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Fundamentals of Nursing > chapter 39: Immobility > Flashcards

chapter 39: Immobility Flashcards

1
Q

Pathological fractures

A

those caused by weakened bone tissue

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2
Q

5 main pathological influences on mobility

A

Postural abnormalities
Muscle abnormalities
Damage to CNS
Direct trauma to musculoskeletal system
Joint disease

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3
Q

Postural abnormalities

A

disorders of stance results in inequal muscle tone

Congenital stuff: scoliosis

Limits ROM

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4
Q

Damage to CNS

A

Long bed rest = sensorimotor dysfunction –> instability

Trauma, ischemia (from stroke), and bacterial infection (meningitis) can damage cerebellum or motor strip in cerebral cortex

Trauma to spinal cord too

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5
Q

Reasons for a fracture

A

trauma (obvi)

Deformities of bone:
-osteoporosis
-Paget’s disease
-metastatic cancer
-osteogenesis imperfecta

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6
Q

Joint disease

A

ARTHRITIS!!!!

osteoarthritis is one of most common causes of chronic disability
-hip and knees
- used to be considered “wear and tear” = degenerative joint disease
-now known to involve biomechanical factors, inflammatory factors and proteases

Rheumatoid arthritis is a chronic systemic inflammatory autoimmune disease
-swollen, tender joints –> destruction of synovial joints
-usually fingers, feet, wrists, elbows, ankles, knees
-also affects lungs, heart, and kidneys
-Pain

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7
Q

Reasons for bed rest

A

-limit oxygen needs of body
-reduce cardiac workload and pain
-allow debilitated person to rest

-They physically can’t move

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8
Q

Why do old people stay voluntarily inactive?

A
  1. fear of bothering staff
  2. not wanting to further overburden staff
  3. viewing asking for help as negative
  4. not wanting to be dependent
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9
Q

How fast does muscle deteriorate when on bed rest (for a normal person)?

A

within days
lose 3% muscle strength per day
disuse atrophy –> muscle fibers get smaller

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10
Q

Metabolic changes due to immobility

A

changes in mobility alter endocrine metabolism, calcium reabsorption, and GI functioning

decreases BMR (unless fever/inflammation)

Excretes more nitrogen than it ingests in prot –> neg nitrogen balance –> muscle catabolism

Calcium resorption from bones –> possible hypercalcemia

GI slows - constipation or pseudodiarrhea

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11
Q

Respiratory changes from immobility

A

Pulmonary atelectasis = collapse of alveoli due to blocked bronchi from secretions –> whole lung can collapse! –> can’t cough well –> mucus accumulates in bronchi (esp if supine, prone, or lateral)

Hypostatic pneumonia = inflammation of lung from stasis or pooling of secretions

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12
Q

Cardiovascular changes with immobility

A

Orthostatic hypotension bc of less circulating fluid, pooling blood, and low ANS respone

Increased cardiac workload: CO falls, so heart works more

Thrombus formation = accumulation of platelets, fibrin, clotting factors, and cellular elements of blood on wall of vessel

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13
Q

Virchow triad

A

Factors contributing to thrombus formation

  1. damage to vessel wall
  2. alterations in blood flow
  3. alteration in blood constituents
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14
Q

Pulmonary embolus

A

Can begin as a deep vein thrombosis
thrombus breaks off, travels to pulmonary artery, keeps blood away from lung

Symptoms:
range from nothing to shock and death
usually dyspnea and pleuritic chest pain and cough

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15
Q

Bone changes in immotility

A

-obvi increased Ca+ resorption –> Disuse osteoporosis

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16
Q

Joint changes in immobility

A

Joint contracture = fixation of joint
-muscle atrophy = shortening of fibers = contracture

*note: flexors are stronger than extensors

Foot drop is a common contracture –> permanent plantar flexion –> ppl with hemiplegia are at risk

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17
Q

Urinary elimination changes with immobility

A

Urinary stasis if gravity doesn’t help urine get from pelvis to bladder

Renal calculi due to hypercalcemia bc of bone resorption and lack of fluid intake

