Mobility pt 2 Flashcards
what are pt care ergonomics
proper body mechanics
what are some proper body mechanics
bend w/ knees
carry pt close to body
raise bed
ask for help
lift @ same time
use assisted lifts
feet shoulder width apart
face toward object lifting
lower side-rail
use step stools
what does deconditioned mean
loss of physical fitness
what part of the brain is responsible for mobility
motor cortex (frontal lobe)
what are some factors affected by immobility
musculoskeletal system
cardiovascular system
respiratory system
urinary system
integumentary system
gastrointestinal system
metabolic system
mental health
what are some effects of immobility
decreased muscle size
decreased tone and strength
decreased joint mobility and flexibility
bone demineralization
contractures or ankylosis
what is the best way to avoid osetoporosis
walking
what is stasis
slow
what are the effects of immobility on the cardiovascular system
increased cardiac workload
orthostatic hypotension
venous stasis
venous thrombosis
what is venous thrombosis
clot
what does venous stasis lead to
venous thrombosis
what are some effect of immobility on the respiratory system
decreased ventilatory effort (harder to breathe lying down)
increased respiratory secretions
decrease in depth and rate of respirations
poor exchange of carbon dioxide and o2
atelectasis
what is atelectasis
incomplete expansion or collapse of lung tissue
what are some effects of immobility on the urinary system
increased urinary stasis
increased risk of renal calculi
decreased bladder tone
what does urinary stasis mean
urine stays in bladder and can lead to uti
what are renal calculi
kidney stones
what does decreased bladder tone lead to
incontinence
what are some effect of immobility on integumentary system
increased risk of skin breakdown
increased risk of pressure injury
how often are you supposed to turn pt’s
every 2 hrs
what are some effects of immobility on gi system
disturbance in appetite
altered digestion
altered metabolism of nutrients
decreased peristalsis
what are some effects of immobility on metabolic system
increase for electrolyte imbalance
altered exchange if nutrients and gases
what are some effects of immobility on mental health
decrease self-concept
decrease social interaction
increase sense of powerlessness
increased risk of depression
what are 2 common disorders of the joints and bones
rheumatoid arthritis and osteoporosis
what are some characteristics of rheumatoid arthritis
Inflammatory, systemic,
autoimmune
Affects synovial joints primarily
Affects men and women
Results in joint stiffness, pain,
swelling and deformity
what is the goal of treating rheumatoid arthritis
decrease pain and inflammation
prevent disabling deformities
what are the 3 main types of drugs to treat RA
NSAID’s (nonsteroidal anti-inflammatory drugs)
glucocorticoids
DMARD’s (disease modifying antirheumatic drugs)
what are some characteristics of DMARD’s
Immunosuppressive
Decrease joint inflammation
Symptomatic relief
Delay progression
2 types: Non Biologic and Biologic
on the med continuously
what is the prototype of non biologic antimetabolite
methotrexate
what class is methotrexate
antirheumatic
what is the pharmacologic action of methotrexate
immunosuppression
what are the adverse reactions to methotrexate
Dizziness
headache
blurred vision
nausea and vomiting
bone marrow suppression
gastrointestinal ulceration and pulmonary fibrosis teratogenic effects
what is pulmonary fibrosis
damage on lungs
what are the interventions for methotrexate
monitor lab values: RBC,WBC & Platelets
Liver Function
abdominal pain
diarrhea
nutritional status
GI bleed
Respiratory distress
jaundice
how do you administer methotrexate
once a week
orally, subcutaneously, or IM
what are some contraindications for methotrexate
clients with liver insufficiency
renal insufficiency or alcoholism
pregnancy and breast feeding
what are some precautions for methotrexate
caution if client has bacterial or viral infection or peptic ulcer disease or
ulcerative colitis
what are some interactions of methotrexate
Can cause digoxin toxicity
NSAID’s and sulfonamide toxicity
caffeine decreases effectiveness
warfarin increases the risk for bleeding
alcohol ingestion
increases chance of hepatotoxicity
what is the prototype of biologic antimetabolite
etanercept
what class is etanercept
antirheumatic
what is the pharmacologic action of etanercept
inactivation of tumor necrosis factor
what are some adverse reactions with etanercept
Dizziness
pharyngitis
upper respiratory infections
abdominal pain
psoriasis
pancytopenia
heart failure
reactivation of latent TB or new development of
TB
what are some interventions of etanercept
Monitor signs of infection
cough
shortness of breath
elevated blood
pressure and heart rate
production of pink sputum
