Download Mobility

Mobility and Immobility
Taylor, ch 33
Jensen, ch 23
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Regulation of Movement
• Bones
• Joints
• Ligaments—bone to bone
• Tendons—muscle to bone
• Cartilage—joint cushion (unossified)
• Skeletal muscle—attached to skeleton; contract and relax
• Nervous system—neurotransmitters; inner ear
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Role of Skeletal System in Movement
• Supports soft tissues of body
• Protects crucial components of the body
• Furnishes surfaces for the attachment of muscles,
tendons, and ligaments
• Provides storage areas for minerals and fat
• Produces blood cells
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Relationship of Skeletal Muscles to Bones
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Bones Classified by Shape
• Long bones
• Short bones
• Flat bones
• Irregular bones
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Question
Which of the following classifications describes the bones
located in the wrist?
A. Long bones—humerus, femur
B. Short bones—wrist, ankle
C. Flat bones—skull, ribs
D. Irregular bones—spinal column, jaw
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Answer
Answer: B. Short bones
Rationale:
Short bones located in the wrist and ankle contribute to
movement.
Long bones found in the upper and lower extremities
contribute to height and length.
Flat bones (ribs, skull) are thin and contribute to shape.
Irregular bones are all the remaining bones not included
in the above classifications (e.g., jaw and spinal column).
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Types of Joints
• Ball-and-socket—hip, shoulder
• Condyloid—wrist, ankle
• Gliding—between carpal bones of wrist and tarsal bones
of feet
• Hinge—knee, elbow
• Pivot—proximal ends of radius and ulna
• Saddle—joint between the thumb and the wrist
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Joint Movements
• Abduction
• Adduction
• Circumduction
• Flexion
• Extension
• Hyperextension
• Dorsiflexion
• Plantar flexion
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Joint Movements (cont.)
• Rotation
• Internal rotation
• External rotation
• Supination
• Pronation
• Inversion
• Eversion
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Question
A nurse stretches out a patient’s leg and moves it in a
circle. This is an example of what type of body
movement?
A. Abduction
B. Flexion
C. Circumduction
D. Dorsiflexion
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Answer
Answer: C. Circumduction
Rationale:
Circumduction occurs when the distal part of the limb is
moved to trace a circle while the proximal end of the
bone remains fixed.
Abduction occurs with the lateral movement of a body
part away from the midline of the body.
Flexion is the state of being bent.
Dorsiflexion is the backward bending of the hand or foot.
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Three Types of Muscles
• Skeletal
• Cardiac
• Smooth or visceral
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Important Functions of Muscles
• Motion
• Maintenance of posture
• Heat production
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Effect of Nervous System
on Muscle Contraction
• Afferent nervous system conveys information to CNS.
• Neurons conduct impulses from one part of body to
another.
• Information is processed by CNS.
• The efferent system conveys response from CNS to
skeletal muscles via somatic nervous system.
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Types of Exercises
• Isotonic—involves active movement
• Isometric—muscle contraction only
• Isokinetic—muscle contraction with resistance applied
• Aerobic—systematic movements which improve CV
system—need 30” day
• Stretching—should be done before exercise
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Advantages of Mobility and Exercise
– Decreases risk of sensory deficits
– Decreases social isolation
– Decreases risk of personal injury
– Improves VS and labs
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Risks of No Exercise
• Muscle strain and sprain
• Pain
• Fractures
• Changes in VS—can be dangerous for people with HD and
pulmonary probs if wrong kind of exercise is done
• Falls
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Factors Influencing Mobility
• Developmental considerations
• Physical health—conditions of CV, MS, respiratory, and
nervous systems; cancer, congenital abnormalities
• Mental health--depression
• Lifestyle—sedentary vs. active
• Attitude and values—how important is fitness?
• Fatigue and stress
• External factors—trauma
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Physical Assessment for Mobility
• General ease of movement and gait
• Alignment
• Joint structure and function
• Muscle mass, tone, and strength
• Endurance
• Intact nervous system
• Stable center of gravity
• Wide base of support
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Systemic Effects of Immobility (1010)
• Metabolic
• Respiratory
• Cardiovascular
• Musculoskeletal
• GI
• Urinary and bowel elimination
• Integumentary
• Psychological well-being
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Patient Assessment: History
– Activity tolerance
– Daily activities and exercise
– Lifestyle
– Physical or mental conditions that impair mobility
– Risk for falls (use Fall Risk Assessment Tool)
– Medications
– Hx of hospitalizations, surgery, injury, falls, pressure
ulcers
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Patient Assessment: Physical
• Metabolic:
–
Anthropometric measurements (ht & wt)
–
Wound healing
–
Electrolytes
• Respiratory system:
–
Ventilatory status
–
Lung sounds
• Cardiovascular system:
–
BP, apical pulse
–
Peripheral circulation,
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Peripheral Circulation Pneumonic (6 Ps)
• Arterial (to assess for insufficiency or a clot):
– Pulselessness
– Pallor
– Paralysis
– Polar
– Paresthesia
– Pain
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Peripheral Circulation
• Venous—(to assess for insufficiency or a clot):
– Color
– Swelling—bilateral or unilateral? Pitting or nonpitting?
