Fundamentals of Nursing Chapter 44

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sisterbarley
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Fundamentals of Nursing Chapter 44
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2012-11-01 02:29:20
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Activity Exercise Disorders Musculoskeletal System
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Activity and Exercise Flashcards, Chapter 44, Week 10
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  1. What are the four basic elements of normal movement?
    • Body alignment (posture)
    • Joint mobility
    • Balance
    • Coordinated movement
  2. Define proper body alignment and posture
    • Brings body parts into position that promotes optimal balance and body function
    • Person maintains balance as long as line of gravity passes through center of gravity and base of support
  3. What is the key to balance?
    Posture
  4. Define Range of Motion (ROM)
    The maximum movement possible for a joint
  5. ROM varies and is determined by what factors?
    • Genetic makeup (double jointed, etc.)
    • Developmental patterns (baby can put foot in mouth)
    • Presence or absence of disease
    • Physical activity
  6. What are the two types of ROM that can be done?
    • Passive
    • Active
  7. ROM can be done via __a__ and __b__.
    • a. timing
    • b. repetition
  8. Define active ROM
    Patient performs the motion 
  9. Define passive ROM
    Nurse performs the motion for the client
  10. Define flexion
    • Decreasing the angle of the joint 
    • Example: bending the elbow
  11. Define extension
    • Increasing the angle of the joint
    • Example: straightening the arm at the elbow
  12. Define hyperextension
    • Further extension or straightening of a joint
    • Example: bending the head backward
  13. Define abduction
    Movement of the bone away from the midline of the body
  14. Define adduction
    • Movement of the bone toward the midline of the body
    • NOTE: Add-uction
  15. Define rotation
    Movement of the bone around its central axis
  16. Define circumduction
    Movement of the distal part of the bone in a circle while the proximal end remains fixed
  17. Define eversion
    Turning the sole of the foot outward by moving the ankle joint
  18. Define inversion
    Turning the sole of the foot inward by moving the ankle joint
  19. Define pronation
    Moving the bones of the forearm so that the palm of the hand faces downward when held in front of the body
  20. Define supination
    Moving the bones of the forearm so that the palm of the hand faces upward when held in front of the body
  21. What is involved with keeping the body in balance?
    • Complex mechanisms
    • Proprioception
    •  - Awareness of posture, movement, changes in equalibrium
    •  - Knowledge of position, weight, resistance of objects in relation to body
  22. What is involved with keeping the body in coordinated movement?
    • Balanced, smooth, purposeful movement
    • Result of proper functioning of the cerebral cortex, cerebellum, basal ganglia
  23. Define isotonic (dynamic) exercise
    • Muscle shortens to produce muscle contraction and active movement
    • Increase muscle tone, mass, and strength
    • Maintain joint flexibility and circulation
    • HR and CO quicken increase
    • Includes: Acitivities of daily living (ADL), Active ROM, Walking, Jogging, Swimming
  24. Define isometric (static or sitting) exercise
    • Muscle contraction without moving the joint (muscle length does not change)
    • Involve exerting pressure against a solid object
    • Produce a mild increase in HR and CO
    • No apparent increase in blood flow to other parts of the body
  25. Define isokinetic (resistive) exercise
    • Muscle contraction or tension against resistance
    • Can either be isotonic or isometric
    • Person moves (isotonic) or tenses (isometric) against resistance
    • an increase in blood pressure and blood flow to muscles occurs
    • Includes: weight lifting or machines with weight for resistance
  26. Define aerobic exercise
    • Activity during which the amount of oxygen taken in the body is greater than that used to perform the activity
