Module 4 Flashcards
1
Q
4 basic elements of normal movement
A
- body alignment
- joint mobility
- balance
- coordinated movement
2
Q
describe a person maintaining balance
A
line of gravity passes through the center of the gravity and the base of support
3
Q
posture promotes (5)
A
- optimal balance and maximal body function
- lung expansion
- efficient circulatory function
- renal function
- gastrointestinal functions
4
Q
posture reflects (3)
A
- mood
- self-esteem
- personality of an individual
5
Q
example of flexion
A
bending the elbow
6
Q
example of extention
A
straightening the arm at the elbow
7
Q
example of hyperextension
A
bending the head backward
8
Q
definition of abduction
A
movement of the bone AWAY from the midline of the body
9
Q
defintion of adduction
A
movement of the bone TOWARD the midline of the body
10
Q
definition of rotation
A
movement of the bone around its central axis
11
Q
definition of circumduction
A
movement of the distal part of the bone in a circle while the proximal end remains fixed
12
Q
definition of eversion
A
turning the sole of the foot outward by moving the ankle joint
13
Q
definition of inversion
A
turning the sole of the foot inward by moving the ankle joint
14
Q
definition of pronation
A
moving the bones of the forearm so that the palm of the hand faces downward when held in front of the body
15
Q
definition of supination
A
moving the bones of the forearm so that the palm of the hand faces upward when held in front of the body
16
Q
defintion of ROM (3)
A
maximum movement that is possible for that joint. varies from person to person. determined by genetic makeup, developmental patterns, presence or absence of disease, and amount of physical activity
17
Q
definition of balance
A
maintaining balance and posture and involve informational inputs from labyrinth (inner ear) from vision (vestibule ocular input), and from stretch receptors of muscles and tendons (vestibulospinal input)
18
Q
cochlea is concerned with ___
vestibule and semicircular canals are associated with ___
A
- hearing
2. equilibrium
19
Q
define proprioception
A
awareness of posture, movement, and changes in the equilibrium and the knowledge of position, weight, and resistance of objects in relation to the body
20
Q
balanced, smooth, purposeful movement is the result of proper functioning of the ___ (3)
A
cerebral cortex
cerebellum
basal ganglia
21
Q
cerebral cortex initiates
A
voluntary motor activity
operates MOVEMENTS not muscles
22
Q
cerebellum coordinates
A
motor activities of movement (voluntary)
operates below LOC
23
Q
basal ganglia involves
A
maintaining of posture
24
Q
when a clients cerebellum is injured…(3)
A
movements become clumsy, unsure, and uncoordinated
25
define isotonic
muscle shortens to produce muscle contraction and active movement (running, walking, swimming, cycling)
26
___ exercises may increase muscle tone, mass, and strength, and maintain joint flexibility and circulation
isotonic
27
during ___ exercises both heart rate and CO quicken to increase blood flow to all of the parts of the body
isotonic
28
define isometric
muscle contraction without moving the joint
| MUSCLE LENGTH DOES NOT CHANGE
29
isometric exercise is used for
maintaining strength in immobilized muscles in casts or traction
produce mild increase in heart rate and CO
NO appreciable increase in blood flow to other parts of the body
30
isokinetic (resistive) involves
muscle contraction or tension against resistance
31
isokinetic (resistive) exercise is used in
physical conditioning to build up certain muscle groups
| increase in BP and blood flow to muscles occurs
32
aerobic exercises
the amount of O2 taken in the body is greater than that used to perform the activity
improves cardiovascular conditioning and physical fitness
33
aerobic exercise measured in 3 ways
1. target heart rate
2. talk test
3. Borg scale of perceived exertion
34
anaerobic involves
activity in which the muscles CANNOT draw out enough O2 from the bloodstream, and anaerobic pathways are used to provide additional energy for a short amount of time
35
anaerobic exercise is used
in endurance training for athletes such as weight lifting and sprinting
36
effects of exercise on the cardiovascular system (9)
1. increases heart rate
2. increases strength of heart muscle contraction
3. improves blood supply to the heart and muscles through increased CO
