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Questions and Answers
Which system is responsible for controlling all voluntary muscles?
Sensory deprivation could lead to cognitive disturbances.
True
What type of sensory disorder occurs when one or more senses are impaired or absent?
Sensory deficit
The nervous system uses __________ pathways to transmit motor information from the central nervous system to the muscles.
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Match the nursing process components with their descriptions:
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Which of the following medications is likely to depress the central nervous system and alter sensory perception?
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All patients experience the same sensory processing requirements based on their personality and lifestyle.
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Name one consequence of sensory overload.
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To prevent injury-related to impaired sensory perception, nursing interventions should include ensuring a __________ environment.
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Which state of arousal is characterized by confusion or delirium?
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What is one primary nursing diagnosis related to impaired mobility?
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Regular exercise can improve cardiovascular efficiency and decrease heart rate.
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Name one type of exercise that promotes muscle strength through contraction against a stationary object.
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The practice of designing equipment and work tasks to conform to the capability of the worker is known as ______.
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Match the types of exercise to their descriptions:
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Which intervention might be used to prevent deep vein thrombosis (DVT)?
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Tendons attach muscles to bones and are elastic in nature.
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What is hematopoiesis?
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The muscle type responsible for involuntary contractions in internal organs is called ______.
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Match the following conditions to their description:
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Which of the following factors can influence mobility?
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Sleep disturbances have no impact on mobility.
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What does the nursing process of assessment include?
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The method that preserves joint mobility after surgery is known as ______.
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Which of these is a key focus of the Safe Patient Handling & Mobility (SPHM) program?
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What is the role of the nervous system in movement?
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Sensory overload occurs when there is not enough stimuli for the brain to process.
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What are the two types of pathways used by the nervous system for sensory information?
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The state of awareness characterized by confusion or altered consciousness is known as __________.
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Match the following sensory disorders with their definitions:
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Which factor influencing sensory status refers to changes in function due to aging?
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Cognitive disturbances can be a consequence of sensory deprivation.
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Name one effect of sensory deprivation.
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Medications that alert or depress the CNS can interfere with the perception of sensory stimuli and are commonly referred to as __________.
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Which state of arousal is characterized by the person not being aware of their surroundings?
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Which of the following is NOT a function of the skeletal system?
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Hematopoiesis is the process of producing blood cells such as WBCs, RBCs, and platelets.
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What are the three types of muscle tissues?
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The process of decreased muscle size due to lack of use is known as ______.
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Match the following types of bones with their descriptions:
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Which of the following is NOT a factor influencing mobility?
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Tendons attach muscles to muscles.
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What is a common implication of immobility on the respiratory system?
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________ changes are often experienced by patients who are immobile.
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Which type of exercise is characterized by tightening muscles without moving body parts?
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Increased cardiac workload is an effect of physical activity.
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What is one intervention to prevent deep vein thrombosis (DVT)?
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The practice of designing tasks to conform to the capabilities of workers is called ______.
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Match the following physiological changes with their effects due to immobility:
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Identify one psychological effect of immobility.
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Study Notes
Physiology of Movement
- Movement is achieved through contracting muscles that apply force on tendons, which, in turn, pull on bones.
- Three systems are essential for movement: nervous, muscular, and skeletal.
Nervous System
- The somatic nervous system of the peripheral nervous system controls voluntary muscles.
- Sensory information travels to the central nervous system via the afferent pathway.
- Motor information travels from the central nervous system to muscles via the efferent pathway.
Sensorimotor Function
- Necessary for movement.
- Includes sensory reception (receiving data from visual, auditory, olfactory, gustatory, tactile, and kinesthetic senses) and sensory perception (organizing and interpreting received data.)
- Impaired sensory processing increases the risk of injury.
Sensory Disorders
- Sensory disorders occur when there is insufficient or excessive sensory stimuli, disturbed sensory perception, or a sensory deficit.
- Sensory deprivation is the lack of sufficient sensory stimuli.
- Sensory overload is excessive stimuli, which overwhelms the brain's ability to process, respond, or ignore.
Effects of Sensory Deprivation
- Perceptual disturbances, cognitive disturbances, and emotional disturbances.
Factors Influencing Sensory Status
- Developmental level (elderly individuals may experience sensory decline with aging).
