Mobility objectives (HCD)

Symptoms for Acetaminophen poisoning

-1st 2 hours: nausea, vomiting, pallor, hypothermia, slow weak pulse -Latent period: 1-1.5 days symptoms abate -If no treatment, hepatic involvement -Diagnostic tests- liver and kidney functions

Risk factors for osteoporosis

-60 years + -Postmenopausal -Use of alcohol -Smoking -Sedentary lifestyle -Prolonged use of steroids

Implementation after total hip replacement

-Abduction pillows -Crutch walking with 3-point gate -Dont sleep on operated side -Dont flex hip more than 90 degrees -Dont elevate HOB more than 45 degrees

Uses of NSAID's

-Arthritis -Pain -Fever -Gout/dental pain -TIA/Agina/ MI (aspirin)

Assessment of the immobilized patient

-Assess Gait -Assess joint movement -Assess muscle tone -Assess skin integrity

Teach ADL

-Assess clients abilities -Exercise muscles needed for activity -Start with gross movements, follow with finer movements -Extend activity according to client tolerance -Give positive feedback

Compare and contrast common independent and collaborative interventions for clients with alterations in mobility -Clinical nursing skills for mobility

-Assessment -Patient transfers -Positioning -ROM exercises -Continuous Passive motion -Sequential compression device and elastic stockings -Ambulation -Assistive devices -cane -Crutches -Walker -Wheelchair -traction -Heat and cold therapy -immobilization devices -Medication administration

Implementation of Osteoarthritis

-Balance rest and activity -Medications-analgesics, anti-inflammatory drugs -Weight control if obese

Examine the relationship between mobility and other concepts/systems

-Comfort: increased pain leads to decreased activity intolerance which leads to increased muscles atrophy and bone resorption. Increased fatigue (especially muscle fatigue) leads to decreased muscle control and decreased balance. Clients at end of life often have decreased mobility in general. -Health, wellness, illness: Increased physical activity leads to increased muscle mass/strength and bone density. -Stress and coping: decreased mobility leads to increased stress which leads to difficulty coping. -Collaboration: Alterations in mobility require interaction between multiple clinicians to help the client gain full mobility. -Safety: Infants learning mobility leads to increased risk of injury, falls drowning and head injuries. Children and adolescents who are involved in sports or other actives are at increased risk of injury causing decreased mobility. Decreased mobility leads to risk of falls, and fractures, especially in older adults. Causes: -Intracranial regulation: Individuals who have intracranial regulation problems problems may become immobile as a result of unsteadiness and imbalance. -Nutrition: Individuals who are immobile may be unable to purchase, prepare, and/or consume adequate nutrition; likewise, individuals with inadequate nutrition may have decreased mobility because of excessive fatigue. -Pain: Either acute or chronic pain may interfere with mobility; likewise, some conditions associated with immobility case pain. -Gas Exchange: Individuals who have inadequate gas exchange may become immobile because of excessive fatigue. Immobile patients are at risk of developing complications associated with gas exchange, such as stasis. -Perfusion: Individuals who have perfusion problems are less able to be mobil because of reduced oxygenated blood reaching peripheral tissues. Among individuals who are immobile, perfusion is less effective because of reduced venous return. Effects: -Tissue integrity -Elimination

