Flashcards in Chapter 33 Activity Deck (47):
What action milestones would you expect to see in an infant that is 3 to 6 months old?
ability to sit and head control
sits steadily, rolls over, crawls, pulls up,
progress towards unassisted walking, can pick up small objects
What actions milestones would you expect to see toddlers complete by 15 months?
can stack blocks, string large beads, dress themselves
What action milestones would you expect to see from a child by age 4?
negotiate stairs, walk backward, hop on one foot
skip, jump rope, jump off heights and several steps, can manipulate small writing instruments, all basic mechanisms for locomotion
what physical milestones would you expect to see from an adolescent?
What are the assessment concerns?
growth spurts, secondary sex characteristics appear,
determining activity level and type of regular exercise, screen for scoliosis ,muscle mass , tone and joint mobility
What are some problems with the muscular, skeletal, and nervous systems that can affect mobility?
Congenital abnormalities - scoliosis
Problems with bone formation or muscle development - age related problems like osteoporosis
Trauma to the musculoskeletal system - sprains, strains, and dislocations
problems affecting the central nervous system - stroke or head trauma can damage the motor cortex and may produce temporary or permanent voluntary impairment
What are the effects of immobility on the cardiovascular system?
increased cardiac workload due to venous return
risk for orthostatic hypotension
Risk for venous thrombosis
What are the effects of immobility on the respiratory system?
decreases the depth of respiration
decreases the rate of respiration
pooling of secretions because it cant move
impaired gas exchange
What are the effects of immobility on the gastrointestinal system?
disturbance in appetite
altered protein metabolism
altered digestion and utilization of nutrients
What are the effects of immobility on urinary system?
Increase in urinary stasis that can lead to UTI
Increased risk for renal calculi
decreased bladder muscle tone
What are the effects of immobility on musculoskeletal system
decreased muscle size, tone and strength
decreased joint flexibility
decreased endurance and stability
increased risk for contracture formation
What are the effects of immobility on metabolic system?
increased risk for electrolyte imbalance
altered exchange of nutrients and gases
What are the effects of immobility on integumentary system
increased risk for skin breakdown and formation of pressure ulcers
What are the effects of immobility on psychological well-being?
increased sense of powerlessness, decreased self-concept, decreased social interaction, decreased sensory stimulation, altered sleep-wake pattern, increased risk for depression
What is isotonic, isokinetic, and isometric exercises?
isotonic - involves muscle shortening and active movement
Isokinetic- muscle contraction with resistance
isometric - static contration
When do you need to consult a physician prior to starting an exercise regimen?
if sedentary and over 35, or if you have a current or past cardiovascular condition, asthma, diabetes, osteoporosis, obesity
What is a contracture ?
What is ankylosis?
permanent shortening of muscles due to having been contracted too long.
its a consolidation or immobilization of a joint, can be permanent
When does the physical assessment start? What should you be looking for in terms of action?
As soon as the patient walks into the room
Ease of movement and gait
joint structure and function
Muscle mass, tone and strength
What is critical when moving patients?
Maintaining proper alignment to protect from injury
When communicating action to patients with dementia what form of communication should be used and why?
Positive communication in short easy to understand terms, this is to avoid confusion in what you need.
Do not say " dont sit down"
Say " stand up"
When is a patient considered fully dependent when transferring?
How should the nurse respond?
When the nurse has to support 35 or more lbs of the patients weight
use assistive devices
What are trochanter rolls used for?
To support the hips and legs so that the femurs do not rotate outward
If a foot remains unsupported to long in an immobile patient, what are the complications that could arise and why?
if the foot remains unsupported it will be in the plantar flexion position which could contribute to foot drop
this is when, heel toe walking is impossible because the toes land first.
What is Fowler's position? What is it used for primarily?
What is high Fowler's?
What is low Fowler's?
What areas in Fowler's are in the most danger for skin breakdown?
When the head of the bed is elevated between 45-60 degrees.
Fowler's is used to promote cardiac and respiratory functioning
90 degree elevation
30 degrees elevation
The heels, the sacrum, and scapulae are at risk for skin break down
What is the oblique position? Why is it used?
Modified lateral position where the patient's top leg is flexed at the hip approx 30 degrees and the knew flexed at 35. calf of upper leg is positioned behind the midline pillows support the back and patient's top leg.
Used to relieve pressure off trochanter area
What is the Sim's position? What areas of the body should we be most concerned with for pressure?
Modified lateral position where lower arm is behind the patient and upper arm is flexed
anterior aspects of humerous, clavicle and illium
What position is contraindicated for people with spinal problems?
How often should you check the legs when using antiembolism stockings?
Do they require an order?
at least once every 8 hours
What are the three main categories of joints?
diarthritic (synovial) - moveable
amphiarthritic (cartilagenous)- slightly movable
synarthritic (fibrous)- immovable
What is a condyloid joint? what movement ? give example?
oval head of one bone fits into cavity of another
flexion-extension and abduction-adduction
What is a gliding joint? what movement ? give example?
surfaces are flat
flexion-extension and abduction-adduction
carpal bones of wrist
What is a hinge joint? what movement ? give example?
spool like surface fits into a concave surface
What is a pivot joint? what movement ? give example?
ring like that turns on a pivot
axis and atlas, proximal ends of radius and ulna
What is a saddle joint?
bon surfaces are convex on one side and concave on the other
side to side and back and forth
How does the body know what position its in?
Labryrinthine sense ( inner ear)
Proprioceptors (special nerves )
What is Tonus?
slight contraction of muscles due to bed rest
What are contractures?
permanent contraction of muscles due to bed rest
What is muscle flaccidity and spasticity?
flaccidity is loss of tone from disuse or neurologic impairments
Spasticity is increased tone that interferes wtih movement, is caused by neurologic impairments
What is hemiparesis?
weakness to one half of the body
what kind of patients can use a powered stand-assist or repositioning lift?
If they can bear weight on at least one leg, can follow directions, and are cooperative
How often should you do range-of-motion exercises?
twice a day for 2 to five reps
when reintroducing walking to a bedridden patient, what is the first exercise to start with?
isometric contractions of the quadriceps
how do you prepare a walker for a patient? How do you instruct them to use it?
What should they never do with a walker?
top of the arm should be level with the crease of the patients wrist. patients elbows should be flexed at 30 degrees when they are holding it
move the walker ahead of you and step into it, dont lean over top of it.
NEVER go up stairs
How do you setup a cane for a patient?
How should they walk with it?
Should go from the floor to the hip bone
hold cane in hand opposite to affected leg
stand with weight distributed evenly
advance cane forward, bring affected leg parallel to the cane
advance the nonaffected leg forward till the heel is past the tip of the cane
bring the weaker leg parallel to the other leg, rinse and repeat
If you are applying anti embolism stockings to a patient, and they have been walking recently, what should you do and why?
Keep feet elevated for at least 15 minutes, you dont want blood to pool in the veins
With anti emboli stockings...
If patent has a large amount of pain with application then what?
If patient has an incision on the leg then what?
If the patient is supposed to ambulate with stockings then what?
How often should you remove them?
How often should you assess the skin?
if pain is expected then premedicate
if pain is unexpected then consult physician, pt could have deep vein thrombosis
apply bandage if draining
add slip resistant stockings or slippers
once a shift for 20-30 mins
assess at least every shift for skin color
What are some of the most important things about transferring a pt from the bed to a chair?
MAKE SURE THE BEDS BRAKES AND CHAIRS BRAKES ARE LOCKED!
make sure you stand in front of the pt to catch them in case they fall.
move on the count of three with your legs and not your back`