Mobility and Activity Flashcards by Christine G

is a complex process that requires coordination between the musculoskeletal and nervous systems

movement

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describes the coordinated efforts of the musculoskeletal and nervous systems. An efficient, coordinated and safe use of the body to produce motion and maintain balance during the activity. It prevents injury to self and clients

body mechanics

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the positioning of the joints, tendons, ligaments and muscles while standing, sitting, and lying

body alignment and posture

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Correct body alignment:

-Reduces strain on musculoskeletal structures
-Aids in maintaining adequate muscle tone
-Promotes comfort
-Contributes to balance
-Conservation of energy

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refers to a person’s ability to move about freely

mobility

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the inability to do or move about freely

immobility

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relationship of one body part to another along a horizontal or vertical line, an individual’s center of gravity is stable

body alignment

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Occurs when a relatively low center of gravity is balanced over a wide, stable base of support and a vertical line falls from the center of gravity through the base of support

Techniques:
a. Widening the base of support by separating the feet to a comfortable distance
b. Increasing balance by bringing the center of gravity closer to the base of support

body balance

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Is a result of weight, center of gravity, and balance

coordinated body movement

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Force that occurs in a direction to oppose movement

friction

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is physical activity that conditions the body, improves health, and maintains fitness

exercise

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Factors influencing activity and exercise

-Developmental changes
-Behavioral aspects
-Environmental issues
-Family and social support
-Cultural and ethnic origin

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Principles of BODY MECHANICS

Balance is maintained and muscle strain is avoided as long as the line of gravity passes through the base of support

–Start body movement with proper alignment
–Stand as close as possible to the object to be moved
–Avoid stretching, reaching and twisting

The wider the base of support and the lower the center of gravity, the greater the stability. Before moving objects, put your feet apart, flex the knees, hips and ankles

Balance is maintained in minimal effort when the base of support is enlarged in the direction in which the movement will occur

–Enlarge the base of support by moving the front foot forward when pushing an object
–Enlarge the base of support by either moving the rear leg back (facing the object or moving the front foot forward if facing away from the object) when pulling object

Objects that are close to the center of gravity are moved with least effort

–Adjust the working area to waist level, and keep the body close to the object

The greater the friction against the surface beneath an object, the greater the force required to move an object. Provide a firm, smooth, dry bed foundation before moving the client in bed

Pulling creates less friction than pushing

The heavier an object, the greater the force needed to move an object

–Encourage the client to assist as much a possible (pushing or pulling)
–Use own body weight to counteract the weight of the object
–Obtain the assistance of other persons or use mechanical devices to move objects that are too heavy

Move objects along a level surface requires less energy than moving an object up an inclined surface or lifting it against the force of gravity

–Instead of lifting objects, pull, push, roll or turn
–Lower the head of the client’s bed before moving the client up in bed

Continuous muscle exertion can result in muscle strain and injury

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True or False

The wider the base of support and the lower the center of gravity, the greater the stability. Before moving objects, put your feet apart, flex the knees, hips and ankles

True

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True or False

Balance is maintained and muscle strain is not avoided as long as the line of gravity passes through the base of support

False. Balance is maintained and muscle strain is avoided as long as the line of gravity passes through the base of support

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True or False

Objects that are far to the center of gravity are moved with least effort

False. Objects that are CLOSE to the center of gravity are moved with least effort

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True or False

Balance is maintained in minimal effort when the base of support is enlarged in the direction in which the movement will occur

True

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True or False

The lesser the preparatory isometric tensing, or contraction of muscles before moving an object, the greater the energy required to move it and the less musculoskeletal strain injury

False. The GREATER the preparatory isometric tensing, or contraction of muscles before moving an object, the LESS the energy required to move it and the less musculoskeletal strain injury

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True or False

Synchronized use of many large muscles as possible during the activity increases overall strength and prevents muscle fatigue and injury

True

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True or False

The farther the line of gravity to the center of the base of support the greater the stability

False. The CLOSER the line of gravity to the center of the base of support the greater the stability

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True or False

The greater the friction against the surface beneath an object, the greater the force required to move an object. Provide a firm, smooth, dry bed foundation before moving the client in bed