4. promotes heart health (mediating harmful effects of stress)
5. lowers systolic and diastolic BP
6. improves O2 intake
7. improves heart rate variability
8. improves circulation
9. stress reduction
37
effects of immobility on the cardiovascular system (6)
1. diminished cardiac reserve
2. increased use of the valsalva maneuver
3. orthostatic hypotension
4. venous vasodialation and stasis
5. dependent edema
6. thrombus formation
38
effects of exercise on the respiratory system (5)
1. improves gas exchange
2. more toxins are eliminated with deep breathing
3. problem solving and emotional stability is enhanced
4. prevents pooling of secretions
5. decreasing breathing effort and risk of infection
39
effects of immobility on the respiratory system (4)
1. decreased respiratory movement
2. pooling of respiratory secretions
3. atelectasis
4. hypostatic PNA
40
effects of exercise on the metabolic system (4)
1. elevates metabolic rate (increases production of body heat, waste products, and caloric use)
2. increases use of triglycerides and fatty acids (reduced level of serum triglycerides, A1C, and cholesterol)
3. weight loss, stable blood sugar
4. cells more responsive to insulin
41
effects of immobility on the metabolic system (4)
1. decreased metabolic rate
2. negative Na balance
3. anorexia
4. negative Ca balance
42
effects of exercise on the urinary system (4)
1. promotes efficient blood flow
2. body excretes wastes more effectively
3. stasis of urine is prevented
4. decreases risk of UTI
43
effects of immobility on the urinary system (4)
1. urinary stasis
2. renal calculi
3. urinary retention
4. UTI
44
effects of exercise on the GI system (5)
1. improves appetite
2. increases GI tone
3. facilitates peristalsis
4. can relieve constipation (by rowing, swimming, walking, and sit ups)
5. improve symptoms of IBS and other digestive orders (by doing ab compressive exercises)
45
effects of immobility on the GI system (5)
1. constipation
2. impaction
3. suppresses urge and weakens defecation reflex
4. straining increases intra-abdominal and intra-thoracic pressures
5. places stress on heart and circulatory system
46
effects of exercise on immune system (4)
1. removes foreign antigens
2. improves functions of NK cells, circulating T-cell, and cytokine production
3. increasing resistance to viral infections
4. preventing formation of malignant cells
47
effects of exercise on psychoneurologic system (4)
1. increases levels of metabolites for neurotransmitters (norepinephrine/serotonin)
2. releases endogenous opioids (increasing levels of endorphins)
3. increases levels of O2 to the brain and other body systems
4. releases stored stress associated with accumulated emotional demands
48
effects of immobility on psychoneurologic system (6)
1. negative effects on mood
2. lower self-esteem
3. higher frustration
4. may provoke exaggerated emotional reactions
5. clients perception of time intervals deteriorate
6. lack of intellectual stimulation and the stress of the illness and immobility
49
regular exercise also improves __ (3)
1. quality of sleep (for most individuals)
2. elicits relaxation response (RR)
3. counteracts some of the harmful effects of stress on the body and the mind
50
effects of exercise on cognitive system (2)
1. induces cells in the brain to strengthen and build neuronal connections
2. shown to help people with ADD/ADHD, learning disorders, and mood disorders
51
effects of immobility on integumentary system (3)
1. reduced skin tugor
2. skin breakdown
3. higher risk for pressure ulcer
52
effects of exercise on spirituality
1. yoga style improves the body-mind-spirit
2. improves connection with God
3. establishes balance in the internal and external environment
53
slow breathing enhances
1. heart rate variability
| 2. baroreflex sensitivity
54
slowly walking a labyrinth can induce a meditative state which effects
1. lowering BP
2. decreasing heart rate
3. decreasing respiratory rates
4. reducing incidents of chronic pain and insomnia
55
recitation of a word or phrase (mantra) or prayer while sitting quietly and relaxing your muscles can cause
a relaxation response resulting in a decrease in heart and respiratory rate
56
6 goals/outcomes R/T activity, exercise, and mobility problems
1. increased tolerance for physical activity