Fracture Complications: Compartment Syndrome

-Compartment syndrome is a condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space. Compartment syndrome causes capillary perfusion to be reduced below a level necessary for tissue viability. It is classified as acute, chronic/exertional, or crush syndrome. Thirty-eight compartments are located in the upper and lower extremities. Two basic causes of compartment syndrome are (1) decreased compartment size resulting from restrictive dressings, splints, casts, excessive traction, or premature closure of fascia and (2) increased compartment contents related to bleeding, edema, chemical response to snakebite, or IV infiltration. Depending on the patient's age and body mass index, the expected range of intracompartmental pressure readings is 0 to 10 mm Hg. Readings of 30 mm Hg or higher indicate compartment syndrome. Edema can create sufficient pressure to obstruct circulation and cause venous occlusion, which further increases edema. Eventually arterial flow is compromised, resulting in ischemia to the extremity. As ischemia continues, muscle and nerve cells are destroyed over time, and fibrotic tissue replaces the healthy tissue. Contracture, disability, and loss of function can occur. Delays in diagnosis and treatment cause irreversible muscle and nerve ischemia, resulting in a functionally useless or severely impaired extremity. Compartment syndrome is most commonly associated with trauma, fractures (especially the long bones), extensive soft tissue damage, and crush injury. Fractures of the distal humerus and proximal tibia are the most common fractures associated with compartment syndrome.Compartment injury can also occur following knee or leg surgery. Prolonged pressure on a muscle compartment may result when someone is trapped under a heavy object or a person's limb is trapped beneath the body because of an obtunded state such as drug or alcohol overdose. In the upper extremity this condition is referred to as Volkmann's ischemic contracture and in the lower extremity as anterior tibial compartment syndrome, although the underlying pathophysiologic mechanism is similar. One or more of the following six Ps are characteristic of compartment syndrome: (1) paresthesia (numbness and tingling); (2) pain distal to the injury that is not relieved by opioid analgesics and pain on passive stretch of muscle traveling through the compartment; (3) pressure increases in the compartment; (4) pallor, coolness, and loss of normal color of the extremity; (5) paralysis or loss of function; and (6) pulselessness or diminished/absent peripheral pulses. -Carefully assess the location, quality, and intensity of the pain. -Evaluate the patient's level of pain on a scale of 0 to 10. Pain unrelieved by drugs and out of proportion to the level of injury is one of the first indications of impending compartment syndrome. Pulselessness and paralysis (in particular) are later signs of compartment syndrome. Notify the health care provider immediately of a patient's changing condition.

Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with a fracture

-Diagnostic: History and Physical Exam X-Ray CT Scan MRI -Fracture Immobilization -Casting or splinting -Traction -External fixation Internal fixation Open Fractures -Surgical debridement and irrigation -Tetanus and diphtheria immunization -Prophylactic antibiotic therapy -Immobilization

Implementation of osteoporosis patient

-Diet high in calcium, protein, and vitamin d -Estrogen replacement therapy -Weight bearing on long bones -Medication : Alendronate -Safety precautions to prevent fractures

Contradictions after total hip replacement surgery

-Dislocation of prothesis -Excessive wound drainage -Infection

Casting Immediate care

-Do not cover until dry -Handle with palms of hand -Don't rest on hard surface -Keep above level of heart -Check pulses, color and sensation

Decubitus Ulcer Nursing Considerations

-Draw sheet -Air matres -Flotation pads -Elbow/heel pads -Sheepskin -Stryker frames -Circulation bed

Implementation for the scoliosis patient

-Exercises to strengthen abdominal muscles -Surgery -Braces -Boston Brace (throacolumbosacral orthotic TLSO) -Milwaukee Brace (includes neck ring and goes all he way down to pelvis)

Nursing Considerations for NSAID's

-Eye changes -Client takes with food with or after meals -Monitor liver and renal function -Use cautiously with aspirin allergy -Check for bleeding -Avoid OTC drugs -Monitor vital signs including pain

Assist to stand

-Face-to-face with patient -Grasp each side of the clients rib cage -Push knee against clients knee -Rock client forward to standing position -Pivot client forward to standing position -pivot client to sit in chair -place chair on clients stronger side

Which 2 complications are considered ABC complications and should be the nurses priority?

-Fat emboli -Compartment syndrome

Complications of Fractures

-Fat emboli -Delayed union -Nonunion -Sepsis -Compartment syndrome

Side affects of NSAID's

-GI upsets -Dizziness -Headache -Bleeding -Fluid retention -Bone marrow Depression (indomethacin) -Renal impairment (Ketorolac)

