Activity, Exercise, Restraints, and Orthopedic Care Flashcards

Comprehensive practice flashcards covering activity, exercise, physical positioning, body mechanics, immobility complications, restraints, and orthopedic care.

What initial nursing assessments and alternative measures should be explored before applying restraints to a client?

The nurse must assess for underlying reasons for the client's behavior (e.g., pain, need to use the restroom, environmental confusion) and consider alternative non-restraint interventions, such as reorienting the client or moving them closer to the nurses' station.

What are the administrative and regulatory requirements for restraint orders, consents, and reassessments?

Restraints require a provider's order renewed every $24\,\text{hours}$, written and signed consent from the client or POA/next of kin within $24\,\text{hours}$, reevaluation of need within $4\,\text{hours}$ of application, release and toileting/incontinence checks every $2\,\text{hours}$ (or PRN), and documentation at least every $2\,\text{hours}$. PRN restraint orders are prohibited.

What safety precautions must be maintained when applying and monitoring physical restraints?

Restraints must be attached to the bed frame (never side rails), fitted so $2\,\text{fingers}$ fit underneath, monitored for skin breakdown every $2\,\text{hours}$, and never used for discipline or staff convenience. Continuous audio and visual monitoring is required for seclusion.

What are the Six "P"s of Compartment Syndrome?

Pain, Pallor (the first sign of a cast being too tight), Paresthesia, Paralysis, Poikilothermia, and Pulselessness.

What is the critical window for complete tissue necrosis in Compartment Syndrome, and what immediate interventions are required?

Complete tissue necrosis occurs after $6\,\text{hours}$. Immediate interventions include placing the affected limb at the level of the heart and immediately removing any constricting casts or bandages.

How do Plaster of Paris casts and Fiberglass casts differ in drying time and handling?

Plaster of Paris casts begin drying within $10\,\text{minutes}$ but take up to $48\,\text{hours}$ to fully dry, must never get wet, and must be handled with the pads of the hands (not fingertips) to prevent cracking. Fiberglass casts are lighter, dry faster, and can be used with waterproof liners.

What nursing care actions are indicated for client cast care and swelling reduction?

Elevate the extremity at the level of the heart, apply ice around the cast, check capillary refill and extremity temperature (a hot/warm cast indicates infection), avoid putting powders, lotions, or oils inside the cast, pad rough edges, and use a hair dryer on a cool setting for itching.

What protocol should be followed for sprains or strains, and in which direction should compression bandages be applied?

Follow the RICE protocol (Rest, Ice, Compression, Elevation). Compression bandages should always be wrapped upwards toward the heart to promote venous circulation.

What positioning device is required for a client lying down following a total hip replacement?

An abduction pillow positioned between the legs to maintain hip abduction and prevent adduction/dislocation.

What are the four basic elements of normal body movement?

Body alignment (posture), joint mobility, balance, and coordinated movement.

How do the center of gravity, line of gravity, and base of support interact to maintain standing alignment?

An individual maintains balance as long as the line of gravity (an imaginary vertical line through the body's center of gravity) passes directly through the center of gravity and the base of support.

According to the principles of body mechanics shown, how does the position of the line of gravity relative to the base of support dictate stability?

Stability is greatest when the line of gravity falls close to the center of the base of support (A). Balance becomes precarious when the line of gravity moves to the edge of the base of support (B), and balance is lost entirely when the line of gravity falls outside the base of support (C).

Why do inactive clients tend to develop flexor joint contractures?

Flexor muscles are stronger than extensor muscles. When an individual is inactive, joints are pulled into a flexed (bent) position, leading to permanent muscle shortening and joint contracture if uncorrected.

What is proprioception?

The awareness of posture, movement, and changes in equilibrium, along with knowledge of position, weight, and resistance of objects in relation to the body.

Which structures of the central nervous system control voluntary motor activity, coordination, and posture?

The cerebral cortex initiates voluntary motor activity, the cerebellum coordinates movement motor activities, and the basal ganglia maintain posture.

How do isotonic, isometric, and isokinetic exercises differ?

Isotonic (dynamic) exercises involve muscle shortening and active movement; Isometric (static) exercises involve muscle contraction without changing joint angle or muscle length; Isokinetic (resistive) exercises involve muscle contraction against resistance provided by specialized machines.

How is a client's target heart rate range calculated for exercise intensity?

Calculate maximum heart rate by subtracting age in years from $220$, then multiply the maximum heart rate by $60\%$ to $85\%$ to find the target heart rate range.

