Mobility

Question 1

What is mobility? “Hazards” of mobility same thing as effects of immobility. Give examples.

Answer 1

Being able to move about freely.
*Ice or fallen tree on highway is a hazard of the road.

Question 2

How does age play a role in mobility?

Answer 2

*New infant totally dependent on someone else
*Elder-Everything slows down, atrophy-Muscle wasting away

Question 3

Who is at risk for a mobility problem?

Answer 3

Anyone with anything that can impair their mobility

Question 4

When performing a physical assessment, what finding will be seen with normal mobility functioning?

Answer 4

*Active range of motion
1. Pulling arm to body-adduction
2, Pulling arm away from body-Abduction
3. Hyperextension-pulling head back
4. Flexion-head toward chest
Ex. NG Tube-hyperextension-to look at back of throat, & flexion-Make sure tube is going into stomach

Question 5

What diagnostic tests can be used to detect musculoskeletal disorders, briefly describe each?

Answer 5

-Assess musculoskeletal muscle pull when you first see physical therapists, Range of Motion, CT, ultrasound, MRI
-Severe muscle damage-Biopsy

Question 6

What are the primary prevention strategies to reduce mobility problems?

Answer 6

-Keep them moving (Range of motion/Set goals)
*Measurable goal for surgery pt. who had surgery yesterday on knee (Arthroscopic surgery)
-Pt. will ambulate in hall 50 ft. by 7pm tonight. *Remember how to write a proper measurable goal
-Passive range of motion of pts. For pts. Who can’t move. -Assisted (pt. does part & someone helps them-I can do my hands but nurse with PT helps me)

Question 7

Nursing interventions can be used for patients with mobility problems?

Question 8

Discuss medications used in patients with mobility problems?

Answer 8

-Pain-Naproxen sodium or Aleve, Can’t over medicate but give medication to give before pt. goes to therapy to help with pain.
-Hot/cold therapy-Health care prescription

Question 9

Discuss surgical and other therapies that can be used for mobility problems?

Answer 9

-Fall down steps & break femur (surgical intervention), or twist ankle

Question 10

What is the morse fall scale & ranges.

Answer 10

Number for potential falls/accidents
-Higher the number the higher risk of fall
*History of fall-25, 0 -for no falls
*Secondary diagnosis-15 yes, 0 for no
*Intravenous therapy-0 or 20
*Gait/transferring 0, 10, or 20
*Ambulatory aids 0, 15, or 30
*Mental Status 0 or 15

Question 11

What is the Braden Scale for?

Answer 11

Deals with tissue integrity. To tell skin breakdown and mobility of pt.

Question 12

What is gross motor movement and fine motor movement?

Answer 12

-Gross motor movement-Big movement (Picking up cup or big ball) vs. fine motor movement-Moving fingers, picking up small object to place in area)

Question 13

What is purposeful physical movement?

Answer 13

-Body has to have energy to move it, adequate muscle strength (can’t go any further), underlining skeletal stability (skeletal system intact & bones working where they are, joint movement (Shoulders & hands moving), & neuromuscular coordination (tells muscles what to do-CVA, Spinal cord injury)

Question 14

What is immobility?

Answer 14

-Can’t move freely, or impaired walking
Ex. Like confined to bed or chair.

Question 15

What is deconditioning?

Answer 15

-Immobility to body from laying down for a long time. (Athletes)

Question 16

What is disuse syndrome?

Answer 16

Body systems not used properly. (Heart-muscle)-Person becomes immobile, permanent paralysis & it will affect how heart works

Question 17

What is the mobility range?

Answer 17

Mobile and immobile

Question 18

What are the normal physiological changes?

Answer 18

-Includes cartilage, tendon, & joints
*The motor cortex in the frontal lobe of the brain is responsible for voluntary motor activity through a series of nerve impulses sent from the brain, through the spinal cord and peripheral nerves, to the target muscle. The cerebellum, located at the base of the brain (brainstem injury), coordinates movement, equilibrium, muscle tone, and proprioception.

