Midterm Exam: NSE 111/ NSE111 (New 2026/ 2027 Update) Questions and Answers | Grade A| 100% Correct (Verified Answers)

…. DLDD Midterm Exam: NSE 111/ NSE111 (New 2026/ 2027 Update) Questions and Answers | Grade A| 100% Correct (Verified Answers) Q. What is the nursing process? ANSWERS A decision making approach that helps identify and treat illnesses. Q. Composed of 5 components: ADPIE ANSWERS Assessment Diagnosis Planning Implementation Evaluation Q. What is assessment? ANSWERS Collecting patient's datas and cues in order to understand them. This could be through verbal communication, looking at their charts, or a visual assessment. An example of this would be a patient describing their symptoms when they are first admitted to the hospital. Q. What is diagnosis? ANSWERS Understanding the datas and cues that you collected from the patient in order to determine the root issue. This is where you make a nursing diagnosis where you want to have goals and outcomes. Q. What is planning? ANSWERS Developing a health care plan, where you have expected health goals and outcomes. Q. What is implementation? ANSWERS Implementing the plan of care you made. Q. What is evaluation? ANSWERS determining whether or not the plan or strategy you created decreased the patient's pain or was similar to the expected outcome. Q. What is the clinical judgement model? ANSWERS Applying decision-making skills as well as critical thinking, and it's to help novice nurses make less errors and to be better at their job. Q. It has 6 components: ANSWERS Recognizing/Noticing datas and cues Analyzing datas and cues Prioritizing hypothesis Generating Solutions Take Action Evaluative Outcomes Q. What is recognizing/noticing datas and cues? ANSWERS It is necessary for generating a hypothesis and it's about identifying relevant information about a patient through different sources. Q. What is analyzing datas and cues? ANSWERS It is necessary for generating a hypothesis and it's applying knowledge to the datas and cues that you recognize, that the patient has clinically presented. Q. What is prioritizing hypothesis? ANSWERS Determining what to do first and what to intervene with first. It is prioritizing the most concerning part of a patient. Q. What is generating solutions? ANSWERS Creating a plan that has expected outcomes and goals, where you use your hypothesis to create sets of interventions for the patient. Q. What is take action? ANSWERS Implementing the solutions you made. Q. What is evaluative outcomes? ANSWERS Seeing whether the observed outcome is similar to the expected outcomes. Q. What is the similarity with the nursing process and the clinical judgement model? ANSWERS Assessment = Recognizing/Noticing datas and cues Diagnosis = Analyzing datas/cues and Prioritizing hypothesis Planning = Generating solutions Implementation = Take action Evaluation = Evaluative outcomes Q. What are DIPPS and DIPPERS ANSWERS Dignity Independence Preference Privacy Safety Q. What is dignity? ANSWERS The patient feeling that they are worthy of the HCP's attention as well as being valued and respected Q. What is independence? ANSWERS Encouraging self-care as well as letting the patient be independent in doing the most that they can for themselves. Q. What is preference? ANSWERS Including the patient in your decision-making process and letting them have choices, where they get to choose what task they want to complete first. Q. What is safety? ANSWERS Making sure the patient's environment is free from hazard. Q. Who are the College of Nurses of Ontario (CNO)? ANSWERS They protect the public against nurses and they regulate the nurses working in Ontario. Q. What are the 7 standards of practice of the CNO? ANSWERS Accountability Continuing Competence Ethics Knowledge Knowledge Application Leadership Relationship Q. What is accountability? ANSWERS Making sure that your practice and conduct meets the legislative requirements, and the standards of the profession. It is knowing your action has consequences and being responsible. Q. What is continuing competence? ANSWERS Participating through the Quality Assurance program, where your judgement, skills, attitude, beliefs, knowledge, and values are tested to see if you are competent to continue performing. Q. What is ethics? ANSWERS Understanding, promoting, and upholding the values and beliefs of the CNO's ethics practice of standards. Q. What is knowledge? ANSWERS Having basic education, continuing your education, and making sure your education is relevant to your practice. Q. What is knowledge application? ANSWERS Continuing your knowledge as it never stops and using frameworks, processes, and theories in your practice Q. What is leadership? ANSWERS Promoting, facilitating, and providing the best care as possible to the public. Q. What is relationships? ANSWERS Having a therapeutic, collaborative, respected, and valued relationships with your colleagues and your patient. Q. What is person-centered or client-centered care? ANSWERS It is including your patient in your decision-making approaches that will help them as well as tailoring your care base on their needs. Q. What is personhood? ANSWERS The quality or condition of being an individual person and knowing the person behind their illness. Q. What are person-centered care approaches? ANSWERS Validating their emotions and feelings. Collaborating with the patient