Unit 5 Chapter 26: Mobility

A registered nurse teaches a client about magnetic resonance imaging to diagnose osteomyelitis. Which statement made by the client indicates the need for further education? 1 "I expect no pain from the procedure." 2 "I can take an anti-anxiety agent if needed." 3 "I should remain still throughout the procedure." 4 "I will hear loud noises and alarms."

"I will hear loud noises and alarms."

A client with multiple sclerosis is informed that it is a chronic progressive neurologic condition. The client asks the nurse, "Will I experience pain?" What is the nurse's best response? 1 "Tell me about your fears regarding pain." 2 "Analgesics will be prescribed to control the pain." 3 "Pain is not a characteristic symptom of this condition." 4 "Let's make a list of the things you need to ask your primary healthcare provider."

"Pain is not a characteristic symptom of this condition."

A nurse provides education to a client with myasthenia gravis about how to prevent myasthenic crisis. The nurse evaluates that the teaching is effective when the client makes which statement? 1 "I'll take an antihistamine at the first sign of a cold." 2 "I should skip a dose of pyridostigmine bromide (Mestinon) if it upsets my stomach." 3 "We've told our daughter not to let her cold keep her from visiting us." 4 "The healthcare provider may need to adjust the dosage of my medication if I'm more active."

"The healthcare provider may need to adjust the dosage of my medication if I'm more active."

A nurse reviews the prescribed treatment with the parents of an infant born with bilateral clubfeet. Which parental statement indicates to the nurse that further education is required? 1 "We'll have to start serial casting right away." 2 "The casts will have to be changed every week." 3 "The baby may have to have surgery if the problem is not fixed in a few months." 4 "We'll have to have the baby fitted with prosthetic devices before he'll be able to walk."

"We'll have to start serial casting right away."

A nurse provides discharge instructions to a client who had surgery for a left total hip replacement. Which should the nurse include when teaching the client about how to protect the affected hip when in the sitting position? 1 "When sitting in a soft chair, the left leg should be elevated in a straight-out position." 2 "When sitting in a firm armchair, the left foot should be flat on the floor's surface." 3 "Sit in a firm armchair with the left leg elevated on a high stool." 4 "Sit in a soft chair with pillows tucked under the left hip."

"When sitting in a firm armchair, the left foot should be flat on the floor's surface."

Consequence of immobility: Respiratory

-Recued lung expansion-not exercising, not expanding lungs fully -Atelectasis -Pooling of respiratory secretions-an airless state of the alveoli

Consequence of immobility: Cardiovascular

-Reduced cardiac capacity-lack physical exercise -Decreased cardiac output- reduced force of cardiac contraction -Orthostatic hypotension-when an individual attempts to attain an upright position because of blood pooling in the extremities -Venous stasis -Deep vein thrombosis

Consequence of immobility: Integumentary

-Skin breakdown (higher risk if patient has poor nutritional status and is incontinent.): sustained pressure on the skin reduces perfusion to the tissues. A reduced flow of oxygenated blood causes hypoxemia of the tissues. Not able to move in bed- risk of shearing forces that often accompany certain positions or occur during transfers -Pressure ulcers

changes in mobility

-acute illness or injury -debilitating chronic condition -end of life care

individual risk factors

-acute or chronic condition, chronic pain, injury/trauma -orthopedic injuries, congenital deformities, neurological disorder, spinal injury or deformities

exercise therapy

-ambulation, joint mobility, stretching, balance -rehabilitate or prevent

bone mineral density

-determines core mineral content and density of bone -used for diagnosis of osteoporosis and osteopenia

scope of mobility

-full mobility -partial mobility -complete immobility

A nurse plans care to prevent deformities in a client with rheumatoid arthritis. Which intervention should be alternated with periods of rest? 1 Active exercises 2 Passive massage 3 Bracing of joints 4 Isometric exercises

Active exercises

How would the nurse explain that the skeletal system of toddlers differs from older adults? 1 Bones of toddlers are less pliable than those of older persons. 2 Bones of toddlers can withstand falls better than those of older adults. 3 Bones of toddlers are more susceptible to osteoporosis than those of older adults. 4 Bones of toddlers are more susceptible to bone loss than the bones of older persons.

Bones of toddlers can withstand falls better than those of older adults.

An infant with talipes equinovarus has a plaster cast applied to the involved foot. How should the nurse move the infant while the cast is wet? 1 By handling the cast with just the palms 2 By touching the cast with just the fingertips 3 By turning the infant without touching the cast 4 By moving the infant's body while sliding the cast

By handling the cast with just the palms

Immobility: Psychological in children

CONCERNING!!! -physical activity is integral to daily activity. -Not only is it essential for physical growth and development but also it is central to expression, communication, and making sense of the world around them. -Immobilization can interfere with intellectual and psychomotor function. -Emotional responses range from anger and aggressive behavior to passive quiet demeanor and withdrawal. -Developmental regression is common. -Children often become less communicative and may experience depression; in some cases, hallucinations occur.

A nurse is caring for a client with scoliosis of the thoracic spine and lumbar spine. Which risk does the nurse suspect in the client? 1 Osteoarthritis 2 Muscle spasticity 3 Intervertebral disc prolapse 4 Cardiac function impairment

Cardiac function impairment

Which statements are true regarding chondrosarcoma? Select all that apply. 1 Chondrosarcoma can arise from benign bone tumors. 2 Chondrosarcoma develops in the medullary cavity of long bones. 3 Chondrosarcoma is mostly treated by radiation and chemotherapy. 4 Chondrosarcoma occurs mostly in young males between ages 10 and 25 years. 5 Chondrosarcoma most commonly occurs in cartilage in the arm, leg, and pelvic bones.

