Effects of Immobilization and Compartment Syndrome
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Questions and Answers

Which condition results from decreased muscle strength and joint mobility?

  • Hypercalcemia
  • Bone demineralization (correct)
  • Thrombus risk
  • Orthostatic hypotension

    • What is a potential risk associated with immobilization that affects the cardiovascular system?

  • Improved venous return
  • Decreased workload of heart
  • Increased muscle atrophy
  • Increased risk for thrombus (correct)

    • Which of the following is an effect of immobilization on the respiratory system?

  • Increased respiratory effort
  • Enhanced ventilation
  • Normal movement of secretions
  • Decreased respiratory effort (correct)

    • What symptom is considered an early sign of compartment syndrome?

    <p>Poikilothermia</p> Signup and view all the answers

    Which issue can arise from a negative calcium and nitrogen balance during immobilization?

    <p>Bone demineralization</p> Signup and view all the answers

    What management strategy should be employed for cast care?

    <p>Expose plaster cast to air until dry</p> Signup and view all the answers

    Which of the following is a psychological effect of immobilization?

    <p>Frustration and anxiety</p> Signup and view all the answers

    What consequence does immobilization have on bowel mobility?

    <p>Decreased bowel mobility</p> Signup and view all the answers

    What is a late sign of injury indicated by pulselessness?

    <p>Distal paralysis</p> Signup and view all the answers

    What should be done if pulses do not return to the affected limb?

    <p>Perform fasciotomy</p> Signup and view all the answers

    How should a leg with an injury be positioned when sitting?

    <p>Elevated on a pillow</p> Signup and view all the answers

    What is the recommended action for dealing with incontinence associated with injuries?

    <p>Protect with waterproof tape and use diapers</p> Signup and view all the answers

    Which of the following is NOT advised when managing an injured limb in a cast?

    <p>Place in water to clean</p> Signup and view all the answers

    What is an appropriate method to manage pain associated with swelling?

    <p>Calculate elevation and ice application</p> Signup and view all the answers

    Regarding arm or hand injuries, what is the best way to support the limb?

    <p>Keep in a sling and support on pillows</p> Signup and view all the answers

    What is a consequence of overuse syndromes/injuries?

    <p>Repetitive strain on tissues</p> Signup and view all the answers

    What are the primary characteristics of asthma in children?

    <p>Chronic inflammation, airway obstruction, and bronchial hyperresponsiveness</p> Signup and view all the answers

    Which symptom is typically observed during an asthma attack?

    <p>Chest tightness and pain</p> Signup and view all the answers

    What does Status Asthmaticus indicate?

    <p>Severe respiratory distress that does not respond to treatment</p> Signup and view all the answers

    Which of the following is NOT recommended for a child with asthma?

    <p>Eating spicy foods to open airways</p> Signup and view all the answers

    What are common signs of bronchiolitis in infants?

    <p>Rhinorrhea, low-grade fever, and wheezing</p> Signup and view all the answers

    Which treatment is commonly provided in a hospital for a severe case of bronchiolitis?

    <p>IV fluids and bronchodilators</p> Signup and view all the answers

    What is a common misconception about the presentation of bronchiolitis in infants?

    <p>Infants will display many obvious clinical signs</p> Signup and view all the answers

    Which factor does NOT increase the risk of developing asthma?

    <p>Regular physical activity</p> Signup and view all the answers

    What characterizes a greenstick fracture?

    <p>The compressed side of the bone bends while the tension side breaks.</p> Signup and view all the answers

    Which condition is likely to be indicative of abuse?

    <p>Spiral fracture</p> Signup and view all the answers

    What is the primary management strategy for a complicated fracture?

    <p>Immediate surgical intervention and antibiotics.</p> Signup and view all the answers

    Which of the following is a symptom of Osgood-Schlatter disease?

    <p>Pain, tenderness, and swelling around the knee.</p> Signup and view all the answers

    What is the recommended management for a neonatal fracture?

    <p>Monitoring and promoting healing until walking.</p> Signup and view all the answers

    Which of the following is NOT a symptom associated with stress fractures?

