Lecture 3 & NSC 3 Flashcards

Question

What are some neuromuscular changes in elderly populations ?

Answer 1

* speed & power of skeletal muscle contractions * Slowed reaction time * Loss of height * Loss of bone mass * Joint stiffness * Impaired balance * Greater difficulty in complex learning & abstraction * ↓ in muscle fibres * Diminished conduction speed of nerve fibres & ↓ muscle tone * Atrophy of inter-vertebral discs, ↑ flexion at hips & knees * Bone re-absorption outpaces bone reformation * Drying & loss of elasticity in joint cartilage * ↓ muscle strength, reaction time & coordination, changes in center of gravity * Fewer cells in cerebral cortex Loss of speed & power of muscle contractions and muscle wasting in the elderly results in lack of strength and they fatigue easier; plan activities to minimize fatigue Delayed reaction time leads to cautious behaviours (slower driver) Slight loss of overall stature is normal; over exaggeration often associated with muscle weakness can lead to kyphosis Osteoporosis a decrease in bone density can lead to serious fractures (pathological fracture); common causes-poor dietary intake of calcium, women after menopause, immobilization or physical inactivity. Degenerative joint changes can lead to joint stiffness- regular activity & proper nutrition will slow bone loss & decrease muscle atrophy and stiffness. Regular exercise programs also added benefit of socialization.

Answer 2

* Loss of visual acuity * ↑ sensitivity to glare & ↓ability to adjust to darkness * Acrus senilis (cataract) * Degeneration leading to lens opacity; presbyopia * Changes in ciliary muscles, rigid pupil sphincter, ↓ pupil size Acrus senilis: partial or complete white circle around the periphery of the cornea (cataract) Presbycusis: gradual hearing loss affects people over 65, hearing loss is greater at high frequencies. Older adults will hear speakers with low, distinct voices best. Presbyopia: loss of flexibility of lens, less ability to focus on near vision, begins around 40. Shrunken appearance of eyes: loss of orbital fat, slowed blink reflex, looseness of eyelids especially the lower due to poorer muscle tone. Loss of taste and smell may affect appetite and increase risk of poor nutrition. Loss of skin receptors: may not be able to distinguish hot from cold or sense the intensity of heat. Increased risk for injury and burns. * Possible nerve conduction & neuron changes * ↓ number of taste buds in tongue due to tongue atrophy - ↓sense of taste * ↑threshold for sensations of pain, touch & temperature * Changes in the structure & nerve tissues in the inner ear; thickening of ear drum- Presbycusis (hearing loss) * Atrophy of olfactory bulb at base of brain - ↓sense of smell

Answer 3

1. Skeletal system: Support & Movement 2. Skeletal muscle Muscles associated with movement & Muscles associated with posture Bones have 5 functions: support, protection, movement, mineral storage and hematopoiesis. In relation to movement our bones provide a framework and contribute to the shape, alignment and positioning of body parts. In movement bones together with their joints constitute levers for muscle attachment. Muscles contract and shorten pulling on bones producing joint movement. Muscles of movement: located near skeletal region, movement is caused by lever system. Muscles attached to bones of leverage provide the necessary strength to move objects. Example- muscles of humerus, ulna and radius & associated joints. Muscles & posture: gravity constantly pulls on the body, muscles exert a pull on bones in opposite direction- low level of sustained contraction Nervous system: major voluntary motor area located in cerebral cortex is the precentral gyrus. Transmission of impulses from nervous system to MSK system is an electrochemical transmission & requires a neurotransmitter- chemicals that transfer electric impulses across the myoneural junction to stimulate muscle movement. Disorders associated with altered neurotransmitter production- Parkinson’s. Altered transfer from neurotransmitter to muscle- myasthenia gravis. Altered activation of muscle activity- MS. Proprioception: the awareness of the position of the body. Proprioceptors are located on nerve endings in muscles, tendons and joints. Allows people to walk without watching their feet.