Chondrosarcoma can arise from benign bone tumors. Chondrosarcoma most commonly occurs in cartilage in the arm, leg, and pelvic bones.

Some clients self-prescribe over-the-counter glucosamine to help relieve joint pain and stiffness. Which condition should the nurse identify as a reason for a client to reconsider taking this medication? 1 Osteoarthritis 2 Heart disease 3 Hyperthyroidism 4 Diabetes mellitus

Diabetes mellitus

A nurse assesses a client who is suspected of being in myasthenic crisis. Which assessment finding is most definitive in support of this conclusion? 1 Difficulty breathing 2 Decline in physical mobility 3 Disturbed sensory perception 4 Decreased tolerance to activity

Difficulty breathing

A nurse is caring for two clients. One has Parkinson disease, and the other has myasthenia gravis. For which common complication associated with both disorders should the nurse assess these clients? 1 Cogwheel gait 2 Impaired cognition 3 Difficulty swallowing 4 Nonintention tremors

Difficulty swallowing

A client is suspected of having myasthenia gravis. What are the most significant initial nursing assessments that should be performed? 1 Ability to chew and speak distinctly 2 Capacity to smile and close the eyelids 3 Effectiveness of respiratory exchange and ability to swallow 4 Degree of anxiety and concern about the suspected diagnosis

Effectiveness of respiratory exchange and ability to swallow

Which type of burn/injury may cause a client to have a cervical spine injury? 1 Electrical burns 2 Chemical burns 3 Inhalation injury 4 Cold thermal injury

Electrical burns

A client has a fracture of the tibia, and a cast is applied. Which action will the nurse take? 1 Cover the cast with plastic wrap until dry. 2 Assist with weight bearing when the client ambulates. 3 Elevate the affected leg above the level of the heart. 4 Insert a finger inside the edges of the cast to check for skin abrasions.

Elevate the affected leg above the level of the heart.

A client with extensive bone and soft tissue injuries to the right leg is on bed rest. How should the nurse position the client? 1 Keep the right leg resting straight on the bed, parallel to the left leg. 2 Elevate the entire right leg with pillows, keeping the foot higher than the knee. 3 Maintain both legs on the bed and use an abduction pillow to keep them separated. 4 Attach a padded ankle sling to a Balkan frame to support the right foot and elevate the leg.

Elevate the entire right leg with pillows, keeping the foot higher than the knee.

Which synovial joint movement is described as turning the sole outward away from the midline of the body? 1 Pronation 2 Eversion 3 Adduction 4 Supination

Eversion

A client has an open reduction and internal fixation of the hip. The client is to be transferred to a chair for a half hour on the second postoperative day. Before transferring the client, what should the nurse do? 1 Assess the strength of the affected leg. 2 Explain the transfer procedure step by step. 3 Instruct the client to bear weight evenly on both legs. 4 Encourage the client to keep the affected leg elevated.

Explain the transfer procedure step by step.

What clinical finding does the nurse expect when assessing a client with myasthenia gravis? 1 Partial improvement of muscle strength with mild exercise 2 Fluctuating weakness of muscles innervated by the cranial nerves 3 Dramatic worsening in muscle strength with anticholinesterase drugs 4 Minimal changes in muscle strength regardless of the therapy initiated

Fluctuating weakness of muscles innervated by the cranial nerves

Which type of joint is present in between the client's tarsal bones? 1 Pivot joint 2 Hinge joint 3 Saddle joint 4 Gliding joint

Gliding joint

A client is admitted after a motor vehicle crash. The primary healthcare provider has diagnosed the presence of pelvic fractures and bilateral femur fractures. The client's blood pressure has fallen from 120/76 to 60/40, and the heart rate has risen from 82 to 121. Which does the nurse recognize as the most likely reason for the assessment findings? 1 Cardiogenic shock 2 Hypervolemic shock 3 Hemorrhagic shock 4 Septic shock

Hemorrhagic shock

The nurse is caring for a client who is admitted with a crushing injury to the spinal cord above the level of phrenic nerve origin. What should the nurse consider about this type of injury when planning care? 1 Ventricular fibrillation 2 Vagus nerve dysfunction 3 Retention of sensation and paralysis of lower extremities 4 Lack of diaphragmatic contractions and respiratory paralysis

Lack of diaphragmatic contractions and respiratory paralysis

A client who had a right total hip replacement is progressing from the use of a walker to the use of a cane. In which hand should the nurse teach the client to hold the cane? 1 Left hand 2 Right hand 3 Stronger hand 4 Dominant hand

Left hand

A client sustains a complex comminuted fracture of the tibia with soft tissue injuries after being hit by a car while riding a bicycle. Surgical placement of an external fixator is performed to maintain the bone in alignment. Postoperatively it is most essential for the nurse to do what? 1 Cleanse the pin sites with alcohol several times a day. 2 Perform a neurovascular assessment of both lower extremities. 3 Ambulate the client with partial weight bearing on the affected leg. 4 Maintain placement of an abduction pillow between the client's legs.

Perform a neurovascular assessment of both lower extremities.

