Health & Illness Chapter 16 PDF

028ad77cbc7e6ddff52964d46183191f.png **[Moving and Positioning Patients]** **[Effects of Immobility:]** - **Immobility** occurs when patients are bedridden or physically restricted due to illness, injury, or surgery. This restriction has **short-term** and **long-term** physiological an...

028ad77cbc7e6ddff52964d46183191f.png **[Moving and Positioning Patients]** **[Effects of Immobility:]** - **Immobility** occurs when patients are bedridden or physically restricted due to illness, injury, or surgery. This restriction has **short-term** and **long-term** physiological and psychological consequences across all body systems. **Musculoskeletal System** - **[Muscle atrophy]**: Muscle mass and strength decrease due to disuse, which can start after a few days of immobility. - **[Decreased joint flexibility and range of motion (ROM)]**: Tendons, ligaments, and muscles stiffen, making movement more challenging. - **[Contractures]**: Permanent tightening of muscles or tendons leads to joint deformities. - **[Osteoporosis]**: Loss of bone density from lack of weight-bearing activity, increasing fracture risk. - **[Critical Points for Nursing Care]**: - Focus on **preventing contractures** through regular **ROM exercises.** - **Align the body correctly** to maintain joint health, using **trochanter rolls** and **foot splints** to prevent deformities like **footdrops**. **Cardiovascular System** - **[Venous stasis]**: Reduced blood flow increases the risk of clot formation in the legs (deep vein thrombosis, or DVT). - **[Embolism risk]**: If a clot breaks free, it may travel to the lungs (pulmonary embolism, heart (myocardial infarction), or brain (stroke). - **[Orthostatic hypotension]**: A sudden drop in blood pressure when standing up, leading to dizziness or fainting. - **[Critical Points for Nursing Care]**: - Encourage **frequent movement** and **extremity exercises** to prevent blood pooling and DVT. - **Change positions slowly** to reduce the risk of orthostatic hypotension. - Apply **anti-embolism stockings** for **sequential compression devices** (SCDs) if ordered. **Respiratory System** - **[Atelectasis]**: Collapse of alveoli due to shallow breathing. - **[Hypoxemia]**: Low oxygen levels in the blood due to impaired gas exchange. - **[Hypostatic pneumonia]**: Infection caused by fluid pooling in the lungs. - **[Critical Points for Nursing Care]**: - Perform **turning, coughing, and deep breathing** exercises every 2 hours. - Use an **incentive spirometer** to promote lung expansion. - Elevate the head of the bed to promote easier breathing. **Gastrointestinal System** - **[Decreased peristalsis]**: This leads to constipation, gas, and bloating. - **[Loss of appetite and malnutrition]**: Reduced movement slows digestion and impacts nutritional intake. - **[Critical Points for Nursing Care]**: - Encourage **fiber-rich foods** and ensure patients stay **hydrated** to maintain gastrointestinal function. - Assist with early **ambulation** to stimulate bowel function. - Administer **laxatives or stool softeners** if necessary. **Urinary System** - **[Urinary stasis]**: Pooling of urine in the bladder increases the risk of urinary tract infections. - **[Kidney stones]**: Excess calcium in the blood due to bone demineralization increases stone formation. - **[Urinary retention]**: Incomplete emptying of the bladder can lead to infections. - **[Critical Points for Nursing Care]**: - Ensure patients drink **adequate fluids** to avoid concentrated urine. - Help patients **urinate upright** (sitting or standing) to ensure complete bladder emptying. **Integumentary System** - **[Pressure injuries (decubitus ulcers or bedsores]**): Prolonged pressure on bony prominences decreases blood flow, damaging tissue. - **[Shearing and friction]**: Movement against the bed can cause skin abrasions. - **[Critical Points for Nursing Care]**: - **Reposition patients every 2 hours** to reduce pressure on bony areas. - Use **pressure-relief mattresses** or overlays. - Apply **moisturizing lotions** to keep skin hydrated. **Neurological System** - **[Compression neuropathy]**: Pressure on nerves can cause loss of sensation or movement, such as **footdrop**. - **[Reduced