    • Improve cardiovascular conditioning and physical fitness
    • NOTE: should be able to talk when exercising
  27. Define anaerobic exercise
    • Activity in which the muscles cannot draw enough oxygen from the bloodstream
    • Anaerobic pathways are used to provide additional energy for a short time
    • Used in endurance training for athletes
    • Includes: Marathon runners or sprint for a brief time to elevate HR
  28. What are the five types of exercise?
    • Isotonic (dynamic) exercise
    • Isometric (static or sitting) exercise
    • Isokinetic (resistive) exercise
    • Aerobic exercise
    • Anaerobic exercise
  29. What is another name for Planter Flexor Contractor?
    Foot drop
  30. What can help prevent foot drop?
    • Footboards
    • Sneakers
  31. What is the effect of exercise on the musculoskeletal system?
    • Maintain: Size, shape, tone, and strength of muscles (heart muscle, too)
    • Nourish: Joints
    • Increase: Joint flexibility, stability, and ROM
    • Maintain: Bone density and strength
  32. What is the effect of exercise on the cardiovascular system?
    • Increases: HR, strength of contraction, and blood supply to the heart and muscles
    • Mediates: Harmful effects of stress
  33. What is the effect of exercise on the respiratory system?
    • Increases: Ventilation and oxygen intake, improving gas exchange
    • Prevents: Pooling of secretions in the bronchi and bronchioles
  34. What is the effect of exercise on the metabolic system?
    • Elevates: The metabolic rate
    • Decreases: Serum triglycerides and cholesterol
    • Stabilizes: Blood sugar and makes cells more responsive to insulin
    • Increases: Caloric use
  35. What is the effect of exercise on the urinary system?
    • Promotes blood flow to the kidneys, causing body wastes to be excreted more effectively
    • Prevents stasis (stagnation) of urine in the bladder
  36. What is the effect of exercise on the GI system?
    • Inproves: Appetite
    • Increases: GI tract tone
    • Facilitates: Peristalsis
  37. What is the effect of exercise on the immune system?
    • Pumps: Lymph fluid from tissues into lymph capillaries and vessels
    • Increases: Circulation through lymph nodes
    • NOTE: Strenuous exercise may reduce immune function, thus, too much exercise can have the opposite effect
  38. What is the effect of exercise on the psychoneurologic  system?
    • Elevates: Mood
    • Relieves: Stress and anxiety (giving a better quality of sleep)
    • Improves: Quality of sleep for most individuals
  39. What is the effect of exercise on the cognitive system?
    • Positive effects on: Decision-making and problem solving processes, planning, and paying attention
    • Induces cells in the brain to: Strengthen and build neuronal connections
  40. What is the effect of immobility on the musculoskeletal system?
    • Disuse esteoporosis
    • Disuse atrophy
    • Contractures
    • Stiffness and pain in the joints
  41. What is the effect of immobility on the cardiovascular system?
    • Diminished cardiac reserve (HR increases with minimal exersion)
    • Increased use of the valsalva maneuver 
    • Orthostatic hypotension
    • Venous vasodilation and stasis
    • Dependent edema
    • Thrombus formation
  42. What is the effect of immobility on the respiratory system?
    • Decreased respiratory movement
    • Pooling of respiratory secretions
    • Atelectasis
    • Hypostatic pneumonia
  43. Define Atelectasis
    Absence of air in the lungs, due to secretions decreasing the lung volume
  44. Define Hypostatic pneumonia
    Infection in dependent portion of lungs due to decrease in ventalation in that area
  45. What is the effect of immobility on the metabolic system?
    • Decreased metabolic rate
    • Negative nitrogen balance
    • Anorexia
    • Negative calcium balance
  46. Define what a negative nitrogen balance is.
    A condition in which nitrogen output exceeds nitrogen intake, resulting in the body's need to draw on its own stores of protein for energy; may be caused by dietary imbalances, illness, infection, anxiety, or stress.
  47. Define what a negative calcium balance is.
    The result of an increase in calcium extrated from the bones, which cannot be replaced quick enough
  48. What is the effect of immobility on the urinary system?
    • Urinary statis 
    • Renal calculi (Calcium, salts, cholesterol)
    • Urinary retention
    • Urinary infection (not able to empty the bladder completely = UTI)
  49. What causes urinary stasis?
    May be caused by abnormalities in structure or innervation of the urinary outflow tract that result in incomplete emptying of the bladder or pooling of urine in diverticula. Important in the etiology of cystitis.
