1. The effects of Immobility
a) Interventions that improve flexibility
• P.R.E.P.(Perform passive ROM, Reposition Q2HR, Encourage independent activity
... [Show More] as much as possible even in bedrest, Provide assistive devices)
• Know examples of exercises for flexibility
b) Assessment/ Findings of a patient with DVT
• Assessment
(1) Compare distal pulses for pulse quality, observe the color and temp. of extremities, evaluate sensation and motion, and determine speed of capillary refill. Compare calf circumferences.
• Findings
(1) Redness, warmth, tenderness, swelling (Thrombus formation), Peripheral and sacral edema.
c) Identify patients at risk for skin breakdown
• Older adults, immobile, cognitive impairments, incontinence, poor nutrition/ malnutrition. Medications may also cause vasoconstriction and result in poor tissue perfusion.
2. Benefits of Exercise
a) Rationale for weight bearing exercise
• Promotes bone reformation and growth (Makes bones stronger)
• At least 3-5 times a week Identify benefits of exercise
• Bone reformation and growth
• Cardiovascular health promotion
• Promotes balance and stability
• Reduce stress and increase energy levels
b) Identify benefits of exercise
• Bone reformation and growth
• Cardiovascular health promotion
• Promotes balance and stability
• Reduce stress and increase energy levels
• Improves pulmonary circulation, skeletal development, skin tone
• Reduces systemic inflammation
c) Identify negative effects of immobility on musculoskeletal system
• Osteoarthritis
• Rheumatoid Arthritis
• Loss of muscle strength
• Impaired balance
• Altered join mobility
• Decreased stability
• Osteoporosis
• Depression, isolation, anxiety, and mood change
• Can cause decreased peristalsis
d) Explain ways to maintain proper posture for a client
• Place the spine in a neutral position(Resting)
• This allows the bones to be aligned, reduce stress and fatigue & muscle joints, and ligament can work efficiently
• Avoid standing in 1 position for a long period of time
• Do not lock your knees when standing
• Keep core tight and don’t bend at the waist or neck
• No slumping when sitting
• Sit close to your work and use back support
• Sit with feet flat on floor
• Sleep on firm mattress
• Do not wear high heels for a prolonged time, do not slump, and use a chair that supports your back.
e) Identify interventions in minimizing contractures (which is a negative effect of immobility)
• Gently straighten out contracted extremity, fingers. Etc
• Mobility-encouraging interventions such as passive ROM, and rotation. Flexion and extension exercises
• These interventions should be performed about every 2hrs and as needed if the contractures are present
3. Identify bed positions
• Semi-fowlers: Patient is on their back with the head raised between 15 and 45 degrees.
• High-fowlers: Patient is on their back with the head of the bed raised between 60 and 90 degrees.
• Prone: Lying on the abdomen with the head turned to one side
• Supine: Lying on the back
• Sims: Patient lies on their side with the left thigh slightly flexed and the right thigh acutely flexed on the abdomen.
• Trendelenburg's Position: Patient is on their back whose lower section is inclined 15-30 degrees so that the head is lower than the body.
• Reverse Trendelenburg's Position: Patient is in the supine position with the feet facing downward and head is inclined 15-30 degrees.
• Lateral Position: Side lying position, and a pillow is often placed between the legs for patient comfort
4. Identify proper body mechanics for moving the patients in bed
• Transfer board
• Mechanical lift
• Transfer belt
• What are the proper ways to move patients in bed?
5. Explain how to use walkers to the elderly
• Push or lift your walker 6-12 inches forward
• Make sure all 4 tips or wheels of your walker are touching the ground before taking a step
• Step forward with your weak leg first
• Then step forward with your other leg placing it in front of the weaker leg
6. Be able to assess client with diabetic neuropathy
• Monofilament test: touch foot at the same time and have patient which time they were touched
• Vibration perception: use a 128 hz tuning fork and ask the patient if they are able to feel vibrations
• Look for ulceration or inspection of the feet
7. Assessment of pain and questions to ask
• P: What causes the pain or when did it start? What makes it better and what makes it worse?
• Q: How does the pain feel?
• R: Where is the pain? Does it spread from one area to another?
• S: How does the pain rate on a scale of 1-10, with ten being the worst pain?
• T: When did the pain start? Is it sudden or gradual? Intermittent or constant
8. Teaching plan for patients with bunionectomy and healing
• Allow them to walk with foot shoe or boot
• Healing time is 6 to 12 weeks (healing time is slow due to less blood flow)
• Use assistive devices for ambulatory until full weight bearing and allowed after surgery which is several weeks postop.
• When educating patients and they do not follow recommendations, ask them to tell about their experiences.
9. Osteomy elitis
a) Interventions in prevention and risk of osteomyelitis
• Proper dental care
• Maintaining clean & intact skin
• Proper hand hygiene
• Not leaving catheters in long tern
• Understanding who is at risk
• Using proper standard and contact precautions
• Reduce caffeine and stop smoking
b) Explain why clients would have chronic osteomyelitis
• A chronic infection or disease
• If it is difficult to treat the underlying cause or inadequate treatment of acute osteomyelitis
• Misdiagnosis
c) Care for patients with kyphosis
• ROM & mobility issues
• Turn patient every 2 hours
• Passive and active ROM exercises
• Prevention of skin breakdown
• Consider breathing issues & a plan of care that includes this ( auscultate lungs)
d) Teaching plan for care of osteomyelitis
• Use of contact precautions to prevent spread of the infection
• Hand Hygiene
• Complete antibiotic regimen
e) Identify various ROM exercises and when they would be utilized
• Passive ROM – is movement of the [Show Less]