A nurse assists a client who had bariatric surgery to be more mobile. What complication is the nurse attempting to prevent? 1 Incisional pain 2 Wound dehiscence 3 Anastomosis leakage 4 Pulmonary embolism

Pulmonary embolism

A nurse is assessing an infant with talipes equinovarus (clubfoot) who has had a corrective boot cast applied. Which peripheral vascular assessment cannot be performed while the cast is in place? 1 Color 2 Pulse 3 Warmth 4 Blanching

Pulse

A client who is recuperating from a spinal cord injury at the T4 level wants to use a wheelchair. What should the nurse teach the client to do in preparation for this activity? 1 Push-ups to strengthen arm muscles 2 Leg lifts to prevent hip contractures 3 Balancing exercises to promote equilibrium 4 Quadriceps-setting exercises to maintain muscle tone

Push-ups to strengthen arm muscles

After an open reduction and internal fixation of a fractured hip, what assessments of the client's affected leg should the nurse make? Select all that apply. 1 Skin temperature 2 Mobility of the hip 3 Sensation in the toes 4 Condition of the pins 5 Presence of pedal pulse

Skin temperature Sensation in the toes Presence of pedal pulse

Which physiologic changes of the musculoskeletal system are related to aging? Select all that apply. 1 Slowed movement 2 Cartilage degeneration 3 Increased bone density 4 Increased range of motion 5 Increased bone prominence

Slowed movement Cartilage degeneration Increased bone prominence

Which musculoskeletal abnormality does the nurse suspect in a client who exhibits short steps and drags a foot? 1 Torticollis 2 Pes planus 3 Spastic gait 4 Steppage gait

Spastic gait

A client had a cerebrovascular accident (also known as a "brain attack"), and bed rest is prescribed. What can the nurse use to best prevent footdrop in this client? 1 Splints 2 Blocks 3 Cradles 4 Sandbags

Splints

A nurse is assessing an 18-month-old toddler with suspected developmental dysplasia of the left hip. In what position should the nurse place the toddler to elicit the Trendelenburg sign? 1 Standing on the affected leg 2 Supine with the back arched 3 Side-lying on the unaffected side 4 Sitting upright with the legs separated

Standing on the affected leg

A client is admitted to the hospital with a diagnosis of lower extremity arterial disease (LEAD) or peripheral arterial disease. Which is the most beneficial lifestyle modification the nurse should teach this client? 1 Stop smoking 2 Control blood glucose 3 Start a walking program 4 Eat a low-fat, low-cholesterol diet

Stop smoking

The healthcare provider prescribes a progressive exercise program that includes walking for a client with a history of diminished arterial perfusion to the lower extremities. The nurse explains to the client what to do if leg cramps occur while walking. Which instruction did the nurse give the client? 1 Chew one aspirin twice a day. 2 Stop to rest until the pain resolves. 3 Walk more slowly while pain is present. 4 Take one nitroglycerin tablet sublingually.

Stop to rest until the pain resolves.

While assessing a client, the nurse suspects that the client has acute osteomyelitis. Which symptoms in the client support the nurse's suspicion? Select all that apply. 1 Foot ulcer 2 Temperature of 102° F 3 Erythema of the affected area 4 Tenderness of the affected area 5 Drainage from the affected area

Temperature of 102° F Erythema of the affected area Tenderness of the affected area

Range-of-motion exercises are prescribed for a child with juvenile idiopathic arthritis. What criterion should the nurse use to evaluate the effectiveness of the exercises? 1 The pain is relieved. 2 The affected joints can flex and extend. 3 The pedal and radial pulses are diminished. 4 The subcutaneous nodules at the joints recede.

The affected joints can flex and extend.

A client has a total hip arthroplasty. What should the nurse do when caring for this client after surgery? 1 Use a pillow to keep the legs abducted. 2 Elevate the client's affected limb on a pillow. 3 Turn the client using the log-rolling technique. 4 Place a trochanter roll along the entire extremity.

Use a pillow to keep the legs abducted.

optimal mobility relies on

bones, joints, articular cartilage, tendons, ligaments, and mechanics of muscle contraction

Immobility: Psychological effects

boredom depression feelings of helplessness/hopelessness, grieving anxiety anger disturbed body image decreased verbal and nonverbal communication Individuals who are unable to work or are even unable to meet basic activities of daily living often experience a loss of self-worth or value associated with the role change. Social isolation and mood disturbances are common.

physiological effects

boredom, depression, feelings of helplessness, hopelessness, grieving, anxiety, anger, disturbed body image, decreased verbal and nonverbal communication

fibrous joints hold bone together with

connective tissue

Proprioception

mechanism that provides a sense of position and movement; this process allows for accuracy in the degree of movement with muscle contraction

joints provide

mobility and allow skeletal movement

care for immobilized patient

need for early mobility

populations at risk

older adults

remodeling

ongoing maintenance of bone tissue through a process in which new bone tissue replaces existing bone tissue

Remodeling

ongoing maintenance of bone tissue through a process in which new bone tissue replaces existing bone tissue in bone-remodeling units. Provides the mechanism to repair injured bones (e.g., a fracture). Requires adequate nutrition, hormonal regulation, and blood supply. The severity of the bone injury and the availability of remodeling elements influence the rate or speed at which injured bone heals.

