SPHM, Mobility/Immobility

Question 1

Define body mechanics

Answer 1

The coordinated efforts of the msk and nervous systems to maintain balance, posture, and body alignment during motion/movement

Question 2

Define health care ergonomics

Answer 2

Designing and arranging workplace settings in such a way that people interact more effectively with the objects they encounter in that environment

Question 3

Define impaired physical mobility

Answer 3

limitation of physical movement

Question 4

What respiratory changes are caused as a result of immobility?

Answer 4

Increased risk of

• atelectasis (collapse of alveoli in lungs resulting in impaired gas exchange)
• hypostatic pneumonia (inflammation of the lung from stasis or pooling of secretions)

Question 5

What MSK changes are caused as a result of immobility?

Answer 5

• reduced muscle mass (can progress to disuse atrophy)
• impaired calcium metabolism (can lead to disuse osteoporosis)
• joint abnormalities (ex. joint contractures)

Question 6

What are joint contractures? What is a common example?

Answer 6

abnormal (sometimes permanent) fixture of a joint. Limits ROM and may leave joints in a non-functional position.
Ex. footdrop

Question 7

What urinary elimination changes are caused as a result of immobility?

Answer 7

urinary stasis - increases risk of urinary tract infection and renal calculi (kidney stones)

Question 8

What integumentary changes are caused as a result of immobility?

Answer 8

Pressure injuries - localized damage to the skin and/or underlying soft tissue as a result of decreased blood supply in the
tissues

Question 9

Name 5/11 nursing goals for a patient who is immobilized?

Answer 9

• maintain optimal nutritional/metabolic state
• promote expansions of chest and lungs
• prevent stasis of pulmonary secretions
• maintain patient airway
• reduce orthostatic hypotension
• reduce cardiac workload
• prevent thrombus formation
• maintain muscle strength and joint mobility
• maintain normal urinary elimination patterns
• prevent pressure injury/ulcer
• maintain usual psychosocial state

Question 10

Identify two nursing interventions to meet the following nursing intervention: promote expansions of chest and lungs

Answer 10

• Assist the patient with repositioning every 2 hours

- Patient should be encouraged to deep breathe and cough every 1-2 hours

Question 11

Identify two nursing interventions to meet the following nursing intervention: maintain optimal nutritional/metabolic state

Answer 11

• Make sure patient is getting a high-protein, high-calorie diet.
• Ensure patient is taking vitamin B and C if necessary.

Question 12

Identify two nursing interventions to meet the following nursing intervention: prevent stasis of pulmonary secretions

Answer 12

• Change patient’s position every 2 hours

- Make sure patient is getting adequate fluid intake

Question 13

Identify two nursing interventions to meet the following nursing intervention: maintain patient airway

Answer 13

• actively work with patients to deep breath and cough every 1 to 2 hours
• Implement chest physiotherapy (CPT) (percussion and positioning) to prevent mucous plugs

Question 14

Identify two nursing interventions to meet the following nursing intervention: reduce orthostatic hypotension

Answer 14

• attempt to get the patient moving as soon as the physical condition allows, even if this only involves sitting at the side of the bed (dangling) or moving to a chair
• Reminding patient to change positions slowly and gradually

Question 15

Identify two nursing interventions to meet the following nursing intervention: reduce cardiac workload

Answer 15

• Instructing patients to avoid using a Valsalva manoeuvre when moving up in bed, defecating, or lifting household objects. During a Valsalva manoeuvre a patient holds the breath and strains.
• The patient should be reminded to breathe out while defecating, lifting, or moving side to side or moving up in bed

Question 16

Identify two nursing interventions to meet the following nursing intervention: prevent thrombus formation

Answer 16

• Leg exercises, position changes, encourage fluid intake, teaching patient of preventative measures, compression stocking
• Continually assess patient for signs of bleeding Ex. Bruising, bleeding gums, etc.

