Mobility NUR 211 Module 3B

Mobility NUR 211 Module 3B Mobility Learning Outcomes 1. Collaborate with the interprofessional team to coordinate high -quality care for patients with hip fractures, fractures, osteoarthritis, back problems, Parkinson’s Disease, and multiple sclerosis. 2. Implement nursing interventio...

Mobility NUR 211 Module 3B Mobility Learning Outcomes 1. Collaborate with the interprofessional team to coordinate high -quality care for patients with hip fractures, fractures, osteoarthritis, back problems, Parkinson’s Disease, and multiple sclerosis. 2. Implement nursing interventions to help the patient and family cope with the psychosocial impact caused by hip fractures, fractures, osteoarthritis, back problems, Parkinson’s Disease, and multiple sclerosis. 3. Apply knowledge of anatomy, physiology, and pathophysiology to assess patients with hip fractures, fractures, osteoarthritis, back problems, Parkinson’s Disease, and multiple sclerosis. 4. Use clinical judgment to plan care for patients with hip fractures, fractures, osteoarthritis, back problems, Parkinson’s Disease, and multiple sclerosis across the lifespan. 5 . Teach the patient and caregiver(s) about common drugs for hip fractures, fractures, osteoarthritis, back problems, Parkinson’s Disease, and multiple sclerosis. Mobility Concept Resources • Ignatavicius, D. (2021). pp. 853 -859, 872 -877, 1002 -1017, & 1029 -1046 • Ignatavicius, D. (2021). Study Guide, Chapter 39 (questions 11 -17), Chapter 40 (questions 1 -11), Chapter 46 (questions 1 -13), & Chapter 47 (questions 1, 7 -24 ) • Perry & Hockenberry (2023). pp. 1454 -1457 • Silvestri, L. (2023). pp. 902 -903, 868 -869, 878, 892 -893 • ATI RN Adult Medical Surgical Nursing 11.0 – Chapters 7, 10, 71 & 72 • ATI RN Nursing Care of Children 11.0 – Chapter 27 • ATI RN Pharmacology for Nursing 8.0 – Chapters 35 -38 Functions of the Skeletal System • Structural foundation of the body • Protection • Attachment sites • Mineral storage • Hematopoiesis Age - Related Musculoskeletal Changes • Loss of bone mass • Loss of height • Increased risk of osteoarthritis and osteoporosis • Bones heal slower • S tress fractures • Balance problems Fractures Fracture • Break in continuity of bone • Complications • Diagnosis Classification of Fractures • Classified by Appearance • Closed (simple) • Open (compound) • Displaced/nondisplaced Common Types of Fractures Transverse fracture Comminuted fracture Oblique Fracture Spiral Fracture Impacted Fracture Assessment Findings for Fractures Pain Warmth over the injured area Reduced Movement Edema Ecchymosis Muscle Spasms Crepitus Obvious deformity Loss of function Shock Nursing Care of Fracture from Trauma • Provide Emergency Care • Maintain ABC’s • Monitor VS and Neurological Status • Stabilize the injured area • Elevate the limb • Apply Ice • Cover any open wounds • Remove clothing or jewelry if near site • Keep the patient warm • Assess for shock Medical Management of Fractures Closed reduction Repair without surgery Traction Two forces pulling in opposite directions Open reduction (ORIF) Repair under direct visualization Cast Immobilization, support, and protection of affected part Nursing Care of Casts • Neurovascular checks • Handle wet cast carefully • Petal raw edges • Elevate extremity • Ice bags • Keep clean and dry This Photo by Unknown Author is licensed under CC BY -NC-ND External Fixators • Assess pins every 8 hours • Clean pins per facility protocol using sterile technique; one cotton tip swab per pin • Neurovascular checks Types of Traction • Manual • Skeletal • Skin • Balanced Suspension Complications of Fractures • Infection • Osteomyelitis • Delayed Union • Nonunion • Avascular Necrosis • Embolism • Shock • Compartment Syndrome Thromboembolus (DVT) • Clinical Manifestations • Nursing Care • Medical Management Shock • Clinical Manifestations • Nursing Interventions • Medical Management • Clinical Manifestations • Nursing Care • Medical Management Hip Fractures Hip Fractures • A break in the femur at the head, neck, or trochanteric region • Intracapsular • Extracapsular • Risk Factors Prevention of Hip Fractures • Falls prevention • Drug therapy • Early Identification of patients at risk for falls • Non slip footwear • Toileting programs 29 Nursing Care of Hip Fractures Pre -Op: • Buck’s Traction • Keep the hip abducted • Pain management • Neurovascular assessment Post Op: • Wound care • Neurovascular checks • DVT Prevention • Abduction Pillow • Activity • Pain Management • Patient Education • Falls precautions Abduction Pillow Hip Fractures - Medical Management • Immobilization • Maintain proper alignment • Treat shock • Pain management Initial: • Hemiarthroplasty • Sliding nail • Compression screws Surgery: Sliding Compression Screw Gamma Nail Hemiarthroplasty 34 Osteoarthritis Osteoarthritis ( OA) • Localized, noninflammatory disorder • Progressive deterioration of joints • Causes bones and joints to degenerate Osteoarthritis or Rheumatoid Arthritis Osteoarthritis Rheumatoid Arthritis Location Localized response in single area. Weight -bearing joints, hands, back. Systemic (all joints) Cause Joint degeneration with bone spur growth, degenerative Synovial membrane inflammation, inflammatory Onset Gradual Abrupt Symptoms Pain with activity, improves with rest Swelling, redness, warmth, pain at rest or after immobility (morning stiffness) Typically Affects Older adults (usually over 60 ). Leading cause of disability in those 65+. By the age of 70 most adults have hypertrophic joint changes. Most common in women aged 30 -45 Osteoarthritis - Clinical Manifestations • Joint pain • Crepitus • Limping gait • Back pain Osteoarthritis - Risk Factors OVER THE AGE OF 60 WOMEN OBESITY SMOKING GENETIC LINK HISTORY OF REPETITIVE STRESS ON JOINTS Osteoarthritis Health Promotion/Prevention • Use joint saving measures • Lifestyle changes • Falls Prevention • Balance activity with rest • Limit repetitive strain Osteoarthritis - Nursing Interventions • Medication use • P roper body mechanics • Range of motion • U se of ice and heat • Assess neurovascular status • Encourage healthy diet • Nonpharmacological pain relief measures Osteoarthritis - Medical Management • Braces/splints • Drug therapy • NSAIDS • Analgesic (Acetaminophen) • Steroids • Topical Analgesics • Alternative Therapies • Surgical Replacement of joint 43 Surgical Management of Osteoarthritis - Arthroplasty (Joint Replacement) • Replacement of both surfaces within joint capsule • Complications Total Hip Arthroplasty Post Operative Care • Respiratory interventions • Transfusion • Fluids & Electrolytes • Assess surgical site • Neurovascular checks • Wound & drain care • Patient education • Keep Hip abducted Total Knee Arthroplasty Post Operative Care • Most post op care is same as total hip • Monitor • Patient Education • Activity Continuous Passive Motion (CPM) machine Parkinson’s Disease Parkinson’s Disease • Degenerative disease caused by the depletion of dopamine • Exact cause is not known • Risk factors • Diagnosis Clinical Manifestations of Parkinson’s Disease 4 Cardinal symptoms • Tremor • Muscle rigidity • Bradykinesia or Akinesia • P ostural instability Interventions • Assess neurological status • Nutrition • Promote independence • Assist with ambulation • Promote good posture Medical Management • Speech therapy, Physical therapy, and rehabilitation • Dopaminergics or Dopamine Agonists ( Apomorphine , Amantadine, Carbidopa -levodopa) • A nticholinergics ( Benztropine mesylate , trihexphyenidyl hydrochloride) • C atechol -O -methyltransferase inhibitors ( Entacapone , Opicapone , Tolcapone ) • Monoamine oxidase type B inhibitors ( Rasagiline mesylate ) Side Effects of Antiparkinsonian Medications • Dyskinesia • Chest pain • Sleep disturbances, insomnia, or periods of sedation • Orthostatic hypotension and dizziness • Confusion • Mood changes, especially depression • Hallucinations • Dry mouth Complications of Parkinson’s Disease • C rippling disability • Debilitation • Mental deterioration • Changes in cognition Back Problems Back Problems • Prevalence • May be acute or chronic • Symptoms • Compression fractures Back Problems Risk Factors • Age • Lack of exercise • Obesity • Diseases • Improper lifting • Psychological conditions • Smoking • Prolonged sitting Back Problems Medical Management • Positioning • Nonsurgical Management • S urgical intervention (vertebroplasty or kyphoplasty) Multiple Sclerosis Multiple Sclerosis (MS) • L oss of myelin • Autoimmune Disease • Symptoms vary Common Diagnostic Tests • Lumbar puncture (LP) • Imaging procedures • MRI • Brain scan Nursing Interventions - MS • Encourage fluid intake • Monitor cognitive changes • Communication techniques • Promote energy conservation Medical Management MS Immunosuppressive Agents • Azathioprine (Imuran) • Cyclosporine (Sandimmune ) Anti -inflammatory Agents • Steroids -Prednisone Muscle Relaxants • Dantrolene (Dantrium ) • Tizanidine (Zanaflex ) • Baclofen (Lioreseal ) Antispasmodics • Benzodiazepines -Diazepam (Valium)