mental alertness]**: Lack of stimulation and immobility can lead to confusion or disorientation. - **[Critical Points for Nursing Care]**: - Use **neurological checks** to assess cognitive function and sensation. - Provide **foot splints** or **high-topped shoes** to prevent footdrop. - Use **clocks, calendars, and social interaction** to reorient patients. **Psychological Effects (psychosocial)** - **[Depression and anxiety]**: Reduced independence and immobility can lead to feelings of isolation and helplessness. - **[Sensory deprivation]**: Lack of mental stimulation can cause hallucinations or confusion. - **[Critical Points for Nursing Care]**: - Provide **distractions** like TV, music, and books. - Encourage **family visits** and allow patients to perform self-care whenever possible. - Engage patients with sensory activities to combat isolation. **[Breakdown of Skills]** **[Performing Passive ROM Exercises (Skill 16.1)]**: - Why It Matters: - It prevents muscle atrophy and joint contractures and maintains flexibility. - It is essential for immobile patients who cannot exercise independently. - How to Perform: - Move each joint **gently** through its natural range of motion and support the joint to avoid injury. - Exercise each joint **5 to 10 times** per session, 2-3 times daily. - Watch for **resistance or pain**, and do not force movement. **[Positioning Patients (Skill 16.2)]**: - Why It Matters: - Correct positioning reduces pressure injuries, ensures comfort, and maintains muscle tone. - How to Perform: - Reposition patients **every 2 hours**. - Use **pillows** and **support devices** (like trochanter rolls and foot splints) to maintain body alignment. - Ensure that extremities are placed in a **functional position** to avoid contractures (e.g., arms should not slump forward). **[Moving Patients in Bed (Skill 16.3)]**: - Why It Matters: - Frequent movement prevents pressure injuries and helps maintain circulation. - How to Perform: - Use a **draw sheet** or **slide sheet** to reduce friction and facilitate movement. - Ensure the bed is **flat** when moving patients to prevent strain on the body. - **Coordinate movements** with colleagues, count to three, and move the patient gently. **[Logrolling a Patient (Skill 16.4)]**: - Why It Matters: - Logrolling ensures **spinal alignment** in patients with back injuries or after spinal surgery. - How To Perform: - It requires **three people**: one controls the head, and two move the body. - Turn the patient as one unit, ensuring that the **head, shoulders, and hips** remain aligned. **[Transferring Patients from bed to Chair/Stretcher (Skill 16.5)]**: - Why It Matters: - Safe transfers prevent injury to patients and nurses, ensuring mobility is maintained as part of care. - How to Perform: - Use a **transfer belt** to help support the patient and prevent falls. - Ensure the chair is placed on the patient's **stronger side** if they have weakness on one side of the body. - Communicate with the patient throughout to reduce anxiety. **[Lifting and Moving Patients (Skill 16.6)]**: - Why It Matters: - Lifts are crucial for **non-weight-bearing patients**, preventing staff and patient injuries during transfers. - How To Perform: - Use a **sling** under the patient, positioning it correctly under the shoulders and hips. - Operate the lift slowly and **gently guide** the patient during movement. **[Assisting with Ambulation (skill 16.8)]**: - Why It Matters: - Early ambulation helps prevent complications like DVT and pressure injuries and improves respiratory and GI function. - How to Perform: - Use a **gait belt** and stand on the patient's **weaker side** for support. - **Dangle** the patient at the bedside before ambulating to reduce the risk of dizziness or falls. - Encourage the patient to walk short distances initially and gradually increase as tolerated. Key Insights - **[Critical Thinking]**: Nursing students need to anticipate complications before they occur. They should recognize which patients are at the highest risk for complications like DVT or pressure injuries and intervene early. - **[Holistic Care]**: Every immobile patient should receive individualized care for physical and psychological needs.