body through the kidneys.
56
Why would a Ck or Creatinine Kinase test be performed to assess for muscular skeletal disorders?
CK is used to detect muscle damage, muscle inflammation, rhabdomyolysis, polymyositis, and MD. CPK-MM is specific for skeletal muscle.
57
What is rhabdomyolysis?
Rhabdomyolysis is the breakdown of damaged skeletal muscle. Muscle breakdown causes the release of myoglobin into the bloodstream. Myoglobin is the protein that stores oxygen in your muscles. If you have too much myoglobin in your blood, it can cause kidney damage.
It is caused by: Rhabdomyolysis may be caused by injury or any other condition that damages skeletal muscle. Problems that may lead to this disease include: Trauma or crush injuries. Use of drugs such as cocaine, amphetamines, statins, heroin, or PCP.
58
What would a test for GH or growth hormone tell a clinician or nurse?
High levels of GH may indicate acromegaly or gigantism. Low levels of GH may result in dwarfism.
59
What would a clinician be ruling out if testing for Human leukocyte antigen B-27 (HLA-B27)?
The presence of HLA-B27 indicates an increased risk for ankylosing spondylitis and arthritis.
60
What would a clinician be ruling out when evaluating a patient with muscular skeletal issues if testing for Phosphorus?
Increased levels of phosphorus may indicate hypoparathyroidism. Decreased levels may indicate hyperparathyroidism or lack of vitamin D, which increases the risk of rickets and osteomalacia.
61
What would a test for rheumatoid factor (RF) be run to rule out?
Elevated level may indicate rheumatoid arthritis, scleroderma, lupus erythematosus, and adult S till disease.
62
What is a high uric acid level associated with?
Increased uric acid levels may indicate gout, excessive exercise, and a variety of non–musculoskeletal-related disorders.
63
What nursing interventions might promote independence?
Interventions for Promoting Independence
Be encouraging, as this promotes trying.
Offer assistance in determining adjustments that may be needed.
Avoid helping or doing something for a patient because it will get done faster.
Encourage the patient to ease out of his or her comfort zone, as creating a challenge often provides an opportunity to learn something or see what is possible.
Foster adjustments that might be necessary to allow the patient to go out independently, rather than in a group.
Provide information about the proper screenings and healthcare necessary to maintain adequate health to promote independence in healthcare choices and decisions.
Screenings and healthcare will vary depending on medical conditions. For example, screening for a patient with diabetes will include eye examinations to assess for retinopathy, which could make independence difficult.
64
What are some areas a nurse should address when creating a treatment plan with a patient with a musculal skeletal issue?
Promoting comfort, providing education, preventing injury, fostering independence and reducing social isolation.
65
What are fontanelles?
The bones of an infant’s skull are not fused at birth, allowing the bones to shift as needed as the head passes through the birth canal. This also provides flexibility of the skull as the infant’s head grows, preventing excess pressure on the brain. The spaces between the skull bones form membrane-covered fontanels, or “soft spots.”The two largest fontanels are the anterior fontanel (between the frontal and parietal bones) and the posterior fontanel (between the parietal bones and occipital bone). The posterior fontanel usually closes between 1 and 2 months of age, whereas the anterior fontanel remains open until between 7 and 19 months of age
66
A mother of a 10 month old is concerned because the anterior fontalel is not closed. What do you tell her?
The anterior fontanel remains open until between 7-19 months of age. The posterior fontanel (between the parietal and occipital bones) closes between 1-2 months.
67
What is the diaphysis?
The diaphysis is the main or midsection (shaft) of a long bone. It is made up of cortical bone and usually contains bone marrow and adipose tissue (fat). It is a middle tubular part composed of compact bone which surrounds a central marrow cavity which contains red or yellow marrow.
68
What are epiphyseal plates?
The epiphyseal plate (or epiphysial plate, physis, or growth plate) is a hyaline cartilage plate in the metaphysis at each end of a long bone. It is the part of a long bone where new bone growth takes place; that is, the whole bone is alive, with maintenance remodeling throughout its existing bone tissue, but the growth plate is the place where the long bone grows longer (adds length).
The plate is only found in children and adolescents; in adults, who have stopped growing, the plate is replaced by an epiphyseal line. This replacement is known as epiphyseal closure or growth plate fusion. Complete fusion happens on average between ages 12–18 for girls (with the most common being 15-16 years for girls) and 14–19 for boys (with the most common being 18-19 years for boys).
