NUR 118 Lect. Lecture 6 - Mobility Flashcards
number of bones in body
206
What are good body mechanics we will use in Nursing practice?
-Use proper alignment = Proper posture for neutral spine
-Have a wide base of support = Balance
-Avoid bending and twisting
-Squat to lift
-Keep objects close when lifting
-Raise bed to waist height
-Push versus lift
-Get help!
-We should also teach this to our patients and families
Definition of joint
Where 2 bones come together
Define cartilage
Connective tissue, acts as cushion
Define ligament
Fibrous tissue that connects most movable joints
Define tendons
Fibrous connective tissue that connects muscle to bone
What is the goal of ROM? (Immobility)
Keep body in best possible physical condition when bedrest needed, or if immobile
Improve joint mobility & Prevent Contractures
Increase circulation
Maintain function
Difference between AROM vs PROM
Active Range of Motion AROM
-Done by patient WITHOUT ASSISTANCE
-Often in rehabilitation as pt recovering from illness, injury, surgery
Passive Range of Motion PROM
-Intervention to prevent complication of disuse & promote joint mobility
-Prevents contractures, muscle atrophy
-Done by another person for patient BECAUSE THEY CAN NOT DO IT THEMSELVES
What are some factors that affect activity & mobility?
Age - developmental stage
Cognitive Status
Nutrition
Lifestyle - active or inactive
Stress - Tighter muscles
Respiratory/circulatory disorders - fatigue, bed rest
Define Atrophy
a decrease in the size of muscle tissue due to lack of use or loss of innervation
Define Clonus
spasmodic contraction of opposing muscles resulting in tremors
Flaccidity
A decrease or absence of muscle tone
Define hemiplegia
Paralysis of one side of the body
Define hypertrophy
Increase in size of muscle or organ
Define paraplegia
Paralysis of the lower portion of the trunk and both legs
Define paresis
Partial or incomplete paralysis
Define paresthesia
numbness, tingling, or burning due to injury of nerve(s) innervating affected area
Quadriplegia
Paralysis of all four extremities
Define spasticity
Motor disorder of tendon jerks and clonus; characterized by increased muscle tone
Define Tremor
Involuntary quivering movement of a body part
Effects of prolongeed immobility
-Causes physiological changes in every body system
-1 day bed rest requires 7 days to restore function
List some musculoskeletal complications from immobility:
- Atrophy
- Disuse osteoporosis
- Hypercalcemia
- Contractures
- Balance/stability problems
- Loss of endurance
List some musculoskeletal interventions:
- Assist patient to standing position; ambulate as tolerated
- Prevent orthostatic hypotension
- Active & Passive ROM
- Maintain body alignment
List respiratory complications due to immobility:
- Decrease in lung expansion
- General respiratory muscle weakness
- Risk for pneumonia or atelectasis (collapsed lung)
- Stasis & pooling of secretions
List some interventions for respiratory issues due to immobility:
- Orthopneic position (leaning forward with arms folded on table)
- Turn & position q2h
- Cough & deep breath
- Increase fluids to liquify secretions
List cardiovascular complications due to immobility:
- Edema
- Venous stasis (lack of venous return) & blood pooling
- Thrombus formation formation (DVT)
- Orthostatic hypotension
List interventions for cardiovascular complications due to immobility:
- DVT prophylaxis (i.e. an attempt to prevent a disease)
- ROM to prevent edema
- Monitor heart rate
List complication in metabolism due to immobility:
- Decrease in BMR
(decrease protein synthesis, increase fat stores) - Decreased energy
- Edema = d/t decreases serem albumin
(protein pulls water into blood, instead water pulls into tissue) - Muscle loss, atrophy = d/t/ decreased protein stores
- Hypercalcemia, osteoporosis and renal calculi (kidney stones) d/t/ Calcium leaves bones
List interventions for immobility related metabolism complications: (hint: same as GI complications interventions)
- Small frequent meals
- High calorie, high protein diet
- Monitor weight
- Increased fiber AND fluid
List gastrointestinal complications due to immobility:
- Anorexia
- Constipation
List interventions for gatrointestinal complications due to immobility:
- Small frequent meals
- High calorie, high protein diet
- Monitor weight
- Increased fiber AND fluid (stool softeners)
List genitourinary complications due to immobility:
- Renal calculi
- Decreased urinary output
- Urinary stasis
- Urinary tract infections
List interventions for Genitourinary complications due to immobility:
- Monitor Intake and output
- Encourage fluids per condition of patient
List integumentary complications due to immobility:
- Pressure injuries
List interventions for integumentary complications due to immobility:
- Turn & position q2h
- Pressure reducing devices
- Friction reducing devices
- Keep area clean & dry
List psychosocial complications due to immobility:
- Depression
- Sleep disturbances
- Sensory deprivations
List interventions for psychosocial complications due to immobility:
- Provide socialization
- Place in room with others
- Activities
- Social worker consult
Pt is immobile at home, immobility has affected all body systems:
You notice that she has lost muscle mass on her left side and it appears that her joints are
contracting. What can you do to prevent contractures and build muscle mass?
Range of motion exercises, passive and active ROM
Pt is immobile at home, immobility has affected all body systems:
Her breathing is shallow and you hear crackles in her lungs.
What is she at risk for?
What are interventions to prevent this from happening?
At risk for: Pneumonia and Atelectasis
Immobility = decreased lung expansion leads to decreased capacity resp muscle weakness;
weakness prevents proper coughing and clearing of secretions = pooling/stasis
Interventions:
Orthopneic position allows for lung expansion
T&P Q2H, Incentive Spirometer
Deep Breath & Cough exercises
increase fluids to liquefy secretions if able & Pt. can tolerate
Pt is immobile at home, immobility has affected all body systems:
You are also concerned about possible development of deep vein thrombosis.
What can you implement to prevent this?
DVT Prophylaxis = Stockings, Compression devices, exercises PROM - AROM
LEG EXERCISES - GET PT CONSULT - GET OOB ORDER
Pt is immobile at home, immobility has affected all body systems:
Lab results show hypercalcemia (an increase of calcium in the blood.)
Why is this occurring and what is she at risk for?
Immobility/ disuse = Calcium leaves bones and enters the blood stream. Calcium builds up in blood stream and = hypercalcemia
Can lead to renal calculi, osteoporosis, calcium deposit in joints, constipation, muscle weakness & nausea & vomiting
THE BEST PREVENTION IS weight-bearing EXERCISES. STANDING AND WALKING improves bone density & reduces rate of bone loss with aging
Increase fluids = prevent stone formation & constipation
Pt is immobile at home, immobility has affected all body systems:
She is voiding small amounts, and not completely emptying her bladder.
You are concerned about her developing a urinary tract infection.
What can you do?
WHY?
Urinary stasis, Urine sits in the bladder when Pt. unable to completely empty the bladder; warm moist environment, a breeding ground for infection.
Sit Pt up on bed pan or urinal if on bed rest
If able get OOB onto commode/toilet
Monitor I&O
Increase fluids
Proper Hygiene – front to back – keep dry – T&P
One of the first systems affected by immobility is…
Musculoskeletal