True

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True or False

Pushing creates less friction than pulling

False. PULLING creates less friction than PUSHING

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True or False

The heavier an object, the greater the force needed to move an object

True

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True or False

Instead of lifting objects, pull, push, roll or turn

True

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Purposes of Exercises

-To maintain good body alignment -To improve muscle strength -To improve muscle tone -To improve circulation -To relieve muscle spasm -To relive pain -To prevent or correct contracture deformities -To promote sense of well-being

Types of Exercises

Active Range-of-Motion exercises Passive Range-of-Motion exercises Active-Passive Range-of-Motion exercises Active-assistive Range-of-Motion exercises Isotonic exercises Isometric exercises

A type of exercise that is done by the client

Active Range-of-Motion exercise

A type of exercise that is done for the client by the HCPs

Passive Range-of-Motion exercise

A type of exercise that is done by the client against a weight or force

Active-Passive Range of Motion exercise

A type of exercise that is done by the stronger arm and leg to the weaker arm and leg

Activie-Assistive Range-of-Motion exercise

A type of exercise that involves change in muscle length and tension

Isotonic exercises

A type of exercise that involves change in muscle tension only

Isometric exercises

Under isometric exercises, this exercise alternates tension and relaxation of thigh muscles

Quadriceps setting

Under isometric exercise, this exercise alternates tension and relaxation of buttocks

Gluteal setting

Under isometric exercise, this exercise alternates tension and relaxation of pubococcygeal muscles

Kegel's exercise

What is the purpose of ASSISTING CLIENTS IN AMBULATION?

-To increase muscle strength and joint mobility -To prevent some potential problems of immobility -To increase the client’s sense of independence and self-esteem

Considerations in ASSISTING CLIENTS IN AMBULATION

-Ambulate client gradually (to prevent orthostatic hypotension) -Assist client in a sitting position if orthostatic hypotension occur or extreme weakness (Lower the head to facilitate blood flow to the brain) -Ensure safety during ambulation

Considerations in ASSISTING CLIENTS IN AMBULATION

True or False If orthostatic hypotension occur or extreme weakness, you should assist client in a sitting position (Lower the head to facilitate blood flow to the brain)

True

Assistive devices for walking

Walkers, Canes, Crutches, Swing to gait

lightweight movable device that stands about waist high and consists of a metal frame with handgrips, four widely placed sturdy legs and one open side. Can be used by patient who is weak and has problems with balance The top of the walker should line up with the crease on the inside of the wrist Elbows should be flexed about 15 – 30 degrees when standing inside the walker, with hands on the handgrips A patient holds the handgrips on the upper bars, takes a few steps, moves the walk forward, and takes another step. Lift the device up and forward

Walkers

are lightweight, easily movable devices made up wood or metal Provide less support than a walker and are less stable -length is equal to the distance between the greater trochanter and the floor -on the stronger side of the body -Place the cane forward 15 – 25 cm (6-10 inches) keep body weight on both legs -Move weaker leg forward to the cane so body weight is divided between the cane and the stronger leg. -Advance the stronger leg past the cane (so the weaker leg body weight are supported by the cane and weaker leg) Types: single-legged cane quad cane

Canes

A type of canes that are more common; support and balance a patient with decreased leg strength

single-legged-cane

A type of cane that provides the most support; used when there is partial or complete leg paralysis or hemiplegia

quad cane

Is a wooden or metal staff needed to increase mobility Types: double adjustable or forearm crutch and the axillary wooden or metal crutch When these are fitted, ensure the length of the crutch is two to three finger widths from the axilla Position the tips approximately 2 inches lateral and 4-6 inches anterior to the front of the patient’s shoes Position the handgrips so the axillae are not supporting the patient’s body weight (Pressure on the axillae increases risk to underlying nerves, which sometimes results to partial paralysis of the arm) Position of handgrips with the patient upright, supporting weight by the handgrips with the elbows slightly flexed at 20 – 25 degrees (Elbow flexion can be verified using goniometer) Distance between the crutch pad and the axillae is approximately 2 inches (2 – 3 finger width)

Crutches

Distance between the crutch pad and the axillae is

approximately 2 inches (2-3 finger width)