2. restored or improved capability to ambulate and/or participate in ADL's
3. absence of injury from falling or improper use of body mechanics
4. enhanced physical fitness
5. absence of any complications associated with immobility
6. improved social, emotional, and intellectual well-being
57
active ROM involves
isotonic exercises in which the CLIENT moves each joint in the body through its complete ROM, maximally stretching all muscle groups within each plane over the joint
* maintain or increase muscle strength and endurance and help maintain cardiorespiratory function
* prevent deterioration of joint capsules, ankylosis, and contractures
58
passive ROM involves
ANOTHER PERSON moves each of the client's joints though its complete ROM maximally stretching all muscle groups within each plane over each joint
* NO VALUE in maintaining muscle strength
* useful in maintaining joint flexibility
* should only be performed when client is unable to accomplish movements actively
59
active-assistive ROM involves
the client uses a stronger, opposite arm or leg to move each of the joints of a limb incapable of active motion
*client learns to support and move the weak arm/leg with the strong arm
60
Non rapid eye movement (NREM) occurs when
activity in the RAS is inhibited
61
What % of sleep is NREM?
75-80%
62
describe the 1st stage in NREM (6)
* stage of very light sleep
* only lasts few minutes
* person feels drowsy/relaxed
* eyes roll side to side
* heart and RR drop slightly
* sleeper can readily be awakened and may deny that he or she was sleeping
63
describe the 2nd stage in NREM (8)
1. light sleep
2. body processes continue to slow down
3. eyes are generally still
4. heart and RR decrease slightly
5. body temp falls
6. stage only lasts 10-15 mins
7. only 44-55% of total sleep
8. requires more intense stimuli to awaken (shaking/touching)
64
describe stages 3&4 in NREM (7)
1. deepest stage of sleep
2. ONLY diff is % of Delta waves recorded during 30 second period
3. sleeper's heart and RR drop 20-30%
4. sleeper is difficult to arouse
5. snoring is most likely to occur
6. swallowing/saliva production is reduced
7. ESSENTIAL for restoring energy and releasing important growth hormones
65
describe rapid eye movement (REM) (9)
1. recurs about every 90 minutes
2. lasts 5-30 mins
3. most dreams take place/not usually remembered unless aroused briefly at the end of REM period
4. brain is highly active/brain metabolism may increase by 20%
5. levels of acetylcholine and dopamine increase
6. "paradoxical sleep" b/c of EEG activity resembles that of wakefulness
7. distinctive eye movement occurs
8. voluntary muscle tone is dramatically decreased
9. deep tendon reflexes are absent
66
it is thought that the regions of the brain that are used for (3) are stimulated during REM sleep
1. learning
2. thinking
3. organizing
67
normal sleep length for newborn
16-18 hours/day
68
normal sleep length for infants
14-15 hours/day
69
normal sleep length for toddlers
12-14 hours (1-3 years of age)
70
normal sleep length for preschoolers
11-13 hours (3-5 y/o)
71
normal sleep length for school-age children
10-11 hours (12-18 y/o)
72
normal sleep length for adolescents
9-10 hours (12-18 y/o)
73
normal sleep length for adults
7-9 hours (most healthy)
74
normal sleep length for older adults
7-9 hours (go to bed 1 hr before adults and wake up 1.3 hrs before adults)
75
9 factors that affect sleep
1. illness
2. environment
3. lifestyle
4. emotional stress
5. stimulants/alcohol
6. diet
7. smoking
8. motivation
9. medications
76
describe insomnia (3)
1. inability to fall asleep or remain asleep
2. older age is a risk factor
3. female gender is a risk factor
77
describe hypersomnia
affected individual obtains sufficient sleep at night but still cannot stay awake during the day
78
describe narcolepsy
1. excessive daytime sleepiness caused by lack of chemical hypocretin in the area of the CNS that regulates sleep
2. clients have sleep attacks or excessive daytime sleepiness
3. sleep at night usually begins with sleep-onset REM period
79
describe sleep apnea (2)
1. frequent short breathing pauses during sleep
| 2. more than 5 apnea episodes or 5 breathing pauses longer than 10 sec/hr is abnormal
80
describe parasomnias
1. sleepwalking
2. nightmares
3. sleep talking
4. sleep terrors
81
symptoms for sleep apnea (7)
1. loud snoring
