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MODULE 1 > mobility/immobillity > Flashcards

mobility/immobillity Flashcards

1
Q

person’s ability to move about freely

A

mobility

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2
Q

forms of mobility

A

nonverbal gestures, self-defense, ADLs, recreational, satisfaction of basic needs, and expression of motion

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3
Q

factors affecting mobility and activity:

A

developmental, nutrition, lifestyle, stress, environment, and diseases & abnormalities

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4
Q

diseases & abnormalities:

A

-bones, muscles, and nervous system
-pain
-trauma
-respiratory system
-circulatory
-psychological/social

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5
Q

a person’s inability to move about freely

A

immobility

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6
Q

immobility may involve:

A

specific part of body due to injury

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7
Q

paralegia:

A

may involve lower part of body

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8
Q

hemiplegia:

A

may involve one side of the body

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9
Q

quadriplegia:

A

may involve entire body from the neck down

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10
Q

restricts patient to bed for therapeutic reasons:

A

bedrest

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11
Q

bedrest does what for patient:

A

reduces pain, reduces physical activity and O2 demand, allows ill/debilitated/exhausted patients to rest, and the duration of bedrest depends

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12
Q

physical causes of immobility:

A

bone fractures, surgical procedures, major sprain/strain, illness/disease, cancer, and aging process

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13
Q

psychological causes of immobility:

A

stress/depression, decreased motivation, hospitalization, long-term care facilities residents, voluntary sedentary lifestyle

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14
Q

reduced functional capacity -> altered metabolism -> numerous physiological changes

A

prolonged immobility

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15
Q

musculoskeletal effects of immobility:

A

brittle bones, contractures, muscle weakness & atrophy, and footdrop

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16
Q

lung effects of immobility:

A

pneumonia, decreased respiratory effort, decreased oxygenation of blood

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17
Q

heart & vessel effects of immobility:

A

blood clots and reduced blood flow

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18
Q

effects of immobility on gastrointestinal:

A

decreased appetite and low fluid intake, constipation, and/or bowel obstructions, incontinence, electrolyte imbalance

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19
Q

effects of immobility on genitourinary:

A

reduced kidney function, incontinence, UTI, urinary retention

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20
Q

effects of immobility on integument:

A

decreased blood flow, pressure ulcers, infections, skin break down

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21
Q

effects of immobility on nervous system:

A

lack of stimulation, anxiety, isolation, confusion, depression

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22
Q

osteoclasts:

A

break down bone

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23
Q

osteoblasts:

A

build up bone, deposits calcium into the bone, vitamin D and calcium = need both, vitamin D absorption in intestines

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24
Q

____ fractures are caused by weakened bone tissue

A

pathological

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25
Q

risk factors of osteoporois:

A

females are more affected than males, especially after menopause, insufficient exercise/or too much exercise, poor diet (low in Ca or protein), smoking

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26
Q

osteoporosis:

A

a bone disease that develops when bone mineral density and bone mass decreases, or when the structure and strength of bone changes

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27
Q

fractures may occur easily if ___ ___ drops below _____ ______

A

bone mass, fracture threshold

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28
Q

range of motion:

A

maximum amount of movement available at a joint

29
Q

joints not moved are at risk for _____

A

contractures (can begin forming within 8 hours)

30
Q

what is the easiest intervention to maintain or improve joint mobility

A

ROM exercises

31
Q

what improves joint mobility

A

ROM exercises

32
Q

contractures are:

A

limitations in the passive ROM of a joint secondary to shortening of the connective tissues and muscles (can be permanent)

33
Q

active ROM:

A

done by patient

34
Q

active assit ROM

A

done by patient but with help

35
Q

passive ROM

A

done by nurse or other caregiver (continuous passive ROM)

36
Q

when do you do ROM:

A

3x daily (after bath, midday, bedtime)

37
Q

how do you perform ROM?

