Module 10 Flashcards
What does exercising influence?
Metabolic needs (promotes breakdown of triglyceride, maintains homeostasis)
Respiratory ( quicker return to baseline, improve ventilation, decrease having to work hard to breathe)
Cardiovascular (increases strength of cardiac muscles, cardiac output, decreases resting heart rate and pressure, decreases death rate)
MSK (improves muscle tone, increases mobility, increases muscle mass, reduces bone loss)
Activity tolerance
Psychological (treats depression, stress, less illness, provides greater sense of well-being)
What are the hazards of immobility?
Metabolic (decreased appetite, decreased BMR causes carbs, fat, protein metabolism to slow, decreased GI tract activity leading to constipation and obstruction)
respiratory (decreased lung expansion due to not moving enough, atelectasis -collapse of alveoli in lung which can cause frequent fever, hypostatic pneumonia - inflammation of lung due to lack of activity)
cardiovascular (postural hypotension/orthostatic hypotension- when patient has normal bp until they sit up and they exhibit symptoms of low bp, increase of deep vein thrombosis which is blood clot that can dislodge and go into the lung to cause pulmonary embolism)
Musculoskeletal (MSK) - atrophy due to disuse causing 3% of mobility to be loss in a day causes mobility to worsen, calcium resorption occurs causing osteoporosis, joint contracture occurs due to lack of range of motion which causes joints to weaken and break due to lack of lubrication in joint from movement
Genitourinary (GU) - bladder infection and kidney infection these are examples of urine stasis, calculi (kidney stones)
integumentary (skin)- redness occurs due to lack of circulation, abrasions
psychological -depression, sleep wake disturbances, change in behaviour, impaired coping
What is coldspaa? (Symptom analysis) MSK Assessment
Guideline to ask your patients of a particular symptom they’re experiencing
Ex. A stiff neck
C-character “how would you describe the quality of your stiff neck?” Ask them to describe
O-onset “when did it start? Was it gradual or immediate?” Ask them when symptom started
L-location “where is it?”
D- duration “how long does it last?”
S-severity - “rate it from 1-10”
P- pattern “what makes it better or what makes it worse?”
A-associated symptoms “ do you feel any other symptoms when you are experiencing stiff neck?” Ask them if any other symptoms come with their issue
A-affect on life “do you experience limitations of ADL due to your symptoms?” How does their symptom affect their life
What is the template for subjective assessment of all physical body? (Related MSK assessment)
Common concerns or injuries - ask them if they feel any pain, stiffness, swelling, heat, symptoms. If yes use COLDSPAA
past health history- ask them about their personal history and family history relating to MSK disorder or injuries. Ex. Muscular sclerosis
Lifestyle- ask if they exercise, have they loss weight or gain, do they have a nutritious diet
behaviours -“ask them is there repetitive muscle activity, do you take any medication”
environment -ask them “what do you do for work, do you work in the sun”
age related changes- looking at growth and development, if they’re old it is common for them to get arthritis or stiff joints
Objective assessment for MSK assessment
I-inspection (look at their size, shape, colour, masses, body alignment, symmetry, balance, range of motion)
P-palpatation (check for edema, heat, tenderness, nodules, crepitus ex. checking if their joints are fine or if its making a crack, check for their resistance and strength of their resistance using a scale of 0-5)
When we are assessing MSK we only inspect and palpitate
Health promotion teaching for MSK
- Diet for bone health (adequate calcium, protein, vitamin c intake.)
- are they getting enough sun exposure (20 mins Per day for adequate vit d)
- sports (wear proper gear)
- work/ hobbies use of ergonomically correct work stations and taking frequent breaks from repetitive activity
- body weight (maintain ideal body weight)
What does promoting mobility in hospital setting look like?
- encourage them to get up
- encourage patients to wear their usual casual outfits to promote mobility while changing clothes
- encourage patient to walk around
What are some nursing interventions to promote mobility, activity and exercise?
- body mechanics to protect yourself ex. Proper lifting, life with your legs and not your back
- collaboration with your patient
- adequate help ex. Use cane or any assistive devices for your patient if needed, ask for assistance from colleague
- mechanical lifts
Ambulation (for patients requiring assistance with ambulation): minimizes orthostatic hypotension. Aids you can use is gait belt, Walker, cane, crutches
Intervention for patients confined to a bed: repositioning clients every 2 hours to reduce pressure site on one side, doing this will also ensures support of normal body alignment, practice range of motion exercises, active or passive activities are fine, make sure their joint is supported. Do not push past their tolerance.
What are the bed positions you can put your clients into ?
Supported Fowler’s- 45 degrees, pillow under leg, arms are supported. If they are in bed long term, put a pillow at the base of their feet or rolled up towel to prevent foot drop. This position helps with breathing, comfort, and adequate support. You don’t use this position when patient is unconscious
Prone - used after back surgery, rectal surgery, use a pillow underneath belly and feet. Do not use on people that have breathing difficulties, pregnant women.
Sims (semi prone)- used interchangeably, used while unconscious to provide relaxation, pillow between knees, one under upper arm, good recovery position. Do not use for shoulder injury
Lateral (side laying)- legs are supported, legs are supported. Rotate patient from time to time to relieve pressure on one side of body
What are some examples of inter-professional collaboration to promote mobility, activity, and exercise for patient
Physician orders related to mobility Speak to physiotherapist Bed rest Bed rest with bathroom privileges Elevate the head of their bed Activity as tolerated (AAT)- use a rubber band in bed and get patient to pull on it
Issues related to MSK abnormalities
Atrophy: reduction in size, breakdown of tissue
Boutonniere deformity: finger is flexed at joint and hyperextended at joint
Clubfoot: newborn feet appear to be related internally at the ankle. The feet down and inwards.
Footdrop: nerve injury, gait abnormality in which dropping of foot happens. Foot is permanently fixed in plantar flexion
Ganglion: cysts of fluid that appear at bumps
Genu valgum (knock knee): knee angle in and touch each other when legs are straight
Genu varum (bow legs): lower legs angle inward, bending at knee
Hallux valgus: deformity at joint connection
Hammer toe: toe with an abnormality, bend in middle joint, toe may bend backward
Kyphosis: excessive outward curve of the back-hunchback
Lordosis: swayback - inward curve of back, common in pregnancy
Pes planus (flat feet): longitudinal arch in foot (flat)
Pigeon-toe: the toe points in
Scoliosis: sideways curvature of spine
Swan-neck deformity: bending of finer, straightening of middle joint, bending of outermost joint