69
What is the curve of the spine of an infant?
An infant’s spine adapts as the child develops. At birth, the infant’s spinal column is a C-shaped convex curve.
70
What is the curve of a spine after the infant learns to hold up his/her head?
As the infant learns to hold up his or her head, the cervical spine forms a concave curve. Likewise, as the infant starts to crawl and walk, the lumbar spine also forms a concave curve. This gives the spine its characteristic S-shape. This process usually takes about a year to complete. If the spine does not form these curves, the infant may have kyphosis (convex curvature) or lordosis (concave curvature), both of which can decrease mobility.
71
What is kyphosis? What is lordosis?
In normal growth, the infant forms the S shaped spine: cervical, concave, lumbar, concave. If the spine does not form these curves, the infant may have kyphosis (convex curvature) or lordosis (concave curvature), both of which can decrease mobility.
72
What is kyphosis?
convex curvature of the spine
73
What is lordosis?
concave curviture of the spine
74
What are osteoblasts?
. Osteoblasts (cells that produce the matrix for bone formation)
75
What are sarcomeres?
Unlike the skeleton, muscles are almost completely formed at birth. Muscle growth occurs as sarcomeres (filaments made of actin or myosin) are added and lengthened in the muscle fibers; muscle fibers increase only in circumference and length, not in number.
76
Why might anticoagulation therapies be particularly important for pregnant women with injuries?
Anticoagulation therapy may be needed for orthopedic injuries in pregnant women because of the hypercoagulable state of pregnancy and the potential immobility.
77
Would a clinician prescribe warfarin for pregnant women?
Warfarin is contraindicated during pregnancy, as it may cause fetal hemorrhaging and/or abortion.
78
What anticoagulant therapies are used for pregnant women?
Compression stockings and unfractionated heparin or low-molecular-weight heparin may be used during pregnancy
79
What is bone resorption?
Bone resorption (the process by which bone is broken down and its minerals released into the blood) occurs when minerals stored in bones are needed for cellular processes, and bone formation (ossification) occurs when excess minerals are available.
80
What is bone remodeling? What role does stress play on it?
Bone stress also plays a role in the rate of bone remodeling; bones that are used frequently increase their rate of bone formation, whereas bones that are not used undergo a higher rate of bone resorption. These processes must remain in balance to preserve the structural integrity of the bone. Bone remodeling is also a critical factor in repair of bone injuries.
81
What impact does calcium have on the bones?
Hormones that regulate bone remodeling are controlled by blood calcium levels. When blood calcium levels are low, PTH is released to stimulate osteoclast (cell that breaks down bone tissue) activity and bone resorption to increase blood calcium levels. In contrast, when blood calcium levels are high, calcitonin is released to inhibit osteoclast activity and increase osteoblast activity, thus increasing mineral deposition in bones. Calcium regulation is a vital factor in mobility, because calcium is necessary not only for bone strength, but also for transmission of nerve impulses and muscle contraction.
82
What happens to bones when calcium levels are low?
When calcium levels are low, PTH is released to stimulate osteoclasts which break down bones. This is done to increase bone calcium levels.
83
What is the impact of higher calcium levels?
Hormones that regulate bone remodeling are controlled by blood calcium levels. When blood calcium levels are low, PTH is released to stimulate osteoclast (cell that breaks down bone tissue) activity and bone resorption to increase blood calcium levels. In contrast, when blood calcium levels are high, calcitonin is released to inhibit osteoclast activity and increase osteoblast activity, thus increasing mineral deposition in bones. Calcium regulation is a vital factor in mobility, because calcium is necessary not only for bone strength, but also for transmission of nerve impulses and muscle contraction.
84
What is sarcopenia?
Muscle fibers decrease, or atrophy, with age in a process called sarcopenia. This causes muscles to have less tone and decreased speed and power of contractions, partially as a result of changes in the nervous system, causing decreased muscle strength, slower reaction time, more rapid tiring, and impaired balance
85
What happens to the disks in the spinal column during aging?
Aging also produces changes in the spinal discs, which are located in between the vertebrae. Like ligaments, discs hold the vertebrae together. With their tough outer covering and fluid-filled center, discs serve as shock absorbers. Discs also allow the spine to be mobile. With aging, discs between the vertebrae lose fluid and become thinner.
