RNSG 1301 Raising the Bar for Success_ Mobility _ First Semester 2020 – El Centro College | Raising the Bar for Success_ Mobility _ First Semester 2020

RNSG 1301 Raising the Bar for Success_ Mobility _ First Semester 2020 – El Centro College Mobility What is the definition of Mobility? • Factors that facilitate or impair movement of the body What are conditions that places one at risk for altered Mobility? • Older population, esp. females What clinical outcomes should the nurse look for related to Mobility? a. Positive i. Independence ii. Physical activity iii. Weight control b. Negative i. Swelling of Les ii. Dyspnea on exertion iii. Contractures iv. Skin breakdown v. Constipation vi. Incontinencevii. Loss of self-worth - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - How does a patient correctly use a walker? • Adjust to pt. height, assess safety, stability, and stamina • Do not pull self up with walker, push off chair/bed to stand up • If walker has brake, apply it before standing • Look up when walking • Pick up walker: lift and move it forward with each step • Rolling walker: roll forward and walk automatically • Walk into the walker, supporting weight on hands when moving forward • Gain balance, then move walker forward (lift or roll) again. What is important to teach when teaching a patient how to walk with a walker? How will a nurse know if the teaching was affective? • Learning proper methods for sitting, sit to stand, and going up/down (if applicable) stairs What is necessary to consider before transferring a patient who has had a stroke from a bed (or a chair) to a wheelchair? • Give consistent instructions b/w nurse and PT• A transfer/sliding board may be used to assist pt from bed/chair to wheelchair, but be wary of shear, and do not have fingers under board (may get crushed) • Lock both bed and wheelchair before transfer • Remove footrests and detachable arms to make entrance/exit from chair easier What are the steps for transferring a patient from a bed (or chair) to a wheelchair? • Above steps • Support and gently assist pt. during position changes and protect them from injury • Avoid pulling on weak/paralyzed upper extremity to prevent dislocation • Assist pt. to move toward stronger side • Bed in lowest position, raise head to sitting position or as high as pt. can tolerate • Lock bed brakes and chair brakes (or secure if no brakes) • Encourage use of stand-assist device and have pt. sit up on side of bed, swing - - - - - - - - - - - - - - - - - - - - - - - - - - to ischemia How does immobility affect elimination?• Decreased bladder and sphincter tone result in poor urinary control and urinary stasis • Those with catheters lose bladder tone as it is not being stretched • Inactivity decreases GI motility and muscle tone • Adequate tone in abs, diaphragm, and perineal muscles is essential for ease of defacation What nursing interventions can help a patient who is immobile and constipated? • Medications that promote peristalsis (cathartics and laxatives) How does immobility affect comfort? • Swelling of lower extremities, dyspnea, contractures, skin breakdown, incontinence, constipation How does immobility influence functional ability? • Weakened muscles, joint contractures, and deformity are common problems • Nurse should assess pt. mobility and design care that promotes independent mobility within the prescribed therapeutic limits What safety concerns are associated with mobility? • Fall risk • Proper positioning to prevent musculoskeletal complications How is a Hip Fracture diagnosed? • Common type of fracture that can occur as result of a fall• Bone densitometry used to evaluate bone mineral density (BMD) • Dualenergy x-ray absorptiometry (DXA/DEXA) measures BMD and predicts fracture risk What are safety interventions a nurse may implement for a patient with a hip fracture? • Handle affected area gently • Apply Buck’s traction if prescribed or a trochanter rol; • Use pain-modifying strategies (modify environment, administer pain analgesics as needed, encourage pt. to use pain relief measures to relieve pain, evaluate pt’s response to meds and other pain reduction techniques) • Position for comfort and function • Assist with frequent position changes What is the definition of Disuse Syndrome? • a problem with immobile patients that can lead to multisystem problems • deterioration of body systems as a result of prescribed/unavoidable musculoskeletal inactivity What are nursing interventions for a patient with Joint Replacement? • Pain modifying techniques • Notify surgeon about persistent pain What is degenerative joint disease? • Aka osteoarthritisWhat is the definition of Osteoarthritis? • Non-inflammatory degenerative disorder of the joings What are the common symptoms for a patient with arthritis? What should a nurse assess for when a patient has arthritis? • Symptoms: pain, stiffness, and functional impairment • Pain aggravated by movement/exercise and relieved by rest • Morning stiffness is brief and lasts less than 30 min • X-rays show narrowing of joint space, osteophyte formation, and dense, thickened subchondral bone What is crepitus and how does it relate to osteoarthritis? • Grating/crackling sound/sensation when bone fragments rub against each other What is the definition of Osteoporosis? • Chronic, progressive, metabolic bone disease characterized by: porous bone, low bone mass, structural deterioration of bone tissue, increased bone fragility What is a realistic goal for a patient who has osteoporosis? • Change diet to increase calcium and vitamin D intake • Exercise implementation to increase bone mass/density • Avoid smoking/alcohol if applicableWhat activities are helpful for patients with osteoporosis? • Weight-bearing exercise, walking, stairs, dancing Why is early ambulation after a surgery important for a post op patient? • Increase blood flow (O2 and nutrient circulation) How are patients evaluated for the risk of falling? • Identify behaviors/factors that affect fall risks • Monitor gait, balance, and fatigue level with ambulation • - - - - - - -