Answer 4

Isotonic (dynamic): muscles shorten to produce muscle contraction & active movement. Includes most physical conditioning exercises (walking), ADLs & active ROM exercises. Examples for isotonic bed exercises, pushing or pulling against a stationary object, using the trapeze to lift body off bed, lifting buttocks off bed pushing hands against mattress. These types of exercises enhance circulatory and respiratory functioning, increase muscle tone, strength and mass, and promote bone formation (osteoblastic activity). Isometric (static): change in muscle tension but no muscle or joint movement takes place. Bed exercise, squeezing a towel or pillow b/w knees while tightening the muscles in front of the thighs by pressing the knees downward. Helps to maintain muscle strength and prevent muscle wasting. Isokinetic (resistive): muscle contraction or resistance against an object. Usually machines or devices used to provide resistance, generally affect 1 muscle group. i.e. planking these activities help to build muscle strength and also promote osteoblastic activity. Activities: Aerobic: amount of oxygen taken in is greater or equal to requirements, intensity measured by reaching target heart rate, talk test (laboured breathing but still able to carry on conversation), Borg scale of perceived exertion Anaerobic: activities in which muscles cannot draw out enough oxygen from blood and anaerobic pathways are used (weight lifting, sprinting, marathons) Exercise programs for clients should be chosen based on their activity tolerance and abilities and should include a combination of activities that provide various benefits for the client.

Answer 5

Cardiovascular ◦↑ cardiac output ◦Improved myocardial contraction ◦Decreases resting HR ◦Improved venous return Pulmonary ◦Improved alveolar ventilation ◦↓ work of breathing ◦Improved diaphragmatic excursion Activity tolerance ◦Improved tolerance ◦Decreased fatigue Musculoskeletal ◦Improved muscle tone ◦Increased joint mobility ◦Increased muscle mass (possible) ◦Reduced bone loss Psychosocial factors ◦Improved tolerance to stress ◦Feelings of general “well-being” ◦Reports of decreased illnesses Metabolic ◦↑ basal metabolic rate, use of glucose & fatty acids ◦↑ triglyceride breakdown, gastric motility ◦↑ production of body heat

Answer 6

The coordinated efforts of the MSK & nervous systems to maintain balance, posture & body alignment during lifting, bending, moving & ADL’s, ↓ injury, facilitates mobility & allows for efficient use of energy * Body Alignment * Body balance- center of gravity * Friction Wider base of support=greater stability Lower center of gravity=greater stability Equilibrium of an object is maintained as long as the line of gravity passes through its base of support Facing direction of movement reduces twisting Dividing balanced activity between arms & legs ↓ back injury Leverage, rolling, turning, pivoting less work than lifting When friction is reduced, less force is required to move it Reducing force of work ↓ risk of injury Good body mechanics reduces fatigue Alternating periods of rest and activity reduces fatigue Some Pathological influences in body mechanics & Movement: Congenital abnormalities Degenerative disorders Other chronic diseases Episodic illness

Answer 7

1. Arrange for help when moving clients, use a lift team 2. Use patient handling equipment (ceiling-lifts, slide sheets, air-Amattress on maximum inflate, adjust height of bed) 3. Encourage client to help as much as possible (AFTER your assessment) 4. Keep back, neck, pelvis & feet aligned 5. Avoid twisting 6. Flex knees, keep feet wide apart 7. Position yourself close to client, use arms & legs (not your back) 8. Use a pull sheet to move pt towards you, & slide board to move client from bed-stretcher 9. The person with the heaviest load coordinates efforts by counting to 3, then move client together 10. Perform manual lifting as a last resort & only if it doesn’t involve lifting most or all of a client’s weight

Answer 8

Body Alignment: standing, sitting, recumbent Mobility: ROM, gait, exercise, activity tolerance Patient Expectations: ◦Motivation, expectation of pain or undue fatigue with movement, perception of need for activity- Assessment of pt mobility focuses on ROM, gait, exercise & activity tolerance, body alignment. When unsure of the pts abilities, start with the most supportive position & move to higher levels according to pt tolerance.