- Personality and lifestyle (different personalities may require different levels of stimulation, and lifestyle choices influence the quantity and quality of sensory stimuli received.)
- Stress and illness (illness and stress can affect the reception, transmission, and perception of sensory stimuli.)
- Medications (medications that alter or depress the central nervous system can interfere with the perception of sensory stimuli. Narcotics and sedatives reduce alertness, and antipsychotics influence the perception and processing of stimuli.)
States of Arousal and Awareness
-
Conscious State
- Delirium
- Dementia
- Confusion
- Normal consciousness (x3 or x4)
- Minimally conscious states
- Locked-in syndrome
-
Unconscious State
- Asleep
- Somnolence
- Stupor
- Coma
- Vegetative state
Nursing Process: Sensory Alterations
-
Assessments:
- Sensory alteration history, mental status, presence of hazards, ability to perform self-care, use of sensory aids, and risk factors for impaired sensory function.
-
Nursing Diagnoses:
- Disturbed sensory perception, social isolation, risk for injury, disturbed thought process, impaired verbal communication, and risk for impaired skin integrity.
-
Interventions:
- Prevent sensory alterations, assist patients to improve sensory functioning, ensure a safe environment, and ensure patients maintain adequate and varied sensory stimuli, which can include:
- Visual: glasses
- Auditory: hearing aids
- Olfactory: varied smells
- Tactile: varied textures
- Communication: face the patient and enunciate clearly
- Prevent sensory alterations, assist patients to improve sensory functioning, ensure a safe environment, and ensure patients maintain adequate and varied sensory stimuli, which can include:
-
Outcomes:
- The patient will demonstrate intact functioning of the senses, respond appropriately to sensory stimuli, demonstrate appropriate self-care behaviors, remain safe, and be free from injury.
-
Evaluation:
- Were the outcomes met, partially met, or not met?
Functions of the Skeletal System
- Protection
- Support
- Storage
- Hematopoiesis (producing blood cells: white blood cells, red blood cells, platelets)
- Sites for attachment of muscles, ligaments, and tendons
Types of Bones
- Long bones
- Short bones
- Flat bones
- Irregular bones
Factors Influencing Mobility
- Growth and development
- Physical health
- Mental health
- Lifestyle
- Attitudes and values
- Fatigue and stress
- External factors
- Pathological Influences
- Postural abnormalities
- Impaired muscle development
- Damage to the central nervous system
- Direct trauma to the musculoskeletal system
Psychosocial Implications of Immobility
- Feelings of worthlessness
- Ineffective coping
- Depression
- Anxiety
- Altered thought process
- Sleep-wake pattern disturbance
- Inability to interact socially
Continuous Passive Motion (CPM)
- Preserves joint mobility after surgery.
Tendons, Cartilage, and Ligaments
-
Tendons:
- Attach muscles to bones
- Sturdy
- Non-elastic
- Size changes depending on the muscle
- Act as anchors
-
Cartilage:
- Tough
- Flexible
- Located at the ends of bones
- Cushions joints
-
Ligaments:
- Attach bones to bones
- Elastic
- Provide stability
- Composed of many fibers
- Strong
Muscles: Types and Roles
-
Skeletal:
- Motion
- Support
- Protection
- Maintenance of posture
- Heat production
-
Smooth:
- Responsible for movement in internal organs of the digestive, urinary, and reproductive systems, as well as the airways and blood vessels.