Identify commonly occurring alterations in mobility and their related therapies

-Herniated disc: spinal disc that slips out of place or ruptures. -Manifestations: back pain that spreads to the buttocks and legs, or to shoulders and arms. -Tingling or numbness -Muscle spasms or weakness -Limited mobility -Interventions or therapies: -Rest -Pharmacologic therapy to manage pain and prevent muscle spasms -Surgery to remove or replace the disc Scoliosis: A sideways or abnormal S curve or C shaped curve of the spine -Manifestations: -Back pain -Uneven hips or shoulders -Obvious abnormal curve of the spine upon inspection -Leaning to one side -Exhaustion of the spine after standing or stretching -Limited mobility -Interventions: -Regular checkups -Exercise to improve back strength -Back brace to prevent further curving -Surgery to correct curve -Emotional support Fractures: a break in the continuity of a bone Manifestations: -Pain from damage to surrounding tissues -Visible fracture on x-ray -Protrusion of bone out of skin -Limited mobility Interventions: -Ice packs to limit swelling -Pharmacologic therapy to reduce pain and swelling and prevent infection -Immobilization with splint, brace, cast or traction -Surgery to stabilize bone or replace fractured bone Multiple sclerosis: An autoimmune disease that causes damage to the myelin sheath around nerves Manifestations: -Loss of balance/dizziness -Muscle spasms -Numbness or tingling -Problems moving arms or legs -Tremor or weakness in arms or legs -Bowel and bladder problems -Eye, hearing, and speech problems -Cognitive deficits Interventions: -Pharmacologic therapy to slow the progression of disease and decrease severity of attacks -Physical therapy -Speech therapy -Assistive devices for mobility -Healthy lifestyle (nutrition, activity, rest) -Safety measures to prevent falls -Counseling Osteoarthritis: Degeneration of cartilage and bone in a joint Manifestations: -Joint pain and swelling -Joint stiffness -Loss of joint flexibility -Bone spurs -Crackling sounds (crepitation) during movement -Joint tenderness Interventions: -Pharmacologic therapy to reduce pain and swelling -Physical therapy -Reduction of stress on affected joints -Injections of corticosteroids or hyaluronic acid -Surgery to realign bones or replace kings -Gentle exercises -Weight loss -Application of warm or cold compresses Parkinson Disease: A motor system disorder caused by loss of dopamine neurons. Manifestations: -Tremor in the hand, arms, legs, jaw and face -Rigidity and stiffness of the limbs and trunk -Bradykinesia (slowness of movement) -Impaired balance and coordination -Lack of affect -Slurred speech Interventions: -Pharmacologic therapy to manage symptoms -Deep brain stimulation -Healthy lifestyle -Walking carefully -Occupational therapy Spinal cord injury: Direct damage to the spinal cord or indirect due to disease of surrounding tissues Manifestations: -Weakness or numbness below the injury -Muscle spasticity -Loss of bladder and bowel control -Pain -Paralysis -Difficulty breathing Interventions: -Immobilization of the spine -Pharmacological treatment to reduce swelling and prevent further damage -Surgery to remove tissue, fluid or objects pressing on the spinal cord -Bed rest -Spinal traction -Physical and occupational therapy

Examples of NSAID's

-Ibuprofen -Indomethacin -Naproxen -Ketorolac -Asprin

Blood Tests for musculoskeletal disorders: Calcium

-Increased blood calcium levels could indicate the presence of metastatic bone tumors, Paget disease, bone fractures, or hyperparathyroidism. Decreased blood calcium levels could indicate hypoparathyroidism, osteomalacia, or vitamin D deficiency.

Why activity and exercise should be maintained

-Increases joint mobility and function -Increases muscle strength -Maintains circulation and ventilation -Increases appetite and maintains elimination -Increases metabolic rate

Nursing Care for Acetaminophen poisoning

-Induce vomiting -Maintain hydration -Monitor liver and kidney function -Administer antidote (acetylcysteine)

Nursing care for Aspirin Poisoning

-Induce vomiting -Maintain IV hydration -Reduce temperature -Monitor for bleeding -Monitor VS, lab values, and I & O

Illustrate the nursing process in providing culturally competent care across the lifespan for individuals with scoliosis Slide 41

