Mobility+Lecture+SP+2025+-+Students

MOBILITY

• Definition: Ability to move or be moved freely and easily, essential for daily activities.

• Factors Affecting Mobility: Physical conditions such as musculoskeletal injuries, degenerative diseases, aging.

• Importance in Nursing: Nurses assess, maintain, and improve patients' mobility, addressing underlying health concerns and quality of life issues.

LEARNING OBJECTIVES

• Differentiate between strains, sprains, & dislocations.

• Identify clinical manifestations, treatment modalities, complications, and rehabilitation needs of common fractures.

• Describe nursing management and health education for patients with casts, splints, braces, or in traction.

• Utilize the nursing process for adult patients with hip fractures or knee injuries.

• Recognize sports and occupation-related musculoskeletal disorders, their signs/symptoms, and treatments.

• Describe site actions, indications, pharmacokinetics, contraindications, adverse reactions, and drug-drug interactions for:

  • Anti-inflammatory agents

  • Bisphosphonates

  • Muscle Relaxants

  • Opiates.

• Outline nursing considerations and patient teaching needs for each class mentioned.

NCLEX TEST PLAN

• Management of Care

• Safety and Infection Control

• Health Promotion and Maintenance

• Psychosocial Integrity

• Basic Care and Comfort

• Pharmacology

• Reduction of Risk

• Physiological Adaptation

REVIEW OF THE SKELETAL SYSTEM PHYSIOLOGY

1. Number of Bones: Adult human skeleton consists of 206 bones for structural support, protection, and mobility.

2. Joints: Connections between bones allowing a wide range of motion.

3. Growth & Development: Bone growth primarily occurs during childhood and adolescence, peaking in early adulthood.

4. Bone Remodeling: Continuous process of bone resorption and formation, ensuring strength and adaptation to stress.

FUNCTIONS OF THE SKELETAL SYSTEM

• Framework: Supports the body, maintaining its weight-bearing and upright structure.

• Support: Maintains the shape/form of the body by supporting surrounding tissues like muscles and organs.

• Movement: Assists through muscle attachment and joint formation, enabling motion.

• Protection: Shields vital organs like the brain, heart, and lungs from injury.

DYNAMIC NATURE OF BONES

• Bone Remodeling: Process of constant remodeling and adaptation throughout life.

• Peak Bone Mass: Achieved during puberty; critical for future bone health.

• Bone Loss: Increases with age, heightening fracture risk. Importance of calcium, exercise, and vitamin D for health.

MUSCULOSKELETAL SYSTEM PHYSIOLOGICAL CHANGES IN THE ELDERLY

• Increased Bone Resorption: Leads to osteoporosis and higher fracture risk.

• Decreased Bone Density: Loss of muscle mass/strength affects mobility and balance.

• Joint Stiffness and Pain: Due to cartilage degeneration and inflammation.

• Reduced Flexibility: Impacting overall movement restrictions.

EXEMPLARS: MOBILITY ISSUES

• Fractures (Hip): Common in elderly post-fall; types include comminuted, displaced, and non-displaced.

• Joint Replacement (Hip and Knee): Surgical replacements due to arthritis.

• Sprains, Strains, and Dislocations: Definitions and differences in injuries to ligaments and muscles.

CLINICAL PRESENTATIONS OF FRACTURES

• Fractures: Pain, swelling, bruising, deformity, limited motion, inability to bear weight.

• Sprains: Pain, swelling, bruising, joint movement difficulty.

• Strains: Pain, spasms, swelling, weakness in muscles or tendons.

• Dislocations: Deformity, pain, loss of function.

CAUSES OF FRACTURES

• Trauma from falls, accidents, sports injuries.

• Osteoporosis or weakened bone structure.

• Overuse/repetitive stress injuries (stress fractures).

• Diseases impacting bone integrity (e.g., cancer).

TYPES OF FRACTURES

• Simple (Closed): Bone breaks without puncturing skin.

• Compound (Open): Bone breaks and pierces skin; higher risk of infection.

• Comminuted: Bone shatters into multiple pieces.

• Displaced: Bone fragments misaligned.

• Greenstick: Partial fracture, typically in children.

• Transverse: Straight break across bone.

• Spiral: Twisting break from rotational forces.

COMPOUND VS. COMPLEX FRACTURES

• Compound (Open): High infection risk; requires immediate surgical intervention.