On the Borg scale of perceived exertion, what rating corresponds to the recommended target level for most exercising individuals?

A rating of $13/20$ ("somewhat hard"), which corresponds to approximately $75\%$ of maximum heart rate.

What are the primary cardiovascular complications associated with prolonged immobility?

Diminished cardiac reserve, increased use of the Valsalva maneuver, orthostatic hypotension, venous vasodilation and stasis, dependent edema, and thrombus or embolus formation.

What respiratory complications result from static secretions and decreased chest expansion in immobile clients?

Pooling of secretions in dependent lung areas, atelectasis (collapse of a lobe or entire lung due to mucous blockage and reduced surfactant), and hypostatic pneumonia.

How does immobility impact protein metabolism and nitrogen balance?

Immobility causes catabolic processes (protein breakdown) to exceed anabolic processes (protein synthesis), leading to catabolized muscle mass, excessive nitrogen excretion, and a negative nitrogen balance.

Why are immobile clients in a supine position at increased risk for urinary stasis and renal calculi?

In a supine position, gravity impedes complete urinary bladder and renal pelvis emptying. Excessive calcium extracted from demineralized bones accumulates in stagnant, alkaline urine, causing calcium salts to precipitate into renal calculi (stones).

What is the maximum manual lifting weight limit recommended for a nurse without using assistive equipment?

$35\,\text{lb}$ ($15.9\,\text{kg}$). If a client handling task requires lifting more than $35\,\text{lb}$ of the client's weight, the client is considered fully dependent and assistive equipment must be used.

What upper body elevation angles define Fowler's, Semi-Fowler's, and High-Fowler's bed positions?

Fowler's position involves elevation at $45^\circ$ ($45^\circ \text{ to } 60^\circ$); Semi-Fowler's (low Fowler's) involves elevation at $15^\circ \text{ to } 45^\circ$ (typically $30^\circ$); High-Fowler's involves elevation at $60^\circ \text{ to } 90^\circ$ (sitting upright).

What unique advantage and specific disadvantages are associated with placing a client in the prone position?

Advantage: It is the only bed position that allows full extension of hip and knee joints, helping prevent flexion contractures. Disadvantages: Produces marked lumbar lordosis, lateral neck rotation, plantar flexion of feet, and restriction of chest expansion.

What is logrolling, and how many caregivers are required to perform the procedure safely?

Logrolling is a transfer technique used to turn a client while keeping their entire body in straight alignment (like a log), commonly used after spinal surgery or injury. It requires at least $2 \text{ to } 3$ caregivers (with one dedicated to maintaining head and neck alignment if a cervical injury exists).

When transferring a client who has an injured lower extremity from a bed to a wheelchair, on which side of the client should the wheelchair be placed?

On the client's unaffected (strong) side, allowing the client to use the strong leg muscles most effectively during the pivot.

What limb support techniques are depicted for performing passive range-of-motion (ROM) exercises?

Cupping (A), where the joint is supported in the palm of the hand, and Cradling (B), where the client's limb is supported along the nurse's forearm.

What type of cane is illustrated, and what advantage does it provide over a standard cane?

A quad cane, which has four feet and provides the maximum amount of base support and stability compared to standard straight-legged or tripod canes.

How are axillary crutches measured for correct standing height and handpiece position?

The crutch shoulder rest must be $3\,\text{fingerwidths}$ ($2.5 \text{ to } 5\,\text{cm}$ or $1 \text{ to } 2\,\text{in}$) below the axilla when standing tripod position. Handpiece placement should allow an elbow flexion angle of approximately $30^\circ$.

What are the dimensions and configuration of the Tripod Position for crutch stance?

Crutches are placed about $15\,\text{cm}$ ($6\,\text{in}$) in front of the feet and $15\,\text{cm}$ ($6\,\text{in}$) laterally out to the sides, forming a wide triangular base of support.

What are the step-by-step actions for a client climbing stairs using axillary crutches as shown?

1. Assume tripod position at the bottom of stairs. 2. Transfer weight to crutches and move the unaffected (strong) leg up onto the step. 3. Transfer weight to the unaffected leg on the step and bring the crutches and affected leg up to the step.

Which composite muscle group connects the spine and pelvis to the femur to enable hip flexion and upright posture?

The iliopsoas muscle group, which is a blending of the psoas (originating on lumbar vertebrae) and iliacus (originating on pelvic crest) muscles attaching to the femur.