1. Chapter 23 Mobility

2. Introduction Benefits of regular activity
Multiple health problems can be avoided with maintenance of an active state
Maintaining physical activity can be a challenge in late life
Effects of aging
Common chronic health conditions
Nursing interventions

3. Effects of Aging on Musculoskeletal Function
Decline in size and number of muscle fibers, and reduction in muscle mass
Decreased body strength
Endurance declines
Connective tissue changes
Reduced flexibility of joints and muscles

4. Effects of Aging on Musculoskeletal Function (cont.)
Sarcopenia
Age-related reduction of muscle mass or function resulting from a reduction in protein synthesis and an increase in muscle protein degeneration
Can lead to disability
Causes
Psychosocial factors impacting activity

5. Musculoskeletal Health Promotion
Promotion of physical exercise
Education related to importance
All exercise programs should address:
Cardiovascular endurance
Flexibility
Strength training

6. Musculoskeletal Health Promotion (cont.)
Health assessment includes:
Quality of exercise
Quantity of exercise
Review desirable exercise goals and strategies

7. Question Is the following statement true or false?
Key elements of strength training are resistance and progression.

8. Answer
True
Rationale: Key elements of strength training are resistance and progression. Resistance is achieved by lifting weights and the use of weight machines and isometric exercises or the use of one’s own body weight through calisthenics.
Progression involves increasing the workload on the muscles, such as by lifting heavier weights.

9. Calculating Maximum and Target Heart Rates
Maximum heart rate = 220 − age
Target heart rate = maximum heart rate × 75%
Target heart rate range = 65% to 80% of maximum heart rate
(Commercial heart rate monitors, available at sports supplies stores, can provide feedback on heart rate during exercise without the inconvenience of having to stop to palpate the pulse.)

10. Musculoskeletal Health Promotion
Exercise programs
Benefits
Need for adjustments based on age
Age-related changes affect a person’s ability to exercise
Importance of assessment prior to starting a program and monitoring status during physical activity

11. Musculoskeletal Health Promotion (cont.)
Match individuals’ interests and needs
Range of options should be considered
Enhance physical activity during daily routines
Pace exercise throughout the day
Begin gradually and increase over time
Rest after activity

12. Question
Which of the following age-related changes warrants adjustments in exercise programs for the older adult?
Increased stroke volume
Increased resistance to blood flow
Decreased residual capacity of the lungs
Proportionate decrease in body fat

13. Answer B. Increased resistance to blood flow
Rationale: The increased resistance to blood flow may result in higher systolic blood pressure during exercise. A decreased stroke volume makes it difficult to increase the cardiac response necessary for exercise. An increased residual capacity of the lungs may limit air movement and effect respiratory function during exercise. An increase in body fat causes heat to dissipate less effectively which increases susceptibility to heat stroke.

14. The Mind–Body Connection
Cognitive and emotional states can influence physical activity
Inactivity and ill effects of immobility
Positive effects on mood and cognition
Individualized activities
Therapeutic recreation

15. Prevention of Inactivity
Inactivity can result in deconditioning
Need to compensate for age-related changes
Public education is crucial
Education for family caregivers
Creativity in suggesting stimulating pastimes results in increased movement

16. Promotion of Activity Enhance motivation by demonstrating interest
Community resources
Arranging transportation to and from activities
Assessment of capacities, limitations, interests, and abilities
Avoid stereotyping

17. Promotion of Good Nutrition
Recognize the importance of good nutrition
Well-balanced diet helps maintain the structure of bones and muscles
Calcium
Both quality and quantity are important
Obesity places strain on the joints
Weight reduction

18. Question Is the following statement true or false?
Choosing an exercise program for an older adult can be achieved by identifying common activities that older adults enjoy and implementing a program based on your findings from the literature.

19. Answer
False
Rationale: An older adult’s unique capacities and limitations, as well as interests, will dictate appropriate activities for that individual. Stereotyping older adults by assuming they all enjoy exactly the same activities violates the underlying principles of individualized care and limits the opportunities available for older persons.