-Infantile idiopathic scoliosis: occurs from birth to 3 years of age. It typically results in a left thoracic curve of the spine and is most commonly seen in boys of European descent. Infantile scoliosis may resolve as the child ages. -Juvenile idiopathic scoliosis: Occurs in children between 3 and 9 years old. Symptoms are similar to those of adolescent scoliosis. Children with juvenile idiopathic scoliosis are most likely to have progression of the curve and require surgery. Adolescent idiopathic scoliosis: occurs in children between 1- and 19 years old. This is the *Most common type of scoliosis; progression of the curvature is seen more frequently in girls. Progression is more likely to occur in younger children with large curves than in older small. Adult idiopathic scoliosis: may be present from childhood or may develop as a result of aging. Aging causes may be related to degenerative changes of the spine (adult degenerative scoliosis), osteoporosis, previous fractures, spondylilisthesis, infections, or tumor.

Actions of NSAID's

-Inhibit prostaglandin synthesis -Block enzyme responsible for inflammation

Casting intermediate care

-Isometric exercises -Check for odors -Dont put anything into cast

Assessment of fractured hip

-Leg shortened -Adducted -Externally rotated

Patient teaching after total hip replacement

-Maintain abduction -Dont sleep on operated side -Dont flex the hip more than 90 degrees -Never cross legs -Resume ADL in 3 months

Safety related issues to:

-Motor vehicle accidents -Job-related -Contact Sports -Age -Condition

Immobility common affects on body systems:

-Musculoskeletal: -Brittle bones -Contractures -Muscle weakness and atrophy -Foot drop -Nervous System: -Lack of stimulation -Feelings of anxiety -Feelings of isolation -Confusion -Depression -Digestive System -Decreased appetite and low fluid intake -Constipation and/or bowel obstruction -Incontinence -Electrolyte imbalances -Integumentary System: -Decreased blood flow -Pressure ulcers -Infection -Cardiovascular system -Blood Clots -Reduced blood flow -Respiratory System: -Pneumonia -Decreased respiratory effort -Decreased oxygenation of blood -Urinary System: -Reduced kidney function -Incontinence -Urinary tract infections -Urinary retention

Analysis of Osteoarthritis

-Nonsystemic -Degenerative -No remission

Decubitus Ulcer

-Osteomyelitis -Tissue Maceration -Infection

Assessment of osteoarthritis

-Pain and stiffness in the joints -Heberden's and Bouchards nodules of the fingers

Therapeutic exercises for immobilized patient

-Passive ROM -Active Assistive ROM -Active ROM -Active Resistive ROM -Isometric Exercise

Isometric Exercise

-Performed by client -Alternate contraction and relaxation -Joint remains immobile -Maintains strength of muscles when joint is immobilized

Active Resistive ROM

-Performed by client against resistance -5lb weights used -Increases muscle power

Active Assistive ROM

-Performed by client with assistance -Increases motion in the joint

Active ROM

-Performed by client without assistance -Maintains mobility of joints

Passive ROM

-Performed by nurse -Maintains joint movement and circulation

Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with osteoporosis

-Physical therapy: tai chi or yoga (for balance) any weight bearing exercises (walking, jogging, rowing, weight lifting, swimming) -Dietary management: Choosing diets high in vitamin D and calcium, (Calcium rich- dairy, vegetables, and beans, OJ, cereal, bread) (Vitamin D rich- Fish) -Pharmacological therapy: Calcium glutinate and other calcium compounds are used to treat or prevent osteoporosis.

Traction

-Reduces the fracture -Alleviates pain and muscle spasm -Prevents or corrects deformities -Promotes healing -Types: -Skin traction: pulling force applied to skin -Skeletal traction: pulling force applied to bone

Assessment of osteoporosis patient

-Reduction in bone mass -Decreased height -Low back pain -Kyphosis

Formulate priority nursing diagnoses appropriate for an individual with osteoporosis

-Risk for injury

Describe diagnostic and laboratory tests to determine the individuals mobility status

-Screenings -Physical assessment (

Implementation of fractures

-Splinting: immobilization to prevent movement -Internal fixation: screws, plates, nails to stabilize -Open reduction: surgical dissection for reduction and alignment -Closed reduction- manual manipulation or traction

Therapeutic positions for the immobilized patient

-Supine -Dorsal recumbent -Prone -Side lateral -Knee-chest -Sims -Fowlers -Modified Trendelburg -Lithotomy