2. frequent nocturnal awakenings
3. excessive daytime sleepiness
4. difficulties falling asleep at night
5. morning headaches
6. memory and cognitive problems
7. irritability
82
although sleep apnea is frequently diagnosed in men and postmenopausal women, it may also occur in
childhood
83
name the 3 types of sleep apnea
1. obstructive apnea
2. central apnea
3. mixed apnea
84
describe clients with obstructive apnea (5)
1. pharynx or oral cavity block the flow of air
2. enlarged tonsils and adenoids
3. deviated nasal septum (RARE)
4. nasal polyps
5. obesity
85
describe clients with central apnea (5)
1. defect in respiratory center of the brain
2. brainstem injuries
3. muscular dystrophy
86
describe clients with mixed apnea
combination of central and obstructive apnea
87
the major goal for clients with sleep disturbances is to maintain ___
a sleeping pattern that provides sufficient energy for daily activities
88
5 parts of client teaching with sleep apnea
1. learn conditions that promote sleep and those that interfere with sleep
2. safe use of sleep medications
3. effects of other prescribed medications on sleep
4. effects of their disease states on sleep
5. importance of long periods of uninterrupted sleep
89
describe nocireceptive pain and give example
1. experienced when an intact, properly functioning nervous system sends signals that tissues are damaged, requiring attention and proper care
(pain experienced following a cut/broken bone that alerts the person to avoid further damage until it is properly healed)
2. can either be somatic/visceral
90
describe somatic nocireceptive pain and give example
originates in the skin, muscles, bone, or connective tissue
| sharp sensation of a paper cut or aching of a sprained ankle
91
describe visceral nocireceptive pain and give examples
results from activation of pain receptors in the organs and/or hollow viscera
characterized by cramping, throbbing, pressing, aching
associated with feeling sick (vomiting, sweating, nausea)
Ex: labor pain, angina pectoris, irritable bowel
92
describe neuropathic pain
associated with damaged/malfunctioning nerves due to illness, injury
"chronic"
described as burning, electric shock, tingling, dull, aching
93
peripheral neuropathic pain
phantom limb pain, post-herpetic neuralgia, carpal tunne syndrome, follows damage or sensitization of peripheral nerves
94
central neuropathic pain
spinal cord injury
post-stroke pain
multiple sclerosis pain
results from malfunctioning nerves in CNS
95
sympathetically maintained pain
occurs occasionally when abnormal connections between pain fibers and the sympathetic nervous system perpetuate problems with both the pain and sympathetically controlled functions (edema, temperature, and blood flow regulation)
96
describe pain threshold
least amount of stimuli that is needed for a person to label a sensation as pain
97
describe pain tolerance
maximum amount of painful stimuli that a person is willing to withstand without seeking avoidance of the pain or relief
98
name the 4 physiological processes R/T pain perceptions
1. transduction
2. transmission
3. perception
4. modulation
99
describe the transduction physiological process (3)
1. stimuli tigger the release of biochemical mediators (prostaglandins, bradykinin, serotonin, histamine, and substance P) that sensitize nocireceptors
2. pain medications can work during this phase by blocking the production of prostaglandin (ibuprofen/aspirin) or decreasing movement of ions across the cell membrane (local anesthetic)
3. another example is the topical analgesic (zostrix) which depletes the accumulation of substance P and blocks transduction
100
describe the transmission physiological process
includes 3 segments:
1. pain impulses travel from peripheral nerve fibers to spinal cord
substance P serves as a neurotransmitter, enhancing the movement of impulses across the nerve synapse from the primary afferent neuron to the second-order neuron in the dorsal horn of the spinal cord
2. transmission from the spinal cord, and ascension, via spinothalamic tracks, to the brainstem and thalamus
3. transmission of signals between the thalamus to the somatic sensory cortex where pain perception occurs
opioids block the release of neurotransmitters, particularly substance P, which stops the pain at the signal level
