SPHM, Mobility/Immobility Flashcards
Define body mechanics
The coordinated efforts of the msk and nervous systems to maintain balance, posture, and body alignment during motion/movement
Define health care ergonomics
Designing and arranging workplace settings in such a way that people interact more effectively with the objects they encounter in that environment
Define impaired physical mobility
limitation of physical movement
What respiratory changes are caused as a result of immobility?
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)
What MSK changes are caused as a result of immobility?
- reduced muscle mass (can progress to disuse atrophy)
- impaired calcium metabolism (can lead to disuse osteoporosis)
- joint abnormalities (ex. joint contractures)
What are joint contractures? What is a common example?
abnormal (sometimes permanent) fixture of a joint. Limits ROM and may leave joints in a non-functional position.
Ex. footdrop
What urinary elimination changes are caused as a result of immobility?
urinary stasis - increases risk of urinary tract infection and renal calculi (kidney stones)
What integumentary changes are caused as a result of immobility?
Pressure injuries - localized damage to the skin and/or underlying soft tissue as a result of decreased blood supply in the
tissues
Name 5/11 nursing goals for a patient who is immobilized?
- 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
Identify two nursing interventions to meet the following nursing intervention: promote expansions of chest and lungs
- Assist the patient with repositioning every 2 hours
- Patient should be encouraged to deep breathe and cough every 1-2 hours
Identify two nursing interventions to meet the following nursing intervention: maintain optimal nutritional/metabolic state
- Make sure patient is getting a high-protein, high-calorie diet.
- Ensure patient is taking vitamin B and C if necessary.
Identify two nursing interventions to meet the following nursing intervention: prevent stasis of pulmonary secretions
- Change patient’s position every 2 hours
- Make sure patient is getting adequate fluid intake
Identify two nursing interventions to meet the following nursing intervention: maintain patient airway
- 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
Identify two nursing interventions to meet the following nursing intervention: reduce orthostatic hypotension
- 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
Identify two nursing interventions to meet the following nursing intervention: reduce cardiac workload
- 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
Identify two nursing interventions to meet the following nursing intervention: prevent thrombus formation
- 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.
Identify two nursing interventions to meet the following nursing intervention: maintain muscle strength and joint mobility
- Promote exercise or perform passive ROM exercises 2-3 times a day
- Teach patients to integrate exercises during ADLs
Identify two nursing interventions to meet the following nursing intervention: maintain normal urinary elimination patterns
- Ensure adequate hydration
- Assess freq and amount of urine output; teach bladder training if necessary; may need to insert Foley catheter
Identify two nursing interventions to meet the following nursing intervention: prevent pressure injury
- 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.
Identify two nursing interventions to meet the following nursing intervention: maintain psychosocial state
- Use assessment data to identify the psychosocial effects of prolonged immobilization
- Observe patient’s ability to cope and provide formal/informal socialization.
Define Tissue Ischemia
a restriction in blood supply to tissues, causing a shortage of oxygen that is needed to keep tissue alive (causes ulcers)
Defining blanching
when blood flow to a region of skin is prevented, making that skin appear white
Compare:
Shearing force vs. friction
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
Define DVT
accumulation of platelets, fibrin, clotting factors, and the cellular elements of the blood attached to the interior wall of a vein
What are elastic stockings (TED stockings) used for?
specialized hosiery designed to help prevent the occurrence of, and guard against further progression of, venous disorders
What is an embolus
a dislodged venous thrombus (clot)
Define hemiplegia
muscle paralysis on one side of the body
What factors can you assess to determine the effectiveness of safe patient handling in an institution?
- 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
List 4 risk factors for injury occurrence in nurses.
previous history of back pain
lack of personal physical conditioning
stress
not taking the time to obtain assistance
List 3 risk factors in the work environment that may cause injury.
- 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.
List the principles of safe client handling (8)
- Ask for help
- Use patient transfer devices where possible
- Encourage the patient to assist
- Position yourself in close proximity to the patient – minimize the amount of reaching
- Tighten core muscles and keep back, neck, pelvis and feet aligned
- Avoid twisting
- Bend at the knees and keep your feet wide apart
- Use your arms and legs, NOT your back
List the 5 components of SPH programs
- 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
List 3/5 SPH Aids
Give a short description of each.
Mechanical lifts (hoyer lift, ceiling lift) Transfer board Transfer belt / Gait belt Stand-assist device Trapeze bar
What are the key consideration for transferring a patient? (4)
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?
List the steps you can take to ensure safety when transferring a client. (7)
- 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
List 4 ways to mobilize a patient while they’re still in bed (position changes)
Rolling to side-lying position Moving pt up in the bed Supine to Sit Sit to Stand Bed to Chair
List 5/11 side effects of immobility on the body.
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
List the 5 considerations for taking a patient through passive ROM.
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
List the 6 considerations for ambulating clients.
- 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
List 3 types of ambulation assistive equipment.
walker
cane
crutches
What are some bony prominences that are at greatest risk for forming pressure injures (8)
Elbows Hips Shoulder Blades Ankle bones Sacrum Knees Heels Ears, back of head
What are some precautions that can be taken to prevent pressure injuries? (6)
- 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
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
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)
know what each of the following is:
- fowler’s position
- supine position
- prone position
- side-lying position
- sims’ position
:)
Define what a support surface is and its function
A specialized device for pressure redistribution designed to prevent skin breakdown
List and describe 3 types of support surfaces.
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
