NUR 2356 MDC EXAM 2 REVIEW_2020 - Johns Hopkins University

1. The effects of Immobility a) Interventions that improve flexibility • P.R.E.P.(Perform passive ROM, Reposition Q2HR, Encourage independent activity as much as possible even in bedrest, Provide assistive devices) • Know examples of exercises for flexibility b) Assessment/ Findings of a patient with DVT • Assessment (1) Compare distal pulses for pulse quality, observe the color and temp. of extremities, evaluate sensation and motion, and determine speed of capillary refill. Compare calf circumferences. • Findings (1) Redness, warmth, tenderness, swelling (Thrombus formation), Peripheral and sacral edema. c) Identify patients at risk for skin breakdown • Older adults, immobile, cognitive impairments, incontinence, poor nutrition/ malnutrition. Medications may also cause vasoconstriction and result in poor tissue perfusion.