JLH ATI- Mobility exam| 136 questions and answers

Musckuloskeletal is a general term used to refer to the muscles and the skeleton. ****The musculoskeletal system is a detailed grouping of tissues that are important for stability and proper body functioning ***These tissues include muscles, bones, joints, tendons, cartilage, and ligaments Muscles are soft tissues that provide: the motor power or force for movement; bones are hard connective tissues that create the rigid structure and shape of the human body Tendons and ligaments connect: muscles and bones synovial joints enable: motion and flexibility between bones The muscular and skeletal systems work as a team: continually adjusting to balance and coordinate the body during everyday movements and to maintain good body positioning Functions of Skeletal Muscle Movement (main function): The skeletal muscles work with the skeleton to create body movements such as texting, sitting, standing, walking, running, and dancing. Posture and positioning: The skeletal muscles maintain posture and body positioning without a person's conscious control. They cause motion through a series of contractions and relaxations, or contract to hold the body in a certain position such as sitting or standing. Generate body heat: Contracting muscles generate heat that assists in maintaining body temperature. Shivering is an example of the muscles working to produce heat. Functions of the Skeletal System Support: Provide a solid and stable framework. Protect: Provide mechanical protection for the internal organs such as the brain, spinal cord, heart, and lungs. Produce: Red bone marrow in the center of the bones produces red blood cells, white blood cells, platelets, and macrophages. Storage: Provide storage for calcium, phosphorus, magnesium, iron, and lipids. Movement: Bones work with the muscular attachments to create motion. Proprioception Feedback from sensory receptors to coordinate, balance, and fine-tune body positioning and movement. Reduces friction between the bones: Cartilage Maintain posture and generate heat: Muscles Allow for flexibility and movement of joints: Synovial joints Provide a solid and stable framework; produce red blood cells Bones Provide for connections of muscle and bones: Ligaments and tendons Control contraction and relaxation of muscles; coordinate balance and movement: Nerves The nervous system consists of two subsystems: the central nervous system and the peripheral nervous system. The central nervous system includes: the brain and the spinal cord The peripheral nervous system is made up of: thousands of nerves that interface with the spinal cord. Although muscle movement is under a person's conscious control, the brain: coordinates the action. Nerve cells in the spinal cord connect to the: muscles throughout the body and fire signals that cause those muscles to contract. Health care workers have the highest incidence of back injuries worldwide, mainly occurring when assisting clients. A knowledge of proper body mechanics and the use of ergonomics can decrease the risk of a nurse experiencing a work-related injury. Health care workers have the highest incidence of _____ injuries worldwide, mainly occurring when assisting ____. back; clients Body mechanics involves: the combined effort of the musculoskeletal and nervous systems to maintain posture, alignment, and balance in daily life. It describes how a person uses their body to do things such as sitting, standing, lifting, carrying, bending, or lying When a person does not move safely and correctly, abnormal stress is placed on the______. Over time, such stress will result in injury or degeneration from wear and tear on the ________ __________. Spine; spinal structures The three key principles of body mechanics are: body alignment, balance, and body movements Body alignment: The positioning held by the various parts of the body while performing activities or during rest. Optimal posture supports the ______, ________, and ________, which increases strength, reduces fatigue, and uses less energy spine, muscles, and joints Good body alignment is determined based: an imaginary line that passes vertically through the body and divides it into two equal halves ****This vertical line should run from the top of the head and straight down through the ear lobe, shoulder, trunk, hip, femur, knee, and ankle**** When handling clients or lifting objects, keep the: back straight, the chin level, and tighten abdominal muscles to maintain alignment throughout the task The center of gravity: is the central point of weight for an object or the body Using Proper Body Mechanics: Stand or move as close to the object as possible. Keep the abdominal muscles contracted and the lower back in its normal position. Maintain the head upright with shoulders raised up. Bow the hips slightly and squat. Do not twist the torso. Always pivot or side-step. Push up from the knees and use that momentum to lift the object. Which of the following actions demonstrates the proper use of body mechanics? (Select all that apply.) A. Bend the knees to improve balance. B. Turn the torso when assisting the client to pivot. C. Maintain good posture at all times. D. Bend at the waist to move heavy objects. E. Position objects to be lifted 12 inches away. F. Place the feet in line with the shoulders. A. Bend the knees to improve balance. C. Maintain good posture at all times. F. Place the feet in line with the shoulders. ****The use of proper body mechanics decreases the risk of injury. Bending the knees and spreading the feet apart lowers the center of gravity and improves balance. Good posture decreases the strain on the musculoskeletal systems. In contrast, bending at the waist when lifting, twisting movements, and reaching all increase the risk of a musculoskeletal injury and should always be avoided. Objects should be kept as close to the body as possible when moving.