-
Cardiac:
- Rhythmicity
- Excitability
- Contractility
- Conductivity
Physiological Response to Immobility
-
Cardiovacular Changes:
- Increased cardiac workload
- Decreased venous return
- Thrombus formation (DVT) (blood clots form in veins, usually causing pain, redness, swelling, and warmth)
- Orthostatic hypotension
- Dependent edema
-
Respiratory Changes:
- Decreased ventilatory effort
- Decreased depth and rate of respiration
- Increased respiratory secretions
- Atelectasis
- Acid-base imbalance
- Hypostatic pneumonia
- Bacterial growth in pooled secretions
-
Musculoskeletal System:
- Decreased muscle size (atrophy)
- Decreased muscle tone and strength
- Decreased joint mobility and flexibility
- Increased bone demineralization (osteoporosis)
- Decreased endurance, impacting activities of daily living (ADL)
-
Gastrointestinal System:
- Decreased appetite
- Altered protein metabolism
- Poor digestion and utilization
- Decreased peristalsis
- Constipation
- Weight gain
-
Metabolic Processes:
- Decreased metabolic rate
- Tissue catabolism
- Negative nitrogen balance
- Calcium loss
- Anorexia
- Poor nutrition
- Fluid and electrolyte disturbances
-
Urinary System:
- Urinary stasis (urine cannot be emptied from the bladder)
- Urinary tract infections (UTIs)
- Urinary retention
- Renal calculi (hard deposits of minerals and salts that form in the urinary tract)
-
Integumentary System:
- Impaired circulation
- Tissue ischemia
- Increased risk of pressure ulcers
- Decreased wound healing
Prevention of DVTs
- TED knee-high stockings
- Sequential Compression Devices (SCDs)
- Early ambulation (walking)
- Pharmacological interventions (anticoagulants)
Effects of Exercise
-
Cardiovascular System:
- Increased efficiency of the heart
- Decreased heart rate and blood pressure
- Increased blood flow to all body parts
- Improved venous return
- Increased circulating fibrinolysin (a substance that breaks up small blood clots)
-
Respiratory System:
- Improved alveolar ventilation
- Decreased work of breathing
- Improved diaphragmatic excursion
-
Metabolic System:
- Increased triglyceride breakdown
- Increased gastric motility
- Increased production of body heat
-
Musculoskeletal System:
- Increased muscle efficiency (strength, mass, tone, joint mobility)
- Increased coordination
- Reduced bone loss
- Increased efficiency of nerve impulse transmission
- Slowing of the effects of aging
-
Gastrointestinal System:
- Increased appetite
- Improvement in digestion and elimination
- Weight control
-
Urinary System:
- Increased blood flow to the kidneys
- Improved waste excretion
- Maintenance of fluid balance
- Maintenance of acid-base balance
-
Integumentary System:
- Increased circulation nourishes the skin
- Promotes general health of the skin
-
Psychosocial:
- Increased energy, vitality, and general well-being
- Improved sleep
- Improved appearance
- Improved self-concept
- Increased positive health behaviors
Nursing Process: Mobility
-
Assessments:
- History of daily activity pattern, activity and exercise intolerance, external factors, ability to perform ADLs, type and frequency of exercise
- Physical Examination: gait, body alignment, inspection and palpation of joints and bones, muscle mass, tone, and strength, range of motion (active and passive), activity intolerance
-
Nursing Diagnoses:
- Impaired physical mobility, activity intolerance, ineffective airway clearance, impaired gas exchange, social isolation, sleep pattern disturbance, risk for infection, altered tissue perfusion, disuse syndrome, fluid volume deficit
-
Outcomes:
- The patient will be free of contractures, free from signs of skin breakdown, maintain effective airway clearance, show signs of adequate venous return, demonstrate correct body alignment, and demonstrate full range of joint motion.
-
Interventions:
- Frequent repositioning:
- Fowler's (semi-sitting position)
- Supine (lying face up)
- Side-lying
- Prone (lying face down)
- Assisting with range of motion exercises (passive with help, active without help)
- Teach about the center of gravity for ambulatory patients:
- It is the imaginary balancing point where body weight is concentrated and equally distributed.
- It is the point at which the body can rotate freely in all directions.
- Moving a patient up in bed:
- Move close to the side of the bed.
- Provide explanations to the patient.
- Increase the head of bed (HOB), remove the pillow, and have the patient lift their head.
- One nurse: for cooperative patients.
- Two nurses: heavier patients, or those who cannot assist.
- Position yourself with a straight back, bent knees, one foot forward.
- If the patient cannot assist, have them bend their knees and place their hands on the siderails or across their chest.
- Count to three.
- Encourage patient independence and participation to boost self-esteem.
- Frequent repositioning:
-
Evaluation:
- Determine the effectiveness of activity and exercise interventions, improvement in body alignment, joint mobility, walking, moving or transferring, absence of complications of immobility, and current levels of strength and endurance.
Types of Exercise
-
Isotonic:
- Muscle contraction and change in muscle length (isotonic contraction)
- Benefits:
- Increased circulation and respiratory functioning
- Increased osteoblastic activity (building of bone tissue)
- Increased muscle tone, mass, and strength
- Examples:
- Walking, swimming, moving arms and legs with light resistance
-
Isometric:
- Tightening or tensing of muscles without moving body parts.