Answer 9

The maximum amount of movement available at a joint in one of the 4 planes of the body Nurse assesses ROM before mobilizing client, while laying in bed Active ROM: client performs the exercises, is able to move all joint through motions Passive ROM: nurse performs for the client, who is weak or unable to move the joints We encourage range of motion exercises in clients in order to promote circulation, prevent contractures and muscle wasting. Mobility & Immobility Metabolic: negative nitrogen balance Respiratory: atelactasis (partial or complete collapse of the lung or partial) CVS: orthostatic hypotension, thrombus, embolus MSK: atrophy, osteoporosis, joint contracture, foot drop Urinary: stasis (urinary retention - your bladder cannot completly empty) Integumentary: pressure ulcer Psychosocial: depression, changes in sleep-wake cycles, withdrawn, passive, hostility, fear, anxiety,….

Answer 10

Fowler’s position:HOB 45-60 degrees - Increases comfort, improves ventilation, promotes relaxation Prone position: Pillow under head reduces flexion or hyperextension of cervical vertebra - Pillow under abdomen reduces pressure on breasts and reduces hyperextension of lumbar-reducing low back strain - Pillow under lower legs reduces external rotation of hips, prevents foot drop High Fowler’s HOB 60-90o: This position is frequently used when feeding a client (especially one on feeding precautions, client at risk for aspiration), radiology needing to take a specific type of x-ray at the bedside, client experiencing severe dyspnea, client receiving a breathing treatment (nebulized aerosol) dependent drainage after abdominal surgery, grooming. Supine position: Rolled towel under lumbar area supports lumbar spine - Pillow under head, neck & upper shoulders prevents flexion contractures of cervical vertebrae - Pillow under heels prevents pressure sores - Footboard maintains dorsiflexion of feet and prevents foot drop - Rolls or sandbags along legs prevents external rotation of hips - Hand rolls reduces extension of fingers and abduction of thumb Lateral side Laying: Removes pressure from bony prominences on back and buttocks - Pillow under head & neck reduces lateral neck flexion & reduces strain on sternocleidomastoid muscle - Shoulder flexed forward prevents weight directly on shoulder joint - Pillow under upper arm decreases internal rotation & adduction of shoulder - Pillow under semi flexed upper leg prevents pressure on bony prominences

Answer 11

Elastic stockings or TEDS: aid in maintaining external pressure on the muscles of the lower leg, promoting venous return. Need to be measured to find the correct size with a tape measure, assess circulation, remove & reapply every shift, do not apply if (skin lesions, gangrenous conditions, recent vein ligation as will compromise circulation). Teach exercise to prevent thrombus (foot circles, ankle pumps knee flexion) A method to prevent thrombus/embolus in immobile pts. Or bedridden. Usually also on blood thinners such as S/C low-molecular weight heparin (tinzaparin, enoxaparin, daltaparin) as prophalaxis or DVT. SCT’s: sleeves wrapped around the calf of each leg, attached to a tubing, with a motor. The pump inflates & deflates the tubes intermittently, it increases venous return through the deep veins of the legs.

Answer 12

Gait Belts: Walk slowly•Client sets the pace•Walk on the client's weaker side•Hold the handrail, if available, with client’s strong arm Walkers: Indication: Some imbalance or weakness - must be able to Weight bear on at least one foot & use of hands & arms - Proper Use:•Standing straight with elbows slightly flexed•Provide instructions for use & then evaluate - Used for the client who requires some support when walking due to imbalance or weakness.- Must be able to bear weight on at least one foot, remain balanced in an upright position, have use of hands & arms.- Height is adjusted so that the client is standing straight with elbows slightly flexed.- When moving a rigid frame walker it should never be slid along the floor or ground. Always instruct the client to move the walker forward by lifting it up. The feet should remain still until the walker is moved ahead.- Assist the client to a standing position by straightening your legs as you lift with the gait belt and the client pushes down with his hands on the mattress. - Instruct the client to position his body within the frame of the walker. - Instruct the client to move the walker forward by lifting it up, moving it forward, and setting it down.- Instruct the client to take a step forward with the affected (weak) leg.- Instruct the client to move unaffected (strong) leg forward. - Instruct the client to take short steps and keep his head up and eyes looking forward - This helps to maintain good posture. Canes: Indication: Weakness or paralysis on one side - Safe Use: •Hold on unaffected side •Height- elbow slightly bent when walking•Three-point and four-point canes •Six to ten inches to the outside of the foot•Check rubber tip