**** Ergonomics: is the study of body mechanics in relation to the demand and design of the work environment, along with the equipment used Risk factors in the workplace can be divided into three areas: Practice controls: lighting, noise, transfer lifts, carts, furniture, whole-body vibrations, exposure to heat/cold. Physical characteristics: posture, duration, force, velocity, heavy exertion, repetition, time, lunch/rest breaks, recovery time. Environmental hazards: mental stress, physical stress, workload hours (shift, overtime), falls, slips, exposure to hazards Examples of Ergonomic Practices and Equipment in Health Care: Modifiable workstations and chairs Keyboards with wrist supports Adjustable IV stands and poles Height-adjustable beds Two-person lifts/transfers Client transfer devices Shower chairs Toilet seat risers Side-opening garbage and linen containers Elimination of uneven floor surfaces Correct or incorrect body mechanics? Lift from the large back muscles Place feet closer together Bend slightly at the waist Incorrect body mechanics Correct or incorrect body mechanics? Stand close to the client when lifting Raise the client's bed when positioning Pivot or sidestep when moving client Correct body mechanics A nurse is assessing the competency of a new assistive personnel (AP) as they assist in moving a client up in bed. Which of the following actions by the AP demonstrates competence? A. Lifts with arms fully extended B. Places feet shoulder width apart C. Maintains client’s bed in a low position during move D. Twists at the waist during the move B. Places feet shoulder width apart *****Using Proper Body Mechanics Stand or move as close to the object as possible. Keep the abdominal muscles contracted and the lower back in its normal position. Maintain head upright with shoulders raised up. Bow hips slightly and squat. Do not twist the torso. Always pivot or side-step. Push up from the knees and use momentum to lift the object.**** Place the steps for moving a client up in bed in the correct order: Raise the clients bed Lower the client's bed to the lowest position Lock the wheels of the bed Use the draw sheet to move client Position the client's arms across their chest Assess the client's level of mobility Get lift assistance 1. Assess the client's level of mobility 2. Get lift assistance 3. Lock the wheels of the bed 4. Raise the clients bed 5. Position the client's arms across their chest 6. Use the draw sheet to move client 7. Lower the client's bed to the lowest position ***Assessing is the first step of the nursing process. Assessing the client's level of mobility, allows the nurse to know the level of assistance the client may require when moving. Always get lift assistance to decrease the risk of injury to the client and to the nurse. This should be done before moving the client to assist in the safety of the client and avoid delays which may increase the client's pain or anxiety. The wheels of the bed should be locked prior to any movement of the bed or the client to provide for client safety. Raising the client's bed assists the nurse in using proper body mechanics during the move and reduces the risk of the nurse suffering an injury. Position the client's arms across their chest to reduce friction. The draw sheet should be used to move the client. This assists the nurses to increase the stability and balance of their bodies to perform good body mechanics during the move. When nurses leave a client's room their bed should always be in the lowest position to reduce the risk of the client falling as they get in and out of bed.**** Mobility: is the capacity to move about without restrictions Bones: are living tissues that are constantly remodeling and changing Remodeling: The process of bone breakdown and replacement that occurs throughout a lifespan When does disuse of osteoporosis occur? Disuse osteoporosis occurs when bones have become thinner and weaker as a result of prolonged bed rest. disuse osteoporosis: Loss of skeletal mass, density, and strength caused by immobility. Fragility fracture: Fractures that occur following stress on a bone that would not typically result in a break. The maintenance of muscle mass requires? a significant supply of oxygen and glucose Atrophy: Become smaller and weaker often from disuse Sarcopenia Loss of lean muscle caused by immobility. Joint contractures: are abnormal fixations of the joints that occur as a result of changes to muscles and connective tissue. Immobility leads to: changes in tissue tension, elasticity, and shape, leading to joint stiffness and decreased range of motion, especially in the extremities Prolonged immobilization causes: the formation of abnormal tissue both within and between the joint spaces, which restricts nourishment to the joints As the connective tissue that forms ligaments and tendons continues to soften, weaken, and thicken, the cartilage around the joints begins to: deteriorate Foot drop: is a type of joint contracture that results in a partial or total inability to pull the toes up toward the head (dorsiflexion). cardiac deconditioning: Atrophy of the heart muscle that results in a decreased amount of blood being ejected from the heart during contraction. Orthostatic hypotension: is a decrease in blood pressure and a sensation of dizziness that occurs when a client sits or stands up Orthostatic Hypotension Guidelines: A decrease in systolic blood pressure of 20 mm Hg or more. OR A decrease in diastolic