Lecture 2 Part 1 - Activity

‭Chapter 34: Activity‬ ‭Skeletal System‬ ‭●‬ ‭Consists of bones, joints, tendons, ligaments‬ ‭●‬ ‭Functions:‬ ‭○‬ ‭Supports soft tissues of the body‬ ‭○‬ ‭Protects crucial components of the body‬ ‭○‬ ‭Provides storage areas for minerals and fat‬ ‭○‬ ‭Produces red blood cells (hematopoiesis)‬ ‭Question:‬‭Which of the following classifications describes‬‭the bones located in the wrist?‬ ‭a.‬ ‭Long bones‬ ‭b.‬ ‭Short bones‬ ‭c.‬ ‭Flat bones‬ ‭d.‬ ‭Irregular bones‬ ‭Bones Classified by Shape‬ ‭●‬ ‭Long bones: Height and length‬ ‭●‬ ‭Flat bones: Structural contour/shape‬ ‭●‬ ‭Short bones: Movement‬ ‭●‬ ‭Irregular bones: Protecting nervous tissue and supporting the pharynx and trachea‬ ‭○‬ ‭Ex. spinal column, jaw‬ ‭●‬ ‭Sesamoid bones: Protects tendons from stress and tear‬ ‭Joint Movements‬ ‭●‬ ‭Flexion: Bending‬ ‭●‬ ‭Extension: Returning to anatomical position after flexion‬ ‭●‬ ‭Hyperextension: Increasing angle more than natural position‬ ‭●‬ ‭Abduction: Away from midline‬ ‭●‬ ‭Adduction: Toward midline‬ ‭●‬ ‭Circumduction: Circular motion‬ ‭●‬ ‭Dorsiflexion: Bending up (ex. ankle)‬ ‭●‬ ‭Plantar flexion: Bending down‬ ‭●‬ ‭Internal rotation: Turning extremities inward‬ ‭●‬ ‭External rotation: Turning extremities outward‬ ‭●‬ ‭Pronation: Inward for impact distribution upon landing (ex. Palms down)‬ ‭●‬ ‭Supination: Weight rolls onto the outer edges (ex. Palms up)‬ ‭●‬ ‭Inversion: Moving foot inward‬ ‭●‬ ‭Eversion: Moving foot outward‬ ‭Types of Joints‬ ‭●‬ ‭Hinge joint: Flexion, extension‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ ‬ ‭ex. Elbow and knee‬ ○ ‭Pivot joint: Rotation‬ ‭○‬ ‭ex. neck‬ ‭Ball and socket joint: Flexion, extension, hyperextension, abduction, adduction, internal‬ ‭rotation, external rotation, circumduction‬ ‭○‬ ‭ex. shoulder‬ ‭Saddle joint: Flexion, extension, abduction, adduction, circumduction‬ ‭○‬ ‭ex. Carpometacarpal (CMC) joint of the thumb‬ ‭Condyloid joint: Flexion, extension, abduction, adduction, circumduction‬ ‭○‬ ‭ex. Metacarpophalangeal (MCP) joint of the wrist‬ ‭Gliding joint: Gliding movements‬ ‭○‬ ‭ex. Intercarpal joints‬ ‭ uestion:‬‭A nurse stretches out a patient’s leg and‬‭moves it away from the body. This is an‬ Q ‭example of what type of body movement?‬ ‭a.‬ ‭Abduction‬ ‭b.‬ ‭Flexion‬ ‭c.‬ ‭Circumduction‬ ‭d.‬ ‭Dorsiflexion‬ ‭Types and Functions of Muscles‬ ‭●‬ ‭Skeletal: Framework that supports soft tissues, provides protection, furnishes attachment‬ ‭surfaces, stores minerals/fat, produces blood cells‬ ‭●‬ ‭Cardiac: Forms bulk of heart and produces heart contractions‬ ‭●‬ ‭Smooth/visceral: Forms walls of hollow organs, blood vessels, and tubes‬ ‭Skeletal Muscle Functions‬ ‭●‬ ‭Motion: Contraction creates movement by pulling on‬ ‭tendons‬ ‭●‬ ‭Maintenance of posture: Contractions help us maintain‬ ‭stationary positions‬ ‭●‬ ‭Protection: Provides structure and framework to protect‬ ‭crucial body components (ex. Heart, lung, brain, etc.)