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NURS 3512 acute & chronic > week 7 Mobility > Flashcards

week 7 Mobility Flashcards

1
Q

What are the two benefits of mobilization?

A
  1. Reduce hospital length of stay
  2. Improve overall outcomes
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2
Q

What are the four major interventions we can do (and their sub interventions) for someone who is immobilized?

A
  1. Positioning
    - Turns Q2 hrs
    - body alignment (SIMS)
  2. Skin care
    - pressure reducing mattress
    - dry, clean, protected
    - regular skin assessments
  3. Respiratory
    - DB&C
  4. Circulation
    - bed exercises to lower risk of DVT
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3
Q

What do we use to assess mobility?

A

ACES
A- Alert?
C- cooperative?
E- Extremities - strength like push up off bed and hold weight standing?
S- Sits unsupported

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4
Q

What are some strategies to teach patients regarding falls?

A

-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

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5
Q

What are typical symptoms in someone with a bone fracture?

A

Pain
Bone tenderness
Decreased function of affected area
Edema
Crepitus
Bruising

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6
Q

What are the two most important assesments for patients with bone fracture?

A
  1. Neurovascular assessment
  2. Compartment syndrome
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7
Q

What does closed reduction bone fracture management mean?

A

no incisions
moderately sedated
manual pull to realign bone
Cast/immobilization device

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8
Q

How often do we monitor neurovascular status of distal area to a cast in the first 24 hours? over 24 hours?

A

Q 1 hr
Q 1-4 hrs

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9
Q

What is bucks traction and why is it used?

A

-a pulling force (weights)
- provides bone reduction (realignment)
- can be used to reduce pain and muscle spasms

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10
Q

What two things are we monitoring in someone with bucks traction?

A
  1. tissue integrity
  2. Pain assessment/management
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11
Q

How does someone in buck’s traction reduce pressure ulcers?

A

Learn to change positions in bed

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12
Q

What is the prefered surgical managment of bone fractures?

A

Open Reduction internal fixation (ORIF)

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13
Q

What are the two managment interventions for bone fractures?

A

1.Open Reduction internal fixation (ORIF)
2. Closed reduction external fixation

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14
Q

What is an example of open reduction internal fixation?

A

Hip surgery

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15
Q

Can we mobilize someone soon after bone fracture ORIF or CREF?

A

Yes! early mobility is key (when appropriate)

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16
Q

What 4 complications are we closely monitoring for in patients with bone fracture?

A
  1. infection
  2. compartment syndrome
  3. Venous thromboembolism
  4. Fat embolism
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17
Q

What are the 3 interventions for bone fracture infection?

A
  1. antibiotics
  2. irrigation and debridement
  3. diligent wound care
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18
Q

What are the 6 P’s of compartment syndrome?

A

Pain
Paresthesia
Pulseless
Pale
Pressure
Paralysis

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19
Q

What are two interventions for compartment syndrome?

A
  1. remove the cast
  2. Fasciotomy if very bad swelling
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20
Q

what helps us know the difference between a fat embolism and a thromboembolism?

A

Petechi = found with fat embolism only

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21
Q

What are interventions for fat embolism?

A
  1. Good assessments
  2. O2
  3. hydration (IV fluids)
  4. Possible steroid therapy
  5. Fracture immobilization

*no great treatments but care for the person well

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22
Q

What intervention is unique in amputation management?

A

prevent contractures
prone position Q3-4 hours with limb elevated

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23
Q

When someone is preparing to get a prosthesis, what do we want to help them prevent?

A

excoriation on the limb

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24
Q

What vertebrae are damaged in paraplegia?

A

T1-T6

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25
Q

What vertebrae are damaged in quadriplegia?

A

C8 and above

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26
Q

At what vertebrae level damagae does someone need mechanical ventilation?

A

C4 and above

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27
Q

What are the 2 main priorities in someone with spinal cord injury?

A
  1. ABCs - Airway & circulation
  2. Immobilization issues- skin integrity and infection
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28
Q

What are the 4 things we should assess in someone with spinal cord injury?

A
  1. ABCs
  2. GCS
  3. dermatomes and myotomes - get a baseline
  4. Immobilization issues - skin integrity/infection
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29
Q

What are the 7 complications of spinal cord injuries?

A
  1. Neurogenic shock
  2. Autonomic dysreflexia
  3. Trouble with secretions
  4. GI issues
  5. GU issues
  6. Thermoregulation
  7. skin and prolonged immobility
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30
Q

What happens in Neurogenic shock?

A

disruption of ANS = loss of sympathetic innervation of the heart = decrease/loss of respiratory system

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31
Q

What vertebrae damage is neurogenic shock most common in?

A

T6 and above d/t cardiovascular compromise

32
Q

When does neurogenic shock typically occur?

A

24 hrs after injury

33
Q

What are the two indications of Neurogenic shock?

A

hypotension ( systolic <90)
Bradycardia

34
Q

What is the treatment for neurogenic shock?

A
  1. Fluids (not too much - monitor I&O)
  2. Dextran IV (plasma expander)
  3. vasopressors to treat low BP
  4. Atropine for bradycardia
35
Q

How often and what do we monitor in someone with neurogenic shock?

A

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

36
Q

What complication of spinal cord injury can cause secondary injury to the spinal cord d/t decreased perfusion to the spine?

A

neurogenic shock

37
Q

What complication of spinal cord injury is a medical emergency that needs to be reported immediately?

