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Exam 2 Fundamental Class > Chapter 8 > Flashcards

Chapter 8 Flashcards

1
Q

The majority of injuries are classified as Musculoskeletal disorder (MSD)?

A

back injuries prominent among health care personnel

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2
Q

Awareness of proper ergonomic principles is?

A

relating to or designed for efficiency and comfort in the working environment.

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3
Q

Is the use of body mechanics appropriate ?

A

(the area of physiology for the study of muscle action and how muscles function in maintaining the posture of the body and prevention of injury during activity ) includes knowledge of how certain muscle groups are used .

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4
Q

The term alignment refers to ?

A

workplace conditions and job demands regarding MSDs and prevention good body mechanics help prevent injury

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5
Q

Older Adult Mobility ?

A

-The skin of older adults is more fragile and susceptible to injury
-Explain each step in simple language
- Weakness and hypotension are common signs
-Older adults who have many diseases or have undergone prolonged bed rest have greater risk for hypotension with postural change (orthostatic hypotension )

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6
Q

Patients who use medications to reduce blood pressure?

A

are at greater risk for orthostatic hypotension
-Limited positioning alternatives are available for the older adult who has arthritis, neuropathies, or other restrictive conditions.

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7
Q

Supine or dorsal recumbent position ?

A

The client lies on their back with the head and shoulders elevated on a pillow and forearms on pillows at their sides

A foot support prevents foot drop and maintains proper alignment

Ensure that the vertebrae are in straight alignment without excessive flexion or extension of the head and neck

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8
Q

Reverse Trendelenburg ?

A

The entire bed is tilted with the foot of the bed lower than the head of the bed high

This position promotes gastric emptying and prevents esophageal reflux

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9
Q

Fowler’s position?

A

(posture assumed by patient when head of bed is raised 45 to 60 degrees )

This position is useful during procedures (nasogastric tube insertion and suctioning)

allows for better chest expansion and ventilation and better dependent drainage after abdominal surgeries

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10
Q

Semi - Fowler’s position ?

A

( posture assumed by patient when head of bed is raised approximately 30 degrees).

This position prevents regurgitation of enteral feedings and aspiration by clients who have difficulty swallowing also promotes lung expansion for clients who have dyspnea or are receiving mechanical ventilation

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11
Q

Orthopneic position?

A

( posture assumed by the patient sitting up in bed at 90-degree angle, or sometimes resting in forward tilt while supported by a pillow on an overbed table)

Often used for the patient with a cardiac or respiratory condition.

This position allows for chest expansion and is especially beneficial for clients who have COPD .

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12
Q

Sims position?

A

( position in which the patient lies on side with knee and thigh drawn upward toward chest) (see illustration ).

The left Sims position is appropriate for the enema procedure and administration of a rectal suppository.

This is a comfortable sleeping position for many clients, and it promotes oral drainage .

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13
Q

Prone position?

A

(lying face down in horizontal position)

This promotes relaxation by permitting some knee flexion and dorsiflexion of the ankles

This position promotes drainage from the mouth after throat or oral surgery, but inhibits chest expansion . It is for short-term use only This position helps prevent hip flexion contractures following a lower extremity amputation

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14
Q

Knee-chest ( genupectoral ) position?

A

patient kneels so that weight of body is supported by knees and chest, with abdomen raised, head turned to one side, and arms flexed)

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15
Q

Lithotomy position ?

A

(patient lies supine with hips and knees flexed and thighs abducted and rotated externally [sometimes feet are positioned in stirrups])

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16
Q

Trendelenburg’s position?

A

patient’s head is low and the body and legs are on inclined plane up

The entire bed is tilted with the head of the bed lower than the foot of the bed .

This position facilitates postural drainage and venous return

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17
Q

Mobility is a person’s ability?

A

to move around freely in his or her environment .

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18
Q

ADLs those?

A

activities of daily living(physical self-care such as bathing , dressing , and eating).

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19
Q

The person who is immobile?

