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FUNDAMENTALS OF NURSING
LESSON 5 PROMOTING ACTIVITY AND MOBILITY
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HAZZARDS OF IMMOBILITY
DR. DIETRICK EXPERIMENT 1948 NURSES ARE LEGALLY AND MORALLY ACCOUNTABLE FOR DECREASING THE EFFECTS OF IMMOBILITY
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HAZZARDS OF IMMOBILITY MUSCULOSKELETAL SYSTEM
HYPERTROPHY—INCREASES IN SIZE WHEN USED ATROPHY—DECREASES IN SIZE WITH NON-USE
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HAZZARDS OF IMMOBILITY MUSCULOSKELETAL SYSTEM
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HAZZARDS OF IMMOBILITY MUSCULOSKELETAL SYSTEM
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HAZZARDS OF IMMOBILITY MUSCULOSKELETAL SYSTEM
Osteoporosis=loss of bone mass Pt’s need an increase in Ca and adequate activity to maintain bone strength
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HAZZARDS OF IMMOBILITY MUSCULOSKELETAL SYSTEM
Contractures: stiffness in JOINT caused by shortened muscle
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HAZZARDS OF IMMOBILITY MUSCULOSKELETAL SYSTEM
end stage renal disease patient
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HAZZARDS OF IMMOBILITY MUSCULOSKELETAL SYSTEM
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HAZZARDS OF IMMOBILITY GASTROINTESTINAL SYSTEM
NEGATIVE NITROGEN BALANCE ANOREXIA DECREASED PERISTALSIS
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HAZZARDS OF IMMOBILITY CARDOVASCULAR SYSTEM
ORTHOSTATIC HYPOTENSION HEART WORKS 30% HARDER THROMBUS FORMATION
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HAZZARDS OF IMMOBILITY RESPIRATORY SYSTEM
DECREASED RESPIRATORY MOVEMENT THICK AND STICKY LUNG SECRETIONS
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HAZZARDS OF IMMOBILITY URINARY SYSTEM
KIDNEY STONES INCREASED BLOOD CALCIUM INCREASED URINE pH UTI—KIDNEY INFECTION D/T STASIS OF URINE
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HAZZARDS OF IMMOBILITY SKIN
DECUBITUS ULCERS LATIN WORD FOR LYING DOWN, RECLINING
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HAZZARDS OF IMMOBILITY SKIN
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HAZZARDS OF IMMOBILITY SKIN
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HAZZARDS OF IMMOBILITY SKIN
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HAZZARDS OF IMMOBILITY SKIN
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HAZZARDS OF IMMOBILITY SKIN
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HAZZARDS OF IMMOBILITY NERVOUS SYSTEM
NERVE IMPAIRMENT—PRESSURE ON NERVE OR BLOOD SUPPLY DECREASED INTELLECTUAL AND SOCIAL ABILITIES DECREASED SPEED OF PERCEPTIONS AND REACTIONS INCREASED PAIN PERCEPTION
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HAZZARDS OF IMMOBILITY PSYCHOSOCIAL
DECREASED SELF CONCEPT DECREASED MOTIVATION DECREASED DRIVES INCREASED EMOTIONAL DISTURBANCES
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BODY MECHANICS BODY MECHANICS = USING THE BODY EFFICIENTLY AS A MACHINE A KEY FACTOR IN PROPER BODY MECHANICS IS MAINTAINING PROPER BODY ALIGNMENT
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PRINCIPLES OF BODY MECHANICS
ESTABLISH A WIDE BASE OF SUPPORT FOR BETTER STABILITY AND BALANCE
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PRINCIPLES OF BODY MECHANICS
MAINTAIN EQUILIBRIUM BEND OR FLEX THE KNEES USE LARGE MUSCLE GROUPS (FACE DIRECTION OF MOVEMENT) ADJUST THE WORK LEVEL. (LEVEL SURFACE=LESS WORK) CARRY OBJECTS CLOSE TO MIDLINE
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WHY USE PROPER BODY MECHANICS?
PREVENT STRAIN & INJURY TO PATIENT PREVENT STRAIN & INJURY TO YOU PATIENT SAFETY
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5 MOST COMMON INJURIES LIFTING PATIENT (50%)
HELPING PATIENT OUT OF BED (30%) MOVING A BED (8%) LIFTING PATIENT TO STRETCHER (7%) CARRYING EQUIPMENT (5%)
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PURPOSES FOR PROPERLY POSITIONING THE PATIENT
PRIMARY REASON: TO REDUCE PRESSURE ULCERS TO MAINTAIN BODY ALIGNMENT TO PROVIDE MOVEMENT FOR PATIENT—PROMOTE SKIN INTEGRITY TO PREVENT CONTRACTURES TO PREPARE PATIENT FOR PROCEDURE
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ACTIVITY AND MOBILITY ***THE NURSE SHOULD TURN AN INACTIVE PT EVERY 2 HOURS TO AVOID PRESSURE SORES (a great nurse will turn more often if time permits!!)