Secondary prevention (screening)

osteoporosis, mobility screening, and fall risk assessment. For osteoporosis screening, the U.S. Preventive Services Task Force (USPSTF) recommends screening of women age 65 years or older as well as younger women who have increased fracture risk dual-energy x-ray absorptiometry of the hip and spine is the recommended method to measure bone density. One of the most common screening tests is the Timed Get Up and Go test, which measures mobility in people who are able to walk on their own (assistive devices allowed). Common screening is the Performance-Oriented Mobility Assessment test, aids in identification of gait and balance impairments. Greenville Early Mobility Scale-used in inpatient settings to track the status and progress of a patient's mobility, thus enhancing the effectiveness of mobility interventions among interdisciplinary teams.

arthrography

visualization of the joint my injection of radiopaque substance into the joint cavity allowing for evaluation of bones, cartilage, and ligaments

mobility impairment

-neurologic -musculoskeletal conditions

GI complications

-constipation -reduced peristaltic motility

What population at greatest risk?

-Because of the effects of aging, the population group at greatest risk for impaired mobility is older adults. -These changes predispose older individuals to a greater incidence of falls and greater challenges regaining full mobility following a period of impaired mobility. -An estimated 90% of hip fractures are a result of falling; 76% of hip fractures occur among elderly women.

Individual risk factors

-often attributed to acute and chronic conditions, chronic pain, and injury/trauma. -Specifically, individuals with orthopedic injury, congenital deformities, neurologic disorders, strokes, head injury, spinal injury or deformities, nutritional deficiencies, cardiopulmonary conditions, and end-stage cancer are particularly susceptible. -Side effects and adverse effects of many medications (e.g., corticosteroids and chemotherapy) and medical treatments can also affect mobility.

history

-presence of pain with movement -recent changes in mobility or problems with balance -presence of fatigue -recent falls -recent changes in ability to complete ADLs

respiratory complications

-reduced lung expansion -pooling of respiratory secretions, reduced cough effort

musculoskeletal complications

-reduced mass, atrophy -25% reduction in muscle mass occurs with permanent immobility -bone demineralization and calcium loss

While performing a musculoskeletal assessment, the nurse notices that the client can complete range of motion with gravity eliminated. Which grade would the nurse assign to the client? 1 2 3 4

2

According to the common scale for grading muscle strength, what rating will be given to a client who can complete range of motion with some resistance? 1 2 3 4

4

Who is at risk for altered mobility?

All individuals are potentially at risk for altered mobility regardless of age, ethnicity, race, or socioeconomic status

A nurse is teaching members of a health care team how to help disabled clients stand and transfer from the bed to a chair. To protect the caregivers from injury, the nurse teaches them to lift the client by first placing their arms under the client's axillae and doing what next? 1 Bending and then straightening their knees 2 Bending at the waist and then straightening the back 3 Placing one foot in front of the other and then leaning back 4 Placing pressure against the client's axillae and then raising their arms

Bending and then straightening their knees

The nurse is caring for a client with a spinal cord injury who has paraplegia. The nurse can expect which major problem early in the recovery period? 1 Bladder control 2 Nutritional intake 3 Quadriceps setting 4 Use of aids for ambulation

Bladder control

A client is experiencing both tingling of the extremities and tetany. What should the nurse anticipate will be prescribed by the healthcare provider? 1 Dialysis 2 Calcium supplements 3 Mechanical ventilation 4 Intravenous fluids with potassium

Calcium supplements

Which nursing intervention is indicated for aging clients with decreased bone density? 1 Teaching the client isometric exercises 2 Advising the client to take a moist heat shower 3 Providing supportive armchairs to the client 4 Demonstrating weight-bearing exercises to the client

Demonstrating weight-bearing exercises to the client

The nurse is assisting a client with myasthenia gravis to bathe. The nurse identifies that the client's arms become weaker with sustained movement. What action should the nurse take? 1 Encourage the client to rest for short periods. 2 Continue the bath while supporting the client's arms. 3 Gradually increase the client's activity level each day. 4 Administer a dose of pyridostigmine bromide.

Encourage the client to rest for short periods.

A nurse is caring for a client who will have a below-the-knee amputation with an immediate postoperative prosthesis. The client asks the nurse the advantage of having an immediate prosthesis. What should the nurse explain is the advantage? 1 Decreases phantom limb sensations 2 Encourages a normal walking pattern 3 Reduces the incidence of wound infection 4 Allows for fitting of the prosthesis before discharge

Encourages a normal walking pattern

The nurse is caring for a client who has sustained blunt trauma to the forearm. The nurse assesses the client for which early sign of compartment syndrome? 1 Warm skin at the site of injury 2 Escalating pain in the fingers 3 Rapid capillary refill in affected hand 4 Bounding radial pulse in the injured arm

Escalating pain in the fingers

A nurse is caring for a client who developed aseptic necrosis after a fracture of the head of the femur. The nurse prepares to administer care based on which factor? 1 Infection at the site of the wound 2 Weight-bearing before the fracture is healed 3 Immobilization after reduction of the fracture 4 Loss of blood supply to the head of the femur

Loss of blood supply to the head of the femur

What are diagnostic tests used for?

Many diagnostic tests are used to evaluate musculoskeletal disorders

After an above-the-knee amputation of a right leg, a client reports pain in the right foot. The nurse should inform the client that phantom limb pain is the result of what? 1 Tactile illusions associated with severed blood vessels 2 Nerve endings in the limb that are still intact and react to stimuli 3 An unconscious phenomenon to aid with grieving over the lost body part 4 Hallucinations secondary to emotional symptoms associated with the distress of amputation

Nerve endings in the limb that are still intact and react to stimuli

After an amputation, the client's residual limb is bandaged snugly throughout the postoperative period. Which goal should the nurse identify as the primary reason for this intervention? 1 Promoting shrinkage 2 Preventing injury to the area 3 Preventing suture line infection 4 Promoting drainage of secretions

Promoting shrinkage

To reduce a hip fracture, the client is placed in traction before surgery for an open reduction and internal fixation. Because the client keeps slipping down in bed, increased countertraction is prescribed. How does the nurse increase the countertraction? 1 Elevate the head of the bed. 2 Add more weight to the traction. 3 Raise the foot of the bed slightly. 4 Tie a chest restraint around the client.