  50. What is the effect of immobility on the GI system?
    Constipation
  51. What is the effect of immobility on the psychoneurologic system?
    • Decline in mood elevating substances
    • perception of time intervals deteriorates
    • Problem-solving and decision-making abilities may deteriorate
    • Loss of control over events can cause anxiety
  52. Describe what happens with venous vasodilation and stasis.
    • Skeletal muscles don't contract, which leads to muscle atrophy, decreased assistance in pumping the blood back to the heart
    • Blood pools and the vein valves no longer work properly, which causes edema, thrombus (blood clots)
  53. Describe a form of exercise that can help with spiritual health.
    Some people believe that Yoga-style exercise improves the mind-body-spirit connection, relationship with God, and physical well-being
  54. Describe the effects of immobility on the integumentary system.
    • Reduced skin turgor
    • Skin breakdown
  55. Describe a labyrinth
    It is generally synonymous with maze, but many contemporary scholars observe a distinction between the two: maze refers to a complex branching (multicursal) puzzle with choices of path and direction; while a single-path (unicursal) labyrinth has only a single, non-branching path, which leads to the center. A labyrinth in this sense has an unambiguous route to the center and back and is not designed to be difficult to navigate.
  56. What are some factors that affect the body alignment and activity
    • Growth and development
    • Nutrition
    • Personal values and attitudes
    • Prescribed limitations
    • External factors
  57. What would be involved in the NURSING ASSESSMENT in regard to body alignment and activity?
    • Nursing History
    • Physical Examination
  58. What would the nurse look for, during the physical assessment, in regard to body alignment and activity?
    • Body alignment
    • Gait
    • Appearance and movement of joints
    • Capabilities and limitations for movement
    • Muscle mass and strength
    • Activity tolerance
    • Problems related to immobility
    • Physical fitness
  59. What would be involved in the NURSING DIAGNOSES in regard to activity and exercise problems?
    • Activity Intolerance
    • Risk for Activity Intolerance
    • Impaired Physical Mobility
    • Sedentary Lifestyle
    • Risk for Disuse Syndrome
  60. What would be involved in the NURSING DIAGNOSIS when impaired physical mobility becomes the etiology?
    • Fear (of falling)
    • Ineffective Coping
    • Low Self-Esteem
    • Powerlessness
    • Risk for Falls
    • Self-Care Deficit
  61. What would be involved in the NURSING DIAGNOSIS in regard to prolonged immobility?
    • Ineffective Airway Clearance
    • Risk for Infection
    • Risk for Injury
    • Risk for Disturbed Sleep Pattern
    • Risk for Situational Low Self-Esteem
  62. What would be involved in the NURSING PLANNING in regard to activity or exercise problems and/or prolonged immobility?
    • Activity tolerance
    • Body positioning
    • Bowel elimination
    • Fall prevention behavior
    • Immobility consequences both physiological and psychocognitive
    • Joint movement
    • Mobility
    • Respiratory status
    • Ventilation and gas exchange
    • Self-care
    • Sleep
    • Stress level
    • Weight control
    • Increased tolerance for physical activity
    • Restored or improved capability to ambulate and/or participate in ADL's
    • Absence of injury from falling or improper use of body mechanics
    • Enhanced physical fitness
    • Absence of any complications associated with immobility
    • Improved social, emotional, and intellectual well-being
    • NOTE: Remember to make these specific to your patient, measurable, and time oriented (be realistic)
  63. What would be involved in the NURSING INTERVENTIONS in regard to activity or exercise problems and/or prolonged immobility?
    • Maintain or promote bady alignment and mobility
    • Positioning clients appropriately
    • Moving and turning clients in bed
    • Trasferring clients
    • Providing ROM exercises
    • Ambulating clients with or without mechanical aids
    • Strategies to prevent complications of immobility
  64. Define body mechanics
    • Used to describe the efficient, coordinated, and safe use of the body to move objects and carry out ADL's
    • Support "no manual lift" and "no solo lift"
    • NOTE: Nurses must PUSH for policies that keep them safe!
  65. How can you greatly enhance body balance?
    • Widening the base of support
    • Lowering the center of gravity, bringing it to the base of support
  66. How many people should you have (at least) when moving a patient with a hoyer lift?
    At a minimum two (2)
  67. Define the fowler's position and pillow placement
    • 45-60 degree angle
    • Pillow placement is under the thighs, legs (knee to ankle) and under arms (at the elbows)
