Mobility, Safety, Transfers, Hygiene

Question 1

Age related factors that affect mobility and safety

Answer 1

decrease in muscle mass, strength, join flexibility 
higher risk of fractures 
decreased bone density 
increased risk of falling 
osteoarthritis 
rheumatoid arthritis 
increased immobility effects

Question 2

The nurse should intervene to prevent _____________

Answer 2

functional decline

Question 3

What is the most prevalent metabolic disease of the bone ?

Answer 3

Osteoporosis- primarily affecting adults in middle to later life.
Decreased bone mass and density
can be caused by inadequate calcium intake, excessive calcium loss, poor calcium absorption

Question 4

What is osteoarthritis ?

Answer 4

The progressive deterioration and abrasion of join cartilage with the formation of new bone at the joint surfaces.
Primarily affects weight bearing joints

It is the leading cause of physical disability in older people.

Question 5

What is rheumatoid arthritis?

Answer 5

Affects the joints- projections of synovial tissue protrude into the joint cavity. Affected joints are extremely painful, stiff, swollen, red and warm to the touch. joint pain present during rest and activity

systemic symptoms include fatigue, malaise, weakness, weight loss, wasting, fever and anemia

Question 6

Consequences of immobility

Answer 6

reduced pulse rate
increased cardiac workload
decreased chest expansion and ventilation
slower GI motility
slower metabolism and lymphatic circulation

increased risk of complications

• pressure ulcers
  obesity
  incontinence
  joint stiffness, limited range of motion

increased dependency
reduced opportunities for socialization

Question 7

What is sarcopenia ?

Answer 7

a decline in walking speed and grip strength

Question 8

Discuss the age related changes in gait

Answer 8

↓ efficiency = More energy expended
↑ fatigue

Sensory changes may decrease balance
Potential for postural hypotension (orthostatic hypotension)
Nervous system changes: Slower reflexes/reaction time, Slower response to changes in balance
↓ step height

Question 9

What environmental factors in a home can increase the risk for falls?

Answer 9

Lighting
Temperature
Colors
Scents
Floor coverings
Furniture
Sensory Stimulation
Bathroom Hazards
Fire Hazards
Psychosocial Considerations

Question 10

______________ factors and ______________ factors = falls

Answer 10

Intrinsic and Extrinsic

Question 11

Can the four siderails on a patient bed ever be put up ?

Answer 11

NOOOOOO! This is considered a restraint…. having 2 or 3 is fine though

Question 12

Interventions to Prevent Falls in acute care setting

Answer 12

bed rails 
bed lowered to lowest position 
remove clutter 
keep sensory aids close by 
non slip socks 

Assess!
Educate !

Question 13

Which position promotes maximal breathing in the thoracic cavity ?

Answer 13

Fowlers position. It is the position of choice when someone is having difficulty breathing

Question 14

Which position is contraindicated in patients who have spinal problems?

Answer 14

Prone position - the pull of gravity on the spine when the patient lies prone produces a marked lordosis or forward curvature of the lumbar spine

Question 15

Connection between mobility and social activity

Answer 15

Being mobile and physically active can be a means of increasing social activity.
Being immobile can ability to engage in social activity

Question 16

Multiple health problems can be avoided when an active state is maintained. What are some of these conditions ?

Answer 16

Atherosclerosis, obesity, joint immobility, depression, constipation, pressure ulcers, pneumonia, insomnia

Question 17

Active Mobility =

Answer 17

avoidance of multiple health problems

Question 18

Nursing interventions to focus on regarding mobility

Answer 18

The nurse should act to prevent functional decline while promoting safety

Question 19

Activities of Daily Living Include

Answer 19

Eating, Dressing, Mobility, Continence, Toileting and Hygiene

Question 20

Difference Between Active Exercise and Passive Exercise and Active Assistive

Answer 20

Active Exercise - patient acts independently
Active Assistive - patient acts with assistance
Passive - no active involvement of the patient

Question 21

Benefits of Range of Motion Exercises

Answer 21

Prevention of Contractures, Improved Joint mobility, stronger muscles, stimulation of circulation, maintenance of functional capacity

ROM seeks to maintain and promote normal functioning

Question 22

What is most important when assessing joints ?

Answer 22

Assessing their ROM , especially the effect any impaired ROM will have on completing ADLs

Question 23

Flexion

Answer 23

Bending

Question 24

Extension

Answer 24

Straightening

Question 25

Hyperextension

Answer 25

extending beyond normal range

Question 26

Adduction

Answer 26

Moving toward body

Question 27

Abduction

Answer 27

moving away from body

Question 28

Physiological Consequences of Immobility

Answer 28

reduced Pulse Rate and increased cardiac workload Decreased Aerobic Capacity Decreased chest expansion and ventilation decreased gastrointestinal motility reduced muscle strength, tone and endurance and joint mobility Demineralization of bones, increased ease of fractures slower metabolism and lymphatic circulation

Question 29

You are performing ROM motion exercises when you notice that the patient is becoming increasingly exerted - what signs would warrant stopping an exercise ?