• Complex (Comminuted): Shattered bone, significant surrounding damage; may require advanced surgery.

MANIFESTATIONS OF FRACTURE

• Acute pain, loss of function, deformity, shortening of the extremity, crepitus, swelling, and discoloration. Typically diagnosed through symptoms and radiography.

EMERGENCY MANAGEMENT OF FRACTURE

• Immobilization: Essential to prevent further injury; immobilize joints above and below the fracture.

• Assess Neurovascular Status: Important before and after splinting.

• Open Fracture: Cover with sterile dressing.

• Do Not Attempt to Reduce: Avoid manipulation of the fracture on site.

MEDICAL MANAGEMENT OF FRACTURE

• Fracture Reduction: Align fractured fragments via manipulation or traction.

  • Closed Reduction: Internal fixation holds fragments (pins, screws).

  • Open Reduction: External casting/splinting.

COMPLICATIONS OF FRACTURES

• Early Complications: Shock, fat embolism, compartment syndrome, VTE.

• Delayed Complications: Delayed union, malunion, nonunion, avascular necrosis, CRPS, heterotopic ossification.

SURGICAL PROCEDURES

• Hemiarthroplasty, meniscectomy, amputation, fasciotomy, open reduction internal fixation (ORIF), joint replacements.

CONTRAINDICATIONS TO SURGERY

• Active infections, rapidly progressing inflammation, osteoporosis, severe medical conditions (heart/lung issues).

HIP FRACTURES

• Initial Treatment: Immobilization, traction, reduction.

• Surgical Interventions: ORIF, hip replacement.

HIP REPLACEMENT POST-PROCEDURE

1. Leg Abduction: Maintained to prevent dislocation.

2. Pain Management: Key to patient comfort.

3. Early Mobilization: Encouraged to prevent complications.

4. Post-Op Education: Focus on precautions and rehabilitation goals.

PREVENTING DISLOCATION

• Focus on positioning, avoid excessive movements, use assistive devices like abduction pillows.

KNEE AND SHOULDER REPLACEMENTS

• Knee Replacement: Commonly for arthritis/trauma; involves prosthetic knee implant.

• Shoulder Replacement: Involves prosthetic implant for various shoulder conditions.

TOTAL KNEE REPLACEMENT

• Weight Bearing: Start with partial; avoid bending/twisting.

• Pain Management: Medications and wound care essential for recovery.

JOINT REPLACEMENT CARE

• Preoperative Care: Assessment, education, and prep.

• Postoperative Care: Focus on pain management, rehabilitation, and mobility exercises.

NURSING CARE & ASSESSMENT

• Monitor for infection, DVT, dislocation risks; assess mobility, pain levels, ADLs.

SPRAINS, STRAINS, AND DISLOCATIONS

• Sprains: Injury to ligaments.

• Strains: Injury to muscles/tendons.

• Dislocations: Bone displacement from joint position.

NURSING MANAGEMENT FOR STRAINS, SPRAINS, AND DISLOCATIONS

• Monitor for pain/inflammation, provide RICE education, assist with immobilization, and follow-up care.

DIAGNOSTIC TESTING

• IMAGERY: MRI, arthrography, electromyography, biopsy, and arthrocentesis.

NURSING INTERVENTIONS

• Pain management, neurovascular assessment, exercise promotion, nutrition, hydration, and improving mobility.

PREVENTION OF MOBILITY ISSUES

• Safe environment, weight management, fall risk assessment, proper warm-up before activities.

CLIENT EDUCATION

• Fractures: Educate on cast care, signs of complications, safe mobility techniques.

• Joint Replacements: Post-operative care, signs of complications, strength exercises.

• Sprains/Strains/Dislocations: R.I.C.E. method for recovery.

EDUCATION NEEDS OF PATIENTS WITH A CAST, BRACE, OR SPLINT

• Signs to report: persistent pain, changes in sensation, infection signs.

• Follow-up care necessary for cast removal and after care.

MEDICATION MANAGEMENT

• Pain Relief Medications: Opioids, NSAIDs, acetaminophen.

• Antibiotics: Post-surgery for joint replacement patients.

• Muscle Relaxants: For strains/sprains.

INTERPROFESSIONAL HEALTH CARE TEAM

• PTs assess functionality; OTs enhance functional independence; Nurses support rehabilitation.