Assessment of Fractures

-Swelling -Pallor -Ecchymosis -Loss of sensation -Crepitus -Decreased or absent pulses -Deformity

Evaluate expected outcomes for an individual with osteoporosis

-The client identifies and implements strategies to change or modify lifestyle factors such as smoking cessation, weight bearing exercise, and moderation in alcohol use. -The client achieve adequate calcium intake -The client identifies and eliminates safety hazards.. -The client experiences relief from acute pain

Symptoms of Aspirin poisoning

-Tinnitus -Nausea, sweating, headache -Change in mental status -Increased temperature -Hyperventilation -Hypvolcemia

Decubitus Ulcer Nursing Interventions

-Turn frequently -Ambulate -Good skin care -Balanced diet with protein, vitamins, and minerals

Assessment of the Scoliosis patient

-Uneven hips or scapulae -Kyphosis lump on back -Bend at waist to visualize deformity -Can be structural or functional -Structural: irreversible -Functional: reversible

Casting after cast care

-Wash area gently -Apply baby powder, cornstarch -Elevate limb -Apply elastic bandage

Emergency Care of fractures

-immobilize joint above and below fracture -Cover open fracture with sterile dressing or cleanest material available -Check temperature, color, sensation, capillary refill distal to fracture

Assist out of bed

-move toward stronger side -use leg muscles, not back to move client -use draw sheets -have assistant for assistance

Assist to sit on side of bed

-place hand under shoulders and knees -have client push elbow into bed -lift shoulders and swing legs over edge of bed

The client who receives Aspirin for osteoarthritis reports bleeding after brushing teeth. Upon examination, the nurse observes several ecchymotic areas on the clients arms and legs. Which is the BEST action for the nurse to take? 1. Tell the client to stop taking aspirin and notify the health care provider 2. Advise the client to take Aspirin wth vitamin c 3. Advise the client to use a soft toothbrush when brushing the teeth 4. Ask the client if he or she is taking OTC medications

1. Tell the client to stop taking aspirin and notify the health care provider

Which of the following would the nurse assess as sign(s) of ibuprofen toxicity? 1. Vertigo and Drowsiness 2. Fever 3. Abdominal discomfort 4. Nausea and vomiting

1. Vertigo and Drowsiness

Which is the antidote for acetaminophen overdose? 1. acetylcysteine 2. Naloxone 3. Syrup of ipecac 4. Biacodyl

1. acetylcysteine

Low fowlers

15-30 degrees

The nurse receives a call from a mother who says: "My toddler swallowed aspirin." Which question should the nurse ask the mother FIRST? 1. "When was the aspirin swallowed?" 2. "How much aspirin did the child swallow?" 3. "Did anyone witness the ingestion?" 4. "Where was the child at the time?"

2. "How much aspirin did the child swallow?"

The nurse is going to transfer the client who has right-sided weakness from the bed to a wheelchair. Where should the nurse position the wheelchair? 1. At a 90 degree angle to the head of the bed on the clients affected side 2. At a 45 degree angle to the head of the bed on the clients unaffected side 3. Parallell to the foot of the bed on the clients affected side 4. Facing the head of the bed on the clients unaffected side

2. At a 45 degree angle to the head of the bed on the clients unaffected side

The nurse cares for the school-aged child diagnosed with a fracture of the the tibia located in the epiphyseal plate. Which is a major complication associated with this type of fracture? 1. Muscle atrophy of the affected leg 2.Bone growth of the fractured leg may be affected 3.Increased risk of osteomyletis of the affected leg 3. Development of degenerative joint disease

2.Bone growth of the fractured leg may be affected

The nurses cares for a teenager with scoliosis who needs to wear a plastic thoracic-lumbar-sacral orthotic. Which instruction should the nurse give the teenager? 1. "Place nothing between the orthotic and your skin" 2. "Apply the orthotic only when you experience pain" 3. "Remove the orthotic for personal hygiene activities" 4. "Where the orthotic 24 hrs per day"

3. "Remove the orthotic for personal hygiene activities"

Semi fowlers

30-45 degrees

The nurse cares for the client who had an open reduction internal fixation of the right hip and femur. On the second postoperative day, the client becomes confused and disoriented and complains of sharp stabbing pain in the chest. The clients RR is 32 and the pulse is 110. Which should be the nurses INITIAL action? 1. Place the client in high fowlers position. 2. Medicate the client for chest pain 3. Retake the clients vital signs in 15 min 4. Apply oxygen and notify the health care provider.