Raise the foot of the bed slightly.

Primary Prevention

Regular physical activity optimal nutrition keeping an ideal body weight getting adequate rest. Taking measures to prevent injury and trauma are also considered primary prevention strategies.

A client with severe varicose veins has surgery that involves ligation, dissection, and removal of incompetent vessels. In which position should the nurse place the client after surgery? 1 Supine with the knee support of the bed raised 2 In a semi-Fowler position with the knees flexed 3 Supine with the legs elevated at a 15-degree angle 4 In a semi-Fowler position with the feet against a footboard

Supine with the legs elevated at a 15-degree angle

A client with multiple sclerosis is in remission. Which diversional activity should the nurse encourage that best meets the client's needs while in remission? 1 Hiking 2 Swimming 3 Sewing classes 4 Watching television

Swimming

Which grows faster- appendicualr or axial?

The appendicular skeleton (extremities) grows faster than the axial skeleton (head, thorax, and spine) partly because the appendicular skeleton is disproportionately shorter than the axial skeleton. Throughout infancy, childhood, and adolescence, bones change in composition, grow in length and diameter, and undergo changes in rotation and alignment. Similarly, the size and composition of muscles undergo changes as a result of physical growth and development throughout childhood, and they are a major factor in weight gain during adolescence.

articular cartilage

acts as cushion by distributing joint loads over a wide area, reduce prolonged compression

remodeling require

adequate nutrition, hormonal regulation, and blood supply

bone serves as a storage system for

calcium and production of RBC within bone marrow

Assessment: History

general health information (past health history, medications, and surgery/treatments) and social history (lifestyle, employment, family assessment, and activities of daily living) as a starting point.10 In addition, the history includes an investigation of specific symptoms experienced by the patient. -Areas of questions specific for mobility include the following: • Presence of pain with movement • Recent changes in mobility or problems with balance • Presence of fatigue • Recent falls • Recent changes in ability to complete activity of daily living

CT scan

identifies soft tissue and bony abnormalities and evaluates musculoskeletal trauma

immobility

inability to move

bones come together at

joints

biphosphonates

stop reabsorption of calcium in bone

disuse syndrome

predictable adverse effects on body tissues and functions associated with sedentary lifestyle and inactivity

What happens with complete immobility?

the greater the extent and length of time, the greater the physiological consequences. A state of complete immobility has a significant impact on the entire body; literally all body systems are affected

On the first postoperative evening after a lumbar laminectomy, a client states, "My feet are as numb as they were before the operation." Which is the nurse's best response? 1 "Let me elevate your feet so the numbness will decrease more quickly." 2 "That's important to know. I will inform your healthcare provider about the numbness." 3 "Continue to let me know how you feel. It often takes time before this feeling subsides." 4 "There is no cause for concern because the numbness will disappear as soon as the anesthesia wears off."

"Continue to let me know how you feel. It often takes time before this feeling subsides."

A client reports mild tenderness and swelling near the ankle while running. Which nursing instruction would best benefit the client? 1 "Do vigorous endurance exercises." 2 "Complete your activity with a balancing exercise." 3 "Perform strengthening exercises in between your activity." 4 "Do warm-up muscle exercises before performing an activity."

"Do warm-up muscle exercises before performing an activity."

After a cervical neck injury, a client is placed in a halo fixation device with a body cast. Which statement indicates the client's concern about body image has been resolved successfully? 1 "I hate having everyone else do things for me." 2 "I've gotten used to the brace. I may even miss it when it's gone." 3 "I've been keeping my daily calories low in an attempt to lose weight." 4 "I can't get to sleep. However, I make up for it in the morning by sleeping later."

"I've gotten used to the brace. I may even miss it when it's gone."

3 possible changes in mobility

-Change in general health -Musculoskeletal, neurologic, and neuromuscular conditions -Medical procedures & Diagnostic tests. -Conditions in these three categories can be caused by congenital defects, genetic conditions, injury, inflammation, infection, autoimmune disorders, and neoplasms.

Consequence of immobility: Gastrointestinal system

-Reduced peristaltic motility: due to GI tract slowing down during states of immonility. -Constipation: not being able to assume an optimal upright position makes having a bowel movement more challenging; for many people, relying on the assistance of others to have a bowel movement is embarrassing and may lead to reluctance in acting on the urge. -Reduced appetite: GI tract slows during -Anorexia -Negatively impacted nutritional status

pharmacological agents

-anti-inflammatory -analgesics, muscle relaxants -supplements

infancy, childhood, and adolescence

-bone changes in composition, grow length in diameter, and undergo changes in rotation and alignment -size and composition of muscles undergo changes as a result of physical growth and development

abnormal findings

-deformities of bone or joint -edema -ecchymosis -localized warmth or tenderness -loss of function -numbness -guarding -limitations in movement of mobility

aging (older adults)

-thinning of vertebral disk, shortening of spinal column, and onset of kyphosis with spinal compression -bone density decreases, bones become brittle -cartilage becomes rigid and fragile, loss of resiliency and elasticity of ligaments -muscle mass and tone reduce significance -reduced ROM, pain in joints, reduced muscle strength

MRI

-uses radiowaves and magnetic fields to provide and image on soft tissue -most efficiently used to evaluate soft tissue, such as vertebral disk, tumor, ligament, and cartilage

What happens to bones, muscles, and cartilage as you age?