A

the inability to move around freely is predisposed to a wide variety of complications

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20
Q

Complication of Immobility and Prevention Measures?Constipation

A

Immobility slows peristalsis, resulting in stool remaining in the colon longer and muscle atrophy in the abdominal muscles that aid in expulsion of stool.

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21
Q

Complication of Immobility and Prevention Measures?
Contractures:

A

When muscles, ligaments, and tendons are not shortened and lengthened with movement, a permanent shortening of these structures may occur.

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22
Q

Complication of Immobility and Prevention Measures?
Disuse osteoporosis:

A

Disuse osteoporosis: Lack of weight bearing on bones causes bone demineralizatio( bone that has had the calcium removed)
, allowing fractures to occur more easily.

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23
Q

Complication of Immobility and Prevention Measures?
Hypostatic pneumonia:

A

Hypostatic pneumonia: Decreased aeration and accumulation of secretions lead to inflammation and infection in the lungs

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24
Q

Complication of Immobility and Prevention Measures?
Muscle atrophy and asthenia

A

Muscle atrophy and asthenia (muscle weakness): Muscles decrease in size and strength when not continually used

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25
Complication of Immobility and Prevention Measures? Pressure ulcer
Pressure ulcer: Tissue ischemia (lack of blood flow to an area) from unrelieved pressure results in skin breakdown
26
Complication of Immobility and Prevention Measures? Pulmonary embolism
(blood clot that has traveled to the lungs): Deep vein thrombosis (DVT) that has broken loose from the vessel and has traveled to the lungs , causing a blockage in a pulmonary vessel.
27
During Ambulation If the patients start to fall?
do not attempt to prevent the fall. Ease the patient to the floor
28
One of the responsibilities of the nurse is frequent monitoring?
patient's neurovascular function , or circulations ,movement and sensation (CMS) assessment
29
This assessment is especially important when compression from external devices, such as casts and bulky dressings , creates the risk of acute?
compartment syndrome, which has the potential to cause extensive tissue damage.
30
Acute compartment syndrome occurs?
in the extremities , especially the legs, where a sheath of inelastic fascia partitions blood vessel , nerve , and muscle tissue does have high blood pressure
31
compartment syndrome can leave?
Permanent nerve damage with irreversible muscle function can occur within 12 to 24 compression
32
Symptoms of acute compartment syndrome include?
-pain within the muscle, especially when stretched, tingling and burning or a feeling of pins and needles in the affected area (paresthesias ) - a full or tight feeling in the muscle.
33
Numbness and paralysis are late signs of?
compartment syndrome and may be indicative of permanent damage .
34
Chronic compartment syndrome is not an emergency situatio? and What are they symptoms ?
usually is caused by exercise that involves repetitive movement, such as bicycling or running The symptoms include pain and cramping during exercise , visible muscle bulging, and numbness . These symptoms usually are alleviated by discontinuing the activity and by rest
35
Passive vs Active ROM ?
exercise is performed by caregivers, and active ROM by patients
36
Shoulder type of joint ball and socket ? Flexion Extention Hyperestentsion
Flexion: Raise arm from side position forward to position above head Extension: Return arm to position at side of body . Hyperextension : Move arm behind body keeping elbow straight.
37
Shoulder type of ball and sockets continue? 1.Abduction 2.Adduction 3.Internal Rotaion 4.Externsl Rotation 5.Circumduction
Abduction: Raise arm to side to position above head with palm away from head Adduction: Lower arm sideways and across body as far as possible Internal rotation : With elbow flexed , rotate shoulder by moving arm until thumb is turned inward and toward back External rotation With elbow flexed , move arm until thumb is upward and lateral to head . Circumduction Move arm in full circle . (circumduction is a combination of all movements of the ball - and - socket joint .)
38