- Benefits:
- Increased muscle mass, tone, and strength
- Increased circulation to the involved body part
- Increased osteoblastic activity (building of bone tissue)
- Examples:
- Quadriceps set exercises, contraction of the gluteal muscles
-
Resistive Isometric:
- Contracts muscles while pushing against a stationary object or resisting the movement of an object.
- Benefits:
- Promotes muscle strength
- Provides sufficient stress against bone to promote osteoblastic activity (building of bone tissue)
- Examples:
- Push-ups, pushing against a footboard to move up in bed, hip lifting
Safe Patient Handling and Mobility (SPHM)
-
Ergonomics:
- The practice of designing equipment and work tasks to conform to the capabilities of the worker.
- Promotes good posture and body mechanics.
-
Variables that can lead to patient handling injuries:
- Uncoordinated lifts
- High extension
- Awkward or static postures
- Manual lifting and transferring
- Repetitive movements or tasks
- Standing for long periods of time
Musculoskeletal Assessment (for Lab Discussion)
-
History
- Family health history
- General health maintenance
- Nutrition
- Occupation
- Learning needs
- Socioeconomic factors
- Medications
-
Physical Examination:
- Functional ability
- Ability to perform ADLs
- Note any mobility-related problems
- Assessments of pain and altered sensation
- Posture and gait
- Joint function and muscle strength
- Active vs. passive range of motion (ROM); upper and lower strength comparisons bilaterally
- Diagnostic Tests:
- X-rays
- MRIs
- Bone scans
- Bone density tests (DEXA)
- CT scans
Spinal Abnormalities
- Kyphosis: Round back or hunchback
- Lordosis: Swayback, excessive curvature of the lower back
- Scoliosis: An S or C-shaped curvature of the spine
Gait Assessment
-
Normal gait:
- Arms swing in time with the legs.
- Center of gravity moves forward without side-to-side movement.
- Even stance.
-
Note:
- If the gait is even or uneven.
- Steady or unsteady.
- Shuffled or stooped forward.
Detecting Fluid in the Knee
- Test 1: [The text is missing a description of how to detect fluid in the knee. Please provide more context]
Physiology of Movement
- Three systems are required for movement: nervous, muscular, and skeletal.
- Movement results from contracting muscles, pulling on tendons, which pull on bones.
Nervous System
- The somatic nervous system controls all voluntary muscles.
- Sensory information (afferent pathway) travels to the central nervous system.
- Motor information (efferent pathway) travels from the central nervous system to the muscles.
Sensorimotor Function
- Sensory processing is essential for movement.
- Sensory reception involves receiving data from the various senses (visual, auditory, olfactory, gustatory, tactile, kinesthetic).
- Sensory perception involves organizing and interpreting the received sensory data.
- Impaired sensory processing increases the risk of injury.
Sensory Disorders
- Sensory deprivation: insufficient sensory stimuli.
- Sensory overload: excessive stimuli, overwhelming the brain.
- Sensory deficit: impairment or absence of one or more senses.
- Disturbed sensory perception: difficulty processing sensory input.
Effects of Sensory Deprivation
- Perceptual disturbances, cognitive disturbances, and emotional disturbances can occur.
Factors Influencing Sensory Status
- Developmental level: Sensory decline can occur with aging.
- Personality and lifestyle: Different personalities require varying levels of stimulation, and lifestyle influences the quantity and quality of stimuli received.
- Stress and illness: Illness and stress can impact sensory reception, transmission, and perception.
- Medication: Medications affecting the central nervous system can interfere with sensory perception. (e.g., narcotics, sedatives, antipsychotics).
States of Arousal and Awareness
Conscious State
- Delirium: A state of sudden, severe confusion.
- Dementia: A progressive decline in cognitive function.
- Confusion: A state of disorientation and impaired mental clarity.
- Normal consciousness: Alert and oriented to person, place, and time (x3 or x4).
- Minimally conscious states: Limited responsiveness and awareness.
- Locked-in-syndrome: Complete paralysis except for eye movement.
Unconscious State
- Asleep: A normal state of unconsciousness during which the body rests.