Answer 29

Dyspnea, pallor, cyanosis resting pulse > 100 bpm dizziness, poor coordination acute confusion, restlessness diaphoresis increase or decrease in systolic BP by 20 mm Hg an exercise heart rate greater than or equal to 35% above the resting heart rate

Question 30

Effects of aging on muscles

Answer 30

Decline in the number and size of muscle fibers and subsequent reduction in muscle mass decrease the body strength Grip strength endurance declines Connective Tissue changes reduce the flexibility of joints and muscles

Question 31

Cardiovascular effects of immobility

Answer 31

``` Increased BP Reduced Pulse Rate Increase Risk for Orthostatic hypotension Increased Cardiac Workload Increased Risk for Venous thrombosis ```

Question 32

Nursing Interventions to Prevent Cardiovascular Complications

Answer 32

Anti Embolism Devices

Question 33

Aging effects on joints

Answer 33

Reduced mobility because of wear and tear, degeneration of collagen loss of cartilage, decreased synovial fluid, decreased ROM

Question 34

Decreased Mobility equals

Answer 34

Increased Dependency

Question 35

Risk factors for Osteoporosis

Answer 35

``` Gender: Women > 65 years, Men > 80 years 80% of cases occur in women and 20% of cases occur in men Ethnicity: White women, Asian women and/or small framed, thin women Calcium deficiency Vitamin D deficiency Estrogen deficiency, early menopause Cigarette smoking, high ETOH consumption Immobility Family history Diseases or chronic use of drugs that ↑ bone loss ```

Question 36

Interventions for Osteoporosis

Answer 36

Focus on modifiable risk factors What can you control? Diet, supplements, social habits ``` Regular exercise Weight bearing Swimming Medication Dexa Scan ```

Question 37

"Secondary to "

Answer 37

Caused by something else Osteoporosis secondary to Cushings Syndrome

Question 38

Primary and Secondary Osteoporosis

Answer 38

Primary Osteoporosis - of unknown cause Secondary Osteoporosis - has a direct cause, such as calcium deficiency

Question 39

What is the leading cause of physical disability in older people ?

Answer 39

Osteoarthritis

Question 40

Osteoarthritis primarily affects which joints ?

Answer 40

Weight bearing joints- | Hip, knee, vertebrae, fingers

Question 41

What is osteoarthritis ?

Answer 41

the progressive degeneration and abrasion of joint cartilage and the formation of new bone at the joint surfaces

Question 42

Osteoarthritis affects most people to some extent over ....

Answer 42

age 55

Question 43

Risk factors for Osteoarthritis

Answer 43

``` Age Gender - occurs in women more than men Excessive use of the joint Trauma Obesity Vitamin D deficiency Vitamin C deficiency Genetic factors ```

Question 44

Nursing Interventions for Osteoarthritis

Answer 44

Focus on modifiable risk factors What can you control? Diet, supplements, social habits Exercise: low impact ``` Pain Management Medication Heat/ice therapy Gentle massage Aquatherapy T'ai Chi Acupuncture ``` Surgical intervention Arthroplasty

Question 45

What is arthroplasty ?

Answer 45

Joint replacement surgery | Can be done to relieve joint pain, restore joint motion and improve function

Question 46

In older patients, arthroplasty is associated with a higher risk of ............... what medication can be used against this ?

Answer 46

deep vein thrombosis and pulmonary embolism Warfarin can be used prophylactically

Question 47

Unrelieved pain can

Answer 47

interfere with older persons abilities to engage in self care, manage their households and maintain social contact

Question 48

What is a muscle spasm?

Answer 48

Involuntary Contraction of muscle started by Nervous system due to overstimulation of muscles - over exertion, not drinking enough water, not getting enough calcium, overstretching

Question 49

What can be done to relieve or prevent muscle spasms?

Answer 49

Drink adequate amounts of water, replenish electrolytes | Use heat to relieve spasms - warm bath, keeping extremities warm at night with blankets and clothing

Question 50

What can be done to relieve joint pain in the weight bearing joints ?

Answer 50

Resting those joints, supporting painful joints during transfers and using a walker or cane Diversional activities to prevent preoccupation with pain - guided imagery, therapeutic touch, acupuncture, chiropractic therapy

Question 51

Nursing Management: Musculoskeletal Conditions

Answer 51

``` Promote Pain Relief/Management Promote/Retain Independence Prevent Injury and Maintain Safety Provide Support Collaborate with Interdisciplinary Team Members ```

Question 52

Gout

Answer 52

Metabolic disorder in which excess uric acid accumulates in the blood; as a result uric acid crystals are deposited in and around the joints causing severe pain and tenderness of the joint and warmth, redness, and swelling of the surrounding tissue

Question 53

Guidelines for Safe Patient Handling and Movement

Answer 53

Know patients limitations and impairments assess ability to assist in movement Use assistive devices when necessary remove clutter and clear path for movement Have a plan for moving the patient explain the plan to the patient and allow them to assist however much they can to promote independence If patient is in pain, administer prescribed analgesic before transfer Elevate bed to work at a comfortable height for you lock wheels of the bed, wheelchair or stretcher so they do not slide use good body mechanics when moving a patient Be sure patient is in good body alignment support patients body properly, avoid grabbing and holding an extremity by its muscles use friction reducing devices, especially during lateral transfers move your body and the patient in a smooth, rhythmic motion use mechanical devices such as lifts, slides, transfer chairs or gait belts for moving patients - if you don't know how to use something, obtain assistance from someone who does assure equipment meets weight requirements - bariatric patients (BMI>50) require bariatric transfer aids and equipment