to enhance their abilities. Facilitating accommodating disabilities for task completion. Play and Celebrate is encouragement. Relax is making a person feel comfortable. Q. What strategies can you use to prevent and diffuse responsive behaviour for older people living with dementia? ANSWERS Using de-escalation techniques. Paying attention to cues. Noting their possible triggers. Time-limited and episodic. Documenting, reporting, and recognizing patterns of behaviour. What is the chain of transmission? Infectious agent Reservoir Portal of exit Mode of transmission Portal of entry Susceptible host What are the normal defences against infection? Normal flora are bacterias that live inside and outside of our body that helps fight pathogens. Inflammatory response is vascular and cellular that helps fight infections. Body systems are our organ systems that help fight infections. What is hospital acquired infection (HAI)? An infection AFTER being admitted to the hospital or institution. Older adults are more susceptible to HAI's because of their weak immune system, especially when they acquire c-difficile from antibiotics. This results in diarrhea due to a dangerous inflamed colon. Proper hand hygiene, wearing gloves, and a gown will help protect you. What is antimicrobial resistant organism (ARO)? Organisms that are resistant to the antibiotics due to continuously taking it, resulting in the organism being harder to treat. An example would be the MRSA. How do you minimize the spread of infection? Medical asepsis is the "clean technique" and this is where you prevent or limit the spread of microorganisms by wearing gloves, gown, doing proper hand hygiene, and cleaning the area routinely. Surgical asepsis is the "sterile technique" and this is where you eliminate all microorganisms from an area. What are contact precautions? Suspecting or know a patient has had direct or indirect contact with microorganisms. Wearing gown, gloves, putting them in a private room or cohort, and proper hand hygiene. What are airborne precautions? Suspecting or know a patient has had contact with airborne microorganisms. Wearing a mask and putting them in a private room that has a negative pressure airflow. What are droplet precautions? Knowing or suspecting that a patient has had contact with someone that has respiratory illness. Wearing eye protection, mask, putting them in private room or cohorts, and proper hand hygiene. What are psychological effects of isolation? Loneliness especially in patients that have Covid-19 because of limited visiting. Body image altered where they believe something is wrong with them whenever people put PPE. Explaining why you put PPE, opening the drapes, listening and talking to them, having them be active and do recreational activities, etc. What is comfort? tailored to every individual patient where they feel a sense of confidence, wellness, and well-being. Comfort is where they are able to cope with their disease as well as feeling safe and relaxed. What does comfort depend on? Age, severity of their illness, and mobility. What are environmental factors of comfort? Noise, lights, and odours. What are infection prevention practices when bed-making? Holding the linen away from you when you are throwing it out. Using incontinent pads. Frequent inspections to see if the patient's linen and bed are clean. Not shaking the linen which causes airflow to blow microorganisms. Not putting a soiled linen on the floor. Hand-hygiene and wearing gloves. What are basic bed positions? Fowlers = 45 degrees Semi-fowlers = 30 degrees Trendelenburg's = head of the bed is tilted upwards Reverse trendelenburg's = foot of the bed tilted upwards. Flat/Supine = flat Prone = the person's posterior is facing anteriorly. Side lateral and sims = supported What is the minimum weight of a patient where you can assist them by yourself? 16 kg is the minimum weight, where they have to be cooperative and not move for you to be able to help them. Anything above 16kg you must have another HCP help you or use assistive devices. What is body alignment? The relationship with one body part to another in a diagonal and horizontal line. It's having proper positioning of your muscles, tendons, ligaments, and joints when you are sitting, standing, and lying down. Having proper body alignment reduces strain because of neutrality. What is a wide-base support? Bending your knees and flexing your hips. What are the benefits of activity and exercise? Cardiovascular it improves your cardiac output, which rises during exercise which increases your stroke volume. Pulmonary it promotes lung expansion, overall WOB, and improves your baseline respiratory rate. Metabolic it promotes gastric motility where you will have less constipation. Skeletal muscle it helps joint movement through lubrication, increase tolerance to physical activity, increases muscle mass, and decrease bone loss. Psychological factors include less behavioural changes, sleep wake alterations, mood swings, social isolation, being dependent which can be increased if immobile and bed-ridden What are factors that affect movement? Body balance which is the centre of gravity, where you need to have a wide-base support in order to support your movement. Friction increase tissue damage due to prolonged pressure especially if the patient is immobile and bed-ridden. The greater the surface the