capsaicin may also deplete substance P, which could inhibit the transmission of pain signals
101
describe perception physiological process
when client becomes conscious of the pain
102
describe modulation physiological process
1. "descending system"
2. occurs when neurons in the thalamus and brainstem send signals back down tot the dorsal horn of the spinal cord
3. tricyclic antidepressants block the reupake of norepinephrine and serotonin
NMDA antagonists may be used to help diminish the pain signals
103
effects of unrelieved pain (3)
1. interferes with sleep
2. affects appetite
3. lowers quality of life for clients and their family members
104
natural response to pain
1. stop activity
2. tense muscles
3. withdraw from the pain-provoking activities
4. reduced mobility may produce muscle atrophy and painful spasm
105
uncontrolled pain impairs
1. immune function (slows healing process and increases susceptibility to infections and dermal ulcers)
106
prevent the development of persistent pain and promote overall health and well being, the nurse must act
to promote optimal and expedient pain control
107
2 scales for rating pain
1. 11 point pain intensity scale
| 2. Wong-Baker FACES rating scale
108
2 barriers to pain management
1. lack of knowledge of adverse effects of pain/may have been provided wrong information about analgesics
2. exaggerated fear of becoming addicted especially when long-term opioid use is prescribed
109
define addiction
primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations
characterized by behaviors that include impaired control over drug use, compulsive use, continued use despite herm, and craving
110
define physical dependence
state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist
111
define tolerance
state of adaptation in which exposure to a drug induces change that result in a diminution of one or more of the drug's effects over time
112
for clients with mild pain (1-3 on a 0-10 scale), administer
nonopioid analgesics (with or without coanalgesic)
113
for clients with moderate pain (4-6 on a 0-10 scale), administer
opioid (codeine, tramadol) or a combo of opioid and nonopioid medicine (oxycodone with acetaminophen, hydrocodone with ibuprofen)
114
for clients with severe pain (7-10 on a 0-10 scale), administer
opioid (morphine, hydromorphone, fentanyl) and is titrated in ATC scheduled doses
115
common SE of opioids and preventative measures (7)
1. respiratory depression ***most concerning
2. sedation
3. nausea/vomiting
4. urinary retention
5. blurred vision
6. sexual dysfunction
7. constipation
116
During the transduction phase of nociception, what method of pain control is most effective?
Ibuprofen
117
When a client has arrived at the nursing unit from surgery, the RN is most likely to give priority to what assessment
Pain intensity
118
A client who describes his pain as a 7 on a scale of 0-10, is classified as having what kind of pain
Moderate
119
A client who had abdominal surgery 4 hours ago is receiving a continuous epidural infusion of an analgesic. What observation indicates the RN should monitor the client closely
Drowsy drifts off to sleep before completing a sentence
120
The client has an order of morphine 2.5-5 mg IV q4. He received 2.5 mg IV 4 hours ago for pain rates at a 3/10. He is now watching tv AMS visiting with the family members. When asked about his pain, he rates it at a 5. V/S are stable. What RN intervention is needed?
Give morphine 5.0 mg IV and reassess in 20 mins
121
During an admission RN assessment, client with diabetes describes his leg pain as a "dull, burning sensation" the RN knows this as ____ pain
Neuropathic
122
What interventions would apply the gate control theory of pain?
Massage
Heat/cold application
Acupressure
123
What statement best reflects the RN's assessment of the 5th V/S?
Are you experiencing any discomfort right now?
124
When planning care for pain control of older clients, these principles should apply
Client may deny pain
| Client may describe pain as an ache/discomfort
125
A client recovering from abdominal surgery refuses analgesia saying he is fine as long as he doesn't move. What RN Dx should apply
Deficit knowledge
126
A client is admitted for a sleep disorder. The RN knows that the RAS (reticular activating system) is involved in the sleep/wake cycle. What letter indicates the location of the RAS?
