Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning VOLUME ONE | SECOND EDITION Nursing:

Copyright © 2015, 2011 by Pearson Education, Inc.All Rights Reserved

Nursing:A Concept-Based Approach to Learning

VOLUME ONE | SECOND EDITION

Nursing: A Concept-Based Approach to Learning Volume One, Second Edition

Mobility

Nursing:A Concept-Based Approach to Learning

MODULE 13

VOLUME ONE | SECOND EDITION



Physiology Review

• Musculoskeletal system Bones and joints of skeletal system Muscles, ligaments, tendons, and cartilage

of the muscular system



Alterations to Mobility

• Musculoskeletal system affects nearly every aspect of life. Alterations in muscles, bones, and joints

link a variety of health problems• Arthritis• Fractures• Neurological disorders• Traumatic injuries



Concepts Related to Mobility

• Comfort• Health, Wellness, and Illness• Stress and Coping• Collaboration• Safety



Alterations and Manifestations

• Back problems• Fractures• Hip fractures• Multiple sclerosis (MS)• Osteoarthritis (OA)• Parkinson disease• Spinal cord injury



Alterations and Manifestations, continued

• Abnormalities of the spine Kyphosis Scoliosis Lordosis

• Joint disorders Temperomandibular joint (TMJ) syndrome Wrist, hand Foot



Genetic Considerations and Nonmodifiable Risk Factors

• Aging is primary risk factor Joint problems decrease mobility

• Osteoarthritis• Gout• Kyphosis• Lower back pain• Inflammatory disorders

Risk of fractures Genetic factors



Prevention

• Good lifestyle habits• Good nutrition

Adequate calcium intake

• Regular exercise



Modifiable Risk Factors

• Obesity Excess weight strains joints Increases destruction rate of cartilage and

other tissues Hinders common movements

• Mobility before birth• Well-balanced diet



Screenings

• Screening tools available for clients with risk factors

• Older clients receive bone density scans• Spinal screenings for children• Genetic testing



Nursing Assessment

• Structure, function assessed Health assessment interview Physical assessment Diagnostic tests Primary manifestations

• Pain, limited mobility Details of lifestyle Client history



Physical Assessment

• Part of a total assessment• Sequence

Assessment of gait, posture Inspect, palpate for obvious deformity,

tenderness Measure extremities for length,

circumference



Physical Assessment, continued

• Sequence Assess muscle mass, strength Muscle function grading scale Assess swelling, pain, redness, warmth,

ROM



Physical Assessment, continued

• 5 P's neurovascular assessment Pain on a 0–10 scale Pulses comparison between

affected/unaffected extremity Pallor in injured/affected area and overall Parasthesia Paralysis/paresis with fractures to indicate

fracture or muscle weakness



Lifespan and Cultural Considerations

• Alterations more prevalent in certain age groups Infants, children may have genetic

disorders or congenital malformations Children, Adolescents, young adults prone

to trauma from sports, abuse or accidents Older adults present inflammatory and

"wear-and-tear"



Diagnostic Tests

• Blood tests• Imaging tests

Bone density scans CT scans MRIs X-rays

• Electrical tests EMG



Interventions and Therapies

• Independent Promoting safety and comfort Injury prevention Client teaching

• Self-care• Chronic condition



Independent

• Providing education Body mechanics, proper posture Importance of exercise and nutrition Medications

• Promoting comfort Client positioning Padding of joints can prevent discomfort

and skin breakdown Braces and support devices



Independent, continued

• Preventing injury Traumatic injury, neurological conditions,

decreased mobility associated with risk of contractures

Exercises and stretches Use braces and splits prescribed by PT, OT Environment screening



Collaborative

• Rehabilitative nursing Preservative Restorative Goals Hospitalization and immobility

• Exercise Muscles that are not used weaken, shorten Passive, active ROM Resistive exercises



Collaborative, continued

• Exercise Muscles that are not used weaken, shorten Passive, active ROM Resistive exercises




• Ambulation Walking Ambulation improves function, well-being,

strength Before assisting client with walking

• Explain purpose, what you are going to do• Prepare client in phases




• Ambulation Crutches

• Axillary• Lofstrand• Platform

Walkers• Assist client with balance, walking• Arms support all, part of body weight

Canes• Protect clients




• Pharmacologic therapy Palliative not curative Antispasmodics Muscle relaxants Analgesics NSAIDs, anti-inflammatory



Exemplar 13.1Back Problems



Herniated Disk

• Herniated intervertebral disc Ruptured disc Slipped disc Hernitated nucleus pulposus

• Rupture in a spinal disk Allow fluids to leak out and irritate nerves



Herniated Disk, continued

• Pathophysiology and etiology Intervertebral disks: shock absorbers Rupture of cartilage surrounding disk

• May occur spontaneously or from trauma• Abrupt or gradual




• Nursing process Relieving pain Healing involved disc Regaining mobility




• Assessment Health history

• Employment• Characteristics of pain• History of previous injury• Sport, recreational activities

Physical assessment• Muscle strength, coordination• Sensation• Reflexes




• Diagnostic tests Mobility tests

• Straight-leg raise, gait tests, reflex tests, muscle strength tests

Imaging tests• CT scans, MRIs• Myelogram• Electromyogram

Blood tests




• Diagnosis Risk for injury Risk for reflex urinary incontinence Risk for bowel incontinence Impaired physical mobility Acute pain Chronic pain




• Planning The client will develop no motor deficits. The client will develop no sensory deficits. The client will remain free from infection. The client will demonstrate normal bowel

function.