– Tenderness
– Heat
– Pain on dorsiflexion (Homan’s sign)
– Pulses should be intact if it is a venous problem
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Physical Assessment cont’d
• Musculoskeletal:
– ROM
– Muscle strength, tone, and mass
– Gait, use of assistive devices
– Skeletal/postural abnormalities
• Scoliosis—curvature
• Lordosis—lumbar
• Kyphosis—thoracic
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Physical Assessment cont’d
• Integumentary:
– Color
– Integrity—if break then assess that
– Turgor—poor, fair, good
– Drainage, rashes
• Elimination:
– I&O balance
– Bowel sounds
– TACCO bowel
and bladder output
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Ongoing Physical Assessment
• Each shift should continue to assess:
– Activity tolerance (subjective and objective)
– Gait and mobility and use of devices
– Lung and heart sounds
– Skin observation and wound healing, if applicable
– Labs
– Use of pain meds
– Watch for depression—note verbal and nonverbal
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Interventions
• Metabolic
– Meet nutritional needs for protein, calories, vitamins
– Promotion of physical fitness and exercise
• Respiratory system
– Maintenance of patent airway: TCDB, FF, remove
secretions
– Ambulation
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Interventions (cont'd)
• Cardiovascular system
– Dangling before OOB to prevent orthostatic
hypotension
– Discourage Valsalva maneuver to decrease cardiac
workload
– Preventing thrombus formation by medications,
exercise, fluids, TED stockings, pneumatic
compression, positioning
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Interventions (cont'd)
• Musculoskeletal system
– ROM
– Promote fitness and exercise
– Progressive ambulation
– Good body alignment
– Teaching on prevention of osteoporosis and injury
– Using assistive devices correctly
– Pain meds
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Interventions (cont'd)
• Integumentary system
– Turning every 1 to 2 hours
– Ambulation
– Hygienic care
– Protection: preventive aids
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Interventions (cont'd)
• Elimination
– Hydration
– I&O
– Nutritional intake: fiber
– Ambulation
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Interventions (cont'd)
• Psychosocial
– Orientation
– Good listening and communication skills
– Client participation in own care
– Encourage diversional activities and visitors
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Positioning Patients
• Pillows
• Mattresses
• Adjustable beds
• Bed side rails
• Trapeze bar
• Footboards
• Hand rolls and splints, trochanter rolls
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Protective Positioning
• Using correct body alignment and protective devices in:
– Fowler’s position
– Supine or dorsal recumbent position
– Side-lying or lateral position
– Prone position
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Question
Tell whether the following statement is true or false.
The oblique position, a variation of the side-lying
position, is recommended as an alternative to the sidelying position because it places significantly less pressure
on the trochanter region.
A. True
B. False
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Answer
Answer: A. True
The oblique position, a variation of the side-lying
position, is recommended as an alternative to the sidelying position because it places significantly less pressure
on the trochanter region.
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Restorative Care
• Occupational Therapy to help with ADLs
• Physical Therapy to help with:
– ROM
– Quadriceps and gluteal setting drills
– Push-ups and other upper body strengthening
– Dangling
– Ambulation with canes, walkers, crutches
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Mechanical Aids for Walking
• Walker—fit; how to walk safely; getting up and down
from chair
• Cane—fit; correct side; how to walk safely
• Braces
• Crutches—fit, gaits: 2 point, 3 point, 4 point, swingthrough; getting up and down in chair and up and down
stairs
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Mechanical Aids to Walking: Walker and
Canes
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Variables Leading to Back Injury in
Healthcare Workers
• Uncoordinated lifts
• Manual lifting and transferring of patients without
assistive devices
• Lifting when fatigued or after recent back injury recovery
• Repetitive movements such as lifting, transferring, and
repositioning patients
• Standing for long periods of time
• Transferring patients
• Transferring/repositioning uncooperative or confused
patients
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Principles of Body Mechanics
• More force required to lift an object than to push or pull it
• Objects closer to center of gravity are easier to lift
• Wide base of support provides stability
• Twisting motions cause back strain
• If load is > force then no movement will occur
• Thigh muscles are stronger than back muscles
• Healthy active muscles are stronger
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Preventing Personal Injury
• Keep object close to maintain balance
• Keep back straight and bend @ knees to maintain center of
gravity and protect back
• Use leg muscles to lift, not back
• Tighten abs and tuck pelvis for balance and back protection
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Proper and Improper Way to Pick up an
Object
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