A number of musculoskeletal changes. In the spinal column, a thinning of vertebral disks, shortening of the spinal column, and onset of kyphosis with spinal column compression occur. Bone density decreases and becomes brittle (particularly in females), leaving older adults more susceptible to fracture. Cartilage becomes rigid and fragile, and there is a loss of resilience and elasticity of ligaments. Muscle mass and tone reduce significantly in late adult years. Cumulatively, these changes result in mobility impairment attributable to reduced range of motion and pain in joints, reduced muscle strength, and increased risk for bone fracture.

A client admitted to the hospital has edematous ankles. What should the nurse do to best reduce edema of the lower extremities? 1 Restrict fluids. 2 Elevate the legs. 3 Apply elastic bandages. 4 Do range-of-motion exercises.

Elevate the legs.

The healthcare provider prescribes enoxaparin to be administered subcutaneously daily to a client who had a total knee replacement. To ensure client safety, which measure would the nurse take when administering this medication? 1 Remove air pocket from prepackaged syringe before administration. 2 Rub the injection site after administration for 30 seconds. 3 Administer medication over 2 minutes. 4 Administer in the abdomen area only.

Administer in the abdomen area only.

A back brace is prescribed for a client who had a laminectomy. What should the nurse include in the client's teaching plan? 1 Use the brace when the back feels tired. 2 Apply the brace before getting out of bed. 3 Put the brace on while in the sitting position. 4 Wear the brace when performing twisting exercises.

Apply the brace before getting out of bed.

A client returns from the postanesthesia care unit after a right rotator cuff repair. What should the nurse do when performing a neurovascular assessment? 1 Monitor for a pulse deficit. 2 Obtain hourly blood pressure readings. 3 Assess for capillary refill in the nail beds. 4 Place the shoulder through range-of-motion exercises.

Assess for capillary refill in the nail beds.

A nurse is caring for a client with compartment syndrome. Which nursing actions are appropriate? Select all that apply. 1 Assisting with splitting the cast 2 Assessing urine output 3 Evaluating the pain on a scale 4 Applying splints to the injured part 5 Placing cold compresses to the affected area

Assisting with splitting the cast Assessing urine output Evaluating the pain on a scale

A newborn has been diagnosed with developmental dysplasia of the hips and is placed in a Pavlik harness. The parents have been instructed that the infant is to wear the appliance full time except for bathing. What additional instruction should the nurse give the parents about the harness? 1 Avoid undershirts or diapers under the harness. 2 The harness may be adjusted as needed as the baby grows. 3 Apply lotion or baby powder under the harness to prevent skin breakdown. 4 Avoid using the legs to lift the infant's buttocks when changing the diaper at bath time.

Avoid using the legs to lift the infant's buttocks when changing the diaper at bath time.

An older client experiences urinary frequency and nocturia. While ambulating, the client develops severe back pain and is found to have a vertebral compression fracture. When planning care, the nurse will focus interventions on which type of fracture? 1 Collapse of vertebral bodies 2 Demineralization of the spinal cord 3 Wear and tear of the spinous processes 4 Bulging of the spinal cord from the vertebra

Collapse of vertebral bodies

A nurse is caring for an older adult who had an open reduction and internal fixation of a fractured hip. What clinical finding requires the nurse to notify the primary healthcare provider? 1 Lack of a productive cough 2 days postoperatively 2 Rectal temperature of 100.2° F (37.9° C) 3 days postoperatively 3 Complaints of right-sided chest pain 6 days postoperatively 4 Fatigue in the leg on the unaffected side 5 days postoperatively

Complaints of right-sided chest pain 6 days postoperatively

A young man who sustained a spinal cord injury at the cervical level expresses concern about sexual functioning. What should the nurse do when counseling this client? 1 Consider that the client most likely will be able to have reflex penile erections. 2 Arrange for the client to see the healthcare provider because sexual performance is unlikely. 3 Discourage the client from forming sexual relationships because little pleasure will be possible. 4 Reassure the client that he will be able to have sexual relationships with the ability to reproduce.

Consider that the client most likely will be able to have reflex penile erections.

A client had an above-the-knee amputation of the left leg because of trauma from a motor vehicle collision. The primary healthcare provider prescribes ambulation with crutches until the residual limb is healed and the client can be fitted with a prosthesis. What should be the nurse's initial action? 1 Demonstrate the swing-through crutch walking gait. 2 Determine whether the client has ever used crutches before. 3 Introduce the client to another client who is using crutches. 4 Provide a pamphlet that has information about using crutches.

Determine whether the client has ever used crutches before.

