Mobility Issue

Question 1

risk factors - behavioral

Answer 1

• hx of falls
• fear of falling
• lack of physical activity
• impaired safety awareness
• inappropriate use of adaptive equipment
• inappropriate footwear
• substance misuse
• poor nutrition/ hydration
• risk taking behavior

Question 2

risk factors - socioeconomic

Answer 2

• communication / language barriers
• living alone
• lack of support network
• limited access to services/ transport
• costs
• income level
• education level
• housing condition
• cultural factors

Question 3

risk factors - environmental

Answer 3

• weather
• clutter
• stairs
• tripping hazards
• slippery surfaces
• poor lighting / contrast
• use of restraints
• lack of railing/ safety equipment
• poor building design

Question 4

risk factors - biological

Answer 4

• impaired balance, mobility, muscle strength, coordination
• cognition and mood
• syncope/ dizziness
• sleep disturbance/ fatigue
• vision/ hearing
• age and gender
• health conditions

Question 5

universal falls risk (SAFE)

Answer 5

Safe environment
Assist with mobility
Fall & injury risk reduction
Engage pt & family/ caregiver

Question 6

pathologic conditions affecting mobility

Answer 6

gait disorders
osteoporosis
arthritic conditions
Parkinson’s disease

Question 7

ataxia gait

Answer 7

disorganized gait
staggering
side-stepping

Question 8

Parkinson’s disease gait

Answer 8

stooped posture
short, rushing, shuffling steps
uncontrollable propulsion
body ahead of feet

Question 9

‘frail senior’ gait

Answer 9

stooped posture
hip and knee flexion
diminished arm swing
stiffness in turning

Question 10

hemiplegia gait

Answer 10

poor arm and leg swing
affected limb does not bend at knee
ankle fixed and inverted
leg swings in wide circles
foot drag

Question 11

osteomalacia gait

Answer 11

softening of bones due to Vit D deficiency
skeletal pain on weight bearing
unable waddling gait

Question 12

osteoporosis

Answer 12

• silent disease
• high risk of bone fracture
• result in significant pain, loss of function, suffering, mortality
• affects about 55% of people 50+

Question 13

risk factors for osteoporosis

Answer 13

non-modifiable factors
- female
- Caucasian race (European)
- advanced age
- family hx

modifiable factors
- osteopenia
- low body weight
(<132 lbs, 60kg)
- low Ca intake
- vit D deficiency
- estrogen deficiency / early menopause
- low testosterone
- inadequate activity
- pathological conditions
- steroids or anticonvulsants
- excess coffee/alcohol intake
- current cigarette smoking

Question 14

arthritic conditions
- osteoarthritis

Answer 14

wear and tear
symptoms: pain, swelling, stiffness
women > men affected
onset = gradual
- begins mid 40s

Question 15

arthritic conditions
- rheumatoid arthritis

Answer 15

RA is chronic, progressive disease that is a systemic disease of the immune system
- auto-immune disorder
- most common arthritis

Question 16

RA cont.

Answer 16

• damage to joints due to inflammation
• synovitis (congestion/ edema) of synovial joint capsules
• pannus formation (destroy the joint capsule)
• fibrous ankylosis (fibrous invasion of the pannus formation that occludes joint space)
• calcification of fibrous tissue

Question 17

rheumatoid arthritis

Answer 17

• 2-3x more common in women
  peak age:
• 20-60 (W)
• 30-60 (M)

Question 18

osteoarthritis vs. rheumatoid arthritis

Answer 18

OA:
Onset: Usually later in life
Speed of onset: Slow (yrs)
Distribution: Asymmetrical
Joint affected:
- Wt bearing (knees, hips)
Worst: pm ( < 1hr)
Systemic Symptoms

RA:
Onset: Any age
Speed of onset: Rapid (wks/months)
Distribution: Symmetrical
Joint affected:
- small joints hands & feet
Worst: In the am ( > 1hr)
Systemic Symptoms:
- fatigue, fever, night sweats

Question 19

nursing assessment for arthritis

Answer 19

• assess pain, mobility, evidence of falls, psychosocial changes
• need for mobilization aids
• assess baseline psychological function within stages of the disease
• assess med management and side effects

Question 20

OA vs RA

Answer 20

wear and tear vs systematic inflammation of joints

Question 21

pharmacological interventions

Answer 21

anti-inflammatory drugs
- NSAIDS (non-steroidal anti-inflammatory drugs)
- steroids
anti-rheumatics and immunity suppressants
- DMARDs (Disease Modifying Anti-Rheumatic Drugs)
drug to protect the stomach from drugs above
(especially NSAIDS)
- antacid

antibiotic if a joint is septic
- ex. minocycline

Question 22

non-pharmacological interventions

Answer 22

• local (ice/ heat to joints and/ or limbs)
• systemic (regular and sufficient sleep 8-10 hrs)
• psychologic (stress reduction)
• PT: exercise, gross motor assistance
• OT: aids to living (larger handled utensils, zipper
  pulls, bath bars, etc.), fine motor assistance
• Stress reduction

Question 23

Parkinson’s disease

Answer 23

neurodegenerative disorder
- tremors
- rigidity, stooped posture
- bradykinesia (slow move)
- hypophonia (lowered voice volume)
- micrographia (small, cramped writing)
- pain
- depression and dementia are common comorbidities

Question 24

effect of dopamine

Answer 24

communication between nerve cells

Question 25

effect of acetylcholine

Answer 25

stimulates skeletal, smooth and cardiac muscle contraction

Question 26

nursing assessment for Parkinson’s disease

Answer 26

• med side effect assessment
• assess mobility, evidence of falls
• mobilization aids
• assess pt, understanding of specific disease process
• psychosocial assessment
  (mood and affect changes)

Question 27

pathologic conditions affecting mobility
– ear & eye

Answer 27

ear: tinnitus
eye: cataract, AMD, glaucoma, diabetic retinopathy

Question 28

pathologic conditions affecting mobility
– GI & GU

Answer 28

GI:
constipation, stroke, c diff, GERD, diverticular disease
GU:
BPH, UTI, paraphimosis

Question 29

wearing off effect

Answer 29

• effect of med diminish before next dose

how to prevent
- increasing dose amount of freq. may worsen dyskinesia
- on time dosing
- close monitoring of function
- listen to the pt.

Question 30

pathologic conditions affecting mobility
– CV, RESP

Answer 30

CV:
orthostatic hypotension
postprandial hypotension
RESP:
pneumonia, TB, COPD