  68. Define the semi-fowler's position and pillow placement
    • 15-45 degree angle
    • Pillow placement is under legs (knees to ankle) and under small of back
  69. Define the high fowler's position
    60-90 degree angle
  70. Define orthopneic
    Unable to breathe while lying down
  71. What is another word for the supine position?
    Dorsal Recumbant
  72. What is another word for the dorsal recumbant position?
    Supine position
  73. Define the supine or dorsal recumbant position and pillow placement
    • Positioning the client on their back
    • Pillows are placed under the small of the back and under the legs (knee to ankle)
  74. Define the prone position and pillow placement
    • Positioning the client on their stomach
    • Pillows are placed under the head (unless contraindicated due to promotion of mucous drainage from mouth) stomach and legs (knee to ankle)
  75. Define the lateral position and pillow placement
    • Positioning the client on their side with the top leg bent
    • Pillows are placed between legs (at the knee), head to promose good alignment and at the stomach/chest for top arm to rest on
  76. Define the sims position and pillow placement
    • Positioning the client on their stomach/side, with one leg bent and the arm on the same side as the unbent leg is placed behind them, while the top arm is facing forward
    • Pillows are placed under the bent leg (knee to ankle), under the head (unless contraindicated for mucous drainage from the mouth), and under the forward facing arm
  77. What is the point of a footboard?
    Prevents foot drop or contracture
  78. What should a nurse be concerned about or do, prior to moving or turning the client, while they are in bed?
    • Before moving, assess!
    • If indicated, use pain relief modalities
    • Prepare any needed assistive devices
    • Plan around encumbrances
    • Be alert to the effects of any medications
    • Obtain required assistance
    • Explain the procedure to the client
    • Raise the height of the bed
    • Lock the wheels
  79. How can the nurse protect themselves, when moving or turning a client in the bed?
    • Face the direction of the movement
    • Assume a broad stance
    • Lean your trunk forward, flex your hips, knees, and ankles
    • Tighten your muscles
    • Rock from front leg to back leg when pulling
    • Rock from bck leg to front leg when pushing
  80. What will the nurse determine and document prior to, and after, the patient has been moved or turned in the bed?
    • Client's comfort
    • Body alignment
    • Tolerance of the activity
    • Ability to assist
    • Use of support devices
    • Safety precautions required
  81. What are the general guidelines for transferring a client?
    • Plan what to do and how to do it
    • Obtain esential equipment before starting 
    • Remove obstacles
    • Explain transfer to client and assistive personnel
    • Support or hold client rather than equipment
    • Explain what client should do
    • Make written plan, including client's tolerance
  82. What are the general guidelines for ambulating?
    • Assess the amount of assistance the client will require
    • Assess for signs and symptoms of orthostantic hypotension
    • Prepare client for ambultion
    • Apply transfer or walking belt
    • Physically support client
    • Obtain assistance to follow with wheelchair or assist with physical support
    • Teach client to correctly use mechanical aids
  83. How does active ROM work?
    • Isotonic exercises
    • Moves each joint in the body
    • Maximally stretching all muscle groups
  84. How does passive ROM work?
    • Another person moves each joint (the nurse)
    • Maximally stretching all muscle groups
    • Useful in maintaining joint flexibility
  85. What are the guidelines for providing passive ROM?
    • Cover body with a bath blanket
    • Use correct body mechanics
    • Position bed at appropriate height
    • Expose only the limb being exercised
    • Support clients limb above and below the joint
    • Use a firm comfortable grip
    • Move body parts smoothly, slowly, and rhythmically
    • Avoid moving or forcing body part beyond the existing range of motion
    • If muscle spasticity occurs, stop
    • If contractures are present, apply slow firm pressure
    • If rigidity occurs, press against rigidity
    • Timing and repetition
  86. How would you teach a patient to use a cane?
    • Hold cane with the hand on the stronger side of the body
    • Position the tip of the cane about 15cm to the side and 15cm in front of the near foot so that the elbow is slightly flexed
    • Maximum support:
    •  - Move the cane and leg forward at same time
    •  - Move stronger leg forward
    •  - Move the unaffected (stronger) leg forward ahead of the cane
    • As you become stronger:
    •  - Move the cane and leg forward at the same time
    •  - Move stronger leg forward
  87. How would you teach a patient to use a walker?
    • When maximum support is required:
    •  - Move the walker ahead (body weight is borne on both legs)
    •  - Move the right foot up to the walker (Body weight is borne by left leg and both arms)
    •  - Move the left foot up to the right foot (Body weight is borne by right leg and both arms)
    • If one leg is weaker than the other
    •  - Move the walker and the weaker leg ahead together (Weight is borne by the stronger leg)
    •  - Move the stronger leg ahead (Weight is borne by the affected leg and both arms)