86
Aside from loss of fluid in the discs and sarcopenia, what other issues may impact the muclual skeletal system of the aged?
1. Tendons and ligaments in joints have decreased elasticity, strength, and hydration, causing stiffness and decreased flexibility and ROM in the joints.
2. Hips and knees may take on a flexed position. Ligaments and tendons tear more easily and heal more slowly.
3. Fluid in the joints may decrease, and cartilage may rub together and erode. This causes pain and inflammation and contributes to slow and unsteady movements, increasing the risk of falls (Berman et al., 2016; Dugdale, 2012a). These changes decrease activity tolerance in older adults, enhancing the effects of aging in the musculoskeletal system.
87
A patient is scheduled for a magnetic evoked potentials exam.
Which explanation should the nurse use in educating the patient about the test's purpose?
"It measures how nerves respond to different types of stimulation."
88
What does an occupational therapist do?
Occupational therapists help a patient maintain and optimize skills that are necessary to complete activities of daily living (ADLs). They can also recommend modifications to the patient's home environment to allow the patient to become more independent. Physical therapists help patients to preserve or regain mobility. Speech therapy deals with speech and swallowing issues. Music therapy is used for psychological issues
89
Why is joint aspiration done?
A joint aspiration removes accumulated fluid from the joint. The fluid is analyzed to detect the presence of blood or fat droplets, which may indicate a fracture. The fluid can also be analyzed to determine if any infection is present.
90
Why is an EMG (electromyography) performed?
An electromyography (EMG) is performed to determine the electrical activity of the muscle. Joints do not have electrical activity.
91
What studies are used to diagnose carpal tunnel?
Carpal tunnel syndrome is diagnosed through nerve conduction studies.
92
What condition might nerve conduction studies diagnose?
Carpal tunnel syndrome is diagnosed through nerve conduction studies.
93
While assessing a patient for posture and gait, the nurse identifies a concave cervical spine, a convex thoracic spine, and a flattened lumbar spine.
Which reason should concern the nurse in the light of these findings?
The patient may have a herniated lumbar disc.
94
What are the signs of a herniated lumbar disc.
concave cervical spine/a convex thorasic spine/and a flattened lumbar spine
95
What does a flattened lumbar curve indicate?
herniated lumbar disc
96
The nurse is planning care for an older adult patient with muscle atrophy and limited mobility. The nurse assigns a goal to promote comfort for the patient.
Which actions are most important for the nurse to include in the plan of care?
When promoting comfort, the nurse should support and pad joints and bony prominences. Encouraging ambulation might not be appropriate because the patient has muscle atrophy and limited mobility. Isometric exercises are used to maintain strength when a joint is immobilized. Range-of-motion exercises are passive exercises that help maintain joint mobility. These exercises will not necessarily promote comfort in the patient with limited mobility.
Additional Learning
Nursing responsibilities in promoting comfort include:
Proper patient positioning.
Proper padding of joints.
Braces or splints to support weak musculoskeletal structures.
Assessment for skin pallor, blanching, weak or absent pulses, and impaired sensation.
97
The nurse discusses scoliosis with a group of parents of school-age children. The nurse includes degrees of curvature of the spine in the discussion.
Which curvature of the spine should the nurse include as being severe?
A 40degree curve or greater is severe.
Curvatures are classified as severe at 40 degrees or greater. Between 20 and 40 degrees, they are classified as moderate. Organ involvement is not a classification criterion. Curvatures greater than 100 degrees are life-threatening.
98
How often should a nurse reposition an immobile patient when concerned about skin integrity?
To maintain skin integrity in an immobile patient, the nurse should encourage and facilitate activities that safely promote mobility, including turning and repositioning the patient every 2 hours. Briskly rubbing the patient's skin could cause it to break down. Having the patient sit in one position for long periods could cause skin breakdown.
99
What is cauda equina syndrome?
Cauda equina syndrome, compression of the nerve roots of the cauda equine, is the only condition for which surgery is absolutely indicated in pregnant women. It can result in permanent neurologic impairment, including urinary incontinence and paralysis. It is considered a medical emergency. Causes include massive lumbar disc herniation, spinal stenosis, epidural hematoma, epidural abscess, and trauma. X-rays, CT scans, and MRIs are diagnostic exams.
100
What are examples of anti-inflammatory Drugs (NSAIDS)? What is their mechanism of action?
