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FUNDAMENTALS OF NURSING LESSON 5 PROMOTING ACTIVITY AND MOBILITY.

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Presentation on theme: "FUNDAMENTALS OF NURSING LESSON 5 PROMOTING ACTIVITY AND MOBILITY."— Presentation transcript:

1 FUNDAMENTALS OF NURSING LESSON 5 PROMOTING ACTIVITY AND MOBILITY

2 HAZZARDS OF IMMOBILITY DR. DIETRICK EXPERIMENT 1948 NURSES ARE LEGALLY AND MORALLY ACCOUNTABLE FOR DECREASING THE EFFECTS OF IMMOBILITY

3 HAZZARDS OF IMMOBILITY MUSCULOSKELETAL SYSTEM HYPERTROPHY—INCREASES IN SIZE WHEN USED ATROPHY—DECREASES IN SIZE WITH NON-USE

4 HAZZARDS OF IMMOBILITY MUSCULOSKELETAL SYSTEM

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7 Osteoporosis=loss of bone mass Pt’s need an increase in Ca and adequate activity to maintain bone strength

8 HAZZARDS OF IMMOBILITY MUSCULOSKELETAL SYSTEM Contractures: stiffness in JOINT caused by shortened muscle

9 HAZZARDS OF IMMOBILITY MUSCULOSKELETAL SYSTEM end stage renal disease patient

10 HAZZARDS OF IMMOBILITY MUSCULOSKELETAL SYSTEM

11 HAZZARDS OF IMMOBILITY GASTROINTESTINAL SYSTEM NEGATIVE NITROGEN BALANCE ANOREXIA DECREASED PERISTALSIS

12 HAZZARDS OF IMMOBILITY CARDOVASCULAR SYSTEM ORTHOSTATIC HYPOTENSION HEART WORKS 30% HARDER THROMBUS FORMATION

13 HAZZARDS OF IMMOBILITY RESPIRATORY SYSTEM DECREASED RESPIRATORY MOVEMENT THICK AND STICKY LUNG SECRETIONS

14 HAZZARDS OF IMMOBILITY URINARY SYSTEM KIDNEY STONES – INCREASED BLOOD CALCIUM INCREASED URINE pH UTI—KIDNEY INFECTION – D/T STASIS OF URINE

15 HAZZARDS OF IMMOBILITY SKIN DECUBITUS ULCERS LATIN WORD FOR LYING DOWN, RECLINING

16 HAZZARDS OF IMMOBILITY SKIN

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21 HAZZARDS OF IMMOBILITY NERVOUS SYSTEM NERVE IMPAIRMENT— PRESSURE ON NERVE OR BLOOD SUPPLY DECREASED INTELLECTUAL AND SOCIAL ABILITIES DECREASED SPEED OF PERCEPTIONS AND REACTIONS INCREASED PAIN PERCEPTION

22 HAZZARDS OF IMMOBILITY PSYCHOSOCIAL DECREASED SELF CONCEPT DECREASED MOTIVATION DECREASED DRIVES INCREASED EMOTIONAL DISTURBANCES

23 BODY MECHANICS BODY MECHANICS = USING THE BODY EFFICIENTLY AS A MACHINE A KEY FACTOR IN PROPER BODY MECHANICS IS MAINTAINING PROPER BODY ALIGNMENT

24 ESTABLISH A WIDE BASE OF SUPPORT FOR BETTER STABILITY AND BALANCE PRINCIPLES OF BODY MECHANICS

25 MAINTAIN EQUILIBRIUM BEND OR FLEX THE KNEES USE LARGE MUSCLE GROUPS (FACE DIRECTION OF MOVEMENT) ADJUST THE WORK LEVEL. (LEVEL SURFACE=LESS WORK) CARRY OBJECTS CLOSE TO MIDLINE

26 WHY USE PROPER BODY MECHANICS? PREVENT STRAIN & INJURY TO PATIENT PREVENT STRAIN & INJURY TO YOU PATIENT SAFETY

27 5 MOST COMMON INJURIES LIFTING PATIENT (50%) HELPING PATIENT OUT OF BED (30%) MOVING A BED (8%) LIFTING PATIENT TO STRETCHER (7%) CARRYING EQUIPMENT (5%)

28 PURPOSES FOR PROPERLY POSITIONING THE PATIENT PRIMARY REASON: TO REDUCE PRESSURE ULCERS TO MAINTAIN BODY ALIGNMENT TO PROVIDE MOVEMENT FOR PATIENT— PROMOTE SKIN INTEGRITY TO PREVENT CONTRACTURES TO PREPARE PATIENT FOR PROCEDURE

29 ACTIVITY AND MOBILITY ***THE NURSE SHOULD TURN AN INACTIVE PT EVERY 2 HOURS TO AVOID PRESSURE SORES (a great nurse will turn more often if time permits!!)

