fund: chap 15.txt

Nurses

Musculoskeletal

Protect large muscles groups of injury and provides safety for patients when assisting with ambulation

• Musculoskeletal disorder
• Abbrev?

• This occurs when you are performing a task that requires you to exert yourself forcefully, perform repetitive movements, or maintain an awkward or static posture
• What occurs?

• This occurs when you twist and lift at the same time or move a pt without help from other personnel or an assistive device
• What occurs?

• This requires adequate staffing, right mix of personnel, and appropriate, readily available, well maintained patient lifting equiptment
• What does?

Making beds, assisting pt to ambulate, carrying supplies, lifting/carrying equipment, provide pt care, and carrying out other procedures

Helps minimized pain/injuries to musculoskeletal system

• Loss of feeling, movement, and strength
• What kind of injury causes this?

Lumbar muscle group strain (lower back) injury

• It affects ability to bend forward, backward, and side to side as well as rotate hips and lower back
• What affects this?

• Field of physiology that studies muscular actions and the functions of muscles in maintaining the posture of the body
• Term?

• Refers to the way we move our body � using good posture; maintain appropriate body alignment
• What refers to this?

• Refers to the relationship of various body parts to each other
• What refers to this?

• Maintaining appropriate body alignment is the key factor for this
• For what?

• Helps balance and helps coordinate movements smoothly and effectively
• What does?

• Spine is in a �neutral� or �resting� position
• What means this?

• They are vertically stacked, held together by a system of muscles and ligaments. They support alignment, allow movement, and protects the spinal cord and nerves
• What are?

• Absorb shock from the changing weight loads applied to the spine
• What does?

• Risk factors: Lifting with your back bowed out, behind and reaching with your back bowed out, slouched sitting, and jerking or twisting, lack of proper rest, obesity, loss of strength and flexibility, stressful living and working habits, smoking, and poor nutrition
• Risk factors for what?

• Position: chin is high and parallel to the floor, abdomen is tightened (internal girdle) in and up with gluteal muscles tuck in, and feet are spread apart for a broad base of support
• Position of what?

• Stance with feet slightly apart
• Term?

• Base of support provides this
• Provides what?

• should be about 1.5 times the length of ones shoes
• What should be?

• Skeletal muscles and the nervous system maintains this
• Maintains this?

• Avoid this so that there is no strain in the lower back
• Avoid what?

• Working at a height or level that is comfortable and easy helps this
• Helps what?

• Extreme or abnormal stretching
• Term?

• Widen your base of support in the direction of movement does this
• Does what?

• These muscles need to be contracted in and down
• What muscles?

• These muscles need to be contracted in and up
• Which muscles?

• Carry objects close to the midline of your body, avoid reaching too far, avoid lifting when other means of movement are available, use devices instead of or in combination with lifting, and use alternating periods of rest and activity
• Why do all this?

• Lying flat on the back
• What position?

• Supine position
• Also known as?

• Supine position with pt lying on back, head, and shoulder with extremities moderately flexed; legs are sometimes extended
• What position?

• Posture assumed by pt when head of bed is raised 45 to 60 degrees
• What position?

• Posture assumed by pt when head of bed is raised approximately 30 degrees
• What position?

• The posture assumed by the pt sitting up in the bed at 90 degree angle, or sometimes resting in forward tilt while supported by pillow on overbed table
• What position?

• Position in which the pt lies on side with knee and thigh drawn upward toward chest
• What position?

• This position is appropriate for enema procedure and administering a rectal suppository
• Term?

• Position: lying face down in horizontal position
• What position?

• Genupectoral position
• Also known as?

• Knee chest position where pt kneels so that weight of body is supported by knees and chest, with abdomen raised, head turned to one side, and arms flexed
• Position?

• Position: pt lies supine with hips and knees flexed and thighs abducted and roatted externally (sometimes feet are positioned in stirrups)
• What position?

• Should be 6-8 inches apart
• What should be?

• Flex them when standing
• Flex what?

Lift with legs

• Keep them close to body of midline
• Keep what? And when?

• Twice: Once mentally than physically
• For what?

• Don�t do: More than 35 % of your own body weight or more than 50 lbs
• What is that?

• Pts head is low and the body and legs are on inclined plane
• Position?

• Trendelenburg position
• What is different about this position?

• Principles: Do not lift higher than chest level, arrange for adequate help, encourage pt to assist as much as possible, flex knee, keep feet wide apart, position self close to object lifting, slide pt toward yourself using a pull sheet, set abdominal and gluteal muscles in preparation for move, person with heaviest load coordinates efforts of team by counting to 3
• Principles of what?

• Place pt on back with head of bed flat, plc small rolled towel under lumbar area of back, place pillow under upper shoulder, neck and head, place trochanter rolls or sandbags parallel to lateral surface of lights, place small pillow or roll under ankle to elevate heels, support feet in dorsiflexion with firm pillow, footboard, or high top sneakers, place pillows under forearms to keep pts parallel to body, and place hand rolls in pts hands
• This puts pt in what position?

• Necessary for body�s nervous, muscular and skeletal systems to be intact, and used regularly
• What is necessary ?

• Muscle/bone atrophy/ contractures, pressure ulcers, constipation, UTI, disuse osteoporosis, and insomnia, renal calculi, deep vein thrombosis, pulmonary embolism, postural hypotension, pneumonia
• Complications of what?

Decline in medical or physical status due to illness, injury, or surgery or can be used therapeutically to limit movement of body or part, or restrict ambulation

• When laying down or sitting up and when one gets up BP drops
• Term?

• Do: Reposition at least Q 2 hrs, provide adequate intake and encourage fluids unless contraindicated, encourage well balanced diet, prevent deformities (use assistive devices), handle/transfer pts carefully, position lower extremities properly, encourage ambulation ASAP, anti-embolism measures, coughing and deep breathing exercises or incentive spirometry, away of side effects of meds, diversional activities, and meticulous skin care, ROM exercises, reality therapy, use gait belt and follow fall safety guidelines, pt family/ education
• Helps in what?

• Move pt and mattress to head of bed, turn pt onto back, assist pt to raise legs, bend knees and allow legs to relax, pt will sometimes need a small lumbar pillow
• This puts pt in what position?

• Move pt and mattress to head of bed, raise head of bed to 45 to 60 degress. Replace pillow, use footboard, use pillows to support arms and hand, place small pill or roll under ankles
• This puts pt in what position?

• Move pt and mattress to head of bed, raise head of bed about 30 degrees, replace pillow
• This puts pt in what position?

• Elevate HOB, dangle at side of bed, stand, take a few steps then sit in chair, advance from chair to bathroom, then about the room, then to the hallway, then ad lib
• Do this when?

• Thyroidectomy, GT feedings, cataract surgery, stroke, laryngectomy, NGT insertions, mastectomy, bronchoscopy post procedure
• For these procedures pt should be in what position?

• Elevate head of bed to 90 degree angle, place pillow btwn patients back and mattress, place pillow on overbed table and assist pt to lean over, placing head on pillow
• This puts pt in what position?

• Assistive devices for positioning?
• Devices: Pillows, foot boots, trochanter roll, and sandbag, hand wrist splint, hand roll, side rail, bed board, wedge pillow, trapeze bar
• What kind of devices and for what?

• Place pt in supine position, pt in lateral position, lying partially on the abdomen, draw knee and thigh up near abdomen and support with pillows, place pts lower arm along back, bring upper arm up, flex elbow, and support with pillow, allow pt to lean forward to rest on chest
• Puts pt in what position?

• Assist pt onto abdomen with face to one side. Flex arms toward the head. Position pillows for comfort. Place a pillow under lower leg to release �pull� on the lower back, or place a pillow under the head (or both)
• Puts pt in what position?

• Turn pt onto abdomen. Assist patient into kneeling position; arms and head will rest on pillow while upper chest rests on bed
• Puts pt in what position?

• Position pt to lie supine, request pt to slide buttocks to edge of examining table. Lift both legs; have pt bend knees and place feet in stirrups
• Put pt in what position?

• Circulation, movement, and sensation assessment
• Abbrev?

• Defined as any body action involving the muscles and joints in naturally directional movements
• What?

• Prevent excessive muscle atrophy and joint contracture (physical disuse syndrome)
• Reason for what?

• Minimum of 2 hrs per day, divided into 20 min sessions throughout the day and each movement done 5 times
• Do this to prevent?

• Persons ability to move around freely in his or her environment
• Term?

• Exercise is performed by caregivers
• Term?

• Exercise is performed by pt
• Term?

• pt uses strong arm to exercise the weaker or paralyzed arm
• Term?

• Caregiver helps the pt finish the full ROM after pt moves limb partially through ROM
• Term?

• It is necessary for the body�s nervous, muscular, and skeletal system to be intact, functioning and used regularly
• Necessary for what?

• Inability to move around freely
• Term?

• hydraulic lifts, roller boards, and gurney lifts
• what are these?

• Used for moving pts safely, protecting the nurse�s back, and full weight lifting of clients who cant assist.
• What is used for this?

• Look at: Skin color, skin temp, movement, sensation, pulses, capillary refill, and pain
• When to look at all these?

• Signs shown by pts: pain, not relieved, paresthesias, pallor, pulse absent, paralysis and palpated tense tissue
• When are these signs shown?

• Shearing or tearing forces, support joints, decreased flexibility and mobility of joints, weakness and hypotension, use ambulatory aids and assistive devices, and fear of assistive equipment
• Factors for what and due to what?

• Focus on ROM, muscle strength, activity tolerance, gait, and posture
• When to look for this?

• Phenomenon occurs in extremities, especially the legs, where a sheath of inelastic fascia partitions blood vessel, nerve, and muscle tissue
• Term?

• Pain, not relieved, paresthesias, pallor, pulse absent (pulselessness), paralysis, and palpated tense tissue
• Known as and due to?

• Any one of the connections between bones
• Term?

• Machine which flex and extend joints in order to passively mobilize them without the strain of active exercises
• term?

• Machine used on: knee, hip, shoulder, and ankle
• What machine?

• Prevents what types of complications: as joint contracture, atrophy of surrounding muscles and thromboembolism
• What prevents these complications?

Goals: increase or maintain physical mobility by improving joint ROM and to prevent skin breakdown at pressure pts