‬ ‭●‬ ‭Heat production: Contractions produce heat and maintain body temperature‬ ‭Skeletal‬ ‭Smooth‬ ‭Cardiac‬ ‭Voluntary‬ ‭Involuntary‬ ‭Involuntary‬ ‭Striated‬ ‭Spindle-shaped‬ ‭Striated‬ ‭Tubular‬ ‭Smooth‬ ‭Branched‬ ‭Many nuclei‬ ‭1 nucleus‬ ‭1-2 nuclei‬ ‭Types of Exercise‬ ‭●‬ ‭Isotonic: Same tension‬ ‭○‬ ‭Muscle contracts, and muscle length changes‬ ‭○‬ ‭Concentric and eccentric contractions‬ ‭○‬ ‭ex. Swimming, bicycling, walking‬ ‭●‬ ‭Isometric: Same length‬ ‭○‬ ‭Muscle contracts, but muscle length does not change‬ ‭○‬ ‭ex. Yoga, squats‬ ‭●‬ ‭Isokinetic: Same speed‬ ‭○‬ ‭Muscle contracts and shortens with a constant speed and resistance‬ ‭○‬ ‭ex. Weight lifting, stationary bike‬ ‭Question:‬‭Jogging is an example of isokinetic exercise.‬ ‭a.‬ ‭True‬ ‭b.‬ ‭False‬ ‭Positioning‬ ‭●‬ ‭Supine position: Back down‬ ‭●‬ ‭Prone position: Face down‬ ‭●‬ ‭Side-lying/lateral recumbent position: On left/right side‬ ‭●‬ ‭Fowler’s position: Sitting upright for comfort or easy breathing‬ ‭○‬ ‭High: 80-90‬ ‭○‬ ‭Standard: 45-60‬ ‭○‬ ‭Semi: 30-45‬ ‭○‬ ‭Low: 15-30‬ ‭●‬ ‭Trendelenberg position: Head is lower than feet to bring more blood to the brain‬ ‭○‬ ‭Used after someone has fainted‬ ‭●‬ ‭Reverse Trendelenburg: Head is higher than feet to direct blood away from the brain‬ ‭○‬ ‭Used during brain or neck surgery‬ ‭●‬ ‭Dorsal recumbent position: Knees up with feet flat‬ ‭○‬ ‭Used during pelvic exams and labor/delivery‬ ‭●‬ ‭Lithotomy position: Legs are elevated during exams‬ ‭○‬ ‭Used during pelvic exams and labor/delivery‬ ‭●‬ ‭Sim’s position (lateral decubitus): In between prone and lateral‬ ‭○‬ ‭Head lies to the side with knee facing toward head‬ ‭●‬ ‭Oblique position (modified lateral position): In between supine and lateral‬ ‭High Fowler’s‬ ‭80-90 degrees‬ ‭Standard Fowler’s‬ ‭45-60 degrees‬ ‭Semi-Fowler’s‬ ‭30-45 degrees‬ ‭Low Fowler’s‬ ‭15-30 degrees‬ ‭Physical Assessment for Mobility‬ ‭●‬ ‭Alignment‬ ‭●‬ ‭General ease of movement and gait‬ ‭●‬ ‭Joint function (ROM)‬ ‭●‬ ‭Muscle mass, tone, and strength‬ ‭○‬ ‭Mass:‬ ‭■‬ ‭Atrophy: Thinning of muscle tissue‬ ‭■‬ ‭Hypertrophy: Increase in the size of a muscle through an increase in the‬ ‭size of its component cells‬ ‭○‬ ‭Tone:‬ ‭■‬ ‭Hypotonicity/flaccidity: Lesser degree of tone/tension from constant‬ ‭relaxation‬ ‭■‬ ‭Hypertonicity/spasticity: Increased tone/tension‬ ‭○‬ ‭Strength:‬ ‭■‬ ‭Paresis (hemiparesis, paraparesis, quadriparesis/tetraparesis): Weakness of‬ ‭muscle strength‬ ‭●‬ ‭Hemi: Half of one side‬ ‭●‬ ‭Para: Loss of legs‬ ‭●‬ ‭Quadri: Arms and legs‬ ‭■‬ ‭Paralysis (hemiplegia, paraplegia, quadriplegia): Total loss of muscle‬ ‭strength‬ ‭●‬ ‭Endurance‬ ‭Factors Influencing Mobility‬ ‭●‬ ‭Developmental considerations‬ ‭○‬ ‭Patient’s age and degree of development‬ ‭○‬ ‭Medical considerations‬ ‭■‬ ‭Achondroplasia: Short-limbed dwarfism‬ ‭■‬ ‭Dwarfism: Short stature resulting from a genetic/medical condition‬ ‭●‬ ‭Physical health (ex. bedridden)‬ ‭○‬ ‭Awareness of how acute and chronic health problems affect patient’s health‬ ‭○‬ ‭Ability to perform ADLs and IADLs‬ ‭‬ M ● ‭ ental health (ex. depression)‬ ‭●‬ ‭Lifestyle‬ ‭○‬ ‭Sedentary vs. active; depends on job‬ ‭●‬ ‭Attitude and values‬ ‭●‬ ‭Fatigue and stress‬ ‭●‬ ‭External factors‬ ‭○‬ ‭SDOHs, weather, finances for physical activity, support, free time, etc.‬ ‭Complications of Immobility‬ ‭●‬ ‭Respiratory system: Lung buildup‬ ‭○‬ ‭Pneumonia‬ ‭●‬ ‭Circulatory system: Blocks the flow of blood in the vein; may cause heart attack/stroke‬ ‭○‬ ‭DVT‬ ‭●‬ ‭Integumentary system: Constant pressure decreases oxygen supply‬ ‭○‬ ‭Pressure ulcers‬ ‭●‬ ‭Muscular system: Loss of muscle mass or shortened/hardened muscle‬ ‭○‬ ‭Atrophy‬ ‭○‬ ‭Contracture: Muscles, tendons, joints, or other tissues tighten/shorten, causing a‬ ‭deformity‬ ‭●‬ ‭Skeletal system: Lack of calcium weakens bones‬ ‭○‬ ‭Osteoporosis: Bones weaken and become brittle‬ ‭●‬ ‭Genitourinary system: Urination in the supine position can leave urine in the bladder‬ ‭○‬ ‭UTI and kidney stones‬ ‭●‬ ‭Gastrointestinal system: Movement aids digestion‬ ‭○‬ ‭Indigestion and constipation‬ ‭○‬ ‭Bedridden patients have an increased chance of choking‬ ‭●‬ ‭Nervous system: ex. Insomnia‬ ‭●‬ ‭Mental health: ex. Depression‬ ‭Range of Motion Exercise‬ ‭●‬ ‭Prevent muscular atrophy and joint contractures‬ ‭○‬ ‭Reduces length of stay, shortens ventilation, and improves independence‬ ‭●‬ ‭Maintain muscle strength and mass; normal joint mobility and flexibility‬ ‭●‬ ‭Passive: When exercise is provided to the pt from the healthcare provider‬ ‭●‬ ‭Active: Patient exercises on their own‬ ‭●‬ ‭Exercising tips‬ ‭○‬ ‭Return the joint to a neutral position‬ ‭○‬ ‭Exercise only to the point of resistance but not pain‬ ‭○‬ ‭Use a cupped hand to support a joint‬ ‭○‬ ‭Support the joint by holding the distal and proximal areas adjacent to the joint‬ ‭ ‬ ‭Cradle the distal portion of a lower extremity‬ ○ ‭ ‬ ‭Procedure:‬ ● ‭○‬ ‭Neck‬ ‭○‬ ‭Shoulder‬ ‭○‬ ‭Elbow‬ ‭○‬ ‭Forearm‬ ‭○‬ ‭Wrist‬ ‭○‬ ‭Thumb‬ ‭○‬ ‭Fingers‬ ‭○‬ ‭Hip‬ ‭○‬ ‭Knee‬ ‭○‬ ‭Ankle‬ ‭○‬ ‭Foot‬ ‭○‬ ‭Toes‬ ‭Protective Positioning‬ ‭●‬ ‭Need to change positions frequently, at least every 2 hours‬ ‭●‬ ‭Importance of using the time allotted to:‬ ‭○‬ ‭Position change‬ ‭○‬ ‭Extremities exercise‬ ‭○‬ ‭Assess and massage the pressure area‬ ‭(reddened areas should not be massaged)‬ ‭Common Devices to Promote Correct Alignment‬ ‭●‬ ‭Pillows‬ ‭●‬ ‭Mattresses‬ ‭●‬ ‭Adjustable beds‬ ‭●‬ ‭Bedside rails‬ ‭●‬ ‭Trochanter rolls: Prevents extension of hip joints‬ ‭in supine position‬ ‭●‬ ‭High-top sneakers‬ ‭●‬ ‭Hand roll‬ ‭●‬ ‭Trapeze bar: Gravity slides the patients down