Mobility, Safety, Transfers, Hygiene Flashcards
Age related factors that affect mobility and safety
decrease in muscle mass, strength, join flexibility higher risk of fractures decreased bone density increased risk of falling osteoarthritis rheumatoid arthritis increased immobility effects
The nurse should intervene to prevent _____________
functional decline
What is the most prevalent metabolic disease of the bone ?
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
What is osteoarthritis ?
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.
What is rheumatoid arthritis?
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
Consequences of immobility
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
What is sarcopenia ?
a decline in walking speed and grip strength
Discuss the age related changes in gait
↓ 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
What environmental factors in a home can increase the risk for falls?
Lighting Temperature Colors Scents Floor coverings Furniture Sensory Stimulation Bathroom Hazards Fire Hazards Psychosocial Considerations
______________ factors and ______________ factors = falls
Intrinsic and Extrinsic
Can the four siderails on a patient bed ever be put up ?
NOOOOOO! This is considered a restraint…. having 2 or 3 is fine though
Interventions to Prevent Falls in acute care setting
bed rails bed lowered to lowest position remove clutter keep sensory aids close by non slip socks
Assess!
Educate !
Which position promotes maximal breathing in the thoracic cavity ?
Fowlers position. It is the position of choice when someone is having difficulty breathing
Which position is contraindicated in patients who have spinal problems?
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
Connection between mobility and social activity
Being mobile and physically active can be a means of increasing social activity.
Being immobile can ability to engage in social activity
Multiple health problems can be avoided when an active state is maintained. What are some of these conditions ?
Atherosclerosis, obesity, joint immobility, depression, constipation, pressure ulcers, pneumonia, insomnia
Active Mobility =
avoidance of multiple health problems
Nursing interventions to focus on regarding mobility
The nurse should act to prevent functional decline while promoting safety
Activities of Daily Living Include
Eating, Dressing, Mobility, Continence, Toileting and Hygiene
Difference Between Active Exercise and Passive Exercise and Active Assistive
Active Exercise - patient acts independently
Active Assistive - patient acts with assistance
Passive - no active involvement of the patient
Benefits of Range of Motion Exercises
Prevention of Contractures, Improved Joint mobility, stronger muscles, stimulation of circulation, maintenance of functional capacity
ROM seeks to maintain and promote normal functioning
What is most important when assessing joints ?
Assessing their ROM , especially the effect any impaired ROM will have on completing ADLs
Flexion
Bending
Extension
Straightening
Hyperextension
extending beyond normal range
Adduction
Moving toward body
Abduction
moving away from body
Physiological Consequences of Immobility
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
You are performing ROM motion exercises when you notice that the patient is becoming increasingly exerted - what signs would warrant stopping an exercise ?
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
Effects of aging on muscles
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
Cardiovascular effects of immobility
Increased BP Reduced Pulse Rate Increase Risk for Orthostatic hypotension Increased Cardiac Workload Increased Risk for Venous thrombosis
Nursing Interventions to Prevent Cardiovascular Complications
Anti Embolism Devices
Aging effects on joints
Reduced mobility because of wear and tear, degeneration of collagen
loss of cartilage, decreased synovial fluid, decreased ROM
Decreased Mobility equals
Increased Dependency
Risk factors for Osteoporosis
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
Interventions for Osteoporosis
Focus on modifiable risk factors
What can you control?
Diet, supplements, social habits
Regular exercise Weight bearing Swimming Medication Dexa Scan
“Secondary to “
Caused by something else
Osteoporosis secondary to Cushings Syndrome
Primary and Secondary Osteoporosis
Primary Osteoporosis - of unknown cause
Secondary Osteoporosis - has a direct cause, such as calcium deficiency
What is the leading cause of physical disability in older people ?
Osteoarthritis
Osteoarthritis primarily affects which joints ?
Weight bearing joints-
Hip, knee, vertebrae, fingers
What is osteoarthritis ?
the progressive degeneration and abrasion of joint cartilage and the formation of new bone at the joint surfaces
Osteoarthritis affects most people to some extent over ….
age 55
Risk factors for Osteoarthritis
Age Gender - occurs in women more than men Excessive use of the joint Trauma Obesity Vitamin D deficiency Vitamin C deficiency Genetic factors
Nursing Interventions for Osteoarthritis
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
What is arthroplasty ?
Joint replacement surgery
Can be done to relieve joint pain, restore joint motion and improve function
In older patients, arthroplasty is associated with a higher risk of ……………
what medication can be used against this ?
deep vein thrombosis and pulmonary embolism
Warfarin can be used prophylactically
Unrelieved pain can
interfere with older persons abilities to engage in self care, manage their households and maintain social contact
What is a muscle spasm?
Involuntary Contraction of muscle started by Nervous system due to overstimulation of muscles
- over exertion, not drinking enough water, not getting enough calcium, overstretching
What can be done to relieve or prevent muscle spasms?
Drink adequate amounts of water, replenish electrolytes
Use heat to relieve spasms - warm bath, keeping extremities warm at night with blankets and clothing
What can be done to relieve joint pain in the weight bearing joints ?
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
Nursing Management: Musculoskeletal Conditions
Promote Pain Relief/Management Promote/Retain Independence Prevent Injury and Maintain Safety Provide Support Collaborate with Interdisciplinary Team Members
Gout
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
Guidelines for Safe Patient Handling and Movement
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