A

Neurogenic shock

38
Q

What is autonomic dysreflexia in spinal cord injury?

A

An exaggerated ANS response

39
Q

What are the 2 immediate things we do if someone is in autonomic dysreflexia?

A
  1. Place patient in sitting position
  2. Assess for and remove/manage the cause
40
Q

What is the FIRST priority in autonomic dysreflexia?

A

Get patient into sitting position!

41
Q

What is usually the cause of autonomic dysreflexia?

A

nauseous stimuli below the injury

42
Q

What are some examples of modifiable causes of autonomic dysreflexia?

A
  1. blocked catheter
  2. catheter kinked
  3. constipation
  4. tight clothing like socks
  5. fecal impaction
  6. ingrown toenail, pressure ulcer, etc.
43
Q

What do we do if we can’t find the cause of autonomic dysreflexia?

A

hypertensive crisis intervention

44
Q

What is used to lower BP in someone with autonomic dysreflexia?

A

IV nifedipine or nitrate

45
Q

How often to we monitor BP in someone with autonomic dysreflexia?

A

Q10-15 min

46
Q

What are the first two signs that someone is experiencing autonomic dysreflexia?

A

Severe headache
blurred vision

47
Q

What are the two vital signs that indicate someone is in autonomic dysreflexia?

A

HR- bradycardia
BP- high = hypertensive crisis

48
Q

What 3 interventions do we use to help someone with a spinal cord injury who is struggling to manage secretions?

A
  1. suctioning
  2. incentive spirometer
  3. assisted coughing “quad cough”
49
Q

what is a GI complication with spinal cord injury and what are the interventions?

A

neurogenic bowel (it ain’t workin right d/t CNS issues)
Constipation or loss of control

  1. bowel routine
  2. suppositories
  3. disimpaction
  4. Good nutritional intake
50
Q

What is a GU complication with spinal cord injury and what are the interventions?

A

Neurogenic bladder - usually retention right after incident

  1. Maybe need intermittent catheterization (spastic bladder)
  2. maybe incontinent so need good skin care (flaccid bladder)
51
Q

What is a thermoregulation issue in spinal cord injury?

A

Poikilothermia - can’t control core temp - takes on temp of environment. risk for hypothermia.

52
Q

What are the interventions for skin and prolonged immobility issues in someone with spinal cord injury?

A

-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)

53
Q

What do we teach people with spinal cord injury (SCI)?

A
  • 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
54
Q

What is Guillain-Barre Syndrome (GBS)?

A

Rare acute inflammatory disorder that affects the axons and myelin sheath of the peripheral nervous system

55
Q

What are we most concerned about with guillain-barre syndrome?

A

respiratory depression = emergency!

56
Q

Where does paralysis start for people with guillain-barre syndrome?

A

tingling in the toes and moves upward

57
Q

What are 2 interventions for guillain barre syndrome?

A
  1. plasmapheresis - exchange plasma to get rid of unhelpful antibodies
  2. IVIG- IV immunoglobulin therapy - dilute bad antibodies with donor good ones
58
Q

What are the 3 ways that IVIG helps someone with guillain barre syndrome?

A
  1. reduced inflammation
  2. prevents nerve damage
  3. reduces progression
59
Q

What 2 things do we monitor in someone with guillain-barre syndrome?

A
  1. progression of paralysis
  2. mobility considerations- turns, mattress, skin check, clots
60
Q

What medications are used for MS?

A

-Corticosteroid (methylprednisolone, prednisone)
-Immunomodulator (Betaseron, Avonex)
-Immunosuppressant (Methotrexate, Imuran, Mitoxantrone)
-Anticholinergic (Ditropan)
Fight fatigue (Ritalin)
-Antispasmodic (Baclofen)
-Medical marijuana (reduces pain and muscle stiffness)

61
Q

What do we teach MS patients to manage their disease?

A

-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

62
Q

What are we concerned about with MS in each of the following systems:
resp.
GI
GU
integ
musculoskeltal

A

resp.- aspiration & PN
GI- nutrition, dysphagia
GU- UTIs
integ- pressure sores
musculoskeltal - falls

63
Q

Which mobility disease is most common in peds?

A

Duchenne Muscular Dystrophy

64
Q

What is Duchenne Muscular Dystrophy? (DMD)

A

Progressive muscle degeneration and weakness (deterioration and repair until repair is no longer enough)

65
Q

What age do kids usually present with DMD?

A

2-5 yrs old

66
Q

What is DMD evidenced by?

A

progressive muscular weakness, wasting and contractures

67
Q

What do kids with DMD typcially pass away from?

A

respiratory failure

68
Q

What are the clinical manifestations of DMD?

A

Increased paralysis
Large calf muscles

69
Q

What is muscle replaced with in DMD?

A

Fat and connective tissue

70
Q

What physical symptom do most patients with DMD present with?

A

calf muscle hypertrophy

71
Q

What age do kids with DMD typically lose independent ambulation by?

A

age 12

72
Q

What do teenagers with DMD present with typically?

A

Generalized weakness

73
Q

What med can delay progress of DMD?

A

corticosteroids

74
Q

What is the goal in DMD?

A

Maintain optimal muscle function for as long as possible

75
Q

What is a child with DMD at risk for in the social domain?

A

Social isolation - help them get out and play as much as possible and life a normal life as much as they can

NURS 3512 acute & chronic (29 decks)

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