are, the greater the friction. Shear is the force exerted against the skin that causes the bony prominence of the body to move, causing pain and pressure ulcers if prolonged. What are factors that affect activity and exercise? Behavioural aspects the patient will include exercise in the schedule if their nurses, doctors, family and friends encourage them too. Which will affect them in a way they want to be better. Developmental changes as our bodies will go through several changes as we age. What are physiological and psychological changes with immobility? Physiological include reduce muscle mass, reduce bone density, friction and shear, weakness, loss of function, etc. Psychological include increased chances of depression, loss of independence, social isolation, mood swings, sleep-wake alterations, etc. What is activity tolerance? It's affected by physical, emotional, and developmental changes. It is the person's ability to tolerate an amount of physical activity. What is deconditioning? Joint contractures and muscle atrophy, which is caused by the reduces or loss of function. What is functional decline? Can come out of deconditioning and it is impaired cognitive/physical function What is a pressure injury? Localized damage to the skin on the outside or soft tissues on the inside of the skin due to prolonged ischemia. Ischemia is reduced blood supply due to prolonged pressure. This causes inflammation of the body prominence in the beginning and then becomes pressure ulcers. How does pressure affect skin? Pressure affects the cellular metabolism of the skin by impairing blood and tissue circulation. What is the Braden scale? The braden scale determines a patient's risk to having pressure ulcers, the lower their braden scale, the higher the risk. It has 6 components: sensory, perception, activity, mobility, nutrition, moisture, friction and shear What are nursing interventions to prevent pressure injuries? Frequent inspection of the skin's integrity, using skin barriers, repositioning the patient every 2 hours, ensuring their skin is clean and dry. What is ROM? Range of motion exercise is the maximum amount of mobility a patient's joint has, which relates to the body planes: transverse, medial, sagittal, and frontal. What is restorative care? Letting patients do as much as they can independently to restore or keep mobility. This is where you collaborate with them by assisting them and focusing on their ADL's and IADL'S. What are the factors that affect a person's hygiene routine? Age, culture, socio-economic status (baseline for hygiene), physical condition, preference, health beliefs and motivations What are the risks for impaired hygiene? Physical impairment where a patient can feel, sense, hear, or is missing a limb for movement. Cognitive impairment when they patient has dementia, is in a lot of pain, or is confused. Unconscious patient they aren't able to voice out their needs to the HCP. Complex health conditions where they need to use mechanics and assistive devices. What are factors that affect urinary elimination? Disease conditions where they are dehydrated. Medications that can increase or decrease their urination. Surgical procedures where it damages their surrounding tissue which could impair urination. Mobility if a person is bed-ridden their urine gets reabsorbed by the kidneys causing it to become more concentrated, having risks for infection. Psychological factors if a person is more anxious and stress they have frequent urination. Sociocultural factors affect urination habits Diagnostic examination can cause short term trauma. Pathological conditions where it affects the CNS can lead to incontinence What are factors affecting bowel elimination? Diet a person most have proper fluid and food intake in order to promote peristalsis. Physical activity also promotes peristalsis. Personal elimination habits where you ask the patient the amount of times they empty their bowels, have it be an open ended conversation to reduce embarrassment. Privacy of the patient. What is defecation? Emptying bowels. What is constipation? Trouble emptying or evacuating bowels which leads to hard feces because of water reabsorption. What is diarrhea? You lose water and it is an increased in stools being emptied that are not uniformed in shape and are liquidated. What is bowel incontinence? loss of voluntary ability to control fecal and gaseous discharges through the anal sphincter. What is flatulence? Walls of your bowels stretches and distends. What is micturition? Urination What is nocturia? Waking up at night to urinate. What is urinary retention? Holding in your urine which causes your stomach to bulge which can cause a lot of pain. What is urinary incontinence? Not being able to control your voiding. What are the characteristics of a normal urine? Colour has to be pale yellow straw to amber. If it is a darker colour it shows dehydration, medications and food can also affect the colour. Odour has to be a mild smell if its foul its not normal. Clarity has to be transparent if it's foggy its not normal. What are the characteristics of a normal stool? Colour, odour, shape, amount, constituents, and consistency What are nursing interventions to promote urination? Encouraging the patient to urinate and have a urination pattern daily every 3-4 hours. Stimulate them: females sitting or squatting and males standing