    <p>Severe muscular rigidity.</p> Signup and view all the answers

    What is a common complication to monitor for after a fracture?

    <p>Compartment syndrome.</p> Signup and view all the answers

    What is the primary nursing concern following a tonsillectomy?

    <p>Minimizing agitation and constant checking for bleeding.</p> Signup and view all the answers

    Which symptom indicates that bleeding may be occurring after a tonsillectomy?

    <p>Frequent swallowing.</p> Signup and view all the answers

    Which of the following is part of the management plan for the Female Athlete Triad?

    <p>Addressing eating disorders and promoting bone health.</p> Signup and view all the answers

    What defines mild asthma symptoms in children?

    <p>Short-acting beta-agonist use more than twice a week</p> Signup and view all the answers

    Which type of dehydration presents with decreased plasma volume and is most commonly seen in children?

    <p>Isotonic Dehydration</p> Signup and view all the answers

    What is a key treatment consideration for hypotonic dehydration?

    <p>Avoiding rapid fluid replacement due to risk of cerebral edema</p> Signup and view all the answers

    What defines severe asthma symptoms in children?

    <p>Frequent nighttime symptoms and continual daily symptoms</p> Signup and view all the answers

    What is a common physical sign of hypovolemic shock in children?

    <p>Tachycardia</p> Signup and view all the answers

    In regards to fluid management for isotonic dehydration, what should be prioritized?

    <p>Replacing loss to equal depletion</p> Signup and view all the answers

    What factor differentiates hypertonic dehydration from other types of dehydration?

    <p>Water loss exceeds electrolyte loss</p> Signup and view all the answers

    Which medical management is indicated for mild dehydration in infants?

    <p>100 mL/kg oral rehydration over 4-6 hours</p> Signup and view all the answers

    Which form of shock is characterized by a reduction in circulating blood volume?

    <p>Hypovolemic Shock</p> Signup and view all the answers

    What symptoms are typically associated with moderate asthma in children?

    <p>PEF/FEV1 values of 75-80%</p> Signup and view all the answers

    Study Notes

    Effects of Immobilization

    • Decreased muscle strength and endurance leads to muscle atrophy and reduced joint mobility.
    • Increased workload on the heart and risk of thrombus formation due to reduced mobility.
    • Reduced orthostatic tolerance and venous return.
    • Increased risk of aspiration due to reduced respiratory effort.
    • Impaired mobility worsens negative calcium and nitrogen balance.
    • Changes in gravitational force and renal stasis.
    • Altered perception of self and environment, leading to frustration, helplessness, anxiety, depression, anger, aggression, and developmental concerns.

    Compartment Syndrome

    • Pain disproportionate to injury, especially with stretching, is an early sign.
    • Poikilothermia (cool limb) is another early sign.
    • Paresthesia (tingling, pins, and needles) is another early sign.
    • Paralysis is a later sign.
    • Pulselessness (lack of palpable pulse) is a very late sign.
    • Pallor in the affected limb.
    • Fasciotomy is performed if pulses do not return.

    Cast Care - Do’s

    • Keep the cast elevated on pillows for the first day and elevate only during rest after the first day.
    • Expose the plaster cast to air until it dries.
    • Lift and support wet plaster casts with the palms of the hands.
    • Observe for swelling, discoloration.
    • Check movement and sensation frequently.
    • Encourage frequent rest for a few days.
    • For arm or hand casts, keep in a sling most of the time and support on pillows at chest level.
    • For leg casts, elevate the injured leg when sitting.
    • Keep small items away from young children.
    • Examine the skin at the cast edges and pad if needed.
    • Incontinence: protect with waterproof tape and plastic and use diapers.
    • Manage pain associated with swelling by elevating and applying ice.

    Cast Care - Don't’s

    • Do not allow the cast to hang in a dependent position for more than 30 minutes.
    • Do not stand on the injured leg for too long.
    • Do not put anything inside the cast.
    • Do not place the cast in water.

