B249 - Activity & Exercise and Safety
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What federal body release ergonomic standards to prevent musculoskeletal injuries in the workplace?
Occupational Safety and Health Administration
What is the action plan for moving a client?
1) arrange for adequate help ( a lift team); use client handling equipment and devices (height adjustable beds, ceiling mounted lifts, etc.); encourage client to assist as much as possible
2) keep back, head, neck, pelvis aligned and avoid twisting (reduces the risk to the lumbar vertebrae and muscle groups).
- 3) flex knees, keep feet wide apart;
- position self close to client and use arms and legs (not back)
4) slide client toward yourself using a pull sheet or slide board. when transferring a client onto a stretcher or bed, a slide board is more appropriate
5) person with the heaviest load coordinates efforts of team involved by counting to three
6) perform manual lifting as a last resort AND only if the lifting does not involve lifting most or all of the client's weight
If a client is unable to participate in active ROM exercises, what is the nurse to do?
The nurse must maintain joint mobility and preventing contractures by performing passive ROM exercises into the plan of care.
* remember bodys are made for movement*
When a client is in acute care, how does a nurse promote body movement?
A nurse is to encourage a client to stretch and use isometric exercises.
The client should increase repetitions as strength improves.
The client should be encouraged to stretch the muscle groups used for walking until the client becomes ambulatory.
What is the easiest intervention to maintain or improve joint mobility for clients?
The ROM exercise.
* If joints aren't moved, overtime the joint may become fixed in one position and the client uses normal use of the joint. *
What is a CPM machine and why would someone use this machine?
CPM or continuous passive motion machines are mainly used postoperatively and usually after a joint replacement surgery.
These machines are used to place joints in a selective repetitive range of motion.
Unless otherwise noted, exercises should include exercising each joint to as close to a full range of motion as possible.
How can a nurse determine the type of assitance one needs to walk?
The nurse must assess the client's activity tolerance, strength, coordination and balance.
Who is at a higher risk for orthostatic hypertension?
Someone who is older, on bedrest, diabetes mellitus, immobilized clients and those with cardiovascular disease.
What are the signs of orthostatic hypertension?
dizziness, light headedness, nausea, tachycardia, pallor and even fainting.
What is the proceedure when the client is failing while using the gait belt?
If the client starts falling, the nurse should:
assume a wide rane of support with one foot in front of the other;
extend one leg and let the client slide against the leg and gently lower the client to the floor, protecting the client's head.
What is the walking proceedure for the use of the walker?
The client holds the hand grips on the walker, takes a step and then moves the walker forward and then takes another step.
What is a clients cane length?
The cane length of a client is the distance from the greater trochanter and the floor.
What type of client would use a single straight-legged cane?
A client that has decreased leg strength. Used for balance and support.
What is the walking proceedure for the use of a cane?
The client should keep the cane on the stronger side of the body.
- The client then places the cane forward (6-10 inches), keeping the body weight on both legs;
- the weaker leg is then moved forward so that the body weight is divided between the cane and the stronger leg; then the stronger leg is advanced past the cane.
What type of person would use the quadcane?
This type of cane is used when the client has partial or complete leg paralysis or some lemiplegia.
You would use the same proceedure as with the single legged cane/
What are the three measurements when fitting a client for crutches?
angle of elbow flexion,
- and the distance between the crutch and
- the axilla
Why is it extremely important that the crutch be 3 to 4 fingers width from the axilla and that the axilla not support the client's body weight?
If the axilla is supporting the clients' body weight, that increases the risk of pressure on the underlying nerves and can cause damage to the nerves.
Explain the four point gait in crutch walking?
The four point stance gives stability to the client, BUT requires weight bearing on both legs.
Each leg is moved alternatively with each opposing crutch.
Remember, everyone starts in the tripod position.
Explain the three point crutch gait?
This gait requires the client to place all of the weight on one foot (the univolved leg).
The affected leg never leaves the ground in the early phase of the three point gait. Gradually the client should progress to touchdown and full weight bearing on the affected leg.
Explain theh two point crutch gait?
The two point crutch gait is at least partial weight bearing on each foot.
The client will move the crutch at the same time as the opposing leg. Similar to arm motion of normal walking.
Which crutch gait is used when stair walking?
The modified three point gait.
What is the proceedure when sitting in the chair with crutches?
The client should hold both crutches in the hand oppostie the affect leg (if a parapalegic, the crutches are held in the hand of the stronger side);
with crutches in both hands, the client supports weight with the crutch and the unaffected leg;
while holding the crutches in one hand, the client grasps the arm of the chair with the remaining hand;
and lowers the body into the chair.
To stand the proceedure is reversed.
What are the three types of preventable medical errors that cause 60% of deaths in the hospital?
infection of the client after surgery;
and failure to diagnose and treat in time
What is the error that is not apart of the 60%, but is relevant in the hospital setting?
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