Which assessment finding supports the nurse's conclusion that a prosthesis for a client with an above-the-knee amputation fits correctly? 1 Skin that is cool to the touch 2 Shrinking of the residual limb 3 Absence of phantom limb pain 4 Evenly darkened skin of the residual limb

Evenly darkened skin of the residual limb

During the neurologic assessment of a client with a tentative diagnosis of Guillain-Barré syndrome, what does the nurse expect the client to manifest? 1 Diminished visual acuity 2 Increased muscular weakness 3 Pronounced muscular atrophy 4 Impairment in cognitive reasoning

Increased muscular weakness

A client with a chest tube is to be transported via a stretcher. When transporting the client, what should the nurse do? 1 Keep collection device attached to mechanical suction 2 Keep chest tube clamped distal to the water-seal chamber 3 Keep collection device below the level of the client's chest 4 Keep chest tube end covered with sterile gauze pads taped to the client

Keep collection device below the level of the client's chest

A nurse is caring for depressed older adults. What precipitating factors for depression are most common in the older adult without cognitive problems? Select all that apply. 1 Dementia 2 Multiple losses 3 Declines in health 4 A milestone birthday 5 An injury requiring hospitalization

Multiple losses Declines in health

A registered nurse is teaching isometric exercises to an 80-year-old client. Which age change in the client necessitates the teaching of this exercise? 1 Kyphotic posture 2 Muscular atrophy 3 Decreased bone density 4 Cartilaginous degeneration

Muscular atrophy

X-ray films reveal that a client has closed fractures of the right femur and tibia. In addition, multiple soft-tissue contusions are present. Which action is most important for the nurse to take? 1 Perform a neurovascular assessment of the extremity. 2 Reassure the client that these injuries are not that serious. 3 Gather equipment needed for the application of skeletal traction. 4 Prepare the client for a surgical reduction of the injured extremity.

Perform a neurovascular assessment of the extremity.

A client sustains a crushing injury to the lower left leg, and a below-the-knee amputation is performed. For which common clinical manifestations of a pulmonary embolus should the nurse assess this client? Select all that apply. 1 Sharp chest pain 2 Acute onset of dyspnea 3 Pain in the residual limb 4 Absence of the popliteal pulse 5 Blanching of the affected extremity

Sharp chest pain Acute onset of dyspnea

Which information indicates a nurse has a correct understanding about skeletal muscles? 1 Skeletal muscle accounts for about half of a human being's body weight. 2 Skeletal muscle contraction propels blood through the circulatory system. 3 Skeletal muscle contraction is modulated by neuronal and hormonal influences. 4 Skeletal muscle occurs in the walls of hollow structures such as airways and arteries.

Skeletal muscle accounts for about half of a human being's body weight.

The nurse is caring for a client with a long leg cast. Which clinical findings indicate compromised circulation? Select all that apply. 1 Foul odor 2 Swelling of the toes 3 Drainage on the cast 4 Increased temperature 5 Prolonged capillary refill

Swelling of the toes Prolonged capillary refill

Which joint surgery is used as a prophylactic measure and as a palliative treatment for clients with rheumatoid arthritis (RA)? 1 Osteotomy 2 Arthrodesis 3 Synovectomy 4 Debridement

Synovectomy

A client who had a total hip replacement is receiving continuous regional analgesia. The nurse recognizes what as the benefit of this treatment over conventional methods? 1 It is easy to adjust the dose. 2 Neuropathic pain can be relieved. 3 Systemic side effects are minimal. 4 The need for parenteral medication is prevented.

Systemic side effects are minimal.

Upon palpation, the nurse identifies spongy swelling caused by synovial fluid. Which joint was most likely palpated? 1 Biaxial joint 2 Pivotal joint 3 Synovial joint 4 Temporomandibular joint

Temporomandibular joint

Which drug may cause tooth and bone anomalies as a teratogenic effect? 1 Alcohol 2 Estrogen 3 Tetracycline 4 Valproic acid

Tetracycline

Which principle should the nurse consider when assisting a client with crutches to learn the four-point gait? 1 Elbows should be kept in rigid extension. 2 Most of the weight should be supported by axillae. 3 The client must be able to bear weight on both legs. 4 The affected extremity should be kept off the ground.

The client must be able to bear weight on both legs.

Radiographic Diagnostics

The x-ray: evaluates the integrity of bones and joints and is the most common radiographic test used to diagnose fractures. • Computed tomography scan: identifies soft tissue and bony abnormalities and evaluates musculoskeletal trauma. • Magnetic resonance imaging: uses radio waves and magnetic fields to provide an image of soft tissue. This is used most efficiently to evaluate soft tissues, such as a vertebral disk, tumor, ligaments, and cartilage.

What is the main reason a nurse raises three of the four side rails on the bed of a 63-year-old client who had surgery for a fractured hip? 1 As a safety measure because of the client's age 2 Because clients older than 60 years of age should use side rails 3 To be used as handholds to facilitate the client's ability to move in bed 4 Because older adults often are disoriented for several days after anesthesia

To be used as handholds to facilitate the client's ability to move in bed

What does the nurse instruct a client to do while performing McMurray's test? 1 To raise the leg to 60 degrees 2 To abduct the arm to 90 degrees 3 To flex, rotate, and extend the knees 4 To flex the knee to 30 degrees and pull the tibia forward

To flex, rotate, and extend the knees

While caring for a client with a second-degree left ankle sprain, a nurse raises the injured part above heart level. What is the reason behind this nursing intervention? 1 To promote bone density 2 To prevent further edema 3 To reduce pain perception 4 To increase muscle strength

To prevent further edema

What should a nurse explains to a client is the best way to achieve stimulation of calcium deposition in the bone after a distal femoral fracture? 1 Resting the extremity 2 Weight-bearing activity 3 Normal aging processes 4 Ingesting foods high in calcium

Weight-bearing activity

blood test

alkaline phosphate, calcium, phosphorus, uric acid, creatine kinase, BUN, creatinine, myoglobinuria