Elbow type of joint Hinge ? flexion extension hyperextension
Flexion;Bend elbow so that lower arm moves toward its shoulder joint and hand is level with shoulder Extension :Straighten elbow by lowering hand Hyperextension : Bend lower arm back as far as possible.
39
Forearm type of joint Pivot? Supination Pronation
Supination Turn lower arm and hand so that palm is up . PronationTurn lower arm that palm is down.
40
Wrist type of joint Condyloid ? Flexion Extension Hyperextension Radial flexion Ulnar flexion
Flexion : Move palm toward inner aspect of forearm . Extension: Move fingers so that fingers, hands, and forearm are in the same plane , in a straight line. Hyperextension : Bring dorsal surface of hand back as far as possible. Radial flexion : Bend wrist medially toward thumb . Ulnar flexion : Bend wrist laterally toward fifth finger .
41
Fingers type of joint Condyloid Hinge? Flexion Extension Hyperextension Abductions Adding
Flexion: Make fist. Extension: Straighten fingers . Hyperextension: Bend fingers back as far as possible Abduction : Spread fingers apart . Adduction: Bring fingers together
42
Thumb type of joint saddle? Flexion Extension Abduction Adduction Opposition
Flexion Move thumb across palmar surface of hand Extension: Move thumb straight away from hand Abduction Extend thumb laterally ( usually done when placing fingers in abduction and adduction). AdductionMove thumb back toward hand Opposition: Touch thumb to each finger of same hand.
43
Hip and type of joint Ball and Socket ? Flexion Extension Hypertension Abduction Adduction Internal/External Circcumduction
Flexion : Move leg forward and up with knee in extension . Extension: Move leg back beside other leg while knee joint remains in extension . Hyperextension Move leg behind body. AbductionMove leg laterally away from body . Adduction Move leg back toward medical position and beyond possible Internal rotation: Turn foot and leg toward other leg External rotation: Turn foot and leg away from other leg. Circumduction : Move leg in circle.
44
Knee type of joint Hinge ? flexion extension
Flexion: Bring heel back toward back of thigh . Extension : Return heel to floor.
45
Ankle type of joint Hinge? Doors flexion Plantar flexion
Dorsiflexion Move foot so that toes are pointed upward . Plantar flexions Move feet that are pointed downward .
46
Foot type of joint Gliding ? Inversion Eversion
Inversion: Turn sole of foot medially . Eversion: sole of foot laterally .
47
Toe type of joint Condyloid hinge ? Flexion Extension Abduction Adductin
Flexion: Curl toes downward. Extension : Straighten toes . Abduction : Spread toes apart . Adduction : Bring toes together .
48
Position patient for comfort. To prevent?
contracture (an abnormal shortening of a muscle)
49
Patients who are partially immobile or unable to move about freely from ?
paraplegia , quadriplegia weakness or fatigue) need the nurse and other healthcare personnel to assist with passive ROM exercises .
50
Older Adult range of Motion exercises?( ROM)
-exercises into two or more sessions to control fatigue Inadequate -intake of calcium or exposure to sunlight
51
Body mechanics?
Area of physiology that studies muscle action and how muscles function in maintaining the posture of the body and prevention of injury during activity
52
Principles of body mechanics?
-Maintain appropriate body alignment -Maintain wide base of support ' -Bend knees and hips -Do not bend from waist
53
What are the rationale for proper body mechanics?
-Must be learn by personal to prevent injury - back injury rank second in occupational injuries
54
Using proper body body mechanics?
Protect larger muscle group from injury provide safety
55
Mobility vs Immobility ?
Mobility Ability to move around freely Immobility Inability to move around freely
56
Assistive device?
Pillows , Foot boots ,( protect broken bones and other injuries of the lower leg, ankle, or foot) Trochanter rolls (used to support the hips and legs so that the femurs do not rotate outward) ,Sandbags (atient's positioning, rehabilitation, and therapeutic purposes. ) Trapeze bars (is a handgrip suspended from a frame near the head of the bed. A pt can grasp the bar with hands)
57
Complications of immobility ?
Muscle atrophy and asthenia (muscle weakness ) ,Contractures, Osteoporosis Pressure ulcer Constipation Pneumonia , pulmonary embolism
58
Dorsal? Dorsal recumbent? Fowler's? Semi-Fowler's?
