Lecture of Sensory-Motor Activity PDF

LECTURE OF SENSORY - MOTOR ACTIVITY Physiology of Movement 3 systems are required for movement - Nervous System - Muscular System - Skeletal System Movement: results from contracting muscles placing force on a tendon which in turn pulls on a bone Nervous System - The somatic nervou...

LECTURE OF SENSORY - MOTOR ACTIVITY Physiology of Movement 3 systems are required for movement - Nervous System - Muscular System - Skeletal System Movement: results from contracting muscles placing force on a tendon which in turn pulls on a bone Nervous System - The somatic nervous system, part of the peripheral nervous system, controls all voluntary muscles - Sensory information travels to the central nervous system; AFFERENT PATHWAY - Motor information travels from the central nervous system to the muscles; EFFERENT PATHWAY Sensorimotor Function Sensory Processing = needed for movement Includes-> - Sensory Reception: receiving data (visual, auditory, olfactory, gustatory, tactile, kinesthetic) - Sensory Perception: organizing & interpreting the data Impaired sensory processing places the pt at risk for injury Sensory Disorders - Not enough or too much stimuli - Disturbed sensory perception - Sensory deficit (when one or more of the senses is impaired or absent) - Sensory deprivation (not enough stimuli) - Sensory overload (excessive stimuli); brain can’t process, respond or ignore Effects of Sensory Deprivation - Perceptual Disturbances - Cognitive Disturbances - Emotional Disturbances Factors Influencing Sensory Status - Developmental Level (elderly pt can experience sensory decline w/ aging) changes in eyesight, hearing, balance coordination - Personality & Lifestyle different personalities types demand different levels of stimulation lifestyle choices influence the quantity & quality of stimuli received - Stress & Illness illness, stress can affect the reception of sensory stimuli & their transmission & perception - Medication medications that alert or depress the CNS may interfere with the perception of sensory stimuli Narcotics & Sedatives: go down in alertness Antipsychotics: influence how sensory stimuli are perceived & processed States of Arousal & 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 - Assessments sensory alteration Hx, mental status, presences of hazards, ability to perform self-care, use of sensory aids, risk factors for impaired sensory function - Nursing Diagnosis disturbed sensory perception, social isolation, risk for injury, disturbed thought process, impaired verbal communication, risk for impaired skin integrity - Interventions prevent sensory alterations, assist pt to improve sensory functioning, ensure safe environment, ensure pt maintains adequate & varied sensory stimuli like Visual: glasses; Auditory: hearing aid; Olfactory: varied smell; Tactile: varied textures; Communications: face pt, enunciate - Outcomes the pt will: demonstrate intact functioning of the senses, respond appropriately to sensory stimuli, demonstrate appropriate self-care behaviors, remain safe & free from injury - Evaluation Were the EO met/partially met/not met? Functions of The Skeletal System - Protection - Support - Storage - Hematopoiesis (process of producing blood cells WBC, RBC, platelets) - Sites for attachment; muscles, ligaments, tendons Types of bones - Long bones - Short bones - Flat bones - Irregular bone Factors Influencing Mobility - Growth & Development - Physical health - Mental health - Lifestyles - Attitudes & values - Fatigue & Stress - External Factors - Pathological Influences - Postural abnormalities - Impaired muscle development - Damage to the central nervous system - Direct trauma to the musculoskeletal system Psychosocial: Possible Implications - Feelings worthlessness - Ineffective coping  - Depression - Anxiety - Altered thought process - Sleep-wake pattern disturbance - Unable to interact socially Continuous Passive Motion (CMP): preserves joint mobility after surgery - Skeletal muscles produce movements by pulling on bones - Bones serves as levers - Joints acts as fulcrums for the levers - The lever & fulcrums principle is shown by a forearm lifting a weight Tendons, Cartilage, & Ligaments Tendons - Attaches to the bone - Sturdy - Non Elastic - Size changes depending on muscles - Anchor Cartilage - Tough - Flexible - At the end of the bone - Cushions Ligaments - Attaches bone to bone - Elastic - Stabilize - Made of many fibers - Strong Muscles: Types & Roles Skeletal - Motion - Support - Protection - Maintenance of posture - Heat production  Smooth (responsible for movement in - Internal organs for the digestive, urinary, & reproductive systems & airways & blood vessels Cardiac - Rhythmicity - Excitability - Contractility - Conductivity Physiological Response to Immobility Cardiovascular Changes - Increased cardiac workload - Decreased venous return - Thrombus formation (DVT); blood clots forms in veins, usually pain, red, swollen, warm - Orthostatic hypotension - Dependent edema Prevention for DVTs - TED knee high - Sequential Compression Device (SCD) - Early ambulation - Pharmacological (anticoagulants) Respiratory Changes - Decreased ventilatory effort - Decreased depth/rate of respiration - Increased respiratory secretions - Atelectasis - Acid base imbalance - Hypostatic pneumonia - Bacterial growth-pooled secretion Musculoskeletal System - Decreased muscle size (atrophy) - Decreased muscle tone & strength - Decreased joint mobility & flexibility - Increased bone demineralization (osteoporosis)  - Decreased endurance/problem ADL Gastrointestinal System - Decreased appetite - Altered