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NP Ch 39 CCC 105

NP Ch 39 CCC PN105

conditions that may require bedrest stroke, trauma, neuromuscular disorder, chronic debilitating illness
complications caused by immobilization pressure injuries, pneumonia, bone loss, loss of function in immobilized part
immobilization effect - cardiovascular venous stasis, increased cardia workload, blood pressure alterations
cardiovascular problems from immobilization thrombus, thrombophlebitis, pulmondary embolus, orthostatis hytptension, increased pulse rate
immobilization effect - respiratory stasis of secretions, decreased elastic recoil, decreased vital capacity
respiratory problems from immobilization hypostatic pneumonia, bacterial pneumonia, atelectasis, decreased gas exchange
immobilization effect - GI anorexia, metabolic change to catabolism and negative nitrogen balance, decreased peristalsis
GI problems from immobilization weight loss, protein deficiency, abdominal distention, constipation
immobilization effect - musculoskeletal decreased muscle mass and tension, shortening of muscles, loss of calcium from bone matrix, decrease in bone weight
musculoskeletal problems from immobilization fibrosis of connective tissue, atrophy, weakness, joint contracture, osteoporosis, bone pain
immobilization effect - urinary stasis of urine, UTI, renal stones
urinary problems from immobilization precipitation of calcium salts, frequency of urination, dysuria
immobiliation effect - skin decreased circulation from pressure, ischemia, necrosis of tissue
skin problems from immobilization skin breakdown, pressure ulcers
immobilization effect - psychological/brain decreased mental activity, decreased sensory input, decreased socialization, decreased independence
psychological/brain problems from immobilization disorientation, confusion, boredom, anxiety, depression, lonliness
prevention of immobilization complications (physical) increase fluid intake to 3L/day; adequate nutrition; increased fiber; stool softeners/laxatives; passive/active ROM; isometric exercises; turn q2h; keep skin clean and dry; use pressure-relief devices
types of immobilization splints, traction, traction, cast, external fixators
types of splints molded, immobilizers, inflatable, cervical collars, traction
splint protects injured parts by immobilizing them; can be used prior to cast application
splint to control bleeding inflatable splint
amount to inflate inflatable splint until can be indented 1.2" by fingertips
splints are made of _________ cloth, foam, velcro
types of traction skin and skeletal
how traction works pulling force is used to maintain body alignment, maintain fracture alignment, and relieve pain and muscle spasm
considerations for patients in traction should have overhead frame and trapeze bar; weights should seing freely without touching bed or floor
skin traction is made of ___________ velcro boots, belts, halters, slings
purpose of skin traction decrease spasm accompanying fractures
skin traction is applied _________ snugly to the skin
considerations of skin traction skin pain must be reported; weight is limited to 5-10 lbs
skeletal traction requires surgical placement of pins, tongs, screws, or wires anchored to the bone
which supports more weight, skeletal or skin traction skeletal traction
considerations of skeletal traction clear fluid drainage around pins; sign of infection immediately reported; circulation checks q1h for first 24h, then q4h
for skeletal traction, the nurse is responsible for maintaining _______ correct weight, alignment, and balance
cast used to immobilize and extremity following a fracture or orthopedic procedure
cast protects by _____________ layer of stockinette followed by layer of padding; plaster or fiberglass cast then applied
cast considerations protection during drying to prevent dents and uneven pressure which can cause circulatory impairment and pressure injuries
how to handle a cast use palm of hands and plat part of fingers
problems with cast swelling is common anc can cause circulatory impairment and pressure injury
to fix a tight cast can be bivalved
hip spica cast should not_____ be used for turning or lifting
external fixators pins, screws, or tongs inserted through one or more bones to stabilize fragments during healing; metal inserts are attached to external frame
considerations for external fixators allows for more activity; device needs to be checked for stability q4h; pine care required to prevent infection
pressure relief devices aid in reducing skin trauma from pressure for patients in standard hospital beds
types of pressure relief devices foam and gel pads; sheepskin pads; heel and elbow protectors; pulsating air pads; water mattresses on top of regular mattress
types of devices to prevent immobility problems pressure relief devices; continuous passive motion machine; therapeutic exercise
continuous passive motion machine ordered to restore joint function after orthopedic surgery to replace joint
how continuous passive motion machine works exercises extremity and joint thus preventing contracture, muscle atrophy, venous stasis, and thrombus formation
therapeutic exercise physical therapy ordered for patient who is immobilized for extended period of time
ROM exercises full ROM exercises shoudl be performed either actively or passively several times a day
to prevent injury during passive ROM _________ support limb to be exercised above and below the joint
assessing immobilized patient circulatory impairment; respiratory impairment; which ADL can perform; neurovascular assessment for cast/traction; cultural beliefs/customs; pulleys/ropes function properly; ambulation aids; patient gait
how to apply bandage elevate and support limb; wrap from distal to prosimal using even pressure; overlap turns equally; smooth wrinkles; secure end with safety pin/tape/clips; check neurovascular status; remove and rewrap at least 2x daily
bandage wrapping techniques circular turn; spiral turn; spiral reverse turn; figure 8 turn
circular turn used to anchor bandage and terminate the wrap
spiral turn used to bandage parts of body uniform in circumference
spiral reverse turn used to bandage body partgs not uniform in circumference
figure 8 turn used to bandage and stabilize elbow, knee, ankle, or fractured clavicle
aids to mobilization walkers, crutches, canes, wheelchairs, braces, splints, prostheses, rehabilitation
walkers first mechanical aid used when training individual to walk following loss of function
crutches follow use of walker or first aid to ambulation
canes standard (one point) and quad (four point)
wheelchairs for patients who are not able to ambulate independently or with aids
braces and splints used to strengthen and support areas affected by weakness or paralysis
prostheses used to replace missing body parts
rehabilitation prescribed exercise to improve muscle tone, joint flexibility, or cardio fitness
rehabilitation parameters determined by target heart rate during activity based upon age and condition
neurovascular assessment use dorsum of hand to check temp; movement distal to injury; sensation bilaterally; pulses distal and bilaterally; capillary refill; pain level
advantage of quad cane will stand by itself
guidelines for cane use intact rubber tip; use on unaffected side; not bear full weight on affected side; walk beside patient; elbow bend 15-30 degrees when weight bearing; tip is 6-10" to side and 6" from front on near foot; patient looks straight ahead
how continuous passive motion machine works extends extremity to prescribed angle for specific period of time and then releases joint, flexing it again
pain and continuous passive motion machine assess pain and medicate prior to use; closely monitor pain level during; pain is best controlled before it becomes severe
prior to using continuous passive motion ____ check dressing for need of reinforcement; check function of machine; check electrical safety of machine
Created by: cmp12345
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