- Somnolence: A state of drowsiness and sleepiness.
- Stupor: A state of deep sleep or unresponsiveness.
- Coma: A prolonged state of unconsciousness.
- Vegetative state: A state of wakefulness without awareness.
Nursing Process: Sensory Functions
- Assessments: Include history of sensory alterations, mental status, presence of hazards, self-care ability, use of sensory aids, and risk factors for impaired sensory function.
- Nursing diagnoses: May include disturbed sensory perception, social isolation, risk for injury, disturbed thought processes, impaired verbal communication, and risk for impaired skin integrity.
- Interventions: Focus on preventing sensory alterations, assisting patients to improve sensory functioning, ensuring a safe environment, and providing adequate and varied sensory stimuli.
- Outcomes: Patients should demonstrate intact sensory function, respond appropriately to stimuli, exhibit appropriate self-care behaviors, and remain safe from injury.
- Evaluation: Assess whether outcomes were met, partially met, or not met.
Functions of the Skeletal System
- Protection, support, storage of minerals, hematopoiesis (blood cell production), and provides attachment points for muscles, ligaments, and tendons.
Types of bones
- Long bones: Longer than wide (e.g., femur, humerus).
- Short bones: Cube-shaped (e.g., carpals, tarsals).
- Flat bones: Thin and curved (e.g., skull, ribs, sternum).
- Irregular bones: Unusually shaped (e.g., vertebrae, facial bones).
Factors Influencing Mobility
- Growth and development: Mobility changes throughout life.
- Physical health: Conditions impacting physical ability.
- Mental health: Mental state can influence motivation.
- Lifestyles: Activity levels and habits impact fitness.
- Attitudes and values: Personal beliefs about movement.
- Fatigue and stress: Can decrease energy and motivation.
- External factors: Environment and accessibility.
- Pathological influences:
- Postural abnormalities: Impacts alignment and balance.
- Impaired muscle development: Affects strength and coordination.
- Damage to the central nervous system: Impacts nerve signals controlling movement.
- Direct trauma to the musculoskeletal system: Injuries to bones, muscles, or joints.
Psychosocial Implications of Immobility
- Feelings of worthlessness, ineffective coping, depression, anxiety, altered thought processes, sleep-wake pattern disturbance, and difficulty with social interaction.
Continuous Passive Motion (CPM)
- Preserves joint mobility after surgery by providing continuous, passive movement.
Tendons, Cartilage, and Ligaments
- Tendons: Connect muscles to bones, strong and non-elastic.
- Cartilage: Tough, flexible tissue found at the ends of bones, acts as a cushion.
- Ligaments: Connect bones to bones, elastic and provide stability.
Muscles: Types and Roles
- Skeletal muscles: Responsible for movement, support, protection, posture maintenance, and heat production.
- Smooth muscles: Control movement in internal organs (e.g., digestive, urinary, reproductive systems).
- Cardiac muscle: Found in the heart, responsible for rhythmic contractions.
Physiological Response to Immobility
Cardiovascular Changes
- Increased cardiac workload, decreased venous return leading to thrombus formation (DVT).
- Orthostatic hypotension (sudden drop in blood pressure upon standing).
- Dependent edema (swelling in areas of the body closest to the ground).
Prevention of DVTs
- TEDs (thromboembolic deterrent stockings)
- Sequential Compression Devices (SCDs)
- Early ambulation
- Anticoagulant medication
Respiratory Changes
- Reduced ventilatory effort, decreased respiratory rate and depth, increased respiratory secretions, atelectasis (collapse of lung tissue), acid-base imbalances, hypostatic pneumonia (inflammation of the lung due to pooling of secretions), bacterial growth in pooled secretions.
Musculoskeletal System Changes
- Muscle atrophy (decrease in muscle size), decreased muscle tone and strength, reduced joint mobility and flexibility, increased bone demineralization (osteoporosis), decreased endurance, and difficulty performing activities of daily living (ADL).
Gastrointestinal System Changes
- Decreased appetite, altered protein metabolism, poor digestion and utilization, decreased peristalsis (intestinal movement), constipation, and weight gain.
Metabolic Process Changes
- Decreased metabolic rate, tissue catabolism (breakdown), negative nitrogen balance, calcium loss, anorexia, poor nutrition, and fluid and electrolyte imbalances.
