Safety, Activity, Mobility Flashcards
What is violence?
Aggression, verbal abuse, threatening behaviour and/or physical assault.
What do you do when a patient gets violent?
Remain calm, communicate in short, clear sentences
Listen attentively and validate patients feelings
Don’t respond to aggression with aggression
Get help!
Document occurrences in hospital incident report
How would you move a patient if they cannot bear weight
Use a mechanical lift
What are some barriers to the mechanical lifts?
Patient aversion (fear) to equipment
Time constraints like if the patient needs to use the bathroom asap! (Using hoyer lift)
Weight limitations
Cleaning/infection control
Ratio of falls every year of people over 65?
1 out of every 4 older people, but fewer than half of them tell their provider.
Why do many falls at home go unreported?
They do not cause injuries requiring medical attention
Why would injuries from falls go unreported?
Older adults fear activity restrictions, loss of independence, or placement in a long-term care facility
What should you note when doing a risk for falling assessment?
Note any assistive devices that the patient uses a cane or Walker
Be alert to any history of drug or alcohol used disorder
Consider comorbidities, such as obesity, osteoarthritis, diabetes, hypertension, chronic pain, depression, and any associated medication’s
What characteristics of older adults are most strongly associated with fall risks?
Depression
Difficulty completing routine errands
Difficulties with ADLs
What are accidental falls?
Falls of low risk adults
Clutter or a spill causes a person to trip
What are anticipated physiological falls?
A direct consequence of gait imbalances, effects of medication, or dementia
What are unanticipated physiological falls?
Caused by unknown or unexpected medical issues, such as stroke or seizure
What is HAC?
Hospital acquired condition
The joint commission requires hospitals implement fall prevention assessments and programs.
How do you prevent falls?
Orient patients to surroundings*
Remind patient to call for assistance
Bed rails*
Call light and possessions in reach
Bed in lowest position
Purposeful hourly rounding!
5Ps
Alarms for beds, chairs, commodes*
Lock the wheels on bed and chairs
Slip resistant socks
How many bed rails can we have up?
There are 4 rails.. but we can only have 3 up at the most
What are the 5 Ps?
Potty (do you need to use the bathroom?)
Pain (are you in pain? Scale from 1-10?)
Positions (are you in a comfortable position?)
Possessions (put within arms reach personal belongings)
Pumps (limit clutter of medical equipment at the bedside that may create a fall hazard)
What is the least to most restrictive restraints?
Mitt
Wrist
Vest and jacket restraints
Wrist and ankle restraints
What are mitt restraints?
Limits use of fingers, prevent removal of tubes, lines and catheters.
Prevent scratching
What are wrist restraints?
2 point restraints
Prevents removal of tubes, lines, and catheters
What are vest and jacket restraints?
Prevent getting out of bed or chair, permits turning from side to side. Used with violent behavior.
What are wrist and ankle restraints?
4 point restraints
Prevent hitting, or kicking others
What is a good reason to put a person in restraints?
Trying to pull out a tube they need
Criminal
Dementia
Do you need a doctors order for restraints
Yes, and it cannot be PRN. If it’s a medical need, the order has to be on the chart within an hour. If it’s behavior (threatening to harm themselves or someone else) the doctor must come and see the patient face to face within the hour
Do you need to involve family before putting on restraints?
Yes and the restraints have to be tied to the bed frame, not side rail!
How often do you have to remove and assess the restraints
Every 2 hours
What are the different kind of restraint orders
Situational
Medical
Behavioral
How long is a restraint order good for?
24 hours
What are the functions of the skeletal system?
Supporting the soft tissues of the body (maintains body form and posture)
Protecting crucial components of the body, like the brain, heart, lungs, and spinal cord
Furnishing surfaces for the attachments of muscles, tendons, and ligaments, which in turn, pull on the individual bones and produce movement
Providing storage areas for minerals, (such as calcium) and fat
Producing blood cells
Define abduction
Lateral movement of a body part away from midline
Define adduction
Lateral movement of a body part towards the midline of the body
Define Circumduction
Turning in a circular motion. Example: circling the arm at the shoulder.
Define flexion
The state of being bent
Define extension
The state of being in a straight line. Example: A persons cervical spine is extended when the head is held straight on the spinal column.
Define hyperextension
The state of exaggerated extension. It often results in an angle greater than 180°. Example: A persons cervical spine is hyperextended when looking overhead, towards the ceiling.
Define dorsiflexion
Backward bending of the hand or foot. Example: a persons foot is in dorsiflexion when the toes are brought up as though to point them at the knee.
Define planter flexion
Flexion of the foot. Example: a persons foot is in planter flexion in the foot drop position.
Define rotation
Turning on an axis; the turning of a body part on the axis provided by its joint. Example: a thumb is rotated when it is moved to make a circle.