    Fractures

    • Complete vs. Incomplete: Complete fractures break the bone completely, Incomplete fractures break the bone partially.
    • Greenstick: A type of incomplete fracture where the tension side of the bone breaks, but the compression side only bends.
    • Simple vs. Compound/Open: Simple fractures do not break through the skin. Open fractures involve the bone breaking through the skin.
    • Complicated: Complicated fractures damage other organs or tissues.
    • Transverse/Oblique/Spiral: Fractures can be transverse (across the bone), oblique (angled), or spiral (twisted).
    • Comminuted: Comminuted fractures have multiple bone fragments.

    Osteomyelitis

    • Inflammation and infection of bony tissue from an external or infectious (hematogenous) source.
    • Can be subacute or spreading.
    • Early signs mimic arthritis and leukemia.
    • Marked leukocytosis.
    • Bone scans and bone cultures via biopsy or aspirate are used for diagnosis.
    • Treatment involves vigorous IV antibiotics for 3 to 4 weeks to months, bed rest, and immobility of the limb.
    • Amputation may be necessary if the infection does not resolve.

    DDH (Developmental Dysplasia of the Hip)

    • Hip instability present at birth, particularly associated with breech deliveries.
    • Diagnosis: Ortolani and Barlow tests until the baby is walking (1 to 4 weeks of age), and radiographic exam.
    • Signs and Symptoms: Galeazzi sign and limp/leg discrepancy in older children.
    • Management: Pavlik Harness or cast to promote normal growth and development.

    Overuse Syndromes/Injuries

    • Syndromes resulting from repetitive microtrauma with inflammation of the involved structure.
    • Examples: Tennis elbow, Osgood-Schlatter disease.
    • Signs and Symptoms: Pain, tenderness, swelling, disability.
    • Causes: Repetitive muscle contraction, repetitive weight-bearing activities like running, gymnastics, and basketball.
    • Tibial fractures are the most common stress fracture.
    • Stress Fractures: Begin after starting an activity, characterized by pinpoint pain, aching, swelling, and resolution with rest.
    • Management: Rest, ice, NSAIDs.

    Torticollis

    • Congenital or acquired limited neck motion with the neck flexed to the affected side.
    • Management: Heat, NSAIDs (Motrin), physical therapy if congenital.

    Female Athlete Triad

    • A combination of amenorrhea (absence of menstruation), osteoporosis, and eating disorders.

    Tonsillectomy Nursing Concerns

    • Airway: Careful positioning, frequent swallowing can indicate bleeding, observe for hemorrhage, suction at the bedside.
    • Bleeding: Check for frequent swallowing, minimize agitation and crying, avoid suctioning, a small amount of bleeding is normal around 7 to 10 days due to scabbing.
    • Comfort: Control with Tylenol/Motrin, cool water or crushed ice, flavored ice pops, avoid red or brown-colored foods and fluids, no straws, if refusing oral meds, administer PR pain meds.
    • Food: Gelatin, cooked fruits, sherbet, soup, mashed potatoes.

    Tonsillectomy Home Teaching

    • Do’s: Discourage coughing/putting objects in the mouth, alternate Tylenol/Motrin, stay ahead of pain for the first 48 hours by waking them up, limit activity, observe for signs of dehydration.
    • Don’ts: Eat spicy or irritating foods, gargle or brush vigorously.

    Asthma

    • Chronic inflammatory disorder characterized by recurring symptoms, airway obstruction, and bronchial hyperresponsiveness.
    • Inflammation causes recurrent wheezing, breathlessness, chest tightness, and cough.
    • Most common chronic disease of childhood.
    • Risk Factors: History of allergies or atopic dermatitis, hereditary, gender, smoking, African American, low birth weight, overweight.

    Classic Asthma Symptoms

    • Dyspnea (shortness of breath).
    • Wheezing.
    • Coughing.
    • Chest tightness and pain in older children.
    • Gradual or abrupt onset.
    • Symptoms are worse at night or during exercise.
    • Coughing at night without infection.
    • Course, loud, prolonged expiration.
    • Generalized wheezing.

