Exam of 10 pages for the course NR224 Study Guide at NR224 Study Guide exam 2 (NR224 Study Guide)

Mobility – Repositioning (What are things you need to think about when repositioning a client?) • Seeking assistance when moving or lifting a patient (e.g., when the patient is overweight or confused). • Patient limitations (e.g., changes in blood pressure, mobility restrictions) that affect safe transfer techniques Isometric verses isotonic contraction: • Isometric contraction (static contraction) causes an increase in muscle tension or muscle work but no shortening or active movement of the muscle (e.g., instructing the patient to tighten and relax a muscle group, as in quadriceps set exercises or pelvic floor exercises). Voluntary movement is a combination of isotonic and isometric contractions. • Eccentric tension helps control the speed and direction of movement. For example, when using an overhead trapeze, the patient slowly lowers himself to the bed. The lowering is controlled when the antagonistic muscles lengthen. Concentric and eccentric muscle actions are necessary for active movement and therefore are referred to as dynamic or isotonic contraction. What is orthostatic hypotension? • Orthostatic hypotension is an increase in heart rate of more than 15% and a drop of 15 mm Hg or more in systolic blood pressure or a drop of 10 mm Hg or more in diastolic blood pressure when the patient changes from the supine to standing position. • In the immobilized patient decreased circulating fluid volume, pooling of blood in the lower extremities, and decreased autonomic response occur. These are especially evident in the older adult. • As the workload of the heart increases, so does its oxygen consumption. Therefore the heart works harder and less efficiently during periods of prolonged rest. As immobilization increases, cardiac output falls, further decreasing cardiac efficiency and increasing workload. • When patients who are on bed rest or are immobile move to a sitting or standing position, they often experience orthostatic hypotension. They have an increased pulse rate, a decreased pulse pressure, and a drop in blood pressure. • To prevent injury, nurses implement interventions that reduce or eliminate the effects of orthostatic hypotension. Mobilize the patient as soon as the physical condition allows, even if this only involves dangling at the bedside or moving to a chair. • This activity maintains muscle tone and increases venous return. Isometric exercises (i.e., activities that involve muscle tension without muscle shortening) have no beneficial effect on preventing orthostatic hypotension, but they improve activity tolerance. • When getting an immobile patient up for the first time, assess the situation using a safe patient–handling algorithm. This is a precautionary step that protects the nurse and patient from injury and also allows the patient to do as much of the transfer as possible. What are some nursing diagnosis for activity levels? How would you assess activity level? What do you do if someone starts to fall? We want to break fail and slowly lower them to floor. Why do we raise the bed when doing a dressing change? Read over balance – balance is enhanced by what? • Without balance control the center of gravity is displaced, thus creating a risk for falls and subsequent injuries. Balance is enhanced by keeping the center of gravity of the body low with a wide base of support and maintaining correct body posture. Why do we want are clients to perform self-care activities? • We want to keep pt’s active and involved. • Develop goals and expected outcomes to assist the patient in achieving his or her highest level of mobility and reducing the hazards of immobility. • People use these activities to maintain their body image, thus improving their outlook. Is mobility a risk factor for pressure ulcers? Explain why or why not. FYI: When a person is mobile they are moving which decreases the chance of pressure ulcers. The blood is flowing throughout body and there is no pressure on any bony prominence. • The changes in metabolism that accompany immobility add to the harmful effect of pressure on the skin in the immobilized patient. This makes immobility a major risk factor for pressure ulcers. Any break in the integrity of the skin is difficult to heal. Preventing a pressure ulcer is much less expensive than treating one; therefore preventive nursing interventions are imperative. • A pressure ulcer is an impairment of the skin as a result of prolonged ischemia (decreased blood supply) in tissues. The ulcer is characterized initially by inflammation and usually forms over a bony prominence. Ischemia develops when the pressure on the skin is greater than the pressure inside the small peripheral blood vessels supplying blood to the skin. • When a patient lies in bed or sits in a chair, the weight of the body is on bony prominences. The longer the pressure is applied, the longer the period of ischemia and therefore the greater the risk of skin breakdown. The older adult is especially at risk. For example, an older adult who is immobilized on a backboard following a trauma can develop skin breakdown within 3 hours. How could someone’s self-concept change due to immobility? • Patients with restricted mobility may have some depression. Depression is an affective disorder characterized by exaggerated feelings of sadness, melancholy, dejection, worthlessness, emptiness, and hopelessness out of proportion to reality. It results from worrying about present and future levels of health, finances, and family needs. • Because immobilization removes the patient from a daily routine, he or she has more time to worry about disability. Worrying quickly increases the patient's depression, causing withdrawal. Withdrawn patients often do not want to participate in their own care. What are some prolong effects of bed rest and/or immobility? • Immobility disrupts normal metabolic functioning: decreasing the metabolic rate; altering the metabolism of carbohydrates, fats, and proteins; causing fluid, electrolyte, and calcium imbalances; and causing gastrointestinal disturbances such as decreased appetite and slowing of peristalsis. • However, in the presence of an infectious process, immobilized patients often have an increased BMR as a result of fever or wound healing because these increase cellular oxygen requirements.