Mobility and Activity Flashcards
is a complex process that requires coordination between the musculoskeletal and nervous systems
movement
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
the positioning of the joints, tendons, ligaments and muscles while standing, sitting, and lying
body alignment and posture
Correct body alignment:
-Reduces strain on musculoskeletal structures
-Aids in maintaining adequate muscle tone
-Promotes comfort
-Contributes to balance
-Conservation of energy
refers to a person’s ability to move about freely
mobility
the inability to do or move about freely
immobility
relationship of one body part to another along a horizontal or vertical line, an individual’s center of gravity is stable
body alignment
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
Is a result of weight, center of gravity, and balance
coordinated body movement
Force that occurs in a direction to oppose movement
friction
is physical activity that conditions the body, improves health, and maintains fitness
exercise
Factors influencing activity and exercise
-Developmental changes
-Behavioral aspects
-Environmental issues
-Family and social support
-Cultural and ethnic origin
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
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
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
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
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
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
True or False
Synchronized use of many large muscles as possible during the activity increases overall strength and prevents muscle fatigue and injury
True
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
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
True or False
Pushing creates less friction than pulling
False. PULLING creates less friction than PUSHING
True or False
The heavier an object, the greater the force needed to move an object
True
True or False
Instead of lifting objects, pull, push, roll or turn
True
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
-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
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
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