30 BODY POSITIONS AS APPLIES TO NURSING INTERVENTIONS DORSAL (SUPINE) – FLAT ON BACK DORSAL RECUMBENT

31 BODY POSITIONS AS APPLIES TO NURSING INTERVENTIONS SEMI FOWLERS – HOB AT 30° FOWLERS – HOB AT 45-60° HIGH FOWLERS – HOB AT 90° TRENDELENBERG

32 BODY POSITIONS AS APPLIES TO NURSING INTERVENTIONS ORTHOPNEIC: LITERALLY SITTING UP

33 BODY POSITIONS AS APPLIES TO NURSING INTERVENTIONS SIMS – POSITION OF CHOICE FOR ENEMA OR RECTAL EXAM

34 BODY POSITIONS AS APPLIES TO NURSING INTERVENTIONS LATERAL SIDE- LYING

35 BODY POSITIONS AS APPLIES TO NURSING INTERVENTIONS RARELY USED EXCEPT LOWER EXTREMITY AMPUTATIONS PRONEPRONE

36 BODY POSITIONS AS APPLIES TO NURSING INTERVENTIONS LITHOTOMY GENUPECTORAL

37 RANGE OF MOTION DEFINED: THE MAXIMUM MOVEMENT THAT IS POSSIBLE FOR A JOINT INFLUENCED BY – GENETIC INHERITANCE – DISEASE – NORMAL AMOUNT OF ACTIVITY – INJURY – DEVELOPMENTAL PATTERNS

38 TYPES OF RANGE OF MOTION ACTIVE—PATIENT PERFORMS INDEPENDENTLY PASSIVE—PERFORMED FOR PT BY NURSE OR PHYSICAL THERAPIST ACTIVE ASSISTED ISOMETRIC ISOTONIC CONTINUOUS PASSIVE MOTION—CPM MACHINE

39 PURPOSES FOR RANGE OF MOTION TO PREVENT CONTRACTURES TO RESTORE, INCREASE, OR MAINTAIN THE STRENGTH OF MUSCLES TO MAINTAIN OR INCREASE FLEXIBILITY OF JOINTS

40 PURPOSES FOR RANGE OF MOTION TO MAINTAIN OR PROMOTE THE GROWTH OF BONES THROUGH STRESS IF NOT STRESSED THEY BEGIN TO DECALCIFY TO IMPROVE FUNCTION OF OTHER BODY SYSTEMS (GI OR CV) – HOSPITALIZATION DECREASES MOBILITY – EVERY SYSTEM IS AT RISK OF IMPAIRMENT

41 NURSE’S RESPONSIBILITY ASSESS PATIENT’S LEVEL OF FUNCTION IF PARTIALLY IMMOBILE, ASSIST WITH ROM EXERCISES ASSESS NEED AND IMPLEMENT INTERVENTIONS TO PREVENT COMPLICATIONS ROM NEEDS TO BE STARTED EARLY TO PREVENT COMPLICATIONS

42 ANGLES OF RANGE OF MOTION FLEXION EXTENSION HYPEREXTENSION LATERAL FLEXION ROTATION ABDUCTION ADDUCTION EXTERNAL ROTATION INTERNAL ROTATION CIRCUMDUCTION SUPINATION PRONATION OPPOSITION INVERSION EXERSION

43 PRINCIPLES OF PERFORMING ROM MOVE FROM HEAD TO TOE SUPPORT THE JOINT CPM DOCUMENTATION DEFINITIONS

44 TECHNIQUES FOR MOVING PATIENTS PROPRIOCEPTION CHECK EQUIPMENT – IV’S, FOLEYS, FEEDING TUBES, RESTRAINTS – DON’T ATTEMPT >35% OF YOUR OWN BODY WEIGHT PROTECT SKIN – PRESSURE, FRICTION, SHEARING PROTECT YOURSELF DANGLE PATIENT ORTHOSTATIC HYPOTENSION – BEDREST – HYPOVOLEMIA— DECREASED CIRCULATING BLOOD – HYPOKALEMIA—LOW SERUM POTASSIUM – MEDICATIONS

45 TECHNIQUES FOR MOVING PATIENTS LOSS OF SENSATION – HEMIPLEGIA—ONE SIDED WEAKNESS OR PARALYSIS – PARAPLEGIA—PARALYSIS OF LOWER LIMBS – SPASTIC—SPASMS – PARESIS—PARTIAL PARALYSIS – PARALYSIS—LOSS OF MUSCLE FUNCTION OR LOSS OF SENSATION – FLACCID—WEAK, SOFT, FLABBY, LOSS OF TONE – QUADRIPLEGIA—LOSS IN ALL 4 LIMBS

46 TECHNIQUES FOR MOVING PATIENTS AMBULATING – NORMAL WALKING POSITION – IF FALLS: CALL FOR HELP ARMS AROUND WAIST, LOWER PT TO FLOOR SLOWLY STAY WITH PT UNTIL HELP ARRIVES HOYER LIFT LOG ROLL BED TO STETCHER

47 INDICATIONS FOR PERFORMING ROM PHYSICIAN ORDER IMMOBILITY MUSCLE ATROPHY OR WEAKNESS INJURY TO JOINT DISEASE PROCESSES

48 DATA TO KNOW R/T ROM AND CPM ASSESS THE PATIENT – PAIN – INCISION INFLAMMATION, DRAINAGE – OTHER CHECK CPM MACHINE – CORRECT FLEXION AND EXTENSION – ALL PARTS OPERABLE – SPEED CONTROL

49 THE END


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