CH 21: Mobility Flashcards by Tyece Henry

degenerative joint disease in which there is progressive deterioration and abrasion of joint cartilage, with the formation of new bone at the joint surfaces

osteoarthritis

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bone condition characterized by low bone density and porous bones

osteoporosis

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a decline in walking speed or grip strength associated with an age-related decrease in muscle mass and function

sarcopenia

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Effects of Aging on Musculoskeletal Function**

Decline in number and size of muscle fibers and muscle mass _ decreased body strength
Grip strength endurance declines
Connective tissue changes reduce flexibility of joints/muscles
Sarcopenia can be caused by disease, immobility, decreased blood flow to muscle, and decreased caloric intake
Activity impacted by psychosocial factors (grief, retirement, relocation)

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decline in __ leads to decrease body strength

number and size of muscle fibers and muscle mass

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reduce flexibility of joints/muscles

connective tissue changes

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can be caused by disease, immobility, decreased blood flow to muscle, and decreased caloric intake

sarcopenia - decline in muscles mass

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psychosocial factors that impact activity

grief
retirement
relocation

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musculoskeletal health promotion**

Maintain a physically active state
Exercise programs should address cardiovascular endurance, flexibility, and strength training
Exercise improves body tone, circulation, appetite, digestion, elimination, respiration, immunity, sleep, and self-concept
Enhance physical activity during daily routines
Exercise 30 min x 5 days/week
Pace exercise throughout the day
Adjust exercise as indicated
Prepare for longer rest periods
Seek advice from PCP about type of exercise best suited for their capacities and limitations
If unable to do aggressive exercise, promote activities that include ROM, joint mobility, and circulation
Well balanced diet with 1500 mg calcium
Weight reduction if obese

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Guidelines for Exercise Programs for Older Adults

Physical examination FIRST
Assess current activity level, ROM, muscle strength and tone, and response to physical activity
Emphasize exercises that focus on good speed and rhythm
To determine age-adjusted training HR, subtract age from 220 and multiply by 70%; assesses maximum rate to provide vascular benefits and prevent complications, max range for safety
Monitor pulse during exercise and reduce activity if above 10 bpm of target HR
Consult PCP if resting HR > 100
Wear proper-fitting, shock absorbing shoes with traction
Encourage warm-up and cooling down
Begin with conservative exercise program and gradually increase activity
Stop for adverse s/s

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4Ms Framework

-What matters
-Medication
-Mentation
-Mobility

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mind body connection

Exercise can influence mood and behavior, and vice versa
Physical activity aids respiratory, circulatory, digestive, excretory, and musculoskeletal function
Used to engage in social activity
Find activities appropriate for their capabilities and needs
Use 4M model for age-friendly care
Use therapeutic recreation

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prevention of inactivity

-Effects of inactivity(Decreased muscle strength, GI motility, metabolism, ventilation/chest expansion, and aerobic capacity)
-Don’t encourage dependence!!!!
-Activity can lower BP, maintain muscle strength, improve lymphatic circulation, sharpen mental
acuity, elevate mood, improve digestion and
elimination
-Enhance motivation by showing interest
-Local resources (senior centers, exercise classes, volunteer opportunities, recreational programs, clubs)
-Keep older adults active in the community

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common causes of fractures in older adults

trauma (FALLS)
cancer
osteoporosis (brittle bones)
other skeletal diseases

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when to suspect fx with older adults

with any fall or bone trauma

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what does it mean for absence of typical symptoms

does not r/o fracture; can appear days after initial injury

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s/s of fx

change in shape/length of limb
restriction of limb
edema
discoloration
bone protrusion
spasms

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fx healing in older adults

Fractures heal slowly in older adults with higher risk of complications

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interventions to prevent fx

Advise to avoid risky behaviors
Rise from a kneeling or sitting position
Safe, properly fitting shoes
Watch your step!
Use of nightlights or sunglasses to prevent glare

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interventions for fx

Activity within the limits of provider
Joint exercise and proper positioning to prevent contractures
Correct body alignment
Measures to prevent immobility complications
Gradually mobilize ASAP

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osteoarthritis affects what age