Question 17

Identify two nursing interventions to meet the following nursing intervention: maintain muscle strength and joint mobility

Answer 17

• Promote exercise or perform passive ROM exercises 2-3 times a day
• Teach patients to integrate exercises during ADLs

Question 18

Identify two nursing interventions to meet the following nursing intervention: maintain normal urinary elimination patterns

Answer 18

• Ensure adequate hydration

- Assess freq and amount of urine output; teach bladder training if necessary; may need to insert Foley catheter

Question 19

Identify two nursing interventions to meet the following nursing intervention: prevent pressure injury

Answer 19

• Turning patients every 1-2 hours. Amount of time sitting uninterrupted should be monitored – limited to <1hour. Patients in wheelchairs should move every 15 minutes
• Use devices to relieve pressure on the skin.

Question 20

Identify two nursing interventions to meet the following nursing intervention: maintain psychosocial state

Answer 20

• Use assessment data to identify the psychosocial effects of prolonged immobilization
• Observe patient’s ability to cope and provide formal/informal socialization.

Question 21

Define Tissue Ischemia

Answer 21

a restriction in blood supply to tissues, causing a shortage of oxygen that is needed to keep tissue alive (causes ulcers)

Question 22

Defining blanching

Answer 22

when blood flow to a region of skin is prevented, making that skin appear white

Question 23

Compare:

Shearing force vs. friction

Answer 23

Shearing - when the skin and subcutaneous layers adhere to the surface of the bed, while layers of muscle and the bones slide in the direction of body movement
Friction - friction is present when there is a mechanical force exerted on the skin

Question 24

Define DVT

Answer 24

accumulation of platelets, fibrin, clotting factors, and the cellular elements of the blood attached to the interior wall of a vein

Question 25

What are elastic stockings (TED stockings) used for?

Answer 25

specialized hosiery designed to help prevent the occurrence of, and guard against further progression of, venous disorders

Question 26

What is an embolus

Answer 26

a dislodged venous thrombus (clot)

Question 27

Define hemiplegia

Answer 27

muscle paralysis on one side of the body

Question 28

What factors can you assess to determine the effectiveness of safe patient handling in an institution?

Answer 28

- rate of msk injuries in nurses - rate of falls in patients - rate of deconditioning in patients - rate of pressure ulcers in patients - rate of functional decline in patients

Question 29

List 4 risk factors for injury occurrence in nurses.

Answer 29

previous history of back pain lack of personal physical conditioning stress not taking the time to obtain assistance

Question 30

List 3 risk factors in the work environment that may cause injury.

Answer 30

- Workplace with poor ergonomics: slippery or wet surfaces, uneven floor surfaces, physical obstructions, small spaces, uneven work spaces, etc. - staffing levels, patient assignment, availability of equipment etc. - Poor body mechanics: reaching and lifting loads far from the body, heavy loads, twisting while lifting, changes during lifting, frequent lifting, etc.

Question 31

List the principles of safe client handling (8)

Answer 31

1. Ask for help 2. Use patient transfer devices where possible 3. Encourage the patient to assist 4. Position yourself in close proximity to the patient – minimize the amount of reaching 5. Tighten core muscles and keep back, neck, pelvis and feet aligned 6. Avoid twisting 7. Bend at the knees and keep your feet wide apart 8. Use your arms and legs, NOT your back

Question 32

List the 5 components of SPH programs

Answer 32

- Patient assessments and algorithms - Proper equipment (SPH aids) - Resources nurses (sometimes) – people who’s job it is to lift - Staff training - Minimal or no-lift policies – equipment use only

Question 33

List 3/5 SPH Aids | Give a short description of each.