Answer 13

* Manage underlying health conditions (osteoporosis, delirium, infections) * Exercise programs * Strategies to promote continence * Ensure use of aids (glasses, walkers) * Monitor medications, reduce polypharmacy * Bed-exit alarm * Appropriate footwear * Minimize environment clutter * Minimizing effects of orthostatic hypotension Risks for falls: confusion, disorientation, impulsivity symptomatic depression altered elimination dizziness, vertigo male sex administration of anti-epileptics (or dosagechanges or cessation) administration of benzodiazepines poor performance in the “Get-Up-and-Go” test of rising from a seated position The Hendrich II Fall Risk Model: is a tool used to assess fall risk. Individualized care plans can be developed to minimize risk according to how the individual client scores. www.hartfordign.org

Answer 14

Falls account for up to 90% of all reported incidents in hospital Factors contributing to falls: * age * previous falls * gait disturbance * balance * mobility problems * medications * postural hypotension * sensory impairment * urinary & bladder dysfunction * certain medical diagnoses

Answer 15

Using the Hendrick II Fall Risk: & categories: ## Footnote * Confusion or disorientation: acute or chronic earn same score (interview, patterns of behaviour) * Depression: history or diagnosis, observed signs or client’s expression * Altered elimination * Dizziness or vertigo: client’s expression or observed * Gender - Male * Medications: anti-epileptics & benzodiazepines * Get-Up-and-Go test (scoring mobility) Hendrich II Fall Risk Model: course website Confusion of disorientation: (4) * impulsive or unpredictable behaviour * Hallucinations * Agitation * Changes in attention, cognition, psychomotor level, LOC, sleep-wake states * Disoriented to time, person or place * Inability to follow directions, self-care deficits Depression: (2) history of depression or current diagnosis * Prolonged feelings of hopelessness, helplessness or being overwhelmed * Tearfulness, flat affect, loss or lack of interest in life, melancholy mood * Withdrawn or client’s statement of feeling depressed. Altered elimination: (1) * Urinary or fecal incontinence, diarrhea, frequency * Urgency or stress incontinence, nocturia Dizziness or vertigo (1) Based on client’s report. Can also be assessed by performing Get-Up-and-Go test Male sex (1) Medications: antiepileptics (2) & benzodiazepines (1)- affect central nervous system & can cause cerebellar ataxia, weakness & gait changes Get-Up-and-Go: 0-4 depending on assistance required Total score: 5 or greater=high risk for falls

Answer 16

Note: if your patient has a weakness on one side, instruct patient to place unaffected foot forward and weak leg back, instruct to pivot on strong leg while your knee supports the weaker leg. * One nurse- patient who can assist * Explain procedure first * Chair beside bed with back same plane as HOB * Consider transfer belt * Use good body alignment

Answer 17

* Requires minimum 3-person carry * Similar heights-center of gravity on is the same plane * Use of draw sheet to“cradle” * Establish a leader * Maintain patient’s alignment

Answer 18

•Assessment prior to using: cognition, predictability, trunk control Stand lift- suitable for clients who are able to weight bear or partial weight bear. Cognition: scientific term for mental processes. These processes include attention, remembering, producing and understanding language, solving problems, and making decisions Clients responses must be predictable, clients who have erratic behaviour, uncontrolled muscles movements, uncontrolled seizures would not be appropriate . Clients must have trunk control; refers to the ability to control the trunk (torso). Ability to hold body upright when sitting or moving. Loss either partial or complete may be associated with stroke, brain or spinal cord injury, Parkinson’s disease or multiple sclerosis.

Answer 19

* Ceiling models * Floor models Principles: Requires 2 persons for safe client transfers – never by yourself Use proper sling size and position properly under client Ensure proper support of head and neck Careful attention to increased pressure on skin, pad for comfort. Remove sling after client transferred, reduces skin breakdown.

Lecture 3 & NSC 3 Flashcards

(43 cards)