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18
Q

Skin changes with immobility

A

Pressure injuries –> due to prolonged ischemia and superficial shear
-starts out as inflammation
-worse if moist or poor nutrition
-body cant carry out metabolic processes so skin breaks down

19
Q
  • Caution: don’t provide too much help
A

This could keep someone - esp old ppl- from regaining mobility and lead to rapid loss of many functions

20
Q

ROM

A

sagital plane: flexion, extension, hyperextension, plantar flexsion, dorsiflexion

frontal plane: adduction, abduction, eversion, inversion

transverse plane: supination, pronation, internal and external hip rotation

21
Q

How to assess body alignment of immobile or unconscious person?

A

remove pillows/positioning supports and place patient in suppine position

22
Q

Whose sitting posture is important to assess?

A

those with muscle weakness/paralysis or nerve damage –> can’t tell when they’re cutting off their own circulation

Also those with respiratory disease - might lean on table to make breathing easier

23
Q

How should a conscious, lying down patient’s posture be assessed?

A

in the lateral position without any supports

24
Q

How often do you do a respiratory assessment for an immobile patient?

A

every 2 hrs –> auscultate

25
Q

signs of pneumonia

A

productive cough with green-yellow sputum
fever
pain on breathing
crackles, wheezes, and syspnea

26
Q

Signs of DVT

A

occur in one side of body at a time
-swelling of limb
-warm cyanotic skin
pain

measure calves or thighs regularly

27
Q

how often to change compression devise?

A

every 8 hrs

28
Q

Results of sensory deprivation (consequence of immobility)

A

retlessness, increased aggression, and insomnia

29
Q

Abrupt changes in personality

A

usually have physiological cause like surgery, meds, PE or infection

e.g. UTI or fever in old ppl = confusion/delerium

30
Q

Two diagnoses most directly related to mobility probs

A

Impaired mobility

Risk for Dissuse Syndrome

31
Q

How to bolster metabolic system of someone who’s immobile

A

high-cal ntake to meet body needs to func and replace subcutaneous tissue
vit B for energy metabolism
vit C for skin integrity and wound healing

32
Q

What happens if ppl who are immobile dont regularly fill lungs to capacity

A

they lose the elastic revcoil

33
Q

link between mucus and hydration

A

ppl need AT LEAST 1100-1400 mL of uncaffeinated liquid a day
w/o adequate hydration pulmonary secretions become thick, tenacious, and difficult to remove

34
Q

how to reduce:
Orthostatic hypotension
Cardiac Workload
Thrombus Formation

A

Ortho:
-get them moving/mobile ASAP –> isometric exercises don’t help

Cardiac Workload:
-valsalva maneuver when moving up in bed

Thrombus:
-compression stockings and VTE prophylaxis (anticoagulant therapy)
-IPCs are best (cuffs rather than stockings)
-foot pumps –> mimics walking
-calf pump, ankle pump, knee flexion

35
Q

How often to do ROM?

A

2-3 times a day

5 reps per joint

head to toe –> larger to smaller joints –> support the joints in cupped hand

36
Q

foot boots and ankle foot orthotic (AFO) devices

A

prevents drop foot by keeping feet in dorsiflexion

37
Q

Trochanter roll

A

prevents external rotation of hips when patient is in supine position

38
Q

hand roll

A

maintains thumb in slight adduction and in oppostition to fingers

39
Q

when actual or potential pressure areas exist, what angle should bed be at?

A

30 derees

40
Q

max time someone should be in chair

A

1 hr

41
Q

Instrumental activities of daily living

A

activities that are necessary to be independant in society beyond eating, grooming, transferring, and toiinting

include shopping, cooking, banking, taking meds…

42
Q

hemiplegia and hemiparesis

A

one sided paralysis

one sided weakness

43
Q

Supported fowlers

A

Fundamentals of Nursing (13 decks)

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