Ibuprofen, aspirin, naproxen, diclofenac, indomethacin, celocoxib; They block production of inflammatory mediators by inhibbiting Cox-1 and/or COX-2.
101
What type of drug is naproxen, diclofenac, indomethacin, celocoxib?
NSAID.
102
What are nursing three considerations important for Nsaids?
Aspirin therapy is not commonly recommended for children and should be avoided in children with an active virus or infection (influenza in particular)
NSAIDS may interfere with clinical tests usch as pregnancy tests, urine tests and liver function tests
Patients should be monitored for GI distress, bleeding and allergic reactions.
103
A nurse is to administer an NSAID to a patient. What n type of medication is this? What nursing considerations should he have?
Aspirin therapy is not commonly recommended for children and should be avoided in children with an active virus or infection (influenza in particular)
NSAIDS may interfere with clinical tests usch as pregnancy tests, urine tests and liver function tests
Patients should be monitored for GI distress, bleeding and allergic reactions.
104
What are examples of antisamoitcs or skelatal muscle relaxants?
cyclobenzaprine, dantrolene, baclofen, chlorzoxazone, orphenadrine, mthocarbarnol, carisoprodol, tizanidine.
105
What is the mechanism of action of antispasmodics?
Antispasmodics act in the CNS to decrease nerve transmission to skeletal muscles. They may interfere with calcium release during muscle stimulation.
They may also be used for pain.
106
What nursing considerations should a nurse have when administering antispasmotics?
Patients should be observed carefully for CNS effects, including confusion, depression, and hallucinations.
These drugs may cause orthostatic hypotension, loss of spasticity, dizziness, increase of risk of falls
Patients should not drive or participate in other hazardous activities until they know how these drugs affect them.
Effects may be addictive with other CNS depressants such as alcohol.
Monitor for allergic response.
Cyclobenzaprine is not recommended for pediatric use.
Some may discolor urine
107
What are examples of direct-acting antispasmodic drugs? What is their Mechanism of Action?
Examples of direct-acting antispasmotic drugs are abobotulinumtoxinA, incobobtulinumtoxinA, onabotulinumtoxinA, rimabotulinumtoxinB. These drugs block the release of acetylcholine -- necessary for voluntary contraction of skeletal muscles, from cholinergic nerve terminals.
108
What nursing considerations should be engaged when administering a DIRECT acting antispasmotic?
Because of the ability of these medications to spread to other parts of the body, serious effects include angina, difficulty breathing, extreme muscle weakness, dysrhythmias, difficulty swallowing, loss of bladder control.
instruct patients on gradual onset
109
What are examples of bone growth stimulators? What are their mechanism of action?
Bisphosphonates or bone growth stimulators include the following: alendronate, risendronate, ibandronate and zoledronic acid. They inhibit osteoclast-medicated bone resorption.
110
What are nursing considerations a nurse should take into account when administering a bone growth stimulator?
Use cautiously in patients with renal impairment or liver disease.
Hypocalcemia should be corrected before therapy begins. Do not administer within 2 hours of consuming calcium.
111
What genetic disorder leads to elongated arms?
Marfan Syndrome https://www.youtube.com/watch?v=p4Ev9KEyw78
112
What genetic disorder leads to muscle weakness and degeneration?
Muscular Distrophy
| https://www.youtube.com/watch?v=p4Ev9KEyw78
113
What are Lordosis, kyphosis and scholiosis?
Lordosis:A curving inward of the lower back.
Some lordosis is normal. Too much is referred to as swayback. It may be inherited or caused by conditions such as arthritis, muscular dystrophy, and dwarfism.
Lordosis causes an unusually large, inward arch on the lower back, just above the buttocks. The condition may cause lower back pain.
In children, lordosis often fixes itself. Some adults with lordosis may need physical therapy.
Kyphosis: A forward rounding of the back.
Hunchback (kyphosis) usually refers to an abnormally curved spine. It's most common in older women and often related to osteoporosis.
Some people with kyphosis have back pain and stiffness. Others have no symptoms other than an exaggerated forward rounding of the back.
https://www.youtube.com/watch?v=DOi24AH5yiE
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A clinician orders an ALP test (alkaline phosphitase) for a patient with issues with bone growth. What are they ruling out?
Paget's Disease: https://www.youtube.com/watch?v=e6yNx74wEKI
haphazard bone growth.