blood pressure of 10 mm Hg or more within 3 minutes of changing to a sitting or standing position. Deep vein thrombosis: A condition that results from a blood clot inside a deep vein, usually within the extremities. ***Clients who are immobile are at a greater risk for developing a DVT due to their increased blood viscosity and the atrophy of muscles that normally assist the body in pumping the blood. These factors diminish the body's ability to effectively circulate blood, leading to venous stasis. Blood that is not moving freely is more likely to clot*** The most serious complication of DVT is a: pulmonary embolism, which occurs when part of the thrombus breaks off and travels into the lungs via the bloodstream ***Alternatively, the clot could travel to the brain, resulting in a stroke (cerebrovascular accident), or the heart, causing a heart attack (myocardial infarction)*** Immobility, especially with supine positioning, reduces the amount of air exchanged and increases the risk: of infection Atelectasis: is the partial or complete collapse of the lung, including airways and small sections of lung tissue. ***It occurs as a result of shallow breathing. This collapse decreases the number of alveoli that are available to exchange oxygen and carbon dioxide** Pneomonia is an infection that often occurs in clients with limited mobility as a result of shallow breathing, thickened mucus, and decreased ability to cough. The gastrointestinal tract uses: gravity to optimize the movement of food from the mouth to the rectum. Malnutrition Imbalance in a client's intake that can include deficiencies or excesses in nutrients, vitamins, or calories. Constipation occurs ____ times more often in clients who are prescribed bed rest than in those who are active. 16 Fecal impaction A hardened mass of stool that creates a blockage in the intestines. Constipation A condition in which the client has infrequent bowel movements where the stool is hard, lumpy, and difficult to pass. Gastroesophageal reflux A backflow of gastric fluids into the esophagus that can result in irritation of the tissue. Urinary retention A condition in which the bladder does not completely empty with urination. Renal calculi Stones that develop in the kidney and usually related to dehydration or an increase of stone-forming substances. Skin that is exposed to moisture from perspiration, wound drainage, or incontinence is at: an even greater risk for skin breakdown The areas most susceptible to the effects of pressure are bony prominences, which have thinner skin; Some examples are the back of the head, shoulder blades, elbows, sacrum, ischium, and heels Tissue damage can occur due to: prolonged pressure or trauma Pressure injuries can range from intact skin with nonblanchable redness to: deep wounds with exposed bone and necrotic tissue Integumentary Damage Due to Pressure: Damage with skin intact Damage into the skin layer Damage beyond the skin layer Deep damage through the skin and tissue layer Damage with skin intact: Can present as: Persistent redness or discoloration Temperature difference compared to the surrounding skin Firmness in the area ​​​​​​​Damage into the skin layer: Can appear as: An area of skin that is lighter in color than the usual skin tone Open or intact blister Shallow wound with a pink or red bed Damage beyond the skin layer: Open wound, possibly with adipose tissue or granulation tissue visible Deep damage through the skin and tissue layer: Deep wound with exposed muscle, ligaments, or bone, and dead tissue A nurse is caring for a client who is prescribed bed rest. The nurse should recognize that which of the following are complications of bed rest? Categorize the following: True or False Loose frequent stools Increased muscle mass Reddened areas of skin Inability to flex the foot downward Manifestations of a blood clot in a extremity Reports of heartburn Resistance to extension of a extremity Elevated blood pressure when sitting Rapid shallow breathing True Reddened areas of skin Manifestations of a blood clot in a extremity Reports of heartburn Resistance to extension of an extremity Rapid, shallow breathing False Loose, frequent stools Increased muscle mass Inability to flex the foot downward Elevated blood pressure when sitting ****Bed rest can lead to the development of orthostatic hypotension, which is characterized by a drop in blood pressure with a change to an upright position. Supine positioning impairs the ability of the ribcage to freely expand due to the physical restriction caused by the bed. Additionally, the abdominal organs shift toward the diaphragm, which decreases the depth of the breaths and the effectiveness of coughing. With supine positioning, gastric fluids accumulate in the upper portion of the stomach and exert pressure on the lower esophageal sphincter. This can cause irritation and ulcerations of the esophagus. Bed rest can lead to muscle atrophy due to lack of use, which then results in the muscles becoming smaller and weaker. Clients who are prescribed bed rest are more likely to develop constipation due to hardened stool and the decreased urge to defecate. Prolonged pressure of the skin and tissue against a firm surface restricts the flow of blood and lymph, leading to damage or necrosis of the area. Foot drop, which is an inability to flex the foot upward, can occur with bed rest as a result of nerve entrapment and muscle shortening due to atrophy. Bed rest can lead to joints becoming stiff and resisting movement, especially in the extremities. Decreased muscle mass and dehydration associated with immobility increase venous pooling, which can lead to the development of a deep vein thrombosis.****