week 7 Mobility Flashcards
What are the two benefits of mobilization?
- Reduce hospital length of stay
- Improve overall outcomes
What are the four major interventions we can do (and their sub interventions) for someone who is immobilized?
- Positioning
- Turns Q2 hrs
- body alignment (SIMS) - Skin care
- pressure reducing mattress
- dry, clean, protected
- regular skin assessments - Respiratory
- DB&C - Circulation
- bed exercises to lower risk of DVT
What do we use to assess mobility?
ACES
A- Alert?
C- cooperative?
E- Extremities - strength like push up off bed and hold weight standing?
S- Sits unsupported
What are some strategies to teach patients regarding falls?
-good non-slip footwear is better
-area free of clutter
-clear pathways
-make sure hearing aids or glasses are available
-call bell – to prevent people from feeling helpless
-check on them every hour
-ask people if they are in pain – need bathroom – need anything before you go
What are typical symptoms in someone with a bone fracture?
Pain
Bone tenderness
Decreased function of affected area
Edema
Crepitus
Bruising
What are the two most important assesments for patients with bone fracture?
- Neurovascular assessment
- Compartment syndrome
What does closed reduction bone fracture management mean?
no incisions
moderately sedated
manual pull to realign bone
Cast/immobilization device
How often do we monitor neurovascular status of distal area to a cast in the first 24 hours? over 24 hours?
Q 1 hr
Q 1-4 hrs
What is bucks traction and why is it used?
-a pulling force (weights)
- provides bone reduction (realignment)
- can be used to reduce pain and muscle spasms
What two things are we monitoring in someone with bucks traction?
- tissue integrity
- Pain assessment/management
How does someone in buck’s traction reduce pressure ulcers?
Learn to change positions in bed
What is the prefered surgical managment of bone fractures?
Open Reduction internal fixation (ORIF)
What are the two managment interventions for bone fractures?
1.Open Reduction internal fixation (ORIF)
2. Closed reduction external fixation
What is an example of open reduction internal fixation?
Hip surgery
Can we mobilize someone soon after bone fracture ORIF or CREF?
Yes! early mobility is key (when appropriate)
What 4 complications are we closely monitoring for in patients with bone fracture?
- infection
- compartment syndrome
- Venous thromboembolism
- Fat embolism
What are the 3 interventions for bone fracture infection?
- antibiotics
- irrigation and debridement
- diligent wound care
What are the 6 P’s of compartment syndrome?
Pain
Paresthesia
Pulseless
Pale
Pressure
Paralysis
What are two interventions for compartment syndrome?
- remove the cast
- Fasciotomy if very bad swelling
what helps us know the difference between a fat embolism and a thromboembolism?
Petechi = found with fat embolism only
What are interventions for fat embolism?
- Good assessments
- O2
- hydration (IV fluids)
- Possible steroid therapy
- Fracture immobilization
*no great treatments but care for the person well
What intervention is unique in amputation management?
prevent contractures
prone position Q3-4 hours with limb elevated
When someone is preparing to get a prosthesis, what do we want to help them prevent?
excoriation on the limb
What vertebrae are damaged in paraplegia?
T1-T6
What vertebrae are damaged in quadriplegia?
C8 and above
At what vertebrae level damagae does someone need mechanical ventilation?
C4 and above
What are the 2 main priorities in someone with spinal cord injury?
- ABCs - Airway & circulation
- Immobilization issues- skin integrity and infection
What are the 4 things we should assess in someone with spinal cord injury?
- ABCs
- GCS
- dermatomes and myotomes - get a baseline
- Immobilization issues - skin integrity/infection
What are the 7 complications of spinal cord injuries?
- Neurogenic shock
- Autonomic dysreflexia
- Trouble with secretions
- GI issues
- GU issues
- Thermoregulation
- skin and prolonged immobility
What happens in Neurogenic shock?
disruption of ANS = loss of sympathetic innervation of the heart = decrease/loss of respiratory system
What vertebrae damage is neurogenic shock most common in?
T6 and above d/t cardiovascular compromise
When does neurogenic shock typically occur?
24 hrs after injury
What are the two indications of Neurogenic shock?
hypotension ( systolic <90)
Bradycardia
What is the treatment for neurogenic shock?
- Fluids (not too much - monitor I&O)
- Dextran IV (plasma expander)
- vasopressors to treat low BP
- Atropine for bradycardia
How often and what do we monitor in someone with neurogenic shock?
monitor at least Q1hr
1. O2 sats
2. Resp compromise (stridor etc)
3. Symptomatic bradycardia
4. Decreased LOC
5. Decreased urine output
6. Systolic <90 or MAP<65
What complication of spinal cord injury can cause secondary injury to the spinal cord d/t decreased perfusion to the spine?
neurogenic shock
What complication of spinal cord injury is a medical emergency that needs to be reported immediately?
Neurogenic shock
What is autonomic dysreflexia in spinal cord injury?
An exaggerated ANS response
What are the 2 immediate things we do if someone is in autonomic dysreflexia?
- Place patient in sitting position
- Assess for and remove/manage the cause
What is the FIRST priority in autonomic dysreflexia?