protein metabolism - Poor digestion/utilization - Decreased peristalsis - Constipation - Weight gain Metabolic Process - Decreased metabolic rate - Tissue catabolism - Negative nitrogen balance - Calcium loss - Anorexia - Poor nutrition - Fluid & electrolyte disturbances Urinary System - Urinary Stasis (urine cant be emptied from the bladder) - UTI - Urinary retention - Renal calculi (hard deposits of mineral & salts that from in urinary tract) Integumentary System - Impaired circulation - Tissue ischemia - Increased risk of pressure ulcers - Decreased wound healing - Effects of Exercise Cardiovascular System - Increased efficiency of the heart - Decreased heart rate & blood pressure - Increased blood flow to all body parts - Improved venous return - Increased circulating fibrinolysin (substance that breaks up small 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 - Reduce bone loss - Increased efficiency of nerve impulse transmission - Slow effect of aging Gastrointestinal System - Increased appetite - Improve digestion & elimination - Weight control Urinary System - Increased blood flow to the kidneys - Improves waste excretion - Maintain fluid balance - Maintain acid-base balance Integumentary - Increased circulation nourishes the skin - Promote general health of the skin Psychosocial - Increased energy, vitality, general well-being - Improve sleep - Improve appearance - Improve self-concept - Increased positive health behaviors Nursing Process - Assessments Hx: daily activity pattern, activity & exercise intolerance, external factors, ability to performs ADLs, type & frequency of exercise PE: gait, body alignment, inspection & palpation of joints & bones, muscles mass, tone & strength, ROM active & passive, activity Intolerance - Nursing Diagnosis Impaired physical mobility, activity intolerance, ineffective airway clearance, gas exchange impaired, social isolation, sleep pattern disturbance, risk for infection altered tissue perfusion, disuse syndrome, fluid volume deficit - EO the pt will: be free of contractures, be free from signs of skin breakdown, maintain effective airway clearance, show signs of adequate venous return, demonstrate correct body alignment, demonstrate full range of joint motion - Interventions frequent repositioning - Fowler’s (semi sitting position) - Supine (lying face up in back) - Side - Lying - Prone (lying face down on stomach) Assisting with ROM exercises; Passive ( w/ help) vs Active (w/o help) ROM Teach Center of Gravity (ambulatory pts) - Imaginary balancing point - Body’s weight is concentrated & equally distributed - Point at which the mass of an object is centered - Point of exact center where the body can rotate freely in all directions Moving pt up to the bed - Move close to the side of the bed - Provide explanations - Increased HOB, remove pillow, pt lift head up - 1 Nurse: pt cooperative - 2 Nurse: heavy pt, or cannot assist  - back straight, knees bent, one foot forward - If cannot assist, pt bend knees, hands of side rails, or across chest, - Count to 3 - Encourage pt independence & participation -> self esteem - Evaluation Determine: effectiveness of activity & exercise interventions, improvement in body alignment, joint mobility, walking, moving or transferring, absence of complications of immobility, present level of strength & endurance Types of Exercise - Isotonic: muscle contraction & change in muscle length (isotonic contraction) benefits- increased circulation & respiratory functioning, increased osteoblastic activity , increased muscle tone, mass, & strength Ex: walking, swimming, moving arms & legs with light resistance - Isometric: tightening or tensing of muscles without moving body parts benefits- increased muscle mass, tone & strength, increased circulation to the involved body part; increased osteoblastic activity Ex: quadriceps set exercises & contraction of the gluteal muscles - Resistive Isometric: contracts the muscles while pushing against a stationary object or resisting the movement of an object benefits- promote muscle strength, provides sufficient stress against bone to promote osteoblastic activity Ex: push-ups, pushing against a footboard to move up in bed, & hip lifting Safe Patient Handling & Mobility (SPHM) - Ergonomics: practice of designing equipment & work tasks to confirm to the capability of the worker (postures) Variables that can lead to pt handling injuries - Uncoordinated lifts - High extersion - Awkward or static postures - Manual lifting & transferring - Repetitive movements or tasks - Standing for long periods of time  Lab Discussion Musculoskeletal Assessment HX - Family health Hx - General health maintenance - Nutrition - Occupation - Learning needs - Socioeconomic factors - Medications PE - Function ability - Ability to perform ADL - Note any problems related to mobility - Assessments of pain & altered sensation - posture & gait - Joint function & muscle strength - Active vs Passive ROM; upper & lower strength & compare bilaterally - Diagnostic Tests: X-rays, MRI, Bone Scan, Bone Densitometry, CT Scan 3 Abnormalities for Spine - Kyphosis: round back or hunchback - Lordosis: swayback, excessive curvature of the lower back has - Scoliosis: an S or C shape curvature of the spine Gait Assessment - Normal gait: arms swing, center of gravity moves forward-not side to side, even stance Note if gait is even or uneven, steady or unsteady, shuffled or stooped forward Detecting Fluid in the Knee 1. Milk downward 2. Apply medial pressure 3. Tap & watch for fluid wave Atrophy: is shrinkage or decrease in the size of the muscle Rheumatoid Arthritis ROM Assessment