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> 55 yo

Leading cause of physical disability in older adults

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osteoarthritis

causes of osteoarthritis

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excessive use of the joint
obesity
trauma
low Vit D and C
genetics

what joints most affected by osteoarthritis

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Weight-bearing joints
(knees, hips, vertebrae, and fingers)

sx of osteoarthritis

No systemic symptoms, localized disease Excessive exercise may cause more pain

tx of osteoarthritis

analgesics (acetaminophen) rest heat/ice aquatherapy t’ai chi massage acupuncture splints braces canes proper body alignment and mechanics weight reduction nutritional intake PT/OT avoid stress on the joints ROM allow independence hip and knee replacements

RA in older adults

Most older patients developed it earlier in life Greater systemic involvement occurs in older adults Joint pain is present during rest and activity

interventions for RA

rest and support the limb ROM PT/OT heat massage analgesics NSAIDs/immunosuppressants/corticosteroids for inflammation diet change

gout is characterized by:

exacerbations and remissions

interventions of gout

Encourage fluid intake, low-purine diet (avoid many kinds of meat) avoid alcohol thiazide diuretics can exacerbate colchicine for acute attack long-term meds allopurinol indomethacin probenecid

when does osteoporosis normally affect

Primarily affects adults in middle to later life

potential causes of osteoporosis

Inactivity/immobility Disease (Cushing's, diverticulitis, hyperthyroidism) Reduction in anabolic sex hormones Insufficient diet or loss of calcium, Vit D/C, and protein Meds (antacids, corticosteroids, thyroid supplements)

osteoporosis can cause:

kyphosis height reduction fractures

tx of osteoporosis

SERMs calcium & Vit D supplements bisphosphonates diet rich in protein and calcium braces regular exercise avoid heavy lifting, jumping, etc. ROM, ambulation, PT

caused by friction and irritation on the feet that create layers of thickened skin; usually appears on the heels and soles of feet

calluses

cone-shaped layers of thick, dry skin that forms over a bony prominence

corns

a bony prominence over the first metatarsal head

bunions

hyperextension at the metatarsophalangeal joint with flexion and corn formation at the proximal interphalangeal joint

hammer toe

inflammation of the ligamentous band at its heel attachment in the foot

plantar fasciitis

Podiatric Considerations

Encourage no self-treatment of conditions Proper foot care Seek professional podiatric care Foot massages (but not those with PVD, lesions, or nerve damage) Shoe shops can modify shoes Orthotics Foot exercises, ice Antimicrobials for infections

how to manage pain

Can interfere with mobility, activity, ADLs, and social life Avoid injury Passive stretching to control muscle cramps Avoid excessive exercise Correct positioning Gentle touch and movement Diversional activities (Guided imagery) Heat (cautious with neuropathy)

preventing injury

Fall prevention Do not straighten a contracture Be careful with turning and transfers

promoting independence

Minimize limitations and strengthen capacities Appropriate use of mobility aids PT/OT collaboration

how to facilitate proper positioning

correct body alignment

assisting with range of motion

Promotion of joint motion & muscle strength, stimulation of circulation, maintenance of functional capacity, and prevention of contractures Active  independently by patients Active assistive  with assistance to the patient Passive  with no active involvement of the patient Most significant concern is degree of ROM to complete ADLs Put all joints through full ROM daily

steps for assisting with range of motion

Offer support above and below joint Move joint slowly and smoothly x3 Do not force past resistance Document

stop ROM if:

resting HR >100 bpm exercise HR >35% above resting HR increase/decrease in SBP by 20 mm Hg angina dyspnea pallor cyanosis dizziness poor circulation diaphoresis acute confusion restlessness

Assisting with mobility aids and assistive technology

Enable patients to independently fulfill needs and enhance function Evaluate for true need Individually fitted

use of a cane

Provide wider base of support; not for weight bearing; used on unaffected side and advanced when affected limb advances

use of walkers

Offer broad base and used for weight bearing and stability Advance the walker then step forward

use of wheelchairs

Promote mobility for persons unable to ambulate, disabilities, paralysis, or cardiac disease

use of assistive technology

Promote independent function Splints, utensil grips, Velcro attachments, computers, voice synthesizers, Braille reading, remote control devices, robotic arms

CH 21: Mobility Flashcards

(52 cards)