up. Daily fluid intake of ml Sensory stimulation by stroking your hand on their inner thigh, hearing the water run down the faucet, and pouring warm water on their perineum. What are nursing interventions to promote normal bowel movement? Daily fluid and food intake 25-30mg of fiber. Physical activity and exercise. Privacy Establishing a daily bowel routine. What are nursing interventions to prevent urinary tract infections? Ensuring the perineum is clean and dry using clean catheters that promote urinary flow in the catheter bag for inspection if patient has low dexterity make them use a squirt bottle with warm water to pour over their perineum cleaning and drying their perineum every time they void or eliminate their bowels daily fluid intake setting schedules for voiding and eliminating What is Canada's Food Guide and Nutritional Intakie? It is a food guide that helps HCP's in their practice. It's developed for those who are 2 years of age and older. It helps Canadians in nutritional eating, nutritional well-being, and diet depends on the disease process. It integrates nutritional diet in Canadians. 50% vegetables, 25% protein, and 25% carbs, it promotes food skills and health literacy, and reduces Canadian's consumption on processed foods. What are the nutritional requirements across lifespans? under 6 months = breastfed or formula fed, they also need vitamin D in oil for better mimicking and absorption. over 6 months = introduction to solid foods. toddlers (1-3) = increased protein and calcium preschoolers (3-5) = increase nutrient density, which matters more than quantity. school aged (6-12) = concerns for obesity because of high fat, sodium and sugar diet, with low fruits and vegetables. adolescents = need iron, calcium and vitamin D, may have body images altered, and eating disorders may develop. young to middle age adults = decrease nutrients needs because growth stops, it goes to their maintenance, repair, and energy. pregnancy = omega-3 fats, folic acid, and calcium lactation = need a lot of calories for energy and avoiding alcohol, caffeine, and drugs. older adults (65+)= nutrition is based on their income and may not have enough, need vitamins C and D to fight osteoporosis. What factors that affect Nutritional Status? age-related gastrointestinal changes such as changes in gums and teeth, decrease bite force, saliva production, increased taste threshold, atrophy, decreased peristalsis, decreased gag reflex, and decrease thirst sensation malnutrition due to low education, low income, and immobility. presence of other diseases risks of osteoporosis medication affecting the body. What are the 9 components of diet history taking? Food practices, elimination patterns, chemical substance use, hunger, knowledge, symptoms, allergies, 24 hour recall, chewing and swallowing How do you promote appetite in a hospital setting? Have the patient in a high Fowler's position with pillows to support peristalsis. Normalizing the patient care setting Eliminating foul odours to promote eating Maintaining comfort What are alternative food patterns? Individuals intake their food base on their culture, religion, concerns, preferences, beliefs, and ethics This may prevent them from eating certain types of food but it doesn't mean they don't get enough nutrition. What are therapeutic diets? Tailored to each individual patient and based on their disease process. Clear liquid such as tea, apple juice, and water helps prepare patients for tests Pureed Thickened liquid where powder is added to thicken food into pudding helps patients with dysphagia. Mechanical soft are foods that have no hard pieces. Soft/low residue have no side pieces. Full liquid is just liquids. high fibre, low cholesterol, low sodium, regular, diabetic diets etc. What is dysphagia? Dysphagia is difficulty swallowing which can cause aspirations because food can go to the respiratory system, which causes pneumonia. What are symptoms of dysphagia? coughing when swallowing abnormal gag reflux regurgitation abnormal movements of tongue, mouth, and lips changes in swallowing pocketing of food changes in tone of voice How do you prevent dysphagia? Consulting with a language pathologist and occupational therapist. thickened foods and liquids making them sit straight up for 30 minutes after eating frequent inspection of their mouth, tongue, and lips, checking for pocketing. putting small amounts of food on their unaffected side of the mouth suction airway What is incident reporting? and how does it help maintain cultural safety? Incident reporting is when a nurse or HCP involved in an incident makes a report of it. The report is confidential, examine areas for improvement, look for patterns and trends based on the incident, and involves the patient. It focuses on the incident not the patient which promotes cultural safety. What are risks to patient safety? Falls are the most common risk: based on age, history of previous falls, postural hypotension, sensory impairment, balance and mobility issues, and medications. procedure-related incidents: IV blown, IV insertion fails, and medication errors. Equipment-related incidents: malfunctions of assistive devices. Risks of individuals of developmental stages? infants to toddlers is poisoning due to oral cavity exploration. toddlers to preschoolers is drowning due to fasciation with water. 