B
127
A client has a history of sleep apnea. What is the most appropriate question for the RN to ask
Difficulty with daytime sleepiness
128
Because of significant concerns about the financial problems, a middle aged client complains of difficulty sleeping. What outcome would be the most appropriate for the nursing care plan? "By day 5, the client will"
Report falling asleep within 20-30 mins
129
The client reports to the nurse that she has been taking barbiturate sleeping pills every night for several months and now wishes to stop taking them. What statement is most appropriate advice for the RN to provide the client?
continue taking the pills and discuss tapering the dose with the PCP
130
During a well child visit a mother tells the nurse that her four-year-old daughter typically goes to bed at 10:30 PM and awakens each morning at 7 AM. She does not take a nap in the afternoon. How should the RN respond
Encourage the mother to consider putting her daughter to bed between 8 and 9 PM
131
A college student was referred to the campus health service because of difficulty staying awake in class. What should be included in the nurses assessment?
Amount of sleep he usually obtained during the week and on weekends
Onset and duration of symptoms
What medications including herbal remedies he is taking
132
During a yearly physical, a 52-year-old male client mentioned that his wife frequently complains about his snoring. During the physical exam, the nurse notes that his next size is 18 inches, his soft palate and uvula are red and and swollen, and he is overweight. What is the most appropriate nursing intervention for the nurse to recommend for this client?
Refer him to a sleep disorder center for evaluation and treatment of his symptoms
133
A new nursing graduate first job requires 12 hour night shift. What strategy will make it easier for the graduate to sleep during the day and remain awake at night?
Wear dark wraparound sunglasses when driving home in the morning and sleep in a darkened bedroom
134
The nurses answering questions after a presentation on sleep at a local senior citizen center. A woman in her late 70s asks for a Pinyan about the advisability of allowing her husband to nap for 15 to 20 minutes each afternoon. What is the nurses best response?
Unless your husband has trouble falling asleep at night a brief afternoon nap is fine
135
During admission to the hospital unit, the client tells the nurse that her sleep tends to be very light and that is difficult for her to get back to sleep if she's awake and at night. What intervention should the nurse implement?
Reminder colleagues to keep their conversation to a minimum at
Deliver necessary medications and procedures at 1.5 or three hour intervals between 11 PM and 6 AM Encourage the client to ask if he remembers to bring in a fan to provide white noise
136
To increase stability during client transfer the nurse increases the base of support by performing what action?
Facing the feet farther apart
137
Isotonic exercises such as walking are intended to achieve what?
Increased muscle tone and improve circulation
Increase muscle mass and strength
Maintain joint range of motion
138
Five minutes after the clients first postoperative exercise, the clients vital signs have not yet returned to baseline. What is an appropriate nursing diagnosis?
Activity intolerance
139
What statement from a client with one week leg regarding use of crutches when using stairs indicates a need for increased teaching?
The weaker link always goes first with both crutches
140
A nurse is teaching a client about active range of motion exercises. The nurse then watch as the client demonstrate these principles. The nurse would evaluate that teaching was successful when the client does what?
Uses the same sequence during each exercise session
141
When assessing a client gate, what does the nurse look for and encourage?
The spine rotates, initiating locomotion
142
Performance of activities of daily living and active range of motion exercises can be accomplished simultaneously as illustrated by what?
Elbow flexion with eating and bathing
Thumb ROM with eating and writing
Hip flexing with walking
143
A client weighs 250 lbs and Ned's to be transferred from the bed to a chair. What instruction from the UAP is most appropriate?
use the mechanical lift and another person to transfer the client from the bed to the chair
144
The client is ambulating for the first time after surgery. The client tells the nurse I feel faint. What is the best action by the nurse?
Assist the client to nearby chair
145
The nurse is performing an assessment of an immobilized client. What assessment causes the nurse to take action?
Reddened area on the sacrum
