I Fall to Pieces
True or false. Patients who suffer from immobility can have low self-esteem
TRUE
What are some way(s) to prevent respiratory complications of immobility?
incentive spirometry, turn every 2 hours, increase fluids to thin secretions, oxygen as needed, prone if needed
What is the name of the tool that evaluates a patient's mobility?
Mobility Assessment Tool (MAT)
What is a great device to use if a nurse is assisting with ambulation?
Gait belt
What position is flat on the back with knees straight or bent?
Dorsal recumbent
Decreased activity leads to ________ of the GI system
decreased peristalsis, constipation, impaction
What is the number one way to prevent blood clots?
Ambulation!
How much time out of bed does it take for a patient to be at risk for falling?
12 seconds
What device do you use if the patient can ambulate independently but needs assistance on one side?
200 points for naming device
double points to say how to properly use it
cane
use on strong or unaffected side
What is prone position?
Lying on the abdomen with the head to the side
What is a complication of immobility that can lead to a pulmonary embolism, stroke, or heart attack?
DVT or blood clot
Name 3 ways to prevent genitourinary complications of immobility
All or nothing!
fluids, HOB up, assist to bathroom frequently, exercises, good peri hygiene
When should you ambulate a patient?
Early and often!
What is a good device to use for weaker patients who may fall easily?
Walker
What is the difference between active and passive range of motion?
Active the patient can do themselves, pass requires movement by the nurse
Name 4 complications of immobility
Double or Nothing!
Disuse osteoporosis, fragility fractures, atrophy, sarcopenia, weakness, decreased range of motion, stiffness, joint contractures, foot drop
Name at least 2 nursing interventions that help prevent pressure injuries
Q2 turns, pillows/cushions, minimize friction, incontinence care every 2 hours, distribute weight off bony prominences, nutrition
Name 4 signs and symptoms of activity intolerance
weakness, fatigue, lightheadedness, chest pain, diaphoresis, significant changes in vital signs with activity
If a patient falls, they require priority intervention
True or false?
TRUE
What position is flat on the back with foot of the bed above the head?
Trendelenburg
Older adults are more prone to ______ from immobility because of _____
Double or nothing!
pressure injuries, thinning skin
What are 3 nursing interventions to prevent immobility and/or musculoskeletal complications
All or Nothing!
weight bearing exercises, fall precautions, range of motion exercises, Splints, Encourage ADLs, ensure good alignment
What are age related muscle mass changes that affect mobility in the older client?
Name 2 for 500 points
Name all 4 for double points!
less endurance, decreased strength, loss of muscle mass, increased fatigue with ambulation
Patients with ________may take priority over other patients if they are at immediate risk for falls
unsteady gait
What position(s) promotes lung expansion?
Double points to name all three plus degrees
Semi, Fowler, or High Fowler
15, 30, 45, 60, 90