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Lecture 18

NUR 229 Lecture Notes - Lecture 18: Rib Cage, Muscle Atrophy, Respiratory Sounds


Department
Mennonite College of Nursing
Course Code
NUR 229
Professor
Blanca Miller
Lecture
18

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NUR 229: Mobility
In Class Notes:
1. Causes of Immobility
a. Physical: Trauma, surgery, fracture/breaks bone, obesity, aging adults, Osteoarthritis,
Osteoporosis
b. Environment: Put side rails up, use restraints
c. Neurological: Stroke, vertigo/dizziness, Parkinson’s Disease, ALS, paralysis (cevered
spinal cord)
d. Psychosocial: All alone can lead to depression; stress
e. Medications: Chemically paralyze someone, sedatives, narcotics
2. Body Systems
a. Cardiovascular
i. What happens? Someone is on bed rest and the heart will increase in cardiac
workload because decrease of circulation, decrease in contraction of skeletal
muscles, decrease in pumping blood by the rest of the body so the heart has to
pump harder to get the blood back
ii. Results in: Tachycardia, HTN, orthostatic HTN,, pooling blood ends up with
venous stasis/DVT
iii. Assessment: Take blood pressure, pulse, pulse ox. Monitor for S&S of DVT
iv. Intervention: Have pt. sit up slowly and dangle feet before they get up to walk to
prevent from orthostatic HTN, wear TED hose, SCDs, give prophylaxis (LMWH
and subcutaneous Heparin)
b. Respiratory
i. What happens? Decrease in lung expansion as much as they normally do
person is not taking in deep breaths because they body says “I don’t need that
much oxygen” so lungs don’t have to expand so much; secretions start pooling
and it will be harder to cough up (tenacious/thicker)
ii. Results in: Decrease in thoracic cage and increase of secretion pooling
1. Hypostatic Pneumonia: Due to decrease in lung expansion, which leads
to decrease in depth of respirations and rate of respirations, which leads
to secretions pooling (harder to get them out because they’re thicker)
2. Atelectasis: Alveoli collapse from a decreased use of oxygen
iii. Assessment: Observe for S&S of respiratory distress, look at chest movement
(symmetrical?) Listen to lung sounds, check oxygen saturation level,
iv. Interventions: Turn, cough & deep breath every 2 hours, chest physiotherapy,
push more fluids to decrease the thickness of secretions so pt. can cough them up
more easily
c. Musculoskeletal
i. What happens? Decrease in muscle mass and strength leads to muscle atrophy
ii. Results in:
1. Joint Contractures: When the joint raises and stays in a different place
2. Disuse Osteoporosis: Calcium loss because you’re not utilizing weight
bearing
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3. Plantar Flexion: “Foot drop”
iii. Assessment: Assess ROM to have a baseline to compare and see if it’s getting
worse/better;
iv. Interventions: Use active ROM, splints
1. To prevent foot-drop, wear high tops
d. Urinary System
i. What happens? Urinary stasis if you’re laying flat, the urine is in the bladder
and it gets over extended so the urine goes back to his kidneys, end up with
kidney stones or UTI
ii. Results in:
1. Renal Calculi
2. UTI: Reflex of urine
iii. Assessment: Analyze I & O to make sure it’s adequate, monitor S&S of UTI
(confusion in older adult, pain, burning when urinating, can bleed, skin gets
sensitive), Monitor color & clarity of urine
iv. Interventions: Push fluids, report the I & O, if they have a kidney stone then
strain urine to get the stone, drink cranberry juice
e. GI
i. What happens? Decrease in fluid intake, activity, renal sphincter can become
weak and makes it difficult to eliminate
ii. Results in:
1. Constipation:
2. Fecal Impaction: Stool builds up that needs to be excreted
iii. Assessment: Assess for daily bowel movement (find out baseline- when do they
usually go to the bathroom?), make sure if you see liquid coming out then check
for fecal impaction
iv. Interventions: Chart BM, encourage fluids to help push things out, increase fiber
in diet, take laxatives/enemas/stool softener as needed, if you have an impact you
have to digitally remove it
f. Integumentary
i. What happens? You have a pressure ulcer from the pressure
ii. Results in:
1. Pressure Ulcer
iii. Assessment: Assess skin and make sure there’s no moisture, don’t massage it
(causes trauma to tissue) to prevent from pressure ulcer
iv. Interventions: Turn pt. every 2 hours and use barrier creams
g. Psychosocial
i. Results in: Depression, anxiety, isolation
ii. Assessment: Assess the patient’s mood/behavioral changes, support system, what
could be causing it, changes in sleep, exaggerated response to situations
iii. Interventions: Support groups, get pt. out of room to break up their day, be an
active listener, provide things for them to do (based on their likes)
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Objectives
1. Discuss physiological and pathological influences on body alignment and joint mobility
2. Identify changes in physiological and psychosocial function associated with mobility and immobility
3. Assess for correct and impaired body alignment
4. Discuss interventions and care plans for patients with impaired body alignment/immobility issues
5. Describe the effects of immobility on major body systems
6. Discuss principles of body mechanics and safe patient handling
7. Identify nursing interventions to prevent complications in patients with mobility and immobility issues
8. Use the nursing process as a framework for care of the patient with immobility issues, osteoporosis,
rheumatoid arthritis, osteoarthritis
Terms to Know
Atrophy
Active exercise
Body mechanics
Contractures
Dangling
Flaccidity
Foot drop
Isokinetic exercise
Isometric exercise
Isotonic exercise
Paresis
Passive exercise
Range of motion
Spasticity
Osteoporosis
If you need to review physiology of movement and alignment please read pages 1038-1042
Normal Movement and Alignment Page 1042-1043
1. Body alignment or posture: Good posture is the alignment of body parts that permits optimal
musculoskeletal balance and operation, and promotes healthy physiologic functioning. A person in correct
alignment is experiencing no undue strain on the joints, muscles, tendons, or ligaments while balance is
maintained.
2. Balance: Center of gravity is close to its base of support, the line of gravity goes thru the base of
support, and the object has a wide base of support; center of gravity of an object is the point at which its
mass is centered; body balance increases when people spread the feet farther apart and flex the hips and
knees
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