Dorsal? lying flat on back Dorsal recumbent? supine lying on back, head, and shoulder with extremities moderately flexed Fowler's? head of bed is raised 45-60 degrees Semi-Fowler's? head of bed raised 30 degrees
59
Orthopneic? Sims? Prone? Knee-chest (genupectoral) ?
Orthopneic? sitting up in bed at 90 degree angle or sometimes resting in forward tilt while supported by pillow on overbed table Sims? lying on side with knee and thigh drawn toward chest Prone? lying face down in horizontal position Knee-chest (genupectoral) ?kneels so weight of body is supported by knees and chest, abdomen raised, head turned to one side and arms flexed
60
Lithotomy? Trendelenburg's ?
Lithotomy? lying supine with hips and knees flexed, thighs abducted and rotated externally Trendelenburg's ? head is low, body and legs are on inclined plane
61
Neurovascular Assessment (circulation,movement,and sensation CMS) ?
-Neurovascular function or circulation -Movement -Sensation - LPN/ LVNs check skin color, temperature, movement , sensation , pulses , capillary refill, and pain
62
Range of motion exercises? -
Movement of the body that involves the muscles and joints in natural directional movements
63
Range of motion Active vs Passive ?
Active-performed by patient Passive -performed by caregivers
64
Lifespan considerations (older adults)?
-Inadequate calcium intake -Fear of falling -Depression -Arthritic -Chronic illness
65
Moving the Patient?-
Assists patient with moving -assist with Ambulation using a lift
66
Passive motion mechanics?
Machine that flexes and extends joints to passively mobilize them -Prevents complications Joint contracture, atrophy of muscles thromboembolism
67
NURSING PROCESS FOR MOBILITY Assessment?
-Focus ROM muscle strength , activity tolerance, gait, posture -Observe for fatigue , muscle strength , -Assistance needed for transfers -Patient problem statement -Expected goals and planning -Implementation -Evaluation
68
High-Fowler's position?
The client lies supine with the head of the bed elevated to 90 This position promotes lung expansion by lowering the diaphragm and thus helps relieve sevece dyspnea. It also helps prevent aspiration during meals
69
. Modified Trendelenburg position ?
.The client remains flat with the legs above the level of their heart . This position helps prevent and treat hypovolemia and facilitates venous return.
70
Lateral or side -lying ?
The client lies on their side with most of the weight on the dependent hip and shoulder and the arms in flexion in front of the body. They should have a pillow under the head and neck, upper arms, and legs and thighs to maintain body alignment . This is a good sleeping position , but the client needs turning regularly to prevent the development of pressure ulcers on the dependent areas . A 30° lateral position is essential for clients at risk for pressure ulcers .
71
1.A wedge pillow (also called an abduction pillow) is used to ? 2. A trochanter roll is used?
1.maintain the legs in abduction after hip replacement surgery 2. A trochanter roll is used to prevent the external rotation of the legs.
72
1.Sandbags are used . 2.A pillow provides
1.to provide support and they shape to body contours 2. support of the body or extremity; it elevates a body part.
73
1.A trochanter roll is used 2.A footboard is used
1. to prevent the external rotation of the legs. 2. to prevent the complication of footdrop.
74
1.A trapeze is used 2.An air mattress is used i
1.A trapeze is used by the patient with limited mobility to assist with turning and positioning in bed. 2.An air mattress is used in the prevention of pressure injuries in immobile patients.
75
Which techniques are most appropriate for the nurse to use to prevent self-injury when providing patient care?
Flexing the knees slightly, keeping the head erect and chest up, pushing/pulling/sliding heavy objects are all appropriate use of body mechanics. A person should stand with the feet 6 to 8 in apart to provide a base of support. The nurse should lift with the strength of the legs.
76
Active assisted ROM?
exercises are used when the patient uses the strong arm to exercise the weaker, paralyzed arm.
77
Passive assisted ROM exercises are used?
for a patient who is weak and may be able to move a limb partially, but a nurse helps the patient finish the full ROM. (Passive ROM exercises are used with a patient who is partially immobile and unable to move about freely.)

Exam 2 Fundamental Class (8 decks)

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