  88. What will the nurse look for when assessing the client for crutches?
    • Ability to take steps
    • Ability to bear weight and keep balance
    • Ability to hold body erect
    • Ability to get into and out of chairs safely
    • Ability to go up and down stairs safely
  89. What are the various gaits for an individual using crutches?
    • Crutch Stance (Tripod position)
    • Four-Point Alternate Gait
    • Three-Point Gait
    • Two-Point Alternative Gait
    • Swing-to Gait
    • Swing-through Gait
  90. How do you teach a client to get into a chair, when they are using crutches?
    • Stand with back of the unaffected leg centered against the chair
    • Transfer crutches to the hand of the affected side
    • Grasp the arm of the chair with the unaffected side
    • Lean forward, flex the knees and hips, and lower into the chair
  91. How do you teach a client to get out of chair, when they are using crutches?
    • Move forward to edge of the chair
    • Place unaffected leg slightly under or at teh edge of the chair
    • Grasp the crutches by the hand bars in the hand of the affected side
    • Grasp the arm of the chair by the hand on the unaffected side
    • Push down on the crutches and the chair armrest while elevating the body out of the chair
    • Assume tripod position before moving
  92. How do you teach a client, on crutches, to go up the stairs?
    • Assume tripod position at bottom of stairs
    • Transfer weight to the crutches
    • Move the unaffected leg onto the step
    • Transfer body to the unaffected leg on the step
    • Move the crutches and affected leg up to the step
    • The affected leg is always supported by the crutches
    • Repeat until top of stairs
  93. How do you teach a client, on crutches, to go down the stairs?
    • Assume tripod position
    • Shift weight to unaffected leg
    • Move crutches and affected leg down onto next step
    • Transfer body weight to crutches
    • Move unaffected leg to that step
    • Teh affected leg is always supported by the crutches
    • Repeat until the bottom of stairs
  94. What is involved with the NURSING ASSESSMENT for individuals who have activity or exercise problems?
    • The goals established during the planning phase are evaluated according to specific desired outcomes.
    • If outcomes not achieved, the nurse, client, and support person, if appropriate, need to explore the reasons before modifying the care plan
  95. What position is this?
    Fowler's
  96. What postion is this?
    Lateral
  97. What position is this?
    Prone
  98. What position is this?
    Semi-fowler's
  99. What position is this?
    Sims
  100. What position is this?
    Supine or Dorsal Recumbant
  101. What are these used for?
    • To prevent foot drop or contracture
    • NOTE: a foot board can also be used
  102. How do you hold a arm when doing ROM?
    • Support the elbow 
  103. How do you hold a leg when doing ROM?
    • Support the knee
  104. How do you hold a foot when doing ROM?
    • Support the ankle
  105. Assess these feet . . . What is wrong with them?
    What could have been done to prevent it?
    • Foot drop or Contracture
    • Foam boots or a foot board could have been used
  106. What type of exercise is this?
    Isokinetic
  107. What type of exercise is this?
    Isometric
  108. What type of exercise is this?
    Isotonic
  109. What is this and what is it used for?
    • A labyrinth
    • An intricate structure of interconnecting passages, which can be used to ease stress by walking the paths
  110. What does this picture describe?
    Incorrect posture when lifting
  111. What does this picture describe?
    Proper posture, when lifting
  112. What type of lift is this?
    Ceiling mounted lift
  113. What type of lift is this?
    What is wrong with this picture?
    • Hoyer Lift
    • At least two healthcare workers should be available when moving a client with this device, as it has a tendency to "swing" the patient
  114. What type of lift is this?
    Sit to stand lift
  115. If you are ambulating a patient, what should you use?
    • A gait belt
  116. If you are ambulating a client and they start to fall, what should you do?
    • Guide (lower) them to the floor
    • Using your thigh, if necessary to slow the fall
  117. What is a good way to place a patient on their side?
    • Using the transfer sheet, do a log roll
    • 1. Pull the patient to the opposite side that you want them to lay on.



    • 2. One healthcare worker goes to the other side and pulls the sheet to "roll" the patient

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