• Implementation Promoting safety Preventing onset or exacerbation of

neurological deficits Providing adequate pain relief Explain treatment options Nursing care for postsurgical clients




• Surgery Reserved for the most severe cases

• Laminectomy• Discectomy• Spinal fusion• Artificial disc surgery• Laser surgery




• Pharmacologic therapy First line therapy

• Nonsteroidal anti-inflammatory drugs Opioids Antispasmodics Epidural injections of

cortisone/corticosteroids




• Nonpharmacologic therapy Intradiscal electrothermal therapy (IDET) Chiropractic therapy

• Speeds recovery from acute low back pain Massage therapy

• Benefits Acupuncture

• Acute, chronic pain• Motion disabilities



Scoliosis

• Lateral or sideways curve of the spine• C-shaped or S-shaped• Evident during growth spurt• Most cases are mild• Severe cases can cause spine rotation

Deformities and disabilities



Scoliosis, continued

• Etiology Idiopathic scoliosis, most common

• Acquired after injury Congenital scoliosis, individual born with

curved spine Neuromuscular scoliosis, medical

conditions that affect nerves and muscles




• Risk factors Adolescents at greatest risk

• Growth spurt between ages 9 – 15• Girls are prone to greater curvature

Neuromuscular disorder• Cerebral palsy• Muscular dystrophy

Family history of scoliosis




• Assessment Screening

• 5th–7th grades• Visual observation

• From front • From back• Adolescent holding hands together, bent

over slightly• Hands hanging down, not held together




• Clinical manifestations Truncal asymmetry Uneven shoulders, hips One-sided rib hump Prominent shoulder blade




• Diagnostic tests Adam forward bend test X-ray Scoliometer Additional diagnostic studies

• MRI• CT scan• Bone scan




• Diagnosis Risk for Infection related to spinal surgery Impaired Physical Mobility Risk for Impaired Skin Integrity Ineffective Breathing Pattern Readiness for Enhanced Knowledge Disturbed Body Image




• Planning Client, family

• Describe selected treatment regimen, roles• Describe condition, stages of treatment

Client requiring surgery can describe procedure to be performed

Pediatric considerations




• Implementation Promote understanding, acceptance of

treatment plan• Help client adjust to wearing a brace• Provide reassurance, encouragement• Promote interaction with peers• Provide information about fashionable

clothing to wear with brace




• Surgery Mild scoliosis < 20 degrees curvature

• Exercises Moderate scoliosis 20–45 degrees

• Boston (TLSO) or Milwaukee brace• 12–23 hours/day

• Electrical stimulation Severe scoliosis > 50 degrees

• Surgery, spinal fusion




• Pharmacologic therapy Usually not treated with medication Clients may take OTC analgesics for pain




• Nonpharmacologic therapy Depends on severity of curve

• Observation for worsening curvature in clients with < 20

• Brace to prevent further curvature for clients over 10 years old

Chiropractic treatment, electrical stimulation, biofeedback, nutritional supplements, and exercise are ineffective




• Evaluation Client maintains intact skin under brace Client wears brace as directed



Exemplar 13.5Osteoarthritis



Overview

• Most common form of arthritis• Develops as wear and tear on joints

breakdown cartilage Bone on bone

• Hands, knees, and hips



Pathophysiology and Etiology

• Degenerative joint disease Localized Generalized Idiopathic

• Progressive erosion of joint articular cartilage Bone spurs



Prevention

• Maintain ideal body weight• Participate in moderate exercise program• Inactivity and excessive exercise can lead

to premature degeneration of cartilage



Assessment

• Health history Symptoms Physical activity, mobility

• Physical examination ROM Swelling



Clinical Manifestations

• Onset of OA usually gradual, insidious Pain, stiffness in one or more joints Pain may be referred to other parts of body



Diagnostic Tests

• X-rays• MRI• Ultrasound• Joint fluid analysis• Blood tests to rule out other causes



Diagnosis

• Chronic Pain• Impaired Physical Mobility• Dressing Self-Care Deficit• Imbalanced Nutrition: More Than Body

Requirements



Planning

• Client articulates strategies for reducing pain

• Client maintains maximum ROM of involved joints

• Client minimizes impact of osteoarthritis• Client uses assistive devices to maintain

autonomy in performing ADLs



Collaboration

• No treatment available to stop progression Early treatment beneficial Learn to live with chronic disease

• Nonpharmacologic therapies Education Weight reduction Exercise General, specific rest



Surgery

• Arthroplasty Total hip replacement Total knee replacement Total shoulder replacement Total elbow replacement



Surgery, continued

• PT and rehabilitation Focus on building strength, regaining

flexibility Rehabilitation begins in hospital



Pharmacologic Therapy

• Analgesics Aspirin Acetaminophen NSAIDs

• Topicals Counterirritants Salicylates Capsaicin

• NSAID Cox-2 inhibitors



Pharmacologic Therapy, continued

• Conservative treatment Apply heat to painful joints Use cold applications to reduce pain,

swelling Use canes, crutches, walkers to protect

joints Use assistive technology

• Viscosupplementation Hyaluronic acid injected into knee joint



Nonpharmacologic Therapy, continued

• Weight loss Risk factor that can be modified

• Exercise to relieve pain, stiffness Joints dependent on surrounding muscles Lack of use contributes to muscle atrophy Guidelines for older adults with arthritis



Nonpharmacologic Therapy, continued

• Teaching about rest General Specific joint rest

• Frequent short rest periods• Rest acutely painful, inflamed joint• Acupuncture• Massage therapy• Yoga



Evaluation

• Client maintains autonomy in performing ADLs

• Client's lifestyle is not significantly impacted by OA

• Client reports pain control adequate for rest, sleep

Documents

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning VOLUME ONE | SECOND EDITION Nursing: