Health and Illness II - Mobility

C4

Diaphragm

Spinal shock vs Autonomic dysreflexia

Due to actual event/injury "Too relaxed" vs Due to stimuli below site of injury "Vasodilation above & Vasoconstriction below"

What should be your first action with AD?

Elevate the head of the bed Then relieve trigger

What is the risk of analgesics in mobility patients?

Fall risk...

T/F Spinal shock and AD times can over lap.

False Spinal shock resolves before AD can happen

Mobility general care guidelines

Frequent turning SKIN ASSESSMENT Range of motion Deep breathing Weight bearing Measures to optimize elimination Nutrition

T5

GI mobility

Hip fracture presentation

Hip pain Leg shortened Externally rotated

Ms Smith is an 87 yr old who fell at home. She complains of hip pain What would you expect to see during your physical exam that would make you suspect a hip fracture?

Hip pain Leg shortened Externally rotated Check pulses!

Mobility assessmet

History Medications Lifestyle Occupation Environment

How do you decide whether or not to put on C-collar?

If there is (midline) pain on palpation

Degradation nursing care

Muscle weakness Safety Skin integrity Airway Breathing Mental health Often incurable "If your airway isn't moving, you aren't breathing..."

SCIWORA care

Immobilize Steroids Pain meds Symptom control

Open reduction

In OR Pins, rods, replacement...

Compartment syndrome

Increased pressure due to?

Bell's Palsy treatment

NSAIDs Antiviral

What is a secondary concern with bone demineralization due to hip fractures?

Kidney stones... Minerals go to kidneys so patient needs to increase fluids

Spinal shock

Lack of sympathetic nerve response (too relaxed) Hypotension Bradycardia Temperature dysregulation Once fixed it doesn't return

Skeletal (pins) traction

Long term traction (weeks-months) Used if patient is NOT anesthesia candidate

Botulism

Nerve paralysis due to toxin build up

Spinal cord stabilization

Non-operative: Hallo traction Collars Clamshell braces Operative: Pins rods plates

Pins and Plates

Open reduction Quicker recovery Wound infection risk...

Hip replacement education

Osteoporosis Weight-bearing exercises Home safety Evaluation Eat well Stop smoking Vitamin D (absorption) and Calcium

Mobility secondary prevention

Osteoporosis screening Fall assessment screening

Spinal cord injurytreatment

Oxygen Anti-emetics Pain medications Steroids? DVT prophylaxis

Fat embolism care

Oxygen Fluids Pain meds Anxiety meds

P's of compartment syndrome

Pain Paresthesia Paralysis Pulselessness Pallor Poikilothermia? (abnormal temperature)

Mobility symptoms

Pain Reduced joint movement Reduced sensation Falls Fatigue Altered gait Reduced functional ability

What population do greenstick fractures occur in?

Pediatrics due to immature "bendy" bones

Nurse maids elbow

Pulled up as tripping Radial head subluxation

Bucks (skin) traction

Pulls bone Applies tension to reduce muscle spasm and assist in realigning bones

Closed reduction

Pushed or pulled to re-allign Sedation Hematoma block Pain meds

What is the primary purpose of bucks traction?

Reduce muscle spasm and pain

Compartment syndrome care

Reduce pressure by removing cast Elevate limb to level of heart Fasciotomy (cut open to relieve pressure)

Mobility primary prevention

Regular physical activity Protection against injury Optimal nutrition Fall prevention measures

Hip replacement

Rehab for falls and deterioration of hip joints

Skeletal traction concerns

Skin breakdown Pin infection Muscle atrophy Lengthy recovery Bone demineralization (Where is that calcium going? Kidneys...)

How do you care for bucks traction?

Skin care (heel pressure wound) Keep it swinging (weights hanging freely)

Hip Dysplasia risks with brace

Skin damage Safety (think of car seats...) Delayed mobility

Fat embolism

Small globules of fat travel round the body Most common in long bone fractures

SCIWORA

Spinal Cord Injury With Out Radiological Abnormality Numbness, tingling, paralysis X-rays & CT normal

What comes first spinal shock or AD?

Spinal shock

Spinal cord primary prevention

Sports and outdoors education Safety equipment

Degradation treatment

Symptom control (steroids) Comfort measures (pain meds)

Autonomic Dysreflexia

T-6 or higher Triggered by sustained stimuli Vasodilation above injury and vasoconstriction below (more blood in upper half of body...)

What is the importance of stabilizing a fracture?

To prevent damage of surrounding muscles

What are the types of fractures?

Transverse Spiral Greenstick Comminuted Oblique Pathologic Stress

"Toddler fracture"

Twisted as falling often when foot caught in something Arm usually sign of abuse

Bell's Palsy

Unknown cause Facial droop on one side

T1-L2

Urinary issues

Degradation

Usually progressive Distal to central Can be inherited (ALS) or immune (MS)

Autonomic Dysreflexia S&S

Vasodilation above: ^BP Flushed face Headaches Jugular vein distention Decrease HR ^ Sweating Vasocontriction below: Pale Cool No sweating

Hip replacement post op

Vital signs Wound monitoring Abduction pillow Pneumonia Skin breakdown Muscle atrophy Bone demineralization

Should you check pulse and cap refill on a fractured ligament?

Yes

The parent of a 3-week-old states that the infant was recast this morning for clubfoot and has been crying for the past hour. Which intervention should the nurse suggest the parent do first? A)Give pain medication. B) Reposition the infant in the crib. C)Check the neurocirculatory status of the foot. D)Use a cool blow-dryer to blow into the cast to control itching

c

A 6-year-old involved in a bicycle crash has a spleen injury and a right tibia/fibula fracture that has been cast. Which is/are an early sign(s) of compartment syndrome in this child? Select all that apply. A. Edema. B. Numbness. C. Severe pain. D. Weak pulse.

c d

A patient with a spinal cord injury at the T1 level complains of a severe headache and an "anxious feeling." Which is the most appropriate initial reaction by the nurse? 1. Try to calm the patient and make the environment soothing. 2. Assess for a full bladder. 3. Notify the healthcare provider. 4. Prepare the patient for diagnostic radiography.

