Module 6 CHAPTER 33A Flashcards
Role of Skeletal System in Movement
Supports the soft tissues of the body
Protects crucial components of the body
Furnishes surfaces for the attachment of muscles, tendons, and ligaments
Provides storage areas for minerals and fat
Produces blood cells
Bones Classified by Shape
Long bones: upper and lower extremities
Short bones: wrist and ankle
Flat bones: ribs and skull bones
Irregular bones: spinal column and jaw
Types of Joints
Fibrous (immovable/synarthrosis)
Sutures between bones of skull
Cartilaginous (slightly movable/amphiarthrosis)
Pubic symphysis; joints between bodies of vertebrae
Synovial (Freely movable/diarthrosis)
Gliding, hinge, pivot, condyloid, saddle, ball-and-socket joints
Joint Movements #1
Abduction Adduction Circumduction Flexion Extension Hyperextension Dorsiflexion Plantar flexion Rotation Internal rotation External rotation Supination Pronation Inversion Eversion
Three Types of Muscles
Skeletal (Conscious movement)
Cardiac
Smooth or visceral (Controlled by unconscious part of brain)
Important Functions of Muscles
Motion
Maintenance of posture
Support
Heat production
Effect of Nervous System
on Muscle Contraction
The skeletal and muscular systems cannot produce purposeful movement without a functioning nervous system. Nerve impulses stimulate muscles to contract.
Neurons conduct impulses from one part of the body to another.
The afferent nervous system conveys information to the CNS.
Information is processed by the CNS leading to a response.
The efferent neurons convey the response from the CNS to skeletal muscles by way of the somatic nervous system
Postural Reflexes
Postural reflexes are the group of reflexes (automatic movements) that maintain body position and equilibrium, whether at rest or during movement. Labyrinthine sense Proprioceptor or kinesthetic sense Visual or optic reflexes Extensor or stretch reflexes
Factors Affecting Mobility and Alignment
Developmental level/considerations Table 33-3 Physical health Muscular, Skeletal, or Nervous System Problems Problems Involving Other Body Systems Mental health Lifestyle Attitude and values Fatigue and stress External factors
Problems Affecting Joint Mobility
Inflammation, degeneration, and trauma can all interfere with joint mobility.
The term arthritis describes more than 100 different diseases that affect areas in or around joints.
Arthritis is characterized by inflammation, pain, damage to joint cartilage, and/or stiffness
The most common type is osteoarthritis, also termed degenerative joint disease.
Osteoarthritis
Osteoarthritis is a noninflammatory, progressive disorder of movable joints, particularly weight-bearing joints, characterized by the deterioration of articular cartilage and pain with motion.
Once the articular cartilage is damaged, bony deposits (bone spurs) may form in the joints, causing more pain with movement of the joint.
Types of Exercises
Isotonic: muscle shortening and active movement
-ADL’s, swimming
Isometric: muscle contraction without shortening
Yoga,
Isokinetic: muscle contraction with resistance
-weight training
Benefits of Exercise to Cardiovascular System Table 33-4
Increased efficiency of the heart Decreased heart rate and blood pressure Increased blood flow to all body parts Improved venous return Increased circulating fibrinolysin (substance that breaks up small clots)
Benefits of Exercise to Respiratory System Table 33-4
Improved alveolar ventilation
Decreased work of breathing
Improved diaphragmatic excursion
Benefits of Exercise to Musculoskeletal System Table 33-4
Increased muscle efficiency (strength) and flexibility
Increased coordination
Reduced bone loss
Increased efficiency of nerve impulse transmission
Risk Related to Exercise
Cardiac Event
a man older than 45 or a woman older than age 55
family history of heart disease before age 55 in men and 65 in women
currently smoke or quit smoking in the past 6 months
have not exercised for at least 30 minutes, 3 days a week for 3 months or more
overweight or obese
high blood pressure or high cholesterol
impaired glucose tolerance
Orthopedic Discomfort and Disability
Orthopedic problems caused by irritation of bones, tendons, ligaments, and sometimes muscles are the most common injuries associated with exercise. This irritation may result from added weight-bearing stress or from collision with the ground, an object, or another person.
Physical Assessment for Mobility
General ease of movement and gait Alignment Joint structure and function Muscle mass, tone, and strength Endurance
Variables Leading to Back Injury in Health Care Workers
Uncoordinated lifts
Manual lifting and transferring of patients without assistive devices
Lifting when fatigued or after recent back injury recovery
Repetitive movements such as lifting, transferring, and repositioning patients
Standing for long periods of time
Transferring patients
Repetitive tasks
Transferring/repositioning uncooperative or confused patients
Proper Body Mechanics
Use of proper body movement in daily activities
The prevention and correction of problems associated with posture
The enhancement of coordination and endurance
Equipment and Assistive Devices
Gait belts Stand-assist and repositioning aids Lateral-assist devices Friction-reducing sheets Mechanical lateral-assist devices Transfer chairs Powered stand-assist and repositioning lifts Powered full-body lifts
Positioning Patients
Pillows Mattresses Adjustable beds Bed side rails Trapeze bar Additional equipment
Mechanical Aids for Walking
Walker
Cane
Braces
Crutches
Nursing Care Plan for Quan Hong Nguyen 33-1 > PAGE 117
Review Care plan on page 1174-1177
Proprioceptor or kinesthetic sense
Proprioception is the awareness of joint position (the brain is informed of the location of the limb), whereas kinesthesia is the cognizance (awareness) of joint movement.
