ATI Module: Mobility (Fundamentals) | with complete solution

ATI Module: Mobility (Fundamentals) | with complete solution What are bedridden patients at risk for? - DVT (Deep Vein Thrombosis) What is another name for elastic stockings? - Antiembolic or Thromboembolic Device (TED) What do TED's prevent? - These stockings prevent clots by continuous pressure to lower extremities What are common compression strengths for elastic stockings? - 12-20mmhg Sequential Compression Devices or Intermittent Pneumatic Devices are used for? - Intermittent compression to promote venous return and prevent DVT Why do compression devices need to fit properly? - They can either not promote proper compression or cut of circulation if too tight. How do we measure compression stockings? - The circumference and the length of leg. How do we check the fit of compression stockings? - Place two fingers between skin and stocking they must fit. How often should stockings be removed? - Every 8hrs for skin assessment etc. What do we educate patients on when discussing elastic stockings - Do not roll stockings down, do not pull toe openings back, do not place tubes under leg. What must we assess when preparing to move a client? - Muscle strength, ability to move, activity tolerance, need for assistive devices Where should a nurse bend using proper body mechanics? - Bend at knees Where should the client be when transferring? - Close to nurses body When a nurse is working with a client in bed, where should the bed be postioned? - Working height, hip level, so the back is not bending When using proper body mechanics how should the base of support be? - Wide base feet approx.1 foot apart. What are the most common assistive devices? - Gait belt, transfer board, draw sheet. When would we use a gait belt? - Transferring from bed to chair When would we use a draw sheet? - When repositioning a client. When would we use a transfer board? - When transferring from a bed to a stretcher. Why do we reposition a client? (3) - Prevent pressure ulcers, prevent contractures, and foot drop. How often should we reposition a client? - Every 2 hours. What are some support devices used in positioning? - Footboard, trochanter rolls, hand rolls, pillows. How can we prevent hand contractures? - Using a hand roll and placing in clients hand. Supine Position - Laying on back: pillow under head, lower back, knees Prone position - Laying on stomach head to the side: pillow under head, abdomen, knees What can the prone position cause? - Hyperextension of lower back and difficulty breathing Lateral Position - Laying on side: pillow under head and shoulder, between legs, behind back Why do we use the lateral position? - To relieve pressure on sacrum Sims position - Halfway between prone and lateral with one hand behind back What position would we use for clients with breathing problems? - Orthopneic position: Placing head down on surface when sitting up High Fowlers - >80 degrees ; used for eating, drinking, adls Semi Fowlers - 30 degrees Fowlers Position - 45 degrees Trendelenburg Position - Laying flat head is lowered and feet are elevated ; promotes venous return Reverse Trendelenburg - Laying flat head is raised above lower body ; used for gi issues or acid reflex Why do we perform ROM exercises? - To keep the mobility and strength of a clients muscles and joints Active ROM? - Client independently performs ROM. Passive ROM? - Nurse will put clients joints and muscles through ROM. Do muscles contract during PASSIVE rom? - No : passive ROM does not maintain muscle strength. Where do we support when providing passive or assisted ROM? - Above and below joint.