Alterations in Mobility and Musculoskeletal Disorders Review

Course Overview and Incentives

  • Assessments: Includes ATI Swift River Simulations Homework (Clinical), ATI Concept-Based Level 4 with NGN Proctored 30 Assessment (Didactic), and Cumulative Final Exam Week 12 (Didactic).
  • Performance Incentive: Students achieving a Level 22 or higher in the proctored ATT RN Nursing Content-Based Proctored Exam can have their converted score replace their lowest unit test grade (not course grade).

Mobility Assessment and General Interventions

  • Stroke Recovery: Partner with Physical therapy to assist with mobility.
  • Assessment Strategy: Use nursing judgment to assess mobility by assisting the patient to stand; mobility level should be determined before transferring.
  • Acute Injury Protocol: For inflammation or ankle injuries, immobilize and apply ice for the first 48 hours48\,hours, then apply heat after the second 48 hours48\,hours.
  • Inpatient Activity: Encourage patients to get Out of Bed (OOB) during meals (morning, afternoon, evening, and snack time) to prevent risks associated with immobility.
  • Range of Motion (ROM): Use active or passive ROM to strengthen muscles, prevent contractures, and reduce demineralization in osteoporosis.
  • Chronic Prevention: Maintain good posture to strengthen the core and improve balance.

Musculoskeletal Pathophysiology

  • Synovial Joint Health: Synovial fluid lubricates joints. Synovitis involves edema in these joints, with pain and swelling typically increasing at night.
  • Fractures:
    • Stress Fracture: Caused by repeated injury or excessive exercise.
    • Open Fracture: Characterized by skin that is not intact; high risk for infection.
  • Surgical Procedures:
    • Laminectomy: Performed for conditions like spinal stenosis.
    • Fasciectomy: Required for Compartmental syndrome to address poor circulation.
  • Sprains: Involve injury to the tendons and ligaments.

Aging and Chronic Conditions

  • Osteoporosis: Caused by demineralization (cancellous and cortical loss). It frequently affects the Thoracic spine, leading to stiffness and pain that improves with movement.
  • Aging Factors: Loss of muscle mass (sarcopenia), loss of coordination, and reduced power to climb stairs. Fall risk is increased by orthostatic hypotension and decreased proprioception (spatial awareness).
  • Osteoarthritis (OA): Characterized by pain, stiffening, and crepitus.
  • Nutrition: Patients with degenerative diseases should consume a diet high in calcium, such as green leafy vegetables.

Specialized Populations

  • Amputation: Elderly patients can adjust to altered body image regardless of age; confusion may occur due to immobility.
  • Pediatric Cerebral Atrophy: Priorities include safety in the school setting, Physical therapy (PT), a dietician, and passive/active ROM.
  • Toddler Hip Dysplasia: Primarily affects the hips, resulting in limited ROM.

Questions & Discussion

  • Q: Who would you partner with to help with mobility in a patient who had a stroke?

  • A: Physical therapy.

  • Q: What diseases cause an elderly patient to need a Laminectomy?

  • A: Spinal stenosis.

  • Q: What is the nursing priority among a group of patients including those with pain, nausea, or an infiltrated IV?

  • A: The priority is the patient who fell to assess for injuries.

  • Q: What can you do as a nurse to help a patient maintain their calcium level?

  • A: Recommend a diet high in calcium, specifically green leafy vegetables.