Foundations Lecture 2

mobility

refers to the purposeful physical movement, including gross simple movements, fine complex movements and coordination

mobility is dependent on the synchronized efforts of the musculoskeletal and nervous systems as well as...

adequate oxygenation, perfusion, and cognition

mobility requires adequate...

energy, muscle strength, underlying skeletal stability, joint function and neuromuscular coordination to carry out the desired movement

immobility

inability to move

impaired physical mobility

describes a state in which a person has a limitation in physical movement but is not immobile

cardiovascular complications with immobility

occurs both with central and peripheral perfusion, a lack of physical activity results in reduced cardiac capacity, reduced force of cardiac contraction and a reduction in cardiac output, formation of blood clots

respiratory complications with immobility

reduced lung expansion and eventually leads to atelectasis and reduced capacity for gas exchange, pooling of respiratory secretions, coupled with a reduced cough effort, places the immobilized patient at risk for stasis pneumonia

musculoskeletal complications with immobility

significant reductions in muscle mass and atrophy, contracture in the joints, primarily as a result of muscle shortening the lack of weight bearing leads to bone demineralization and calcium loss from the skeletal system, osteoporosis can develop in response to immobility

integumentary complications with immobility

sustained pressure on the skin reduced perfusion to the tissues, a reduced flow of oxygenated blood cause hypoxemia of the tissues and increases the risk for skin breakdown, individuals who lack the ability move in bed have increased risk not only because of pressure but also because of shearing forces that often accompany certain positions or occuterm-8r during transfers, these problems are further exacerbated if the patient has a poor nutrional status and is incontinent, development of pressure ulcers commonly results

gastrointestinal complications with immobility

constipation, not being able to assume an optimal upright position makes having bowel movements more challenging, GI tract slows during states of immobility resulting in reduced peristaltic motility

urinary complications with immobility

bladder loses tone making it difficult to completely empty there bladder, often results in a UTI

fractures

a disruption or break in the continuity of the structure of bone, can be open (compound) or closed (simple)

open fracture (compound)

the skin is broken, exposing bone and causing soft tissue injury

closed fracture (simple)

the skin has not been ruptured and remains intact

complete fractures

the break is completely through the bone

incomplete fracture

fracture occurs partly across a bone shaft but the bone is still in one piece

displaced fractures

two ends of the broken bone are separated from one another and out of their normal positions (usually oblique or comminuted)

nondisplaced fractures

the periosteum is intact across the fracture and the bone is still in alignment (usually transverse, spiral or greenstick)

casts

a temporary circumferential immobilization device commonly used following a closed reduction, it is applied to an extremity and generally incorporates the joints above and below a fracture

pre op care

nurse should inform patients of the type of immobilization and assistive devices that will be used and the expected activity limitations after surgery, assurance that pain medication will be available, preoperative precautions

post op care

monitoring vital signs and applying general principles of postoperative nursing care, frequent neuromuscular assessments of the affected extremity are necessary to detect early and subtle changes, any limitations of movement or activity related to turning, positioning, and extremity support should be monitored closely, dressings or casts should be carefully observed

amputation

the removal of a body extremity by trauma or surgery

immobilizers

nonfunctional brace, provides protection and controls range of motion following orthopedic surgery, immobilizes joints while waiting for orthopedic surgery

common pressure areas

radial styloid, ulna styloid, olecranon, lateral epicondyle, lateral malleolus, tibial tuberosity

interventions for patients with casts or immobilizers

assess and maintain adequate neuromuscular status, assess Circulation, Sensation and Movement, five P's, notify physician at once of signs of compromise, elevate extremity to heart level, encourage movement of fingers or toes

Five P's

pain, paresthesia, pallor, pulse, paralysis

skeletal tractions are used to treat...

fractures, dislocations, and muscle spasms

halo tractions are used to treat...

cervical spine fractures

skin tractions are used to treat...

fractures, dislocations, and muscle spasms, it's also used to correct deformities and relieve pain.

traction must be...

continuous to be effective

weights are not removed unless...

intermittent traction is prescribed

the patients must be in good body alignment...

in the centre of the bed

weights must...

hang freely and not rest on the bed or floor

external fixators are used to treat...

used to manage open fractures with soft-tissue damage, provide support for complicated or comminuted fractures

external fixators discomfort...

is usually minimal and early mobility may be anticipated with these devices

nursing roles for external fixators

reassure patient concerned by appearance of device, elevate to reduce edema, monitor for signs and symptoms of complications including infection, provide pin care