Assessing musculoskeletal

an assessment of gait and body posture; joints; size, symmetry, and strength of muscles; and range of motion of joints. Pediatric assessment also involves observation of motor activities as related to developmental milestones

progressive mobility

application of mobility plan involving a series of gradual interventions and activities

deconditioned

loss of physical fitness

manifestations of disuse syndrome

cardiovascular vulnerability, obesity, musculoskeletal fragility, depression, premature aging

cartilaginous joints feature

cartilage material that hold joints together and provide some movement

mobility requires adequate

energy, muscle strength, underlying skeletal stability, joint function, and neuromuscular coordination

bone scan

evaluates bone uptake of radionuclide material -detect metastatic cancer in bone

x-ray

evaluates integrity of bones and joints and is the most common radiographic test to diagnose fractures

motor neurons

send nerve impulses to skeletal muscles from spinal cord and peripheral nerves

impaired physical mobility

state in which person has limitation is physical movement but is not immobile

Radiographic Diagnostics part 2

• Myelogram: radiographic study of the spinal cord and nerve root using a contrast dye. This is particularly useful in the evaluation of individuals with back pain. • Arthrography (arthrogram): visualization of a joint by injection of a radiopaque substance into the joint cavity, allowing for the evaluation of bones, cartilage, and ligaments. This is most commonly performed on the knee and shoulder joints, but it also can be done on hips, ankles, and wrists. • Bone mineral density: determines core mineral content and the density of bone. Used for the diagnosis of osteoporosis and osteopenia. • Bone scan: evaluates the bone uptake of a radionuclide material; the uptake is related to the metabolism of the bone. The primary indication detects metastatic cancer in the bone, also used to evaluate avascular necrosis or unexplained bone pain.

optimal skeletal function depends on

-nerve impulses reaching muscle -muscle fibers response to nerve stimulus -proprioception -mechanical load -joint mobility

urinary complications

-renal calculi, urinary stasis, and infection -bladder loses tone

movement is coordinated by

-sensing internal and external data signals -integrating data signals -responding by triggering motor activity

bone roles related to mobility

-structural foundation for body and as leverage to move body parts -support and protect tissues and internal organs -provide attachment sites for muscles and ligaments

three classifications of joints

-synarthrosis (non-movable) -amphiarthrosis (slightly moveable) -diarthrosis (freely movable)

types of movement provided by joints

flexion, extension, rotation, adduction, abduction, supination, and pronation. Some of the most common problems associated with mobility arise as a result of joint pain and/or changes in joint function.

various types of movement

flexion, extension, rotation, adduction, abduction, supination, pronation

myofibrils

functional units of muscle contraction

synovial joint elements

join capsule, synovial membrane, joint cavity, synovial fluid, articular cartilage

cerebellum

-located at base of brain -coordinates movements, equilibrium, muscle tone, and proprioception

motor cortex

-located in frontal lobe -responsible for voluntary motor activity through a series of nerve impulses sent from the brain through the spinal cord and peripheral nerves, to target muscle

Consequence of immobility: Urinary system

-Renal calculi: from stasis of urine in the renal pelvis and because of increased circulating serum calcium levels (as a result of bone reabsorption mentioned previously). -Loss of tone in bladder: making it difficult to completely empty the bladder, particularly in a lying position for voiding. -Infection: presence of urinary stasis provides an optimal environment for the growth of bacteria. -Urinary stasis

cardiovascular complications

-central and peripheral perfusion -reduced cardiac capacity -15% reduction in muscle mass will occur after 12 weeks of complications -reduced force of cardiac contraction and reduction in cardiac output -loss of endurance and the deconditioned state presents challenges with resumption of PA -decreased efficiency of orthostatic neurovascular reflexes and diminished vasopressor mechanism -venous stasis -deep vein thrombosis

A client has corrective surgery for a bladder laceration. What nursing intervention takes priority during this client's postoperative period? 1 Turning frequently 2 Raising side rails on the bed 3 Providing range-of-motion exercises 4 Massaging the back three times a day

Turning frequently

electromyography

evaluation of electrical activity generated in the muscle

integumentary complications

-reduced perfusion -hypoxemia -increased risk for skin breakdown

mobility can refer to

particular part of body, person can have immobile extremity but be mobile

Consequence of immobility: Musculoskeletal

-Reduction in muscle mass and atrophy-Skeletal muscle adapts to nonuse by reducing mass. Negatively affect functional ability -Contracture of joints-the lack of activity leads to contracture in the joint, primarily as a result of muscle shortening. -Bone demineralization and calcium loss from skeletal-from the lack of weight bearing. Related to the severity and duration of immobility as well as the degree of weight-bearing ability. Osteoporosis can develop in response to immobility

What should a nurse assess after applying a body jacket brace to a client with severe spine injuries following a car accident? Select all that apply. 1 Pin sites 2 Development of cast syndrome 3 Signs of compartment syndrome 4 Abdomen for decreased bowel sounds 5 Areas of pressure over the bony prominences

Development of cast syndrome Abdomen for decreased bowel sounds Areas of pressure over the bony prominences

myelogram

radiographic study of the spinal cord and nerve root using a contrast dye

arthroscopy

procedure that allows visualization of the interior of a joint a through endoscope

proprioception

provides sense of position and movement and allows for accuracy in the degree of movement with muscle contraction

mobility

purposeful physical movement, including gross simple movements, fine complex movements, and coordination

Three classifications of joints (based on stability and movement)

synarthrosis joints (nonmovable), amphiarthrosis joints (slightly movable), and diarthrosis joints (freely movable).

mobility is dependent on

synchronized efforts of musculoskeletal and nervous system, as well as adequate oxygen, perfusion, and cognition

appendicular skeleton grows faster

than axial skeleton in childhood