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mobility =
the ability to move freely
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body mechanics =
the efficient use of the body as a machine as a means of locomotion
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recommend amount of weight to lift
no more than 35 pounds
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if body alignment and posture is correct
there is no undue strain on joints, muscles, tendons, ligaments
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what should you use to pull a pt up in the bed
maxi slide
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postural =
pertaining to the posture or body postitions
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mobility affects the cardiovascular sys
- increasing efficiency
- increase blood flow to body
- decrease HR
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immobility effects on cardiovascular system
- increased cardiac workload
- increased HR
- orthostatic hypotension
- dependent edema (whatever area lowest on body)
- DVT
- embolus
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how often should you assess respiratory system status of immobile client
every 2 hours
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mobility affects respiratory system by
increasing pulmonary function
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no pitting edema =
swelling but no pitting
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to control edema you can elevate leg how much
6 inches above the heart
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monitor edema by
measure circumference of leg daily
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if you have a pt. without ted hose, and cannot get out of bed what should you have them do
exercise legs in bed
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immobility effects on pulmonary system
- decreased ventilation
- increased secretions - hypostatic pneumonia
- decreased depth and rate
- atelectasis
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pulled secretions in lungs can casue
hydrostatic pneumonia
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atelectasis =
alveoli collapse due to build up of secretion
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supine position affects diameter of airway how
narrows it due to mucus
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mobility effects of musculoskeletal sys
- increased mucle strength
- increased flexibility
- icreased tone
- increased joint mobility
- increased coordination
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immonbility effects on musculoskeletal sys
- decreased size, tone, strength
- decreased mobility and flexibility (contrctures, footdrop)
- bone demineralization
- limited endurance
- footdrop
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footdrop =
plantar flexion
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what happens to calcium in bone when persons are immobile for too long
moves from bone to blood stream
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effects mobility to metabolic system
- increased efficiency whcih leds to increased function
- increased body heat
- increased elimination of waste products
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immobility effects on metabolic system
- decreased metabolic rate
- altered metabolism of carbs, fats and proteins
- fluid and electrolyte imbalances
- GI disturbances
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mobility effects GI
- increased appetite
- increased intestinal tone ---> improved digestion and elimination
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immobility effects on GI
- changes in apptite
- poor digestion
- poor utilization of food
- constipation
- impaction
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mobility effects on urinary system
- increase circulation to kidney
- increased excretion of body wates
- increased efficiency of aicd/base balance
- improved urinary flow from bladder
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immobility effects of urinary system
- • increased risk of UTI
- • increased risk of renal calculi
- • decreased bladder tone
- • Hypercalcemia
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mobility assessment =
- general ease of movement
- gait and posture
- alignment
- joint structures and function
- muscle mass, tone, strength
- endurance
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mobility effects on skin
healthy skin
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immobility effects on skin =
pressure ulcers
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immobility diagnosis for Cardio
- Activity Intolerance: Increased cardiac workload
- Altered Tissue Perfusion: Thrombus formation
- Risk for Injury: Orthostatic Hypotension
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repiratory system mobility diagnosis =
- ineffective breathing pattern
- ineffective airway clearance
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immobility musculoskeletal diagnosis
- self care deficit r/t
- impaired physical mobility r/t
- risk for injury r/t
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mobility diagnosis metabolic =
- Activity Intolerance: Increased cardiac workload
- Altered Tissue Perfusion: Thrombus formation
- Risk for Injury: Orthostatic Hypotension
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GI immobility diagnosis
constipation
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diagnosis immobility urinary system
risk for infection
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implementation of metabolic system outcomes
- encourage high calorie high protin diet
- vitamins
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implementation for respiratory mobility
- cough and deep breath
- incentive spirometer
- chest physiotherapy
- encourage fluids
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chest physiotherapy
cupping hands and breaking up secretions
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implementation cardiovascular mobility
- prevention of orthostatic hypotension - early mobility, dangle legs
- discourage valsalva manuver - bearing down
- prevent thrombus
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prevent a thrombus =
- leg exercises
- heparin
- compression devices OOB when possible
- TED hose
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implementation musculoskeletal mobility
- active and passive ROM
- proper transfers
- proper use of assistive devices
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implementation integumentry system
prevent ulcers -position changes, good skin care, pressure relieving devices
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turning schedule =
every two hours
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prevent uti and kidney stones =
2-3 liters of fluid daily
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how can the nurse effect pt psychosocial in regards to mobility
- involve in care
- provide socialization
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restraint is
any device that limits a pt movement
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some dangers of restraints =
- suffocation
- impaired circulation
- altered skin integrity
- decreased muscle and bone mass
- fractures
- altered nutrtion and hydration
- aspiration
- incontinence
- pneumonia
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alternatives to restraints
- • Assess for Pain
- • Involve family in care
- • Decrease noise
- • Use night light
- • Decrease hazards
- • Disoriented clients near station
- • Allow to walk
- • Orient family
- • Maintain bed in low position
- • Toilet frequently
- • Encourage exercise
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what do you ahve to document in regards to using restraints
- document why pt restrained
- document alternatives to restraints
- observation Q 60 minutes
- release restraint Q 2 hours
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to use restrints must have physcian order every
24 hours
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appropriate to restrain when
you or pt in danger
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