Nur 122

• Reduces 0₂ demand
• directs resourses toward healing
• may reduce pain

Bedrest can kill your patient!!!!

• ↓Muscle strength
• ↓Muscle mass
• disuse osteoporsis- Ca extracted from bone = brittle & break
• fibrosis → contractions

• Observe for joint stifness
• coordination
• ROM
• Labs: serum: protein, Ca (higher) urine: Ca (spilling out)

• Aligment: specific turning schedule
• weight bearing
• indep ADL's
• AROM and PROM
• meds: calcium
• Diet

Warm and dry

• The increased pressure in the thoracic cavity reduces the amount of blood flowing into the thoracic cavity, especially in the veins leading to the right atrium of the heart.
• The maneuver can also cause cause blood clots to detach, bleeding, irregular heart rhythms and cardiac arrest.Many of the heart attacks which occur in bathrooms have been linked to the Valsalva Maneuver, which in turn, is closely associated with sitting toilets...

is swelling (inflammation) of a vein caused by a blood clot.

• General weakness
• disrupted ANS ↑heart rate (0.5 bpm/day)
• ↓diastolic pressure coronary blood flow cardiac ability to respond to demands
• Basically- tachy and pain with slight exertion
• Valsalva Maneuver
• ortho hypotension ( Body does not respond ↓B/P)
• thrombophlebitis

• Heart rate
• Narrowed pulse pressure ( not widening)
• Edema (↓ venous return)
• Skim temp
• Clots
• Chest pain, pressure
• B/P

• Teach not to do the Valsalva Maneuver
• TEDS (Anti embolism stockings and medical support stockings.)
• Good leg positioning
• Meds: anticogulants, stool softners, anti-htpn's

Heart Burn

Arm = MI's or Clot's

• Chest movement impaired→ abdominal organs move↑ →difficult expansion
• Pt doesn't sigh (pt doesn't get air out since they are laying down to long)
• Joints get fixed
• ↓Blood flow to lungs, esp dependant areas + ↓
• cough+ weak cilia ➞atelectasis (is the collapse of part or (much less commonly) all of a lung) and pneumonia (cilia don't move like they have to)

• Listen!!!! Diminshed breath sounds, wheezing (narrowed airway)
• Cough (good)
• Temp
• Pulse ox/ Blood gas (sign of life look at color)

• Deep breathe and cough (you want them to do this)
• Turn, turn, Turn!!!
• Meds: expectorants (thin the mucus that blocks the air tubes leading to the lungs), No cough meds! Bronchodialators (is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lungs), ? suctioning
• Fluids (clear water & tea)

• ↓BMR (not moving)
• ↓GI mobility
• ↓Digestive scretions and then they're not hungry!

• Weight loss (little muscle tone)
• Nutrition
• Labs:↓serum protein ↑serum Ca↑BUN
• slow wound healing

• ↑protein↑calories↑fiber easy to chew and swallo
• may need enteral or parenteral support
• Food they like!
• Meds: appetite stimulants (magaze), supplements, pleasant meal time environment

• Initial diuresis→↑excretion Na excretion
• unable to empty bladder →stasis (stopping of the normal flow)
• stasis compromised by ↓muscle tone
• ↑serum Ca→urine more alkaline crystals→ calculi (15-30%)
• Incontinence/retention/ overflow
• static urine →↑bacterial growth→↑UTI's

• I&O
• urine appearance
• frequency, urgency, pain
• Labs: ↑Spe gravity, BUN, Hct, Urine pH, bacateria, WBC's, cultures

• Turn turn turn
• Push clear fluids-cranberry juice
• perineal hygiene
• good environment
• answer lights
• cath is a last resort

• ↓peristalsis
• ↓Motility
• contracted anal sphincter
• disruption of habits/ bedpan
• water extracted from stool →hard, dry, impaction

• Bowel patterns
• bowels sounds
• general malaise (feeling discomfort)
• temp ( ↑when constipated)

• Exercise
• turn turn turn
• position and privacy
• fluids(caffine, water, prune juice)
• ↑fiber and fruit
• meds: only as last resort Laxatives

If it has eschar can't stage until its debrided.

• Skin trophies
• decreased turgpr
• basic problem is pressure sores
• aka decubiti, bedsore

def: reddened areas, open sores or ulcers usually occuring over bony prominences

• caused by: interupton of blood circulation to tissues
• localized ischemia
• tissue caught between 2 hard surfaces
• cells dprived of 0₂ & nutrients
• cellular waste accumulates tissue dies

• 1. Pressure -perpendicular force (↓↑) highest pressure in sarcrum, buttocks, and heels. Pressure →skin turns white→if relieved→reactive hyperemia last 1/2-3/4 as long as the pressure.
• If redness disapperas in that time, no damage.

2. Forces parallel to skin(↔) abrades the skins, removes superficial layers increase risk of breakdown.

3. comination of pressue and friction seen with smi-fowlers seen if sliding rather that lifting.

• intact reddened
• non-blanching

• Break in epidermis
• blister, abrasion
• surrounding red
• serous drainage (clear or bleeding)

• Break thru dermis and sub q
• serous or purulent drainage
• progresses rapidly

• breaks into: fascia, muscle, bone
• Drainage, osteo, sepsis

• Mositure
• hygiene
• nutrition
• hard support
• body heat
• anemia
• mobility
• poor lifting
• poor position
• injections
• hard support surfaces
• incorrect applications of devices

• Skin turgor
• edema
• redness
• labs: H&H
• temp

• Turn turn turn-all positions every 2 hrs
• bed making
• HOB ↑< 30º
• clean and dry
• bony prominences
• better to prevent than to treat

• More gradual and subtle
• ↑dependance feeling of worthlessness, hopelessness and empitness
• ↓intellectual abilities, ability to concentrate, coping mechanism.
• May have financial concerns, work concerns
• Changes in sexuality and role performance
• May be evidence by hosility, confusion, belligience, withdrawal, apathy and anxiety

More gradual and subtle ↑dependance feeling of worthlessness, hopelessness and empitness↓intellectual abilities, ability to concentrate, coping mechanism. May have financial concerns, work concerns Changes in sexuality and role performanceMay be evidence by hosility, confusion, belligience, withdrawal, apathy and anxiety

• Social stimulation
• consistency
• involve significant others
• encourage ADL's
• appearance, won clothes
• Sleep
• Intellectual stimulation
• hobbies