Module 6: Altered Mobility and Arthritis

Question 1

Cardiovascular response to immobility

Answer 1

Blood volume redistributed
Deconditioning of the heart
venous stasis
reduction in total body water
postural hypotension
Increased risk of: DVT, PE and thrombosis

Question 2

Immobility results in a change in blood volume, what would be some complications of this ?

Answer 2

Headache
Swelling
Nasal Congestion
Swollen eyelids

Question 3

Immobility also results in a change in thoracic blood volume, what would be some complications of this ?

Answer 3

Increased central venous pressure
Increased cardiac output
Increased stroke volume

Question 4

what are the complications of extended periods of rest ?

Answer 4

Increased venous distension
decreased venous return
Stabilisation of SV and CO
Tachycardia
Decreased disatolic filling
Increased energy use and oxygen demand by the heart

Question 5

Describe orthostatic hypotension

Answer 5

Blood flow moves from central circulation to lower extremities:
- bed rest removes affect of gravity and hydrostatic pressure from the CVS

Question 6

Describe Venous Stasis

Answer 6

• Increased pressure on legs from contact with the bed
• Compression leads to damage in the Intima

THREE factors predisposing to DEEP VEIN THROMBOSIS
1. Stasis of flow
2. Hypercoagulability
3. Vessel injury

Question 7

List some of the pulmonary changes due to immobility

Answer 7

1.) Decreased tidal volume (TV)
2.) Decreased functional residual capacity (FRC)
3.) Cannot clear lung secretions
4.) Atelectasis (Lung Collapsing)
5.) Positioning effects on work of breathing
6.) Ventilation

Question 8

List some of the effects on the lungs due to immobility

Answer 8

1.) Inspiratory muscles working in different planes
2.) Abdominal contents push against diaphragm
3.) Collapse of alveoli (atelectasis)
4.) Poor coughing and cough reflex
5.) Predisposition to chest infections

Question 9

Define and outline causes of Atelectasis (collapsed lung)

Answer 9

Occurs from a blocked airway (obstructive) or pressure from outside the lung (non-obstructive)

GENERAL ANAESTHESIA is a common cause. Changes the regular pattern of breathing and affects the exchange of lung gases, which can cause alveoli to deflate. Almost all patients who have major surgery develop this.

MUCUS PLUG is the build up of mucus in the airways. It commonly occurs during and after surgery if the patient can’‘t cough during bed rest

Question 10

Immobilisation effects on fluid balance

Answer 10

in SUPINE position
1.) Increased central blood volume
2.) Inhibition of ADH and aldosterone
3.) water and sodium diuresis
4.) Diuresis starts day one in supine position
5.) Increased haematocrit (volume % of RBC) and haemoglobin

Question 11

Immobilisation effect on metabolism

Answer 11

1.) Negative nitrogen balance (due to protein imbalance, causing elevated nitrogen and loss of muscle mass)

2.) Disuse osteoporosis (Bone demineralisation, causing an imbalance of osteoclasts and osteoblasts which increases serum Ca+

Question 12

immobilisation effect on elimination

Answer 12

URINARY STASIS
May delay due to needing assistance
Difficulty relaxing perioneal muscles
detrusor muscles overstretched due to full bladder
urine flows upwards into ureters
prostatic enlargement in males

UTI
Stagnant urine
Distension (needs catheter)

RENAL CALCULI
Increased calcium and stagnation
Precipitate to form crystals
dehydration enhances calculi formation

CONSTIPATION
Abdominal and perineal muscles weakened due to muscle atrophy
gravity not assisting stool passage
embarrassment
dehydration frequent
urinary retention

Question 13

define pressure injury

Answer 13

defined as a localised damage to the skin or underlying tissue, as a result of pressure in combination with a shear.

Question 14

2 Risk Factors for pressure injuries

Answer 14

1.) Mechanical boundary conditions
2.) Tolerance of individual

Question 15

describe Mechanical Boundary conditions risk factor

Answer 15

1.) Magnitude and duration of mechanical load
2.) Mechanical load can be from air filled, water filled, medical devices and other types of surfaces
3.) duration of mechanical load has significant impact
TYPE OF MECHANICAL LOAD = Pressure and Shear
Shear is a mechanical load

Question 16

Describe shear

Answer 16

a wound caused by a shear is asymmetrical, ragged and uneven in shape (Caused by friction)

Question 17

Stage 1 Pressure Injury

Answer 17

1.) Non-Blanchable redness of a localized area
2.) Area may be painful, firm, soft. , hot or cool
3.) determines at risk persons

Question 18

Stage 2 Pressure Injury

Answer 18

1.) Partial thickness loss of dermis
2.) Open ulcer/ruptured blister
3.) NO slough
4.) NOT to be used to describe skin tears, burns or dermatitis