the bed‬ ‭●‬ ‭Patients can pull themselves up into the correct position‬ ‭Prevention of Deep Vein Thrombosis‬ ‭●‬ ‭Antiembolism stockings‬ ‭●‬ ‭Graduated compression stockings‬ ‭●‬ ‭Pneumatic compression devices‬ ‭Physical Conditioning‬ ‭●‬ ‭Quadriceps and gluteal setting drills: Isometric exercises meant to tone and strengthen‬ ‭these two weight-bearing muscles; prevent atrophy‬ ‭●‬ ‭Push-ups: Raising and lowering the body in a prone position by straightening and‬ ‭bending the arms‬ ‭●‬ ‭Dangling: Hanging the legs over the side of the bed‬ ‭Mechanical Aids for Walking‬ ‭●‬ ‭Walker‬ ‭●‬ ‭Cane‬ ‭●‬ ‭Braces‬ ‭●‬ ‭Crutches‬ ‭Crutches‬ ‭●‬ ‭Forearm crutches: Long-term support with permanent limitations‬ ‭●‬ ‭Axillary crutches: Temporary restrictions; requires significant strength to use‬ ‭Proper Crutch Use‬ ‭●‬ ‭Standing: Hold the handgrip of the crutch on each side to support weight‬ ‭●‬ ‭Sitting: Both crutches in one hand while the other is on the chair‬ ‭●‬ ‭Handrail: Both crutches on one side of the body, and use the other hand to hold the rail‬ ‭●‬ ‭Walking: Move crutch tips in front of the body and swing the injured leg forward, taking‬ ‭a step with the uninjured leg‬ ‭●‬ ‭Getting up: Move the body to the edge of the chair and move it up with the uninjured leg‬ ‭●‬ ‭No handrail: Keep a crutch under each arm‬ ‭Crutch Walking‬ ‭●‬ ‭Prevent pressure on the axillae‬ ‭●‬ ‭Keep elbows close to the sides‬ ‭●‬ ‭Prevent crutches from getting closer than 12 inches to the feet‬ ‭Injuries in Healthcare Workers‬ ‭●‬ ‭Nursing is a physical profession‬ ‭●‬ ‭Injuries are often to the back; causes include:‬ ‭○‬ ‭Uncoordinated lifts‬ ‭○‬ ‭Manual lifting and transferring of patients without assisting devices‬ ‭○‬ ‭Lifting when fatigued or after a recent back injury‬ ‭○‬ ‭Repetitive movements, such as lifting, transferring, and repositioning patients‬ ‭○‬ ‭Standing for long periods of time‬ ‭○‬ ‭Transferring patients, especially when they are confused or uncooperative‬ ‭‬ S ● ‭ ome nurses accept pain as part of the job‬ ‭●‬ ‭Cutting down on occupation-related injuries:‬ ‭○‬ ‭Patient lift teams, transfer belts, mechanical lifts, slide boards‬ ‭Adequate Posture‬ ‭●‬ ‭Core right and feet based‬ ‭●‬ ‭To pick up heavy items, keep object close and lift from legs‬ ‭Devices for Safe Patient Transfer‬ ‭●‬ ‭Gait belts‬ ‭●‬ ‭Transfer chairs‬ ‭●‬ ‭Repositioning aids (ex. E-Z slide, Handi slide)‬ ‭●‬ ‭Lateral-assist devices‬ ‭●‬ ‭PAT slide for lateral transfer‬ ‭●‬ ‭Turn and position system (TAPS)‬ ‭●‬ ‭Sara Stedy (powered stand-assist)‬ ‭●‬ ‭Sara Plus (powered stand-assist)‬ ‭●‬ ‭Maxi Move (powered full-body lifts)‬ ‭Logrolling a Patient‬ ‭●‬ ‭Spinal injury‬ ‭●‬ ‭Recovering from neck, back, or spinal surgery‬ ‭●‬ ‭Keep the body in straight alignment when turning the patient‬ ‭●‬ ‭Four individuals move synchronously to properly logroll a patient‬