TB test
how is etanercept administered
once a week subcutaneously
what are some contraindications/precautions of etanercept
active infection
hematologic disease, or malignancy
autoimmune disorders of the central nervous system such as multiple sclerosis
what are some interactions of etanercept
Can cause bone marrow suppression when used in clients taking chemotherapeutic drugs
do not give with anakinra
due to increased risk of infection avoid use of live vaccines
what are some characteristics of osteoporosis
Reduces bone mass
decreases bone density
progressive
women post menopausal @ higher risk
men @ risk as aging- reduction of testosterone, long term glucocorticoid therapy, alc abuse, caffeine, tobacco, and non weight bearing disorders
Results in increased risk for fractures: most
common sites are hip, wrist and spine
what does SERM stand for
selective estrogen receptor modulators
what is the prototype of SERM’s
raloxifene
what is the class of raloxifene
bone absorption inhibitor
what is the pharmacologic action of raloxifene
activates estrogen receptors decreasing bone loss maintaining bone mineral density
what are some adverse reactions with raloxifene
increased risk of stroke
pulmonary embolism
deep vein thrombosis
hot flashes
teratogenic
what are some interventions for raloxifene
Monitor bone density
signs of DVT
PE and cholesterol
hormones and fibrinogen
how do you administer raloxifene
orally daily w/ or w/out food
take w/ vit D and calcium
perform weight bearing exercises
what are some contraindications of raloxifene
clients with DVT or history of DVT
pregnancy and breast feeding
elevated serum lipid levels
what are some interactions with raloxifene
do not take concurrently w/ estrogen
what is the prototype of bisphosphonate
alendronate
what class is alendronate
bone absorption inhibitor
what is the pharmacologic action of alendronate
decrease bone resorption by
inhibiting activity of osteoclasts
what are some adverse reactions of alendronate
esophagitis
nausea
vomiting
abdominal pain
muscle and joint pain
eye and vision changes
what are some interventions for alendronate
monitor for decreased bone resorption and
changes in vision
manage muscle and joint pain
how do you administer alendronate
orally daily w/ glass of water and 30 minutes before other drugs, food, or drinks
pt needs to remain sitting or standing for 30 min after taking drug
what are some contraindications of alendronate
clients with esophageal strictures or difficulty
swallowing
renal insufficiency
hypocalcemia
upper GI disorders
infections
liver disease
heart failure
what are some interactions with alendronate
do not take calcium
supplements or dairy products
within 30 minutes of administration
what is the prototype of calcitonin
calcitonin-salmon
what is the class of calcitonin
hypocalcemic
what is the pharmacologic action of calcitonin
decrease bone resorption by
inhibiting activity of osteoclasts and increasing excretion of calcium
what are some adverse reactions with calcitonin
allergy to salmon or gelatin diluent can
cause anaphylaxis
hypocalcemia
nasal dryness
headaches
epistaxis
nausea and vomiting
polyuria
what are some interventions of calcitonin
monitor for signs of hypocalcemia such as
muscle spams, tinging of fingers and toes, and low serum calcium levels, allergic reactions and anaphylaxis
how do you administer calcitonin
intranasal, subcutaneous, or IM
protect from light and refrigerate
encourage high calcium and vit d diet
what are some contraindications of calcitonin
pt w/ allergies to salmon or other fish protein
what are some interactions of calcitonin
monitor closely if pt is also taking lithium
what is the prototype of calcium supplements
calcium citrate and calcium carbonate
what is the class of calcium supplements
mineral and electrolyte supplements
what is the pharmacologic action of calcium supplements
non dietary form of calcium
what are some adverse reactions to calcium supplements
hypercalcemia
nausea and vomiting
constipation
polyuria
depression
renal calculi
hypercalciuria
what are some interventions for calcium supplements
Monitor serum calcium
decreased gastric and intestinal motility
urine output
flank pain
blood in urine
how do you administer calcium supplements
orally or IV
give 1 before or 2 hrs after glucocorticoids, thyroid supplements, tetracycline, and quinolone
take w/ glass of water
what are some contraindications of calcium supplements
clients with hypercalcemia or low phosphate level
kidney stones
cardiac arrythmias
what are some interactions with calcium supplements
monitor closely if client also
taking digoxin for digoxin toxicity
clients taking a thiazide diuretic are at increased
risk for hypercalcemia
Do not take close to a meal when eating cereals, rhubarb and spinach as it decreases absorption
