Chapter 40 Mobility And Immobility

Question 0

What two functional systems are essential for mobility?

Answer 0

Musculoskeletal and nervous systems

Question 1

What is mobility?

Answer 1

The freedom and independence in purposeful movement. Mobility refers to adapting to and having self-awareness of the environment.

Question 2

What is one if the key components of reducing the complications of immobility?

Answer 2

Promoting venous return.

Question 3

What are four types of immobility?

Answer 3

Temporary - knee surgery
Permanent - paraplegia
Sudden onset - fractured arm and leg
Slow onset - MS

Question 4

What are the principals of body mechanics based on ?

Answer 4

Alignment, balance, gravity and friction.

Question 5

Movement depends on which intact systems?

Answer 5

Skeletal
Skeletal muscle
Nervous system

Question 6

What does assessment focus on regarding mobility and immobility?

Answer 6

Mobility 
ROM
Gait
Exercise status 
Activity tolerance
Body alignment while sitting standing and lying.

Question 7

What are some factors affecting mobility?

Answer 7

Alterations in muscles
Injury to musculoskeletal system 
Poor posture 
Impaired CNS
Health status and age.

Question 8

Name two changes that occur in the integumentary system:

Answer 8

Increased pressure on skin

Decreased circulation to skin (ulcers)

Question 9

Two changes in the respiratory system are:

Answer 9

• Decreased respiration movement resulting in decreased oxygen and carbon dioxide exchange.
• Stasis if secretions and decreased and weakened respiratory muscles (stele tasks and hypo static pneumonia)

Question 10

Two changes to the cardiovascular system are:

Answer 10

Orthostatic hypotension
Less fluid volume in the circulatory system
Stasis of blood in legs

Question 11

Name two changes to metabolic system:

Answer 11

Altered endocrine system

Changes in protein carb and fat metabolism.

Question 12

Two changes to elimination system:

Answer 12

Genitourinary - urinary stasis
Decreased fluid intake, poor perineal car and indwelling urinary catheters

Gastrointestinal - decreased peristalsis
Constipation, then fecal impaction, then diarrhea

Question 13

Two changes to Musculoskeletal system:

Answer 13

Decreased muscle endurance, strength and mass

Foot drop

Question 14

Two changes to neurological changes:

Answer 14

Changes in emotional status (depression)
Behavior changes (withdrawal, altered sleep)

Question 15

In infants, toddlers and preschoolers what development changes are altered with immobility?

Answer 15

• Slower progression in gross motor skills, intellectual and musculoskeletal development.
• Body aligned with line of gravity resulting in unbalanced posture

Question 16

In adolescents what development changes are altered with immobility?

Answer 16

Imbalanced growth spurt
Delayed development of independence
Social isolation

Question 17

In adults what development changes are altered with immobility?

Answer 17

Alterations in every physiological system
Alterations in family and social systems
Alterations in job identity

Question 18

In older adults what development changes are altered with immobility?

Answer 18

Alterations in balance
Steady loss of bone mass
Decreased coordination

Question 19

What are the therapeutic effects of heat applications?

Answer 19

Increases flood flow
Increases tissue metabolism
Eases joint stiffness and pain

Question 20

What are the therapeutic effects of cold applications?

Answer 20

Decreases inflammation
Prevents swelling
Reduces bleeding
Reduces fever
Diminishes muscle spasms
Decreases pain by decreasing the velocity of nerve conduction

Question 21

What are some explains of clients at risk for injury from heat/cold applications?

Answer 21

Very young, fair-skinned, and older (fragile skin)
Clients who are immobile (may not be able to move away when application becomes uncomfortable)
Impaired sensory perception

Question 22

Name some precautions to use when heat applications are in use:

Answer 22

Monitor bony prominences
Avoid use over metal devices (pacemakers, prosthetic joints)
No hear to abdomen of pregnant women
No heat under client who is immobile.

Question 23

When is cold applications inappropriate for clients?

Answer 23

Clients with cold intolerance
Vascular insufficiency
Disorders aggravated by cold (Raynaud’s phenomenon)

Question 24

When using heat or cold applications make sure the providers prescription includes:

Answer 24

Location Duration and frequency Specific type (moist or dry) Temperature to use

Question 25

Heat application supplies include which two types?

Answer 25

Moist and Dry

Question 26

Name three different types of moist heat applications:

Answer 26

Hot compress (towel, bath thermometer, hot water hot pack) Hot soaks - water, bath thermometer, basin Sitz baths

Question 27

Give the different supplies used for moist cold application and dry cold application.

Answer 27

Moist - cold water and cold pack Dry - ice bag, ice collar, ice glove or cold pack, cooling blanket

Question 28

When using a cold or heat application then site needs to be assessed every 5-10 minutes and checked for what?

Answer 28

``` Redness or pallor Pain or burning Numbness Shivering Blisters Decreases sensation Cyanosis (cold) ```

Question 29

Name four techniques used in promoting venous return.

Answer 29

``` Antiembolic stockings (TED) Sequential compression devices (SCDs) Intermittent pneumatic compression (IPC) Positioning techniques ROM exercises ```

Question 30

Explain what sequential compression devices (SCD) and intermittent pneumatic compression (IPC) are:

Answer 30

Plastic or fabric sleeves that wrap around leg. Sleeves are then attached to electric pump that alternately inflates and deflates. The cycle is typically 10-15 seconds inflation and 45-60 seconds deflation.

Question 31

What are some different ROM techniques that prevent thrombophlebitis and promote venous return?

Answer 31

Ankle pumps Foot circles Knee flexion

Question 32

Do TED hose, SCDs and IPC require a prescription ?

Answer 32

Yes

Question 33

What should immobile clients do to promote venous return?

Answer 33

Leg exercises Increase fluid intake Change position frequently

Question 34

What is thrombophlebitis/deep vein thrombosis?

Answer 34

An inflammation of a vein (usually lower extremities) which can result in clot formation.

Question 35

What are the clinical manifestations of thrombophlebitis?

Answer 35

Pain Edema Warmth Erythema at site

Question 36

What is a pulmonary embolism?

Answer 36

Potentially life threatening occlusion of blood flow to one or more pulmonary arteries by clot.

Question 37

What are some nursing actions if a deep vein thrombosis occurs?

Answer 37

Notify provider Position client in bed with leg elevated Avoid any pressure at site Anticipate giving anticoagulants

Question 38

What are the clinical manifestations of a pulmonary embolism?

Answer 38

``` Shortness of breath Chest pain Hematemesis (coughing up blood) Decreased blood pressure Rapid pulse ```

Question 39

What are nursing actions required of a pulmonary embolism occurs?

Answer 39

Prepare to give thrombolytics or anticoagulants.

Question 40

To promote safe use of a cane for a client recovering from minor musculoskeletal injury or lower left extremity, which instructions should you provide?

Answer 40

Hold the cane on the right side Keep two points of support on floor Advance the weaker leg first

Question 41

What is a spirometer and what does it prevent?

Answer 41

Apparatus for measuring the volume of air inspired and expired by the lungs. It measures ventilation. Prevents atelectasis (collapsed lung)