Get patient into sitting position!
What is usually the cause of autonomic dysreflexia?
nauseous stimuli below the injury
What are some examples of modifiable causes of autonomic dysreflexia?
- blocked catheter
- catheter kinked
- constipation
- tight clothing like socks
- fecal impaction
- ingrown toenail, pressure ulcer, etc.
What do we do if we can’t find the cause of autonomic dysreflexia?
hypertensive crisis intervention
What is used to lower BP in someone with autonomic dysreflexia?
IV nifedipine or nitrate
How often to we monitor BP in someone with autonomic dysreflexia?
Q10-15 min
What are the first two signs that someone is experiencing autonomic dysreflexia?
Severe headache
blurred vision
What are the two vital signs that indicate someone is in autonomic dysreflexia?
HR- bradycardia
BP- high = hypertensive crisis
What 3 interventions do we use to help someone with a spinal cord injury who is struggling to manage secretions?
- suctioning
- incentive spirometer
- assisted coughing “quad cough”
what is a GI complication with spinal cord injury and what are the interventions?
neurogenic bowel (it ain’t workin right d/t CNS issues)
Constipation or loss of control
- bowel routine
- suppositories
- disimpaction
- Good nutritional intake
What is a GU complication with spinal cord injury and what are the interventions?
Neurogenic bladder - usually retention right after incident
- Maybe need intermittent catheterization (spastic bladder)
- maybe incontinent so need good skin care (flaccid bladder)
What is a thermoregulation issue in spinal cord injury?
Poikilothermia - can’t control core temp - takes on temp of environment. risk for hypothermia.
What are the interventions for skin and prolonged immobility issues in someone with spinal cord injury?
-Inspection; skin care, comfort
-Repositioning Q 2 (Logroll until stabilized)
-ROHO cushion for wheelchair
-ROM exercises
-Good Mattress
-Pin site care (if halo vest or traction)
-Assess pressure points under collars, braces
-Keep clean and dry under collars, braces
-DVT Prevention (don’t always need anticoagulant for life)
What do we teach people with spinal cord injury (SCI)?
- mobility skills
- pressure injury prevention
- ADL skills
- Bowel & bladder program
- sexual health (counseling)
- prevention and early signs of autonomic dysreflexia
- support for psychological changes, stress, grief, loss
What is Guillain-Barre Syndrome (GBS)?
Rare acute inflammatory disorder that affects the axons and myelin sheath of the peripheral nervous system
What are we most concerned about with guillain-barre syndrome?
respiratory depression = emergency!
Where does paralysis start for people with guillain-barre syndrome?
tingling in the toes and moves upward
What are 2 interventions for guillain barre syndrome?
- plasmapheresis - exchange plasma to get rid of unhelpful antibodies
- IVIG- IV immunoglobulin therapy - dilute bad antibodies with donor good ones
What are the 3 ways that IVIG helps someone with guillain barre syndrome?
- reduced inflammation
- prevents nerve damage
- reduces progression
What 2 things do we monitor in someone with guillain-barre syndrome?
- progression of paralysis
- mobility considerations- turns, mattress, skin check, clots
What medications are used for MS?
-Corticosteroid (methylprednisolone, prednisone)
-Immunomodulator (Betaseron, Avonex)
-Immunosuppressant (Methotrexate, Imuran, Mitoxantrone)
-Anticholinergic (Ditropan)
Fight fatigue (Ritalin)
-Antispasmodic (Baclofen)
-Medical marijuana (reduces pain and muscle stiffness)
What do we teach MS patients to manage their disease?
-Avoid temp extremes
-Regular exercise but avoid vigorous exercise
-Avoid people with infections, large crowds, handwashing
-Conserve energy, balance rest and activity
-Keep home free from clutter
-Supportive equipment
-Teach family about emotional lability
What are we concerned about with MS in each of the following systems:
resp.
GI
GU
integ
musculoskeltal
resp.- aspiration & PN
GI- nutrition, dysphagia
GU- UTIs
integ- pressure sores
musculoskeltal - falls
Which mobility disease is most common in peds?
Duchenne Muscular Dystrophy
What is Duchenne Muscular Dystrophy? (DMD)
Progressive muscle degeneration and weakness (deterioration and repair until repair is no longer enough)
What age do kids usually present with DMD?
2-5 yrs old
What is DMD evidenced by?
progressive muscular weakness, wasting and contractures
What do kids with DMD typcially pass away from?
respiratory failure
What are the clinical manifestations of DMD?
Increased paralysis
Large calf muscles
What is muscle replaced with in DMD?
Fat and connective tissue
What physical symptom do most patients with DMD present with?
calf muscle hypertrophy
What age do kids with DMD typically lose independent ambulation by?
age 12
What do teenagers with DMD present with typically?
Generalized weakness
What med can delay progress of DMD?
corticosteroids
What is the goal in DMD?
Maintain optimal muscle function for as long as possible
What is a child with DMD at risk for in the social domain?
Social isolation - help them get out and play as much as possible and life a normal life as much as they can