20. Selected Musculoskeletal Conditions
Discomfort, disability, deformity, and functional impairment result from musculoskeletal disorders
Assessment of musculoskeletal system and functional abilities
Prevention
Aggressive intervention to minimize the impact of functional impairment

21. Fractures Risk factors and potential causes Common sites
Brittle bones fracture more easily and heal at a slower rate
Potential for complications associated with immobility
Interventions aimed at prevention

22. Fractures (cont.)
Fracture should be suspected when an older adult falls or has trauma to their bones
Signs and symptoms
Assessment of a potential fracture
The absence of typical signs of fracture does not guarantee no fracture present
Immobility of the injured site

23. Fractures (cont.) Nursing observation essential
Nursing interventions to prevent complications after a fracture
Older adults heal more slowly
Explanation and reassurance essential

24. Question
Which of the following fractures is/are common in older adults as a result of a fall?
Neck of the femur
Colles’ fracture
Vertebral fracture
All of the above

25. Answer D. All of the above
Rationale: The neck of the femur is a common site for fractures in older people, especially in women, and most fractures result from falls. Colles’ fracture (radius) occurs when attempting to stop a fall with an outstretched hand. Older adults are at risk for compression fractures or the vertebrae, resulting from falls or lifting heavy objects.

26. Osteoarthritis
Progressive deterioration of joint cartilage with the formation of new bone at the joint surface
Incidence
Pathophysiology
Causes
Signs and symptoms
Treatment/management
Nursing interventions

27. Rheumatoid Arthritis Incidence/prevalence
Deformities and disability begin at an early age and peak during middle age
Pathophysiology
Causes
Signs and symptoms
Treatment/management
Nursing interventions

28. Question Is the following statement true or false?
Systemic symptoms often accompany osteoarthritis.

29. Answer
False
Rationale: Systemic symptoms are not common in persons with osteoarthritis.
Systemic symptoms of rheumatoid arthritis are more common and include fatigue, malaise, weakness, weight loss, wasting, fever, and anemia.

30. Osteoporosis Most prevalent metabolic disease of the bone Incidence
Risk factors:
Inactivity or immobility
Diseases
Reduction in anabolic sex hormones
Diet
Drugs

31. Osteoporosis (cont.) May cause kyphosis, spinal pain, and fractures
Often asymptomatic
Diagnosis
Bone density
Treatment/management
Nursing interventions

32. Gout
Metabolic disorder in which excess uric acid accumulates in the blood
Pathophysiology
Signs and symptoms
Exacerbations and remissions
Treatment/management
Nursing interventions

33. Question
Which of the following diets is encouraged for those who have the diagnosis of gout?
High calorie
High protein
Low carbohydrate
Low purine

34. Answer
D. Low purine
Rationale: Dietary treatment for gout aims to reduce sodium urate through a low-purine diet which means avoidance of bacon, turkey, veal, liver, kidney, brain, anchovies, sardines, herring, smelt, mackerel, salmon, and legumes.
Alcohol should also be avoided because it increases uric acid production and reduces uric acid excretion.

35. Podiatric Conditions Foot problems are a common occurrence Incidence
Impact on mobility and dependence
Podogeriatrics
Referral to podiatrist necessary for treatment
Education related to proper foot care
Nursing interventions

36. Podiatric Conditions (cont.)
Common conditions:
Calluses (plantar keratoses)
Corns (heloma)
Bunions (hallux valgus)
Hammer toe (digiti flexus)
Plantar fasciitis
Infections (onychomycosis; tinea pedis)
Ingrown nails (onychocryptosis)

37. Nursing Considerations for Musculoskeletal Conditions
Managing pain
Degenerative changes cause joint pain
Cramps
Unrelieved pain affects independence and quality of life
Nursing interventions to decrease pain essential in promoting optimal physical, mental, and social function

38. Nursing Considerations for Musculoskeletal Conditions (cont.)
Preventing injury
Safety interventions essential
Promoting independence
Impact on physical, emotional, and social well- being
Interventions