2

The patient is admitted with injuries that were sustained in a fall. During the nurse's first assessment upon admission, the findings are: blood pressure 90/60 (as compared to 136/66 in the emergency department), flaccid paralysis on the right, absent bowel sounds, zero urine output, and palpation of a distended bladder. These signs are consistent with which of the following? 1. paralysis 2. spinal shock 3. high cervical injury 4. temporary hypovolemia

2

A patient with a spinal cord injury (SCI) is admitted to the unit and placed in traction. Which of the following actions is the nurse responsible for when caring for this patient?Select all that apply. 1. modifying the traction weights as needed 2. assessing the patient's skin integrity 3. applying the traction upon admission 4. administering pain medication 5. providing passive range of motion

2 4 5

While caring for the patient with spinal cord injury (SCI), the nurse elevates the head of the bed, removes compression stockings, and continues to assess vital signs every two to three minutes while searching for the cause in order to prevent loss of consciousness or death. By practicing these interventions, the nurse is avoiding the most dangerous complication of autonomic dysreflexia, which is which of the following? 1. hypoxia 2. bradycardia 3. elevated blood pressure 4. tachycardia

3

A 4 year old has a cast and is complaining of itching what options can you give to make them more comfortable? A) Apply an ice bag for an hour B) Use a high drier on hot C) Stick fingers into the cast D) Use a stick to scratch the itch

A

When caring for a patient with an external fixature a priority is to A)Monitor for infection B)Ensure the fixature doesn't get damaged C)Xrays to ensure the limb is healing D)Keep the patient moving to prevent skin breakdown

A

The nurse is preparing a technique plan for a patient who is being discharged following a total hip replacement. The nurse would include which part of the following content as a part of the teaching plan? Select all that apply A. Avoid low, cushioned chairs B. Use a device that raises toilet seat C. Avoid bending greater than 90 decrees D. Turn at the waist to reach objects E. Do not cross the legs

A B C E

A patient with a fractured arm is complaining of pain. What options are suitable for pain management. Select all that apply A)Apply ice for 15 minutes B)Apply heat with a hairdrier for 15 minutes C)Elevation above the level of the heart D)Muscle relaxers

A D

Ms Smith goes to the OR for a total hip replacement She is coming back to the room How will you prep her room?

Abduction pillow! Incentive spirometer Overhead trapeze (if strong enough)

Mobility at risk populations

Age Acute: Trauma Surgery Chronic: Stroke Muscle/skeletal damage

While in Buck's extension traction, the client may be positioned: A. On the back, with the knees flexed 45 degrees B. On the back, with the buttocks slightly elevated off the bed C. On the back, turning to the unaffected side for 10 to 15 minute period D. On the back, with the bed tilted toward the side that is opposite the traction

C

Pharmacological intervetnions

Anti-Inflammatory Analgesics Nutrition supplementation

Botulism treatment

Antibiotics Botulinum antitoxin May require ventilator

C1-3

Apnea and no cough

A parent call stating her child has a swollen elbow from a bug bite, the redness is circumferential. The child cannot bend their arm and the arm is pale and the child complains of tingling fingers. The nurse should be concerned for: A)Fat embolism B)Compartment syndrome C)Cellulitis D)Fractured elbow

B

A patient with a femur fracture complains of chest pain and feels anxious. The nurse should be concerned for A) Pulmonary embolism B) Fat embolism C) Wound infection D) Pneumonia

B

AD nursing care

Bowel and bladder care Reduce stimulation of impaction with enemas

Fat embolism symptoms

Broken bone Increased pressure Petechiae on the face Shortness of breath Feeling of anxiety/doom

Brown-Sequard Syndrome

Damage to half of cord

Spinal cord secondary prevention

Deep breathing PT/OT Mobility Skin!!!

Above T6

Cardiac: Hypertension Bradycardia

Spinal cord INITIAL care

Check ABC's while stabilizing Maintain C-spine Logroll Check sensation C-collar? Spinal board?

When assessing hip fracture do you check pulses before or after moving?

Check before AND after

Spinal cord tertiary prevention

Community education/awareness (where are wheelchair ramps?)

A patient complains of tingling and numbness in his right leg following application of a long leg cast. The patient's discomfort is most likely the result of: A. Reduced venous return B. Bone healing C. Arterial insufficiency D. Nerve compression

D

An expected outcome of cast application that the nurse evaluate is: A) Skin irritation at the cast edges B) Decreased cap refill C) Tingling and numbness distal to the cast D) Slight edema, soreness, and limitation of range of motion

D

A nurse is caring for a client with a spinal cord injury who reports a severe headache and is sweating profusely. vital signs include BP 220/110, apical heart rate of 54/min. Which of the following acctions should the nurse take first? a. notify the provider b. sit the client upright in bed c. check the client's urinary catheter for blockage d. administer antihypertensive medication

b

Which is the nurse's best explanation to the parent of a toddler who asks what a greenstick fracture is? A. It is a fracture located in the growth plate of the bone. B. Because children's bones are not fully developed, any fracture in a young child is called a greenstick fracture. C. It is a fracture in which a complete break occurs in the bone, and small pieces of bone are broken off. D. It is a fracture that does not go all the way through the bone.

d

What is the difference between splint and cast?

one has room for swelling? circumventail?