Chapter 18

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Author:
SummerC
ID:
258220
Filename:
Chapter 18
Updated:
2014-01-24 15:34:40
Tags:
fundamentals nursing
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Description:
positioning, lifting, and moving
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  1. Four types of bones
    • short
    • long
    • flat
    • irregular
  2. joint
    a union of two or more bones; moves freely
  3. bursa
    a small fluid like sac that provides a cushion at friction points in the joints
  4. Skeletal muscle
    striated muscle surrounded by a connective tissue sheath
  5. Tendon
    fibrous tissue that connects muscle to bone
  6. Ligament
    connects bone to cartilage
  7. Cartilage
    Fibrous connective tissue; acts as a cushion
  8. Functions of bones
    • provides a scaffolding to support the body
    • give shape to the body and support the internal organs
    • provides places for ligaments and tendons to attach to facilitate movement
    • joints allow movement and flexibility of the skeleton
  9. Functions of Muscles
    • can stretch; can be stimulated to contract electrically or to extend elastically
    • provide movement
    • stabilize joints
    • produce heat
    • maintain posture
  10. changes occuring with age
    • bone mass loss leading to osteoporosis (always more sever in women)
    • loss of bone density predisposes the elderly to fractures
    • muscle cells lost and replaced with fat cells
    • elasticity of muscle fibers is decreased, limiting flexibility
    • joint motion may decrease, limiting motion and mobility
  11. body mechanics
    • use it or lose it
    • meaning inactivity leads to deterioration
  12. Disuse syndrome
    common in bedbound, neromuscular disease,cva, head injury
  13. Signs and symptoms of disuse syndrome
    atrophy of the muscles, decreased circulation, breakdown of the skin, contractures and foot drop
  14. Contractures
    shirtening and drawing up of the muscles can be permanent
  15. Ergonomics
    promotes comfort safety and health in the work place
  16. Two main principles for alignment of patients
    • maintain correct anatomical postioning
    • change positions frequently
  17. hazards of improper alignment
    • poor circulation
    • pressure ulcers
    • muscle cramps
    • possible contractures
    • fluid collection in lungs
  18. Lordosis
    sway back/curve of lumbar spine
  19. Kyphosis
    humpback of the thoracic spine
  20. effects of inactivity
    • muscles- weakness,decreased tone, mass and strength, atrophy and stiffness of joints
    • Skeletal- poor posture contractures, foot drop, osteoporosis, and fractures
    • cardiovascular- decreased circulation,increased clots, edema, more MI, CHF and CVA
  21. Respiratory
    less efficient resp., more secretions, more atelectasis, and pneumonia
  22. Urinary
    decreased output, UTI's, more kidney stones and incontinenece
  23. Gastrointestinal
    constipation, decreased peristalsis, hemmorroids, and indigestion
  24. Integumentary
    more skin break down, dryer
  25. CNS
    increased pain perception, sleep pattern disturbances, increased depression
  26. Metabolic/Endocrine
    less efficient calorie. less efficient use of insulin and unstable blood sugar,
  27. When does the metabolism usually slow down?
    with age and can gain the same amount of weight off the same amount of food
  28. Base of support
    center of gravity, widen your stance for more stability
  29. Mobility
    MS movement originates in the joint
  30. Tendons
    attach muscle to bone
  31. ligaments
    attach bone to bone, muscle to muscle,and support organs
  32. plegia (Paralysis)
    little or no purposeful movement (hemi and quad) They will have more skin issues on the injured side
  33. spastic
    overstimulation of the muscle with uncontrolled movement as in Muscular Dystrophy
  34. Flaccid
    too little stimulation, decreased or no muscle toneas in CVA, head or cord injury
  35. Pressure Ulcers
    • also know as decubitis ulcers, or bedsores
    • occurs when pressure on the skin causes an area of local tissue necrosis(breakdown)
    • on bony prominence or surface
    • shearing may occur
  36. Nursing Diagnosis for Problems of body movement
    • risk for injury
    • impaired physical mobility
    • risk for impaired skin integrity
    • impaired walking
  37. Planning
    • decide about patients positioning and delegate talk to assistant
    • plans made for home setting as well
  38. Goals and Expected outcomes
    • patient will experience no musculoskeletal injury
    • formal level of mobility after 6 months
    • skin integrity intact while patient is on bed rest
    • no injury while ambulating
    • ROM exercise passive or active several times of day
  39. Supine
    patient lying on her back
  40. Fowlers position
    HOB 60 to 90
  41. Semi-fowlers
    HOB 30 to 60
  42. Low Fowlers
    HOB 15 to 30
  43. Dorsal rucumbent
    supine with knees up and feet flat on the bed
  44. Dorsal Lithotomy
    feet in stirrups
  45. Patient lying on their side
    alleviates pressure on bony prominence of the back
  46. Oblique side lying
    • removes pressure from shoulder or hip
    • easier for patients
  47. Sims position
    • a variation of side lying used for rectal exams 
    • \insertion of tubes or suppositories
  48. Common positions and variations:
    Prone
    • patient lying face down
    • often used for pts. with spinal cord injuries
    • not tolerated well
  49. Knee chest position
    • on all fours
    • also used for rectal exams

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