Urinary System Changes
- Urinary stasis (urine retention), urinary tract infections (UTIs), urinary retention, and renal calculi (kidney stones).
Integumentary System Changes
- Impaired circulation, tissue ischemia (reduced blood flow), increased risk of pressure ulcers, decreased wound healing.
Effects of Exercise
Cardiovascular System Benefits
- Increased heart efficiency, decreased resting heart rate and blood pressure, enhanced blood flow, improved venous return, and increased circulating fibrinolysin (breaks down small clots).
Respiratory System Benefits
- Improved alveolar ventilation, reduced work of breathing, and increased diaphragmatic excursion.
Metabolic System Benefits
- Increased triglyceride breakdown, improved gastric motility, and increased heat production.
Musculoskeletal System Benefits
- Increased muscle efficiency (strength, mass, tone, and joint mobility), improved coordination, slowed bone loss, enhanced nerve impulse transmission, and slowed effects of aging.
Gastrointestinal System Benefits
- Increased appetite, improved digestion and elimination, and weight control.
Urinary System Benefits
- Increased blood flow to the kidneys, improved waste excretion, maintained fluid and acid-base balance.
Integumentary System Benefits
- Increased circulation, nourishing the skin and promoting overall skin health.
Psychosocial Benefits
- Increased energy, vitality, and general well-being, improved sleep, enhanced appearance, improved self-concept, and encouraged positive health behaviors.
Nursing Process: Mobility
- Assessments: Include history of daily activity patterns, activity and exercise intolerance, external factors, ability to perform ADLs, type and frequency of exercise; physical examination includes gait, body alignment, inspection and palpation of joints and bones, muscle mass, tone, and strength; range of motion (ROM) active and passive; upper and lower extremity strength comparisons bilaterally.
- Nursing diagnoses: May include impaired physical mobility, activity intolerance, ineffective airway clearance, impaired gas exchange, social isolation, sleep pattern disturbance, risk for infection, altered tissue perfusion, disuse syndrome, and fluid volume deficit.
- Outcomes: Patients should be free from contractures and signs of skin breakdown, maintain effective airway clearance, demonstrate signs of adequate venous return, exhibit correct body alignment, and demonstrate full range of joint motion.
- Interventions: Frequent repositioning, assist with ROM exercises (passive vs. active), teach the concept of center of gravity, and assist with moving patients in bed.
- Evaluation: Determine the effectiveness of activity and exercise interventions, improvements in body alignment, joint mobility, walking, moving or transferring, absence of complications from immobility, and current levels of strength and endurance.
Types of Exercise
- Isotonic exercise: Muscle contraction with a change in muscle length (e.g., walking, swimming).
- Isometric exercise: Muscle tightening or tensing without movement (e.g., quadriceps sets).
- Resistive isometric exercise: Muscle contraction against resistance (e.g., push-ups).
Safe Patient Handling and Mobility (SPHM)
- Ergonomics: Designing equipment and tasks to optimize worker safety.
- Variables leading to patient handling injuries: Uncoordinated lifts, high extension, awkward or static postures, manual lifting and transferring, repetitive movements or tasks, and prolonged standing.
Musculoskeletal Assessment
- History: Family health history, general health maintenance, nutrition, occupation, learning needs, socioeconomic factors, and medications.
- Physical Examination: Functional ability, ADL performance, mobility problems, pain, altered sensation, posture, gait, joint function, muscle strength, active vs. passive ROM, upper and lower extremity strength.
- Diagnostic Tests: X-rays, MRI, bone scans, bone densitometry, and CT scans.
Spinal Abnormalities
- Kyphosis: Rounded back or hunchback.
- Lordosis: Swayback, excessive curvature of the lower back.
- Scoliosis: S or C-shaped curvature of the spine.
Gait Assessment
- Normal gait: Arms swing, center of gravity moves forward, even stance.
- Abnormalities: Uneven gait, unsteady gait, shuffled gait, stooped posture.
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Description
This quiz covers the essential systems involved in human movement, focusing on the muscular, skeletal, and nervous systems. It also explores sensorimotor functions and sensory disorders that can impact movement efficiency and safety. Test your knowledge on how these elements interact to facilitate bodily motion.