4. Apply oxygen and notify the health care provider.

The nurse review the plan of care for the client on bed rest. tThe nurse should intervene if which intervention is included in the clients care of plan? 1. Encourage the use of elastic stockings 2. Perform daily ROM activities 3. Encourage weight-bearing activities as soon as permitted 4. Teach the client the use of Vasalva maneuver

4. Teach the client the use of Vasalva maneuver

Formulate priority nursing diagnoses appropriate for an individual with a fracture

5 P's: -Pain -Pulse -Pallor -Paresthesia -Paralysis

High Fowlers

60-90 degrees

Bone healing steps

A. Bleeding at fractured ends of the bone with subsequent hematoma formation. B. Organization of hematoma into fibrous network. C. Invasion of osteoblasts, lengthening of collagen strands, and deposition of calcium. D. Callus formation: new bone is built up as osteoclasts destroy dead bone. E. Remodeling is accomplished as excess callus is reabsorbed and trabecular bone is laid down. (Kids start this remodeling process way sooner than adults)

What will an x-ray of the hand and wrist show?

An x-ray of the hand and wrist will show the growth plates of the individual bones in the hand. These growth plates remain open during growth and have a pattern of closure with skeletal maturity that is actually more reliable than the Risser Sign. Hand x-rays also allow the doctor to compare chronological age (how old you are) with skeletal age (real bone age), which may or may not match up to one's chronological age. This can be helpful in determining how much skeletal growth remains.

Evaluate expected outcomes for an individual with a fracture (Goals of Treatment)

Anatomic realignment of bone fragments (reduction) Immobilization to maintain realignment Restoration of normal or near-normal function of the injured part

Sensory input changes for immobilized patients

Assessment -Confusion/disorientation Implementation -Orient frequently -Place clock and calendar in line of vision

Negative Nitrogen Balance in immobilized patients

Assessment -Anorexia -Debilitation -Weight loss Implementation -High Protein diet -Small Frequent feedings

Boredom in the immobilized patient

Assessment -Bordom Implementation -Equipment- radio, tv, books, phone calls -Encourage visitors -Schedule OT

Contractures in immobilized patients

Assessment -Deformity Implementation -Equipment- pillows, trochanter rolls, foot board -Frequently change position -Exercise

Hypercalcemia in immobilized patients

Assessment -Impaired bone growth Implementation -Reduce calcium in diet -Encourage fluids

Depression in the immobilized patient

Assessment -Insomnia -Restlessness Implementation -Encourage self care -Start with simple, gross activities -Increase actives to client tolerance -Provide positive feedback

Osteoporosis in immobilized patients

Assessment -Pathological fractures -Renal Calculi Implementation -Weight-bearing exercise on long bones -Balanced Diet -Estrogen replacement theory

Thrombus Formation in immobilized patients

Assessment -Pulmonary emboli Implementation -Equipment- TED or elastic hose -Leg exercises for 5 min every hour -Change position, ambulate -Do not use knee gatch -No pillow behind the knees -Check for Homan's sign

Increased Cardiac Workload in immobilized patients

Assessment -Tachycardia Implementation -Use trapeze when moving in bed -Teach to move without holding breath (vasalva maneuver)

Urinary Stasis in immobilized patients

Assessment -Urinary retention -Renal Calculi Implementation -Normal position to void -Increase fluid intake -Low calcium diet -Acidify urine

Orthostatic Hypotension in immobilized patients

Assessment -Weakness -Dizziness Implementation -Change position slowly -Increase activity gradually

Constipation in immobilized patients

Assessment -fecal impaction Implementation -Ambulate -Increase fluids and fiber in diet -Provide privacy -Administer stool softeners

