Mobility, Safety, Transfers, Hygiene Flashcards Preview

Fundamentals of Nursing in the Context of the Older Adult > Mobility, Safety, Transfers, Hygiene > Flashcards

Flashcards in Mobility, Safety, Transfers, Hygiene Deck (53)
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1

Age related factors that affect mobility and safety

decrease in muscle mass, strength, join flexibility
higher risk of fractures
decreased bone density
increased risk of falling
osteoarthritis
rheumatoid arthritis
increased immobility effects

2

The nurse should intervene to prevent _____________

functional decline

3

What is the most prevalent metabolic disease of the bone ?

Osteoporosis- primarily affecting adults in middle to later life.
Decreased bone mass and density
can be caused by inadequate calcium intake, excessive calcium loss, poor calcium absorption

4

What is osteoarthritis ?

The progressive deterioration and abrasion of join cartilage with the formation of new bone at the joint surfaces.
Primarily affects weight bearing joints

It is the leading cause of physical disability in older people.

5

What is rheumatoid arthritis?

Affects the joints- projections of synovial tissue protrude into the joint cavity. Affected joints are extremely painful, stiff, swollen, red and warm to the touch. joint pain present during rest and activity

systemic symptoms include fatigue, malaise, weakness, weight loss, wasting, fever and anemia

6

Consequences of immobility

reduced pulse rate
increased cardiac workload
decreased chest expansion and ventilation
slower GI motility
slower metabolism and lymphatic circulation

increased risk of complications

- pressure ulcers
obesity
incontinence
joint stiffness, limited range of motion

increased dependency
reduced opportunities for socialization

7

What is sarcopenia ?

a decline in walking speed and grip strength

8

Discuss the age related changes in gait

↓ efficiency = More energy expended
↑ fatigue

Sensory changes may decrease balance
Potential for postural hypotension (orthostatic hypotension)
Nervous system changes: Slower reflexes/reaction time, Slower response to changes in balance
↓ step height

9

What environmental factors in a home can increase the risk for falls?

Lighting
Temperature
Colors
Scents
Floor coverings
Furniture
Sensory Stimulation
Bathroom Hazards
Fire Hazards
Psychosocial Considerations

10

______________ factors and ______________ factors = falls

Intrinsic and Extrinsic

11

Can the four siderails on a patient bed ever be put up ?

NOOOOOO! This is considered a restraint.... having 2 or 3 is fine though

12

Interventions to Prevent Falls in acute care setting

bed rails
bed lowered to lowest position
remove clutter
keep sensory aids close by
non slip socks

Assess!
Educate !

13

Which position promotes maximal breathing in the thoracic cavity ?

Fowlers position. It is the position of choice when someone is having difficulty breathing

14

Which position is contraindicated in patients who have spinal problems?

Prone position - the pull of gravity on the spine when the patient lies prone produces a marked lordosis or forward curvature of the lumbar spine

15

Connection between mobility and social activity

Being mobile and physically active can be a means of increasing social activity.
Being immobile can ability to engage in social activity

16

Multiple health problems can be avoided when an active state is maintained. What are some of these conditions ?

Atherosclerosis, obesity, joint immobility, depression, constipation, pressure ulcers, pneumonia, insomnia

17

Active Mobility =

avoidance of multiple health problems

18

Nursing interventions to focus on regarding mobility

The nurse should act to prevent functional decline while promoting safety

19

Activities of Daily Living Include

Eating, Dressing, Mobility, Continence, Toileting and Hygiene

20

Difference Between Active Exercise and Passive Exercise and Active Assistive

Active Exercise - patient acts independently
Active Assistive - patient acts with assistance
Passive - no active involvement of the patient

21

Benefits of Range of Motion Exercises

Prevention of Contractures, Improved Joint mobility, stronger muscles, stimulation of circulation, maintenance of functional capacity

ROM seeks to maintain and promote normal functioning

22

What is most important when assessing joints ?

Assessing their ROM , especially the effect any impaired ROM will have on completing ADLs

23

Flexion

Bending

24

Extension

Straightening

25

Hyperextension

extending beyond normal range

26

Adduction

Moving toward body

27

Abduction

moving away from body

28

Physiological Consequences of Immobility

reduced Pulse Rate and increased cardiac workload
Decreased Aerobic Capacity
Decreased chest expansion and ventilation
decreased gastrointestinal motility
reduced muscle strength, tone and endurance
and joint mobility
Demineralization of bones, increased ease of fractures
slower metabolism and lymphatic circulation

29

You are performing ROM motion exercises when you notice that the patient is becoming increasingly exerted - what signs would warrant stopping an exercise ?