5-14 year olds their risk reflective actions are reflective of others. adolescents are risk-taking behaviour adults is lifestyle habits older adults is aging process What is WHMIS and what's its 3 elements? Workplace Hazardous Material Information System controls hazardous substances in the workplace 3 elements: cautionary labels alert employees of the substances worker education program train and inform employees provision of the material safety data sheet informs employees of what to do in case something happens. What are restraints? restraints occur or are used because of an unmet need of an individual What is the least restrained policy? Using restraints as a final means if patients do not cooperate, it is based on the patient's needs no the staff. What are alternatives to restraints? Diversionary activities, companionship/supervision, relaxation techniques and normal sleep patterns, attend their needs. What are the types of restraints? Physical restraints restrict or control the movement of a patient and it is usually attached to them to create physical barriers. Chemical restraints inhibit a patient not treat their illness such as sedatives and tranquilizers. Environmental restraints modifies the patient's environment to control their mobility. What are the reasons for using restraints? when patient injuring themselves, others, or to maintain treatment. What are potential complications of physical restraints? ROM contractures, poor circulation, damage to tissue, emotional distress/anxiety, severity of falls increased 14 times, incontinence, and respiratory pneumonia. What can you do before using restraints? Look for alternatives, collaborate with family and patient, determining the root cause of distress, and documenting. What is the Quality Assurance program? Ensures nurses are continuing competence and improving their nursing practice and commitment. Engaged in practice reflection of a specific situation they did poorly or well in and setting priorities and goals for themselves. What two parts does the Quality Assurance program involves? Practice self-reflection and developing learning plan which shows competence. What are the 3 components of Quality Assurance program? Coaching support, QA assessment, and self assessment. What are the LEARN acronym? Look back, evaluate, analyze, revise, and new perspective What is the clinical performance appraisals and standards? accountability of being honest when you are documenting and reporting, valuing relationships, and doing the right thing. What is LTC? long term care where older adults are provided 24-hour supervision and care and it acts as a small ecosystem where the people living there have everything they need. Who regulates the LTC? Provincial legislation "The Fixing Long-Term Care Act" MOHLTC sets the standards for care and does compliance reviews yearly. What is the difference between an RN and unregulated care provider? Education and Accountability patient centered care a standard of care that places the patient as the focus of the care DIPPS or DIPPERS dignity, independence, privacy, preference, and safety; dignity, independence, privacy, preference, empathy, respect, and safety nursing process a clinical decision making approach to care that assists nurses with identifying and treating health related concerns and helps the patient reach their health outcomes/goals assessment collection of data or cues that are important to the patient's care to understand the patient's needs diagnosis analysis of the assessment to determine key issues and create a diagnosis creation of outcomes/goals for the patient planning creation of a plan that identifies strategies to reach patient's health outcomes implementation carrying out the plan of care evaluation determining if the implementation of the plan was successful in reaching patient outcomes infections a disease state that results from the entry of a pathogen into the tissue of the host pathogen a microorganism that causes disease local limited to a specific part of the body systemic spreads throughout the entire body chain of infection infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host infectious agent pathogen that causes disease reservoir a site where pathogens can survive but may or may not multiple survival needs of pathogen food, water, pH level (5-8), minimal light, oxygen, and temperature between 35-37 degrees portal of exit the path by which the pathogen leaves the reservoir mode of transmission route of transmission by which the pathogen travel from the reservoir to host direct between infected individual and host (to skin) indirect between the host and contaminated object (intermediate object) airborne organism travel from respiratory system of infected source to host propelled through air farther than 1m (chicken pox, measles) droplet organism travels from respiratory system of infected source to host through air up to 2m (COVID-19) vehicle one contaminated source infects multiple hosts (water in Flint, MI) vectorborne microbes transmitted from insects to humans (West Nile virus) portal of entry the path by which the pathogen can enter the body (possibly through the same path used for exiting) susceptible host a person who gets an infection or disease defences against infection immune system, normal flora, inflammatory response, body system defence factors that affect patient susceptibility age, nutritional