Visual or optic reflexes
• Contributes to posture by alerting the person to spatial relationships
with the environment (nearness of ceiling, walls, furniture, condition
of floor).
Extensor or stretch reflexes
• When extensor muscles are stretched beyond a certain point (when a
knee buckles), their stimulation causes a reflex contraction that aids a
person to reestablish erect posture (straighten the knee).
Nursing and Physical Assessment
• Nursing assessment related to activity includes asking patients about their daily activity
level (Ex. Sedentary lifestyle), endurance, exercise and fitness goals, mobility problems,
physical or mental health alterations that affect mobility, and external factors affecting
mobility.
*Knowing the patients baseline helps you educate them on the importance of checking
their pulse.
*The heart rate is a good indicator of exercise intensity: The higher the intensity, the faster
your heart beats.
Physical assessment of mobility status includes an assessment of general ease of movement and gait; alignment, joint structure, and function; muscle mass, tone,and strength; and endurance. The patient’s ability to stand, walk, sit up, and
grasp are important because these enable the patient to wash, dress, and feed
himself or herself and perform other basic ADLs.
• Example: If a client uses a cane, make sure they are using it correctly.
Which is, holding it on the stronger side.
Components of the physical
assessment
• General ease of movement and gait • Alignment • Joint structure and function • Muscle mass, tone, and strength • Endurance Physical assessment of an ambulatory patient begins the moment the patient walks into a room. • Patient’s medical diagnosis • Patient capabilities • Whether patient movement is allowed • Patient’s ability to assist with planned movement • Patient’s ability to understand instructions • Patient’s ability to cooperate with directions
Assessment of Involuntary
movements:
- Tremors
- Tics
- Chorea
- Athetosis
- Dystonia
- Fasciculations or muscle twitch
- Myoclonus
- Oral-facial Dyskinesias
Factors to Assess (questions and approaches /interview)
Pg 1146
- Daily activity level
- Endurance
- Exercise and fitness goals
- Mobility Problems
- Physical and Mental Health alterations
- External Factors Affecting mobility (environmental or financial)
Diagnosis
Problems of mobility
- Activity intolerance
- Impaired transfer mobility
- Risk for injury
- Risk for constipation
- Toileting self-care deficit
- Risk for ineffective peripheral tissue perfusion
Planning
Patients with no mobility problems,
outcomes are directed towards promotion of physical fitness. Patients at risk for mobility problems, objective includes: • Demonstrate correct body alignment • Demonstrate full range of joint motion • Demonstrate adequate muscle mass, tone, and strength to perform functional ADLs • One nurse vs two nurse assistance • Need for assistive device
Patients that are immobile, objectives include:
• Be free from alterations in skin integrity
• Show signs of adequate venous return
• Be free of contractures
Implementation/Intervention
Equipment and assistive devices
• Gait belts
• Stand-assist and repositioning aids
• Lateral-assist devices (side to side transfer)
• Friction-reducing sheets (prevents skin shearing)
• Mechanical lateral-assist devices
• Transfer chairs
• Powered stand-assist and repositioning lifts
• Powered full-body lifts
Mechanical aids for walking (walker, cane, braces, crutches)
• Positioning patients using (pillows, mattresses, adjustable beds, side
rails, trapeze bar)
• Protective Positioning
Rationales for encouraging your patient to use a
assistive aid
- Encourages patient independence
- Reduces physical strain for staff
- Decreases risk for patient injury
Interventions that can affect patient
positioning
• Tubes: Must be protected to prevent dislodging; they impact direction
the patient can turn
• IV lines: Must be protected to prevent dislodging, if attached to an IV
pump, they will significantly impact positioning direction
• Incisions: May need to be splinted before changing position; avoid
incisional strain while positioning
• Medical equipment: If equipment must remain attached to the
patient, it will directly impact patient mobility—limit how the patient
can move
Activity Variations Based on Developmental
Level:
Adult Assessment Priorities
• Assess balance between activity and rest in person’s lifestyle.
• Note any lifestyle factors or illnesses that interfere with mobility or
ability to carry out activities of daily living.
Nursing Intervention
• Fitness counseling
• clarify misconceptions about exercise
• design and monitor safe exercise programs
• those with mobility alterations may require special care
Older Adult Assessment Priorities
• Assess general ease of movement and gait.
• Assess alignment.
• Check joints and their function.
• Assess muscle mass, tone, and strength
Nursing Intervention
Teach and Council about:
• importance of regular exercise
• need for high protein, calcium, and vitamin D enriched diet
• pacing activities
• using assistive devices safely when needed
• safety proof home to reduce falls
Safe patient handling and transfers
• Many devices and equipment are available to aid in transferring,
repositioning, and lifting patients. It is important to use the right
equipment and appropriate device based on patient assessment and
desired movement.