Question 19

What does the bones do? What are the axial & appendicular skeletal systems?

Answer 19

*Bones also serve as a storage center for calcium and as a production center for red blood cells within the bone marrow (carry oxygen).
*The axial skeleton (bones that comprise the skull, thorax, and spinal column)
*The appendicular skeleton (bones that comprise the upper and lower extremities).

Question 20

What types of movement does joints make?

Answer 20

The various types of movement provided by joints include flexion, extension, rotation, adduction, abduction, supination, and pronation. Know position. Know supine & pronation examples.

Question 21

What are synovial joints?

Answer 21

-Synovial joints have multiple elements, including a joint capsule, synovial membrane, joint cavity, synovial fluid, and articular cartilage.
-Fluid is there to keep from having friction. (Pleural fluid keeps lungs moving (expanding).
*Pericardial fluid around the heart is there to prevent friction and pericarditis.

Question 22

What are disks?

Answer 22

-Disks thin/break as we age, height shortens as age, along with problems with bones.
*Bone density test-measures porous(holes & brittle) bones.

Question 23

What are the variations & Context

Answer 23

*Changes in mobility can be temporary, long term, or permanent, and are influenced by general health status, with specific conditions associated with the neurologic or musculoskeletal system-Flu or fracture (acute illness or injury)
*Congenital problems-club foot-turns in on self. Medical procedures (e.g., surgery) and diagnostic tests may require temporary restrictions on mobility to reduce complications.

Question 24

Review friction/shearing/What is the prevention for ulcer decubitus?

Answer 24

Turning the patient

Question 25

What is included in assessment for mobility of patient; labs & fall prevention? History & questions

Answer 25

-Is there any pain with movement, fatigue with movement, know what gait means, guarding-withdrawing back while doing assessment(something hurts), Understand CT scan or MRI-Looks at Soft Tissue/bone.
-Labs-calcium test (Bone test)
-Fall prevention-good shoes, adequate lighting, see if they have vision problems.

Question 26

What is the primary prevention for mobility?

Answer 26

-Regular physical activity, healthy diet protein & calcium & adequate rest
-Fall prevention-good shoes, adequate lighting, see if they have vision problems

Question 27

What is secondary prevention for mobility?

Answer 27

fall risk, osteoporosis (Screenings).

Question 28

What is the greatest risk for injury with healthcare workers?

Answer 28

-Healthcare workers have the greatest risk for injury due to us pulling, pushing, & lifting, leading to mobility impairment.
*Assistive Devices-Look at PowerPoint-Know safety, basically tell client how to use a walker/cane, know when injured what limb to lead with, Patient handling technology-slings, lift bar-above bed with chain & triangle (Pt. with upper body strength can pull up on-Spinal cord injury-Traction Bar-Weight device-Spinal cord injury.

Question 29

Examples of immobile devices

Answer 29

Common examples of immobile devices include casts, splints, abductor pillows, shoulder restraints, braces, and traction.
*These are used to help stabilize and hold appendage in place so that healing can occur.

Question 30

What to look for in a neurological assessment?

Answer 30

Pain, Pallor, Paresthesia-sleep tingling feeling in extremities, Pulselessness distal of site of cast (circulation problem), Paralysis-can’t move extremities

Question 31

What is included in proper body alignment?

Answer 31

Straight body
-Turn everyone every 2 hours, keep clean & dry,
-Do cough & deep breathe exercises, IS, Range of Motion, Surgical interventions.
-Check for perfusion in extremities (cap refill and pulse)

Question 32

What is osteoarthritis?

Answer 32

-Destruction of joints. Wear and tear of joints. Joints stiff & can impact daily activities.
-Chronic disorder/not curable
-Asymmetrical joints (one side) but can be in more than one place.
*When cartilage disappears, bones rub on each other. It is degenerative.

Question 33

What is rheumatoid arthritis?

Answer 33

Autoimmune disorder. Not mobility of disorder. Very likely to affect both joints in both wrists.

Question 34

What are some causes of osteoarthritis?

Answer 34

-Wear & tear, older age, women after menopause stops producing estrogen-higher risk for osteoarthritis, repetitive motion (hard physical work-grocery stocker/warehouse jobs), obesity & congenital.
*Commonly affects joints-hips, knees, ankles, & wrists (nodules-buildup of fluid)
*Crepitus-bone on top of bone/Osteoarthritis in knees makes patients bo legged.

Question 35

What does it say about pain with osteoarthritis?

Answer 35

-Activity-Makes pain worse-So stop doing activity and pain gets better-Alleviated by getting rest in early stages. Chronic pain.
*If pt. had surgery for something else but has osteoarthritis-You want to get them moving quickly to prevent any hazards of immobility.

Question 36

What things become impacted by osteoarthritis?

Answer 36

-Sit to stand, eating-use an assistive device, daily activities, are impacted (dressing, bathing, cooking, cleaning, & washing clothes.

Question 37

Tests used to test for osteoarthritis?

Answer 37

-CT scan, MRI (causes anxiety), Bone Scan & Fluid analysis of joint. Xray sometimes.
*Laying on hard surface causes pain.
*Synovial joint fluid-taken from joint & sent to lab to be tested.

Question 38

Aspirin

Answer 38

-Drug therapy assists with daily activities of living
*(Aspirin-Baby-taste like orange-pain reliever-children-can cause, chew up whole one for MI)
*Blood thinner to prevent clots-DVT;Keep platelets from sticking together & forming clots
*Teach pt. to not take it with alcohol. Don’t exceed recommended dose. Drink with full glass of water. Sit up right to prevent stasis. You may bleed longer from wound-Apply pressure to stop bleeding. Gi bleeding can kill someone.
*Aspirin bleeding-Any opening of the body, eyes, ears, nose bleeds(don’t stop bleeding), rectal (after bowel movement-tarry black stools), & sputum, urine-hematuria, vomit (hematemesis), brushing teeth-causes teeth to bleed easily
-Notify someone
Allergic/tinnitus(ringing in ears)/They don’t develop any clots-You know its working

Question 39

NSAIDS-Naproxen Sodium

Answer 39

-Non-steroidal anti inflammatory
*Steroids will cause B/P high/Glucose levels will increase
Decreased inflammation in affected joints/Advil, Motrin, Aleve
*Dangers-GI bleeding, GI upset-take it with food
*Abuse can cause kidney to die

Question 40

Enoxaparin

Answer 40

-Anticoagulant/Antithrombotic
*DVT in right calf 40 mg everyday-Given subcutaneous injection (prepackaged) *Given in abdomen & causes bruises.
-Biggest danger-Bleeding
-Lab monitor-CBC- Hemoglobin &Hematocrit (platelets)
Abdominal assessment-Inspect, Asusculate, palpate
-Pt. Teaching-Pill-Food can matter

Question 41

What type of things do you need an order for osteoarthritis?

Answer 41

-Casts, splints, & etc.
-Bed Cradle (Frame over bed-spread sheet over it so cover is not too tight on pt. feet)
*Make up bed good & tuck corners good-Loosen up cover on tip of toes because pt. is immobile & can cause breakdown

Question 42

What is hot & cold therapy for osteoarthritis?

Answer 42

*Can’t have direct contact with skin, certain temp., & pt. can’t sleep on it.
*Most heat pads can shut down. Can’t bring from home healthcare- hazard.
*Sleep disturbances affect sleep & if pt. is hurting.
*Cream-Analgesic-Bengay (Over counter or prescription)-Voltaren gel
*Steroid-Decrease inflammation-Will run up B/P & Glucose
*NSAID-Want run up B/P & Glucose
*Education-Heat is used on affected joint/Cold therapy for when joint is active flare up.

Question 43

Mobility hazards

Answer 43

Adequate lightning, Rugs, stairs, extension cords, & pets