intake, stress, and medication Health care associated infection An infection that is acquired after admission that is not present or incubating at the time of admission aspesis keeping away disease-producing microorganisms medical asepsis reduce and prevent the spread of microorganisms surgical aspesis Use of precise practices to eliminate all micro-organisms including pathogens and spores from an object or area routine practices used in the care of all patients regardless of their diagnosis or possible infection status breaking the chain of infection: infectious agent cleaning, disinfecting, sterilizing, and educating others to reduce or eliminate microorganisms breaking the chain of infection: reservoir eliminating or controlling sources of body fluid that might harbour microorganisms (ex. changing dressings) breaking the chain of infection: portal exit avoiding talking, coughing, or sneezing over open wounds or sterile fields, covering the mouth and nose when coughing or sneezing wearing a mask handling of blood and fluids correct disposal of soiled items breaking the chain of infection: modes of transmission be knowledgeable of modes of transmission appropriate hand hygiene don't share equipment hold soiled linen away from the body breaking the chain of infection: portal of entry maintain patient's skin integrity implement strategies for susceptible skin hygiene correct disposal of soiled linens breaking the chain of infection: susceptible host maintaining patient's skin integrity adequate fluid and diet maintaining immunization regular hygiene soap and water physical removal of microbes using friction if hands are visibly soiled, exposed to C. diff or alcohol-based hand rub is not available alcohol-based hand rub better than soap and water; excellent steps of hand washing 1. Turn on water 2. Wet hands 3. Apply soap 4. Later soap for 20+ seconds 5. Palms, interlaced fingers, knuckles 6. Each thumb and crease 7. Wrist 8. Rinse hands separately pointing down towards sink basin 9. Get paper towel and dry hands (leave water on) 10. Get another paper towel and turn off water steps to alcohol-based hand rub 1. apply 1-2 pumps 2. rub for 20+ seconds or until dry 3. palms, interlaced fingers, knuckles, etc. 4. thumb and pinky personal protective equipment a barrier between a person and pathogens; includes gloves, gowns, masks, and goggles gown prevents contamination of uniform and clothing gloves handwear worn to prevent transmission of pathogens by direct or indirect contact but DOES NOT REPLACE HAND HYGIENE mask and goggles protects eyes, nose, and mouth from splashes of body fluids donning PPE 1. hand hygiene 2. gown 3. mask 4. goggle 5. gloves doffing PPE 1. gloves 2. gown 3. hand hygiene 4. goggles 5. mask 6. hand hygiene Tier 2 of isolation precautions contact: private or cohort room, hand hygiene, and gown with gloves for direct care droplets: private or cohort rooms, hand hygiene, mask, and goggles airborne: N95 mask, hand hygiene, private room with door kept closed and negative air flow systems involved in movement Skeletal Muscular Nervous body alignment relationship of one body part to another along a horizontal or vertical line body balance when the centre of gravity is balanced over a stable base of support; enhanced by posture gait manner of walking gravity A force that exerts a downward force on the body friction occurs in a direction to oppose movement body mechanics movement of the body in an efficient way w/ good posture and using the strongest muscles mobility the ability to move easily and freely immobility inability to move easily and freely functional decline the loss of the ability to perform self care or activities of daily living Systemic effects of immobility Metabolic Respiratory Cardiovascular Urinary Elimination Musculoskeletal Psychosocial Integumentary metabolic changes altered endocrine metabolism calcium Resorption decreased GI motility cardiovascular changes orthostatic hypotension -thrombus formation --damage to the vessel wall --alterations of blood flow --alterations in blood constituents urinary elimination changes Altered urinary elimination Urinary stasis Increased risk of calculi formation respiratory changes Atelectasis Hypostatic pneumonia musculoskeletal changes Temporary or permanent impairment of permanent disability Restricted mobility & impaired joint mobility psychosocial changes Quality of life and well being Boredom Feelings of isolation Depression Anger Grief - coping with the loss Distributive sleep patterns Fear integumentary changes Pressure ulcer Localized injury to skin Usually over bony prominence Results from pressure or pressure with shear & friction restorative care Care that helps a patient maximize functional mobility, independence, and reduce functional deficits includes activities of daily living (ADLs) and instrumental activities of daily living (IADLs) range of motion (ROM) the movement of a joint to the extent possible without causing pain in 1 of 4 planes; steps of ROM start slowly with smooth and easy movements move joint until slight resistance is felt assess for fatigue or pain during ROM leave joint in correct alignment when finished flexion decreases the angle of a joint extension increases the angle of a joint abduction movement of the bone away from the midline of the body adduction movement of the bone toward the midline of the body