Class 3-Activity

Question 1

Patient handling tasks are the primary cause of musculoskeletal disorders among nurses

Answer 1

->35,000 back injuries reported in nurses anually
-RN’s rank 8th for occupations at risk for injury
-89% of nursing back injuries were preventable

Question 2

Variables leading to back injury in health care workers

Answer 2

-manual lifting (sitting pts up in bed alone; no manual lift laws)
-uncoordinated lifts (older and confused pts)
-exceeding recommended lift weight limits
-using out dated techniques
-transferring/repositioning uncooperative or confused patients

Question 3

Proper body mechanics**

Answer 3

1. work close to an object
2. face the direction of movement
3. slide, roll, push, or pull rather than lift
4. broad base of support (feet shoulder width apart)
5. flex your knees and straight back (for balance)
6. strong core (for balance)
7. low center of gravity (for balance)
8. use the largest and strongest bones for power
9. use the weight of your body by rocking

Question 4

Safe patient transfer

Answer 4

-assess the patient’s capabilities and ability to assist in the move (see what pt can do)
-ensure enough staff are available
-remove any clutter and clear path
-decide which equipment to use
-plan the transfer
-**do not put the patient in trendelenburg position (all organs going into thoracic cavity & want room to expand lungs; orthostatic hypotension)

Question 5

What are the guidelines?

Answer 5

-recommended 35 pound maximum weight limit for use in patient handling tasks (if confused/on floor/combative need more people)
-when weight to be lifted exceeds this limit, assistive devices should be used
-no manual lift-safe patient handling laws
-100 lb=3 people; 200lb=6 people

Question 6

use assisting devices

Answer 6

see pictures in slides

Question 7

Effects of immobility (ALL BAD)-increase

Answer 7

-cardiac workload
-risk for venous thrombosis
-urinary stasis
-risk for contractures
-risk for skin breakdown
-sense of powerlessness
-bone loss
-work of breathing

Question 8

Effects of immobility (ALL BAD)-decrease

Answer 8

-depth of respiration
-rate of respiration
-bladder muscle tone
-muscle size, tone, & strength (rapid loss)
-endurance, stability, coordination
-sensory stimulation

Question 9

Prevalence and outcomes of low mobility in hospitalized older patients

Answer 9

-graded groups based on mobility: low, intermediate, high
-patients in the low mobility group were more likely to lose independent function
-patients on bed rest had a higher incidence of death
-conclusions: low mobility and bed rest are common in hospitalized patients and are important predictors of adverse outcomes

Question 10

Patient activity assessment

Answer 10

-activity orders (move as ‘able’)
-muscle mass, tone, and strength
-joint structure and function
-strength and endurance
-mobility problems (fracture; paralyzed; amputation)
-physical health problems (COPD, heart failure)
-mental health problems (anxiety)
-fall risk assessment
-medications
-nutrition deficiencies

Question 11

AMPAC 6 clicks and JH-HLM used together to calculate

Answer 11

-6 clicks is a mobility scale and the JH is a mobility goal scale-the 2 are used together to assess ability and set a goal for mobility
-lowest score available on AMPAC is 6: is a report of what the health care provider thinks the patient should be able to do
-JH-HLM scale is a report of what the patient actually did
-used together because often the patient is capable of achieving a greater level of mobility than performed
-used together to give nurses an assessment tool and a mobility goal tool

Question 12

Clinical site progressive exclusion criteria

Answer 12

-pts that we don’t move!
-physiologically unstable patients
-new EKG changes or elevated cardiac enzymes
-INR> 5 PTT> 100 (potential for bleeding)
-patient who does not respond to verbal stimuli
-suspected spinal trauma and unstable fractures
-presences of femoral sheath (catheter going into main vessel)
-thrombolytic administration

Question 13

Nursing interventions to promote safety and activity

Answer 13

-ambulating
-PROM/AROM (passive vs active-doing itself)
-position changes
-turn Q2 (every 2 hours)
-Fowlers (45-60)
-Semi Fowlers (30..feeding & aspiration)
-High Fowlers (90)
-protective positioning (supporting all bony prominences)
-trapeze bars/slide rails
-physical therapy consults
-turning systems
-avoid knee catching (bend knee in bed; puts pressure on back-predispose to DVT & PE)
-leg rolling
-specialty beds

Question 14

Fowlers position

Answer 14

head of bed elevated 45-60 degrees

Question 15

Low Fowlers

Answer 15

15 to 30 degrees

Question 16

Semi-Fowler’s

Answer 16

30 to 45 degrees

Question 17

High Fowler’s

Answer 17

nearly vertical

Question 18

Look at slides for positions

Answer 18

-fowlers
-orthopneic
-prone
-lateral (side laying)
-sim’s
-lithotomy
-trendelenburg
-reverse trendelenburg

Question 19

protective positioning

Answer 19

-pillows
-pressure reducing mattress
-support boots
-hand rolls
-trochanter rolls

Question 20

Patients are not ambulating

Answer 20

72.9% of patients in study did not walk at all

Question 21

one nurse assist

Answer 21

stand on weak side of patient

Question 22

Walkers and canes

Answer 22

-adjust walkers to the height of patient’s hips

-hold cane on the strong side
-advance cane
-advance weak leg
-advance strong leg

Question 23

crutches

Answer 23

-axillary (short-term)
-forearm (long-term)