True or False Basic crutch stance is the tripod position. Crutches are placed 15 cm (6 inches) in front and 15 cm (6 inches) to the side of each foot

True

Use of CRUTCHES Gait gives stability but requires bearing on both legs Each leg is move alternately with each opposing crutch Have the patient move the right crutch forward and then move the left foot forward to the level of the right crutch. Then have the patient move the left crutch forward and then move the right foot forward to the level of the left crutch

Four-point alternating

Use of CRUTCHES Gait requires the patient to bear all of the weight on one foot Patient bears weight on both crutches and then on the uninvolved leg Have the patient move the affected leg and both crutches forward about 12 inches. Have the patient move the stronger leg forward to the level of the crutches

Three-point alternating

Use of CRUTCHES Gait requires at least partial weight on each foot Patient moves a crutch at the same time as the opposing leg so the crutch movements are similar to arm motion during normal walking Have the patient move the left crutch and the right foot forward about 12 inches at the same time. Have the patient move the right crutch and left leg forward to the level of the left crutch at the same time.

Two-point alternating

Use of CRUTCHES Have the patient move both crutches forward about 12 inches. Have the patient lift the legs and swing them to the crutches, supporting his or her body weight on the crutches

swing-to gait

Use of CRUTCHES A gait in which the crutches are advanced and the legs are swung between and ahead of the crutches.

Swing through

it decreases work effort and places less strain on musculoskeletal structures during routine activities

Principles of safe patient transfer and positioning

Principles of Safe Patient Transfer and Positioning

Mechanical lifts and lift teams are essential when a patient is unable to assist When a patient is able to assist, remember the following principles: The wider the base of support, the greater the stability of the nurse The lower the center of gravity, the greater the stability of the nurse The equilibrium of an object is maintained as long as the line of gravity passes through its base of support Facing the direction of movement prevents abnormal twisting of the spine Dividing the balance activity between arms and legs reduces the risk of back injury Leverage, rolling, turning or pivoting requires less work than lifting When friction is reduced between the object to be moved and the surface on which it is moved, less force is required to move it

Congenital defects

Congenital abnormalities Osteogenesis imperfecta

Congenital defecst that affect the efficiency of the musculoskeletal system in regard to alignment, balance and appearance

Congenital abnormalities

Congenital defects which an inherited disorder that affects bone (bones are porous, short, bowed, and deformed resulting to children’s experience of curvature of the spine and shortness of stature)

Osteogenesis imperfecta

Disorders of Bones, Joint and Muscles

Osteoporosis Osteomalacia

Disorders of bones, joint and muscles that results in reduction of bone density or mass

Osteoporosis

Disorders of bones, joint and muscles in which uncommon metabolic disease characterized by inadequate and delayed mineralization, resulting in compact and spongy bone

Osteomalacia

inflammation or destruction of synovial membrane and articular cartilage and systemic signs of inflammation

Arthritis

Have none of the characteristics of inflammatory disease, and the synovial fluid is normal

Noninflammatory disease

Involves trauma to the articular capsules and ranges from mild, (such as a tear resulting in a sprain, to severe (such as separation leading to dislocation)

Articular disruption

Damage to any part of the CNS that regulates voluntary movement causes impaired body alignment and immobility Example: A patient with (Spinal Cord Injury) SCI has permanent damage below the level of the injury and has control on the trunk muscle but not the lower extremity muscles

Central Nervous System Damage

Often results in bruises, contusions, sprains and fractures

Musculoskeletal trauma

disruption of bone tissue continuity

Fracture

True or False Nurses are exposed to the hazards relating to lifting and transferring patients in many settings such as nursing units, long-term care facilities and operating room

True

Elements of Safe patient-handling programs

-An ergonomics assessment protocol for HC environments -Patient assessment criteria and algorithms for patient handling and movement -Special equipment kept in convenient to help transfer patient -Back-injury resource nurses -An “after-action review” that allows the HC team to apply knowledge about moving patients safely in different settings -A no-lift policy

the study of people's efficiency in their working environment

Ergonomics

a process or set of rules to be followed in calculations or other problem-solving operations

