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?