Dyspnea, pallor, cyanosis
resting pulse > 100 bpm
dizziness, poor coordination
acute confusion, restlessness
diaphoresis
increase or decrease in systolic BP by 20 mm Hg
an exercise heart rate greater than or equal to 35% above the resting heart rate

30

Effects of aging on muscles

Decline in the number and size of muscle fibers and subsequent reduction in muscle mass decrease the body strength
Grip strength endurance declines
Connective Tissue changes reduce the flexibility of joints and muscles

31

Cardiovascular effects of immobility

Increased BP
Reduced Pulse Rate
Increase Risk for Orthostatic hypotension
Increased Cardiac Workload
Increased Risk for Venous thrombosis

32

Nursing Interventions to Prevent Cardiovascular Complications

Anti Embolism Devices

33

Aging effects on joints

Reduced mobility because of wear and tear, degeneration of collagen
loss of cartilage, decreased synovial fluid, decreased ROM

34

Decreased Mobility equals

Increased Dependency

35

Risk factors for Osteoporosis

Gender: Women > 65 years, Men > 80 years
80% of cases occur in women and
20% of cases occur in men
Ethnicity: White women, Asian women
and/or small framed, thin women
Calcium deficiency
Vitamin D deficiency
Estrogen deficiency, early menopause
Cigarette smoking, high ETOH consumption
Immobility
Family history
Diseases or chronic use of drugs that ↑ bone loss

36

Interventions for Osteoporosis

Focus on modifiable risk factors
What can you control?
Diet, supplements, social habits


Regular exercise
Weight bearing
Swimming
Medication
Dexa Scan

37

"Secondary to "

Caused by something else

Osteoporosis secondary to Cushings Syndrome

38

Primary and Secondary Osteoporosis

Primary Osteoporosis - of unknown cause

Secondary Osteoporosis - has a direct cause, such as calcium deficiency

39

What is the leading cause of physical disability in older people ?

Osteoarthritis

40

Osteoarthritis primarily affects which joints ?

Weight bearing joints-
Hip, knee, vertebrae, fingers

41

What is osteoarthritis ?

the progressive degeneration and abrasion of joint cartilage and the formation of new bone at the joint surfaces

42

Osteoarthritis affects most people to some extent over ....

age 55

43

Risk factors for Osteoarthritis

Age
Gender - occurs in women more than men
Excessive use of the joint
Trauma
Obesity
Vitamin D deficiency
Vitamin C deficiency
Genetic factors

44

Nursing Interventions for Osteoarthritis

Focus on modifiable risk factors
What can you control?
Diet, supplements, social habits

Exercise: low impact

Pain Management
Medication
Heat/ice therapy
Gentle massage
Aquatherapy
T'ai Chi
Acupuncture

Surgical intervention
Arthroplasty

45

What is arthroplasty ?

Joint replacement surgery
Can be done to relieve joint pain, restore joint motion and improve function

46

In older patients, arthroplasty is associated with a higher risk of ...............
what medication can be used against this ?

deep vein thrombosis and pulmonary embolism

Warfarin can be used prophylactically

47

Unrelieved pain can

interfere with older persons abilities to engage in self care, manage their households and maintain social contact

48

What is a muscle spasm?

Involuntary Contraction of muscle started by Nervous system due to overstimulation of muscles

- over exertion, not drinking enough water, not getting enough calcium, overstretching

49

What can be done to relieve or prevent muscle spasms?

Drink adequate amounts of water, replenish electrolytes
Use heat to relieve spasms - warm bath, keeping extremities warm at night with blankets and clothing

50

What can be done to relieve joint pain in the weight bearing joints ?

Resting those joints, supporting painful joints during transfers and using a walker or cane
Diversional activities to prevent preoccupation with pain - guided imagery, therapeutic touch, acupuncture, chiropractic therapy

51

Nursing Management: Musculoskeletal Conditions

Promote Pain Relief/Management
Promote/Retain Independence
Prevent Injury and Maintain Safety
Provide Support
Collaborate with Interdisciplinary Team Members

52

Gout

Metabolic disorder in which excess uric acid accumulates in the blood; as a result uric acid crystals are deposited in and around the joints causing severe pain and tenderness of the joint and warmth, redness, and swelling of the surrounding tissue

53

Guidelines for Safe Patient Handling and Movement

Know patients limitations and impairments
assess ability to assist in movement
Use assistive devices when necessary
remove clutter and clear path for movement
Have a plan for moving the patient
explain the plan to the patient and allow them to assist however much they can to promote independence
If patient is in pain, administer prescribed analgesic before transfer
Elevate bed to work at a comfortable height for you
lock wheels of the bed, wheelchair or stretcher so they do not slide
use good body mechanics when moving a patient
Be sure patient is in good body alignment
support patients body properly, avoid grabbing and holding an extremity by its muscles
use friction reducing devices, especially during lateral transfers
move your body and the patient in a smooth, rhythmic motion
use mechanical devices such as lifts, slides, transfer chairs or gait belts for moving patients - if you don't know how to use something, obtain assistance from someone who does
assure equipment meets weight requirements - bariatric patients (BMI>50) require bariatric transfer aids and equipment