Stasis of Respiratory Secretions in immobilized patients

Assessment -hypostatic pneumonia Implementation -Turn, cough, and deep breathe -Postural drainage

Lumbar Lordosis

Concavity in lumbar region

Summarize therapies used by interdisciplinary teams in the collaborative care for an individual with scoliosis

Conservative treatment for adults with scoliosis may include weight reduction, active and passive exercises, and braces for support. Surgery for severe scoliosis involves attaching metal reinforcing rods to the vertebrae. Following surgery: assess the movement and sensation of lower extremities every 2 hours for the first 8 hours, then every shift and as needed Turn by using the log-rolling technique; use a fracture bedpan. Teach how to apply the brace and explain ambulatory restrictions. Teach to change slowly from a reclining position to sitting position and to sit on the edge of the bed for a few minutes before ambulating.

Kyphosis

Convexity in thoracic region

Sims

Decreases abdominal tension

Side lateral

Drainage of oral secretions

What is the Risser Sign?

During puberty, the Risser Sign is used to evaluate skeletal maturity. When the skeleton is fully mature, a "cap" of growth cartilage covers the top of the pelvic bone (iliac wing) and solidifies. This growth cartilage turns to bone and becomes visible on x-ray. As the skeleton begins to mature, the cap of cartilage appears first at the outer edge of the iliac crest (Risser 1) and over a period of eighteen to twenty-four months grows to cover the iliac crest. The stages of skeletal maturity are classified as Risser 0--5, with zero being the time before the bone cap appears and four being complete coverage. Fusion of the growth cap to the iliac wing (Risser 5) signifies completion of spinal growth.

Prone

Extension of the hip joint

Demonstrate the nursing process in providing culturally competent and caring interventions across the lifespan for individuals with common alterations in mobility -Slide 23

History: -Have you ever experienced a bone or muscle injury or problem? -Have you ever taken medications to treat a bone or muscle injury or problem? Current problem: -Do you need to use assistive devices for ambulation -Has your condition ever caused you to fall Lifestyle" -Describe your typical dietary intake in a 24 hour calcium intake -Do you take vitamins or supplements -Describe your physical activity -Does your job require physical labor -Do you smoke, drink or use drugs? Lifespan: elderly -As we age, the spinal column the vertebral disks shorten, and onset of kyphosis with the spinal column compression. -Bone density decreases -Cartilage becomes more rigid and fragile -Loss of elasticity in ligaments Children: -Growing fast -Bones flexible -Greenstick breaks are common

Differentiate common assessment procedures used to examine musculoskeletal health across the life span

Infants & Children: -Infants and children are most likely to have mobility alterations as a result of genetic disorders or congenital malformations -Assessment should be tailored to the specific disorder or malformation Children, Adolescents & Young adults: -Decreased mobility as a result of trauma from sports injuries, abuse or motor vehicle accidents is more common in children, adolescents, and young adults. -Assessment should focus on the specific area affected by the traumatic event, as well as the surrounding joints and tissues. Older adults: -More likely to present with the "wear and tear" mobility problems such as arthritis or back pain -Alterations associated with neurological deficits, such as parkinson disease are also more common in older adults. -Older clients with obesity, and clients who do not exercise regularly may have decreased ROM and strength or increased pain as a result of decreased muscle tone and stress on the joints Pregnant women: -decreased ROM & increased back pain -the client interview for pregnant women should include questions to determine if postural changes or other adaptations could increase mobility and decrease pain

Fracture infections:

Infection Open fractures and soft tissue injuries have a high incidence of infection. An open fracture usually results from the impact of severe external forces. Massive or blunt soft tissue injury often has more serious consequences than the fracture. Devitalized and contaminated tissue is an ideal medium for many common pathogens, including gas-forming (anaerobic) bacilli. Treatment of infection is costly in terms of extended nursing and medical care, time for treatment, and loss of patient income. Osteomyelitis can become chronic .

Evaluate expected outcomes for an individual with osteoarthritis (Goals)

Maintain or improve joint function through a balance of rest and activity Use joint protection measures to improve activity tolerance Achieve independence in self-care and maintain optimal role function Pharmacologic and nonpharmacologic strategies to manage pain satisfactorily.