Answer 33

``` Mechanical lifts (hoyer lift, ceiling lift) Transfer board Transfer belt / Gait belt Stand-assist device Trapeze bar ```

Question 34

What are the key consideration for transferring a patient? (4)

Answer 34

You - do you have any injuries or issues? Your client - what is their physiological capacity to assist? What is their cognitive status? What is their ht/wt? Do they have dressings, tubes etc.? Do they have a history of falls? Can they follow instruction? The environment Is there enough space? Are there any barriers preventing safety? Do you have the correct equipment? Your team - do you have enough help? Do team members understand their roles?

Question 35

List the steps you can take to ensure safety when transferring a client. (7)

Answer 35

- Gather appropriate equipment - Ensure that you have the assistance required - Perform hand hygiene - Ensure that bed brakes are ON - Explain procedure to patient - Ensure patient is wearing not slip footwear if standing - Take bp - Allow patient to dangle at side of bed prior to standing or transferring Dangling: have patient sit on edge of bed with feet dangling to prevent orthostatic hypotension (1 min) - Take bp

Question 36

List 4 ways to mobilize a patient while they're still in bed (position changes)

Answer 36

``` Rolling to side-lying position Moving pt up in the bed Supine to Sit Sit to Stand Bed to Chair ```

Question 37

List 5/11 side effects of immobility on the body.

Answer 37

``` Decreased metabolism Weight loss, muscle wasting GI disturbances Atelectasis (collapse of alveoli) Pneumonia Orthostatic hypotension Increased cardiac workload Thrombus / emboli Disuse atrophy Contractures Foot drop ```

Question 38

List the 5 considerations for taking a patient through passive ROM.

Answer 38

``` Begin exercises as soon as possible Assess patient’s ability to participate Movements should be slow and smooth Support limb above and below joint Each movement should be repeated five times during the session ```

Question 39

List the 6 considerations for ambulating clients.

Answer 39

- Assess the patient (e.g., vital signs, strength, coordination, balance and pain) - Assess the environment for safety - Proper footwear, pain level assessment, ability - Allow patient to sit at side of bed for 1-2 minutes “dangling” - Support patient at the waist (patient’s center of gravity is midline) walk at a diagonal when walking with the patients to catch them if they fall - Use assistive devices if necessary

Question 40

List 3 types of ambulation assistive equipment.

Answer 40

walker cane crutches

Question 41

What are some bony prominences that are at greatest risk for forming pressure injures (8)

Answer 41

``` Elbows Hips Shoulder Blades Ankle bones Sacrum Knees Heels Ears, back of head ```

Question 42

What are some precautions that can be taken to prevent pressure injuries? (6)

Answer 42

- Maintain good body alignment - Change the patient's position while in bed (q2h) + document - Use positioning devices to protect bony prominences - Joints should be slightly flexed - Position extremities to avoid skin-to-skin contact Ex. pillow between knees when sidelying - Keep bed clean, dry, and wrinkle free

Question 43

Describe the purpose/use of the following devices for positioning: - pillows - wedge pillow - foot boot - trochanter roll - sandbags - hand rolls - hand-wrist splints - trapeze bar

Answer 43

Pillows – used to elevate and provide support Wedge Pillow – maintain the legs in abduction after total hip replacement surgery (seen on ortho units) Foot Boot – prevents footdrop by maintaining dorsiflexion Trochanter Roll - prevents hip and leg from rotating outwards Sandbags - immobilize an extremity or maintain body alignment Hand Rolls - maintains fingers in flexed position Hand-wrist Splints - individually moulded for the patient to maintain proper alignment of the thumb (slight adduction) and the wrist Trapeze Bar - patient can use to reposition or transfer (requires upper body strength)

Question 44

know what each of the following is: - fowler's position - supine position - prone position - side-lying position - sims' position

Answer 44

:)

Question 45

Define what a support surface is and its function

Answer 45

A specialized device for pressure redistribution designed to prevent skin breakdown

Question 46

List and describe 3 types of support surfaces.

Answer 46

Low-air loss - Pressure redistribution – provides air flow to manage heat and humidity from the skin Non-powered - air moves with body position Air-fluidized (electronic beds in hospitals) - Pressure redistribution via fluid substance - helpful for patients with excessive moisture