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BODY POSITIONS AS APPLIES TO NURSING INTERVENTIONS
DORSAL (SUPINE) FLAT ON BACK DORSAL RECUMBENT
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BODY POSITIONS AS APPLIES TO NURSING INTERVENTIONS
SEMI FOWLERS HOB AT 30° FOWLERS HOB AT 45-60° HIGH FOWLERS HOB AT 90° TRENDELENBERG
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BODY POSITIONS AS APPLIES TO NURSING INTERVENTIONS
ORTHOPNEIC: LITERALLY SITTING UP
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BODY POSITIONS AS APPLIES TO NURSING INTERVENTIONS
SIMS POSITION OF CHOICE FOR ENEMA OR RECTAL EXAM
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BODY POSITIONS AS APPLIES TO NURSING INTERVENTIONS
LATERAL SIDE-LYING
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BODY POSITIONS AS APPLIES TO NURSING INTERVENTIONS
RARELY USED EXCEPT LOWER EXTREMITY AMPUTATIONS P R O N E
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BODY POSITIONS AS APPLIES TO NURSING INTERVENTIONS
GENUPECTORAL LITHOTOMY
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RANGE OF MOTION DEFINED: THE MAXIMUM MOVEMENT THAT IS POSSIBLE FOR A JOINT INFLUENCED BY GENETIC INHERITANCE DISEASE NORMAL AMOUNT OF ACTIVITY INJURY DEVELOPMENTAL PATTERNS
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TYPES OF RANGE OF MOTION
ACTIVE—PATIENT PERFORMS INDEPENDENTLY PASSIVE—PERFORMED FOR PT BY NURSE OR PHYSICAL THERAPIST ACTIVE ASSISTED ISOMETRIC ISOTONIC CONTINUOUS PASSIVE MOTION—CPM MACHINE
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PURPOSES FOR RANGE OF MOTION
TO PREVENT CONTRACTURES TO RESTORE, INCREASE, OR MAINTAIN THE STRENGTH OF MUSCLES TO MAINTAIN OR INCREASE FLEXIBILITY OF JOINTS
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PURPOSES FOR RANGE OF MOTION
TO MAINTAIN OR PROMOTE THE GROWTH OF BONES THROUGH STRESS IF NOT STRESSED THEY BEGIN TO DECALCIFY TO IMPROVE FUNCTION OF OTHER BODY SYSTEMS (GI OR CV) HOSPITALIZATION DECREASES MOBILITY EVERY SYSTEM IS AT RISK OF IMPAIRMENT
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NURSE’S RESPONSIBILITY
ASSESS PATIENT’S LEVEL OF FUNCTION IF PARTIALLY IMMOBILE, ASSIST WITH ROM EXERCISES ASSESS NEED AND IMPLEMENT INTERVENTIONS TO PREVENT COMPLICATIONS ROM NEEDS TO BE STARTED EARLY TO PREVENT COMPLICATIONS
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ANGLES OF RANGE OF MOTION
INTERNAL ROTATION CIRCUMDUCTION SUPINATION PRONATION OPPOSITION INVERSION EXERSION FLEXION EXTENSION HYPEREXTENSION LATERAL FLEXION ROTATION ABDUCTION ADDUCTION EXTERNAL ROTATION
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PRINCIPLES OF PERFORMING ROM
MOVE FROM HEAD TO TOE SUPPORT THE JOINT CPM DOCUMENTATION DEFINITIONS
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TECHNIQUES FOR MOVING PATIENTS
PROPRIOCEPTION CHECK EQUIPMENT IV’S, FOLEYS, FEEDING TUBES, RESTRAINTS DON’T ATTEMPT >35% OF YOUR OWN BODY WEIGHT PROTECT SKIN PRESSURE, FRICTION, SHEARING PROTECT YOURSELF DANGLE PATIENT ORTHOSTATIC HYPOTENSION BEDREST HYPOVOLEMIA—DECREASED CIRCULATING BLOOD HYPOKALEMIA—LOW SERUM POTASSIUM MEDICATIONS
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TECHNIQUES FOR MOVING PATIENTS
LOSS OF SENSATION HEMIPLEGIA—ONE SIDED WEAKNESS OR PARALYSIS PARAPLEGIA—PARALYSIS OF LOWER LIMBS SPASTIC—SPASMS PARESIS—PARTIAL PARALYSIS PARALYSIS—LOSS OF MUSCLE FUNCTION OR LOSS OF SENSATION FLACCID—WEAK, SOFT, FLABBY, LOSS OF TONE QUADRIPLEGIA—LOSS IN ALL 4 LIMBS
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TECHNIQUES FOR MOVING PATIENTS
AMBULATING NORMAL WALKING POSITION IF FALLS: CALL FOR HELP ARMS AROUND WAIST, LOWER PT TO FLOOR SLOWLY STAY WITH PT UNTIL HELP ARRIVES HOYER LIFT LOG ROLL BED TO STETCHER
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INDICATIONS FOR PERFORMING ROM
PHYSICIAN ORDER IMMOBILITY MUSCLE ATROPHY OR WEAKNESS INJURY TO JOINT DISEASE PROCESSES
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DATA TO KNOW R/T ROM AND CPM
ASSESS THE PATIENT PAIN INCISION INFLAMMATION, DRAINAGE OTHER CHECK CPM MACHINE CORRECT FLEXION AND EXTENSION ALL PARTS OPERABLE SPEED CONTROL
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THE END
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