Contact Dermatitis: Irritant Contact Dermatitis

Manifestations: Painful erythema, edema, and dryness of the skin; lesions may form scales or fissure or become necrotic. Symptoms typically appear int he exposure location and the peak within 24 hours of exposure Clinical Therapies: -Topical Calcineurin inhibitors -Occlusive dressing -Petroleum-based emollients

Contact Dermatitis: Allergic Contact Dermatitis

Manifestations: Urticaria with intense pruritus and erythema; lesion may rupture, ooze, and crust. Symptoms are usually limited to the area of the contact and may occur up to 3 days after exposure to the allergen Clinical Therapies: -Topical Corticosteroids -Antihistamines -Cool, wet compresses -Sooting lotions that promote drying

Plan EB care for an individual with osteoporosis and his or her family in collaboration with other members of the healthcare team

Nursing care fro clients who have osteoporosis focuses on teaching about the disease process, helping maintain physical mobility and nutrition, and solving problems associated with pain and injury: -Prevent injury -Implement safety precautions as necessary for the client who is hospitalized or in a long-term care facility. -Avoid using restraints if at all possible -Encourage older adults to use assistive devices to maintain independence. -Teach older adult clients about safety and fall precautions. -Promote balanced nutrition -Teach clients to get foods that are high in calcium, 1,200-1,500 mg/day. -Encourage postmenopausal women to maintain a calcium intake of 1,000-1,500 mg/day -Teach clients who are taking calcium supplements of the importance of taking the meds at the proper time and about the possible side affects. Free hydrochloric acid is needed for calcium absorption, should be taken 30-60 min before meals to allow for adequate absorption. -Inform clients that calcium absorption requires adequate amounts of Vitamin D. -Relieve Acute Pain: -Suggest the application of heat to relieve pain -Suggest the client takes OTC anti-inflammatory pain meds. -Encourage exercise: -Teach the client who is able to participate in weight-bearing exercises to perform such exercises for a sustained period of 30-40 min 3X per week. -Promote Healthy Behaviors

Fracture complications: DVT

The patient with lower extremity VTE may or may not have unilateral leg edema, extremity pain, a sense of fullness in the thigh or calf, paresthesias, warm skin, erythema, and/or a systemic temperature greater than 100.4° F (38° C). If the calf is involved, it may be tender to palpation. A positive Homans' sign (pain on forced dorsiflexion of the foot when the leg is raised) is a classic but very unreliable sign with frequent false positives. If the inferior vena cava is involved, the legs may be edematous and cyanotic. If the superior vena cava is involved, symptoms may occur in the arms, neck, back, and face.

Modified Trendelburg

Used for shock -feet elevated 20 degrees -knees straight -trunk flat -head slightly elevated -head elevate and knees elevated -evaluation of extremity- increases venous return

Knee-Chest

Visualization of the rectal area

Supine

avoids hip flexion

Flexion

decrease angle of joint

Hyperextension

excessive increase in angle of joint

Extension

increase angle of joint

Fowlers

increases venous return and lung expansion 45-60 degrees

Fracture Complications: Fat embolism Syndrome

is characterized by the presence of systemic fat globules from fractures that are distributed into tissues and organs after a traumatic skeletal injury. FES is a contributory factor in many deaths associated with fractures. The fractures that most often cause FES are those of the long bones, ribs, tibia, and pelvis. FES has also been known to occur following total joint replacement, spinal fusion, liposuction, crush injuries, and bone marrow transplantation. One theory related to the origin of fat emboli suggests that fat is released from the marrow of injured bone and enters the systemic circulation where the fat embolizes to other organs such as the brain.2A second theory postulates that a biochemical change initiated by injury sets up an inflammatory response causing a biochemical injury to the lung parenchyma. The tissues of the lungs, brain, heart, kidneys, and skin are most often affected.

Scoliosis

lateral curve in vertebral column

Rotation

move around central axis

Abduction

move away from midline

Adduction

move toward midline

Dorsal recumbent

supine with knees flexed

Lithotomy

used for vaginal exam