A

start gradually and move slowly using smooth motions, support the extremity, and stretch the muscle only to the point of resistance/pain

38
Q

respiratory assessment:

A

lung sounds, O2 patients, RR, activity tolerance (SOB), chest x-ray, and arterial blood gases

39
Q

TCDB:

A

turn, cough, deep breath (hold 3 seconds) and cough 2x. first cough loosens sputum and second moves it out

40
Q

cardiac asessment:

A

blood pressure, pulse rate, heart sounds, activity tolerance (BP, HR, chest pain), CALF PAIN

41
Q

deep vein thrombosis (DVT)

A

decreased muscle activity - pooling of blood - clot formation - DVT

42
Q

best prevention of DVT

A

early ambulation

43
Q

TED hose:

A

thrombo-embolic deterrent hose: post-surgical, non-walking patient, ** no wrinkles

44
Q

sequential compression device (SCD)

A

sleeves around legs, alternately inflate and deflate, post-surgical/circulatory disorders

45
Q

if your patient has calf pain, do you rub or not rub their calves and why?

A

no, it will dislodge and go to the lungs and causes a pulmonary embolism

46
Q

metabolism assessment:

A

decreased appetite, weight loss, muscle loss, weakness, and labs

47
Q

integument assessment:

A

skin assessment (color changes and integrity), nutrition, and incontinence

48
Q

pressure injury:

A

impairment of the skin as a result of prolonged ischemia in tissues

49
Q

symptoms of DVT

A

pain, swelling, redness

50
Q

pressure injury develops when:

A

pressure on skin is greater than pressure inside small peripheral blood vessels, inflammation forms over bony prominences

51
Q

gastrointestinal assessment:

A

bowel sounds, abdominal palpitation, incontinence, and urine (color, smell, clarity)

52
Q

urinary stasis:

A

when the renal pelvis fills before urine enters the ureters because peristaltic contractions of the ureters are insufficient to overcome gravity

53
Q

urinary elimination changes:

A

immobility (decreased activity), decreased fluid intake, dehydration, concentrated urine, increased risk for UTI and kidney

54
Q

psychosocial assessment:

A

mood, orientation, speech, affect, sleep

55
Q

psychosocial effects:

A

social isolation, loneliness, decreased coping, depression, anxiety, withdrawal, delirium

56
Q

benefits of mobility:

A

strengthens, joint flexibility, stimulates circulation, prevents constipation, prevents osteoporosis, stimulates the appetite, prevents urinary incontinence & infection, relieves pressure, improves self-esteem, decrease anxiety and depression

57
Q

mobility level 1:

A

red- dependent- total lift without assistance from patient, up in chair 3x

58
Q

mobility level 2:

A

orange- moderate assistance - assist x2 - patient requires caregiver to lift more than 35 lbs, patient may be unable to bear weight and require stand lift assistance. Up in chair 3x daily

59
Q

mobility level 3:

A

yellow - minimum assistance - patient requires no more help than standby assist or cueing. Walk 3x daily up in chair and chair 3x daily

60
Q

mobility level 4:

A

green- modified independent - patient performs tasks safely without physical assistance from staff. Walk 3x daily and 3x chair daily

61
Q

restraints:

A

any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move arms, legs, body, or head freely

62
Q

non-violent restraints:

A

actions impede medical care, lack of awareness of potential harm to self and others, unable to follow commands and comply with safety instructions, attempts to pull out tubes/drains, requires every 2 hours monitoring and documentation, new order required every calendar

63
Q

restraint types:

A

extremity, mitten, posey, and belt, papoose or mummy restraint (child)

64
Q

covenant’s restraint policies:

A

prior to restraining, alternatives must be attempted:
-reorientation
-limit setting
-use of sitter
-increased observation and monitoring
-change the patient’s physical environment
-review and modification of medication regimen

65
Q

restraint guidelines:

A

practitioner must order prior to applying, in emergencies - may apply but practitioner must be notified immediately, a new order must be obtained daily, must be d/c at the earliest possible time, monitoring varies- could continuous 15 minutes or every 2-3 hours), assessment includes vital signs, hydration, and circulation, skin integrity, and patient’s level of distressr

66
Q

risk of using restraints:

A

increase in injury or death, loss of self-esteem, humiliation, fear, anger, increased confusion and agitation

67
Q

complications of restraints:

A

impaired skin integrity, lower extremity edema, altered nutrition, physical exhaustion, social isolation, immobility complications, death

68
Q

intervention application:

A

restrict movement as little as is necessary, fits properly, always tie (slip knot or bow tie) to bed frame/mattress springs, never leave patient unattended, pad bony prominences, document

69
Q

if they can respond, ask them to ____ and if they have _____

A

move the limb, tingling

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