Define internal rotation
A body part turning on its axis towards the midline of the body. Example: A leg is rotated internally when it turns inward at the hip and the toes point towards the midline of the body.
Define external rotation
A body part turning on its axis away from the midline of the body. Example: a leg is rotated externally when it turns outward at the hip and the toes point away from the midline of the body.
Define pronation
The prone position. Example: a person is in the prone position when lying on the abdomen; a persons palm is prone when the forearm is turned, so that the palm faces downward
Define supination
The assumption of the supine position
Define inversion
Movement of the sole of the foot inward (occurs at the ankle)
Define eversion
Movement of the sole of the foot outward (occurs at the ankle)
Define opposition
Rotation of the thumb around its long access (movement of the thumb across the palm to touch each fingertip of the same hand)
What are four functions of the muscles?
Motion
Maintenance of posture
Support
Heat production
What are some examples of ADLs?
Activities of daily living, include eating, bathing, dressing, and toileting
What are some examples of IADLs?
Examples of instrumental activities of daily living, include housekeeping, meal preparation, management of finances, and transportation
Effects of exercise on the cardiovascular system
Increases efficiency of heart
Increases blood flow and oxygenation of all body parts
Decreases resting heart rate and blood pressure
Effects of immobility on the cardiovascular system
Increase cardiac workload
Increase risk for orthostatic hypotension
Increase risk for venous thrombosis
Effects of exercise on the respiratory system
Increases depth of respiration
Increases respiratory rate
Increases gas exchange at alveolar level
Increases rate of carbon dioxide excretion
Effects of immobility on the respiratory system
Decrease depth of respiration
Decrease rate of respiration
Pooling of secretions
Impaired gas exchange
In PowerPoints
Atelectasis
Pneumonia caused by buildup on secretions, patient’s inability to cough, bacterial growth
Effects of exercise on the gastrointestinal system
Increased appetite
Increased intestinal tone
Effects of immobility on the gastrointestinal system
Disturbances in appetite
Altered protein metabolism
Altered digestion, and utilization of nutrients
Decreased peristalsis
Constipation*
Effects of exercise on the urinary system
Increase blood flow to kidneys
Increase efficiency in maintaining fluid and acid base balance
Increase efficiency in excreting body wastes
Effects of immobility on the urinary system
Increased urinary stasis
Increase risk for renal calculi
Decrease bladder muscle tone
From power points
Risk of UTI due to
Decreased fluid intake
Use of indwelling catheters
Poor perineal care post bowel elimination (e.coli)
Urine becomes more alkaline
Effects of exercise on the musculoskeletal system
Increase muscle efficiency
Increase coordination
Increase efficiency of nerve impulse transmission
Effects of immobility on the musculoskeletal system
Decrease muscle size, tone, strength
Decrease joint mobility, flexibility
Bone demineralization
Decrease in endurance, stability
Effective exercise on the metabolic system
Increases efficiency of metabolic
Increases efficiency of body temp regulation
Effects of immobility on the metabolic system
Increase risk for electrolyte imbalance
Altered exchange of nutrients and gases
Effects of exercise on the integumentary system
Improved toned, color, and turgor, resulting from improved circulation
Effects of immobility on the integumentary system
Increase risk for skin breakdown, and formation of pressure injuries
How does a persons, mental health influence body appearance and movements?
Body processes tend to slow down with depression, and there is a lack of visible energy and enthusiasm
What does stasis mean
A stopping or slowing down of fluid in the body
Most dangerous complication of immobility
Thrombus formation
May become emboli
How do you assess for a DVT (deep vein thrombosis)
Swelling of leg (or arm)
Red or discolored skin (especially on posterior side of leg)
Pain/tenderness, warmth, or swelling (typically unilateral)
How do you assess for a pulmonary embolism?
Sudden shortness of breath (SOB) (most common)
Chest pain- sharp, stabbing, usually worse with deep breaths
Unexplained cough- may have bloody mucus
Rapid or irregular HR, feelings of anxiety
DVT prevention for immobile patients
Continued bed rest- encourage leg exercises and frequent position changes (if no DVT symptoms)
Ambulate (walk) as soon as possible (if no DVT symptoms)
How to treat edema in patients who are immobile?
Elevate extremities above heart level. This allows blood to circulate back to heart without fighting gravity.
How do pressure injuries form?
External pressure over area results in occluded blood capillaries and poor blood circulation to tissues
Friction and shearing forces tear and injured blood vessels and abrade top layer of skin
**do not massage over bony prominences!
What is the Braden risk assessment used for?
Skin and pressure injuries
Which side of the body does the cane go on?
Strong
If patient has balancing issue, which device is best
Walker, wheels in front and no wheels in the back