Algorithms

Transfer Techniques

Assess every situation that involves patient handling and movement to minimize risk of injury Use algorithm to guide decisions about safe patient handling (describes the steps commonly used in transferring patients safely and effectively) Use a patient’s strength when lifting, transferring or moving when possible (Involving the patient helps in increasing participation in self-care, thus promoting a sense of accomplishment) Nurses need to assume an active role in their workplaces to ensure that a culture of safety exists and that appropriate patient-handling equipment is readily available

due to unused muscle atrophy

decrease in muscle strength

decreased in size of muscles

Muscle atrophy

the bones become depleted of calcium

Disuse osteoporosis

Calcium is withdrawn from the bones after 48 hours of immobility

Demineralization

Stiffness and rigidity of joints; excess calcium may deposit in the joints

Fibrosis and ankyloses

muscle no longer shorten or lengthen, limiting joint mobility

Contracture

Physiologic responses to immobility in cardiovascular system

Use of Valsalva maneuver Orthostatic (postural) hypotension Thrombophlebitis (due to venous stasis, blood clots forms in the venous wall

Physiologic responses to immobility in musculoskeletal system

Decrease in muscle strength (due to unused muscle atrophy) Muscle atrophy (decrease in size of muscles) Disuse osteoporosis (the bones become depleted of calcium) Demineralization (Calcium is withdrawn from the bones after 48 hours of immobility) Fibrosis and ankyloses (Stiffness and rigidity of joints; excess calcium may deposit in the joints) Contracture (muscle no longer shorten or lengthen, limiting joint mobility)

Physiologic responses to immobility in respiratory system

Atelectasis: is collapse of the lungs. This may be due to: Hypostatic pneumonia: accumulated secretions enhance bacterial growth Respiratory acidosis (retention of carbon dioxide due to slow, shallow respiration)

is collapse of the lungs

atelectasis

accumulated secretions enhance bacterial growth

Hypostatic pneumonia

retention of carbon dioxide due to slow, shallow respiration

Respiratory acidosis

Physiologic responses to immobility

Anorexia (results from decreased metabolic rate, and decreased energy requirements) Hypoproteinemia Hypercalcemia

Physiologic responses to immobility in metabolic and nutritional systems

Anorexia (results from decreased metabolic rate, and decreased energy requirements) Hypoproteinemia Hypercalcemia

results from decreased metabolic rate, and decreased energy requirements

anorexia

Physiologic responses to immobility in urinary system

-Urinary stasis -Urinary Tract Infection (accumulation of urine in the bladder enhances bacterial growth) -Renal calculi -Incontinence (poor sphincter control due to increased pressure within the bladder) -Retention with overflow (due to bladder distention, involuntary dribbling of urine occurs) -Urinary reflux (due to bladder distention; contaminated urine from the bldder backs up into the renal pelvis)

Physiologic responses to immobility in fecal elimination

Constipation, flatulence

Physiologic responses to immobility in integumentary system

Loss of skin turgor Decubitus ulcer

Reddened areas, sore or ulcers of the skin occurring over bony prominences due to interruption of the blood circulation to the tissue, resulting in a localized ischemia Causes: Pressure Friction Shearing force

Reddened areas, sore or ulcers of the skin occurring over bony prominences due to interruption of the blood circulation to the tissue, resulting in a localized ischemia

Nursing interventions on preventing pressure sores

Provide smooth, firm, wrinkle-free foundation on which the client can lie down Use foam, rubber pads, sheepskin, egg crate mattress under pressure areas Ongoing assessment of early signs and symptoms of pressure sores Change position of bedfast clients every 15 to 2 hours Reduce shearing force by elevating HOB of bedfast clients no more than 30 degrees Meticulous hygiene Keep skin clean and dry Avoid massaging bony prominences with soap when bathing the client Apply cream or lotion on dry skin Apply powder to tissues with limited blood flow

Transport of client from bed to wheelchair

Position wheelchair parallel to the bed Lock the wheels of the wheelchair

Transport of client from bed to stretcher

Place the stretcher parallel to the bed Lock the wheels of the bed of the stretcher Push the stretcher from the end where the client’s head is positioned When entering the elevator, maneuver the stretcher so that the client’s head goes first