Question 19

Stage 3 Pressure Injury

Answer 19

1.) Full thickness tissue loss
2.) Subcut fat may be visible
3.) bone, tendon + muscle not exposed
4.) NO SLOUGH
5.) depth varies on anatomical position

Question 20

Stage 4

Answer 20

1.) Full thickness tissue loss
2.) Exposed bone + tendon + muscle
3.) SLOUGH may be present
4.) CAN extend into muscle and tendon

Question 21

Unstageable

Answer 21

1.) Full thickness tissue loss
2.) Base of ulcer is covered in slough + eschar and the stage cannot be determined

Question 22

Suspected deep tissue injury

Answer 22

Purple or maroon localised area of discoloured intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear.

The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue

Evolution may include a thin blister over a dark wound bed. The PI may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment

Question 23

Explain Oseoarthritis

Answer 23

OA is a chronic condition characterised by the breakdown of the cartilage that overlies the ends of bones in joints

This results in the bones rubbing together, causing pain, swelling and loss of motion

Osteoarthritis mostly affects the hands, spine and joints such as hips, knees and ankles, and usually gets worse over time

Question 24

Incidence of Osteoarthritis

Answer 24

• most common form of arthritis in Australia
• 1 in 5 Australians (22%) over the age of 45 have osteoarthritis
• It is most common in adults aged 75 and over (36%)

Question 25

Risk Factors - OA

Answer 25

• being female
• genetic factors
• excess weight - obesity
• joint misalignment
• joint injury or trauma (such as dislocation or fracture)
• repetitive joint-loading tasks (for example, kneeling, squatting and heavy lifting)

Question 26

Evidence based management strategies - OA

Answer 26

no cure, OA is long term and treatment aims to manage symptoms, increase mobility and maximise quality of life

treatment options include;
- physical activity
- weight management
- medication
- joint replacement surgery

Question 27

Explain Rheumatoid Arthrits

Answer 27

• RA is a chronic autoimmune disease characterised by inflammation of the joints, causing inflammation, pain, swelling, stiffness and loss of function in the joints.
• RA most often affects the hand joints and both sides of the body at the same time
• In a healthy joint, the tissue lining the joint (called the synovial membrane or joint synovium) is very thin and produces fluid that lubricates and nourishes joint tissues
• In RA, the immune system attacks the synovial membrane, which then becomes thick and inflamed resulting in unwanted tissue growth
• Bone erosion and irreversible joint damage can occur, leading to permanent disability.

Question 28

Pharmacological Management RA

Answer 28

• Simple analgesics (such as paracetamol) may be used for pain management.
• fatty acid supplements
• NSAIDs
• COX-2 inhibitors
• Disease-modifying anti-rheumatic drugs (DMARDs), biologic disease-modifying anti-rheumatic drugs (bDMARDs), and corticosteroids may slow disease progression

Question 29

Describe Juvinile Arthritis

Answer 29

• Juvenile arthritis includes several different kinds of arthritis occurring in children, causing significant pain, disability and restrictions in school and other activities
• Juvenile arthritis is estimated to affect around 1 child in every 1,000 aged 0–15 and is more common in girls than boys.
• Typically affects joints involving long bones (such as the knees, elbows, wrists and ankles). Some children are also affected in areas other than joints such as the eyes, skin or other body tissues.
• If not properly treated, juvenile arthritis can affect growth and development, causing joint damage, growth abnormalities and disability.

Question 30

Pharmacological Management – Juvenile RA

Answer 30

• Pain & inflammation manegment; paracetamol, codeine, and non-steroidal anti-inflammatory drugs (NSAIDs)
• Disease-modifying anti-rheumatic drugs (DMARDs) and biologic disease-modifying anti-rheumatic drugs (bDMARDs) are specialised immunosuppressant medications that alter disease progression

Question 31

Explain Gout

Answer 31

Gout occurs when uric acid builds up in the bloodstream and deposits urate crystals in the joint. These crystals form slowly over months or years and can cause:
* Sudden, severe episodes of extreme pain in the big toe
* tenderness
* redness
* warmth
* swelling

Question 32

Risk factors - Gout

Answer 32

Gout occurs more frequently in men than women, and is also found in people:
* from certain population groups (e.g. Maori)
* who have a family history of gout
* with psoriasis
* who consume a purine rich diet (red meat, seafood)
* who drink alcohol excessively
* Certain health conditions are also associated with developing gout, including high cholesterol, high blood pressure, diabetes and heart disease
* Several types of medication can also raise your uric acid levels, especially diuretic drugs (causing increased passing of urine) and some anticancer drugs along with drugs that suppress the immune system

Question 33

Pharmacological management- Gout

Answer 33

• NSAIDs
• Colchicine medication
• Corticosteroids injections or tablets