    Asthma Severity Classification

    • Mild: Symptoms more than two times a week, but 80% of days are symptom-free.
    • Moderate: Daily symptoms, nighttime symptoms one to two times a month (0 to 4 years) or more than once a week (5 to 11 years).
    • Severe: Continuous daily symptoms, frequent nighttime symptoms.

    Status Asthmaticus

    • Respiratory distress continues despite vigorous therapeutic measures.
    • Some cases have concurrent respiratory infection.
    • Can result in respiratory failure and death.
    • Severe Respiratory Distress: Remains sitting upright, refuses to lie down, sudden agitation, agitated child who suddenly becomes quiet, diaphoresis, pale.
    • Management: Frequent administration of short-acting beta-agonists, humidified oxygen to maintain SpO2 above 90%, IV corticosteroids, and magnesium sulfate, close monitoring (PICU), heart monitor and pulse oximeter on, IV fluids.
    • If using magnesium sulfate, monitor for hypotension and have a fluid bolus ready.

    Bronchiolitis (RSV)

    • An acute viral infection that occurs when bronchial mucosa swells and fills with mucus and exudate.
    • Typically affects infants under 3 months.
    • Begins with an upper respiratory infection (URI).
    • Infants may not have many clinical signs.
    • Peak symptoms typically occur on days 3 to 5.
    • Early symptoms: Rhinorrhea (runny nose) and low-grade fever.
    • Later symptoms: Wheezing, retractions, crackles, dyspnea, tachypnea, diminished breath sounds.

    Bronchiolitis Management

    • Home management (most cases): Adequate fluid intake and fever-reducing medications.
    • Hospital management: Oxygen, bronchodilators, IV fluids, tube feedings, steroids, intubation, contact precautions, frequent suctioning, and monitoring.
    • Hospitalization is recommended for infants with poor feeding, lethargy, respiratory distress, hypoxemia, or apnea.
    • Prevention: Synagis (Palivizumab) every 30 days until the end of the RSV season (for preterm infants).

    Dehydration

    • Diarrhea: 10 mL/kg for each stool is present.
    • Mild Dehydration (3 to 5% weight loss): 100 mL/kg (15%).
    • Moderate Dehydration (6 to 9% weight loss): Slowed capillary refill (2 to 4 seconds), oliguria.
    • Severe Dehydration (10% or more): Tenting, cool/acrocyanotic/mottled skin, oliguria/anuria.
    • Management of Moderate Dehydration: Replace lost fluids equal to depletion, maintenance fluids, and electrolytes, address the root cause, monitor I&Os, VS, UA (SG).
    • Management of Severe Dehydration: Rapid fluid replacement is contraindicated due to the risk of water intoxication and cerebral edema, replace lost fluids slowly, monitor for signs of fluid overload.

    Dehydration Types:

    • Isotonic Dehydration: Water loss equals electrolyte loss (most common).
    • Hypotonic Dehydration: Electrolyte loss is greater than water loss, fluid shifts into the ICF leading to shock.
    • Hypertonic Dehydration: Water loss is greater than electrolyte loss, fluid shifts into the ECF, increases the risk of seizures, but lower risk of shock.

    Shock

    • Hypovolemic Shock: Reduction in circulating blood volume due to trauma, bleeding, burns, or diarrhea.
    • Distributive Shock: Vascular abnormality causes maldistribution of blood supply.
    • Types of Distributive Shock: Neurogenic, anaphylactic, septic shock.

    Shock Signs and Symptoms

    • Hypovolemic Shock: Normal to increased respiratory rate, compensated stage – normal blood pressure, narrow pulse pressure, tachycardia, weak peripheral pulses, pale/cool skin, prolonged capillary refill greater than 2 seconds.
    • Distributive Shock: Normal to increased respiratory rate, may have crackles, normal to decreased blood pressure, tachycardia, weak peripheral pulses, warm skin.

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    Effects of Immobilization PDF

    Description

    This quiz covers the physiological effects of immobilization on muscle strength, endurance, and overall health. It also discusses compartment syndrome, its signs, symptoms, and the critical nature of timely intervention. Understand the implications of reduced mobility on bodily systems and learn to identify early warning signs of complications.

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