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nur 110 chapter 42


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whats the difference in a thrombus and emolus?
-a thrombus is a blood clot attached to a vein wall.
-an embolus is an object, usually but not always a thrombus, which moves from one part of the blood stream to another, causing an obstruction which reduces or occludes blood flow
which type of excercise is used by athletes for endurance training? (aerobic or anaerobic)
what's the effect on bone density when pressure is regularly placed on the bone?
bone density is maintained by weight bearing. disuse osteoporosis occurs when no weight is placed on the bone for an extended period.
what's the most common cause of postural changes in adults between the ages of 20-40?
In an infant's motor development, how does gross and fine motor development occur in relation to each other?
gross motor development occurs before fine motor development
in an infant's motor development, how does motor development occur in regards to the child's body regions?
it procedes from the head down to the toes. the infant develops coordination in the neck first, then arms, then legs.
excercise patterns for a persons life is generally determined during what age group?
6-12yrs old
postural habits of the adult are many times established during what age period?
a newborn's extremities are usually in this position
all the extremities are generally flexed, but can be passively moved through their range of motion
what is atelectasis?
partial or total collapse of a lobe or of an entire lung
what is vital capacity?
the maximum amount of air that can be exhaled after a maximum inhalation
what causes the stiffness and pain in joints that have been immobilized?
the collagen fibers become ankylosed, and calcium may be deposited in the joint
when muscle fibers are not able to allowed to shorten or lengthen, there is a permanent shortening of the muscle. this is called a ________.
unused muscles atrophy. what does atrophy mean?
to decrease in size
a spastic muscle has too much of what?
muscle tone
a flaccid muscle has very little of what?
muscle tone
the talk test keeps most people's heart rate at this percentage of maximum heart rate.
at about 60%
a 7 on the borg scale of perceived exertion indicates what?
very, very light exertion
how do you determine your maximum heart rate?
subtract your age in years from 220
what percentage is your target heart rate (during exercise) of your maximum heart rate?
how do you flex your hip?
move a leg forward and up as though you are going to kick something directly in front of your foot
what determines a person's activity tolerance?
both the type and amount of exercise able to be done without adverse effects
when muscles increase in size, they are said to _______.
in strenuous exercise, the intake of oxygen increases by how much?
by as much as 20 times the normal intake
normal resting tidal volume is how much?
about 5 or 6L/min
what does excercise do for diaphragmatic excursion?
it improves diaphragmatic excursion
how is serum triglycerides and cholesterol affected by exercise?
the metabolic rate will increase which increases the use of triglycerides and fatty acids, resulting in lower serum triglyceride and cholesterol.
by how much can the metabolic rate increase with exercise?
it can increase by as much as 20 times the normal resting rate
how does excercise influence blood glucose levels?
it enhances the effectiveness of insulin, lowering blood sugar.
in the borg scale of perceived exertion, what does a score of 15 indicate?
the exercise is "hard"
how can the Valsalva maneuver be dangerous to someone with cardiac disease?
straining against a glottis can build up pressure on the large veins in the thorax and interfere with venous return. when the client exhales, pressure is released and a sudden surge of blood may cause tachycardia and cardiac arrhythmias
how does innactivity cause dependent edema?
a lack of skeletal muscle activity makes venous return more difficult. this increases venous pressure. the venous walls may become more dilated, causing insufficient valves and even worse venous return. fluid seeps out of veins, becoming interstitial fluid.
what effect does immobility have on the basal metabolic rate?
it decreases the basal metabolic rate
what does "patent" mean?
unblocked and open
why is an immobile person more susceptible to renal calculi?
because of the negative calcium balance due to decreased use of calcium to remodel bones, there occurs an abundance of calcium in the urine, making the urine more alkyline and leading to the development of calculi.
what causes the negative nitrogen balance common in immobile people?
immobility results in a preponderance of catabolism (breaking down proteins) over anabolism (synthesizing proteins). this rusults in more nitrogen being excreted than is ingested, and a depletion of protein stores.
why is constipation a frequent problem for an immobilized person?
lack of muscle movement contributes to decreased peristalsis, and the overall skeletal muscle weakness affects the abdominal and perineal muscles used in defecation.
why is it more difficult to defecate on a bedpan than sitting upright?
the backward-leaning posture does not promote effective use of the muscles used in defecation. some find it embarrasing also.
what is lordosis?
an exaggerated inward-curvature of the lumbar spine
what effects are common due to poor posture?
lower back pain and being easily fatigued
what are the two phases of a normal gait?
the stance phase and the swing phase
when using the nursing diagnosis "impaired physical mobility", what should you specify?
always specify the type of physical ability which is impaired (i.e. "impaired bed mobility" or "impaired walking")
if a person can walk no more than 50 feet on level ground without stopping or experiencing other adverse effects, what levle are they?
Activity Tolerance: Level 3
if a client experiences dyspnea and fatigue at rest, what is her level of activity intolerance?
level 4
assessment of what region of the body is especially important for those clients using walkers and crutches?
the muscle strength of the upper body
what are the most useful measures for determining activity tolerance?
heart rate, strength, rhythm; respiratory rate, depth, and rhythm; BP
when should vital signs be taken when assessing activity tolerance?
-before activity starts
-during the activity
-immediately after the activity stops
-3 minutes after the activity stops and client has rested
what findings would indicate that the activity was safe, when assessing activity tolerance?
if heart rate returns to baseline within 5 minutes after the activity ceases and if the client tolerated it well
immobility causes pooling of secretions in dependent parts of the lungs. how does this affect the client?
secretions around alveoli interfere with O2 and CO2 diffusion. poor oxygenation and retension of CO2 can lead to respiratory acidosis. these secretions also contribute to possible atelectasis and hypostatic pneumonia
the organism most commonly found to cause urinary tract infections if normally found in the colon. what is it?
escherichia coli
what causes urinary retention in the immobile client?
decreased muscle tone of the urinary bladder and the inability to relax the perineal muscles while lying in bed may lead to urinary retention
repeatedly postponing the urge for defecation might lead to what effects?
repeated postponement eventually suppresses the urge and weakens the defecation reflex
a normal walking pace is how many steps per minute?
70-100 steps per minute, however the pace of an older person might slow to 40 steps per minute
a client in shock or with hypotension should be put into what position?
lying flat with legs elevated 45 degrees
a client with a head injury should be placed in what position?
reverse trendelenburg to prevent increased intracranial pressure
why does anorexia occur in an immobile person?
because of the decreased metabolic rate and increased catabolism that accompany immobility
some factors which put clients at a higher risk for complications due to immobility
-poor nutrition
-decreased sensitivity to pain, temp., or pressure
-cardiovascular, pulmonary, or neuromuscular problems
-altered state of consciousness
which signs are indications that an activity is too strenuous or prolonged and should be stopped immediately?
-sudden facial pallor
-feelings of dizziness or weakness
-change in level of consciousness
-heart rate or resp rate that significantly exceeds baseline
-change in heart rate or resp rate to irregular
-weakening of pulse
-dyspnea, SOB, or chest pain
-diastolic BP change of 10mm Hg or more
when problems with mobility affect other areas of functioning, the problem becomes the etiology of the diagnosis. some examples of this:
-fear (of falling)
-ineffective coping
-low self-esteem
-risk for injury (falls)
-self-care deficit
people with sensory or motor deficits on one side of the body, usually prefer to lie on which side?
they usually prefer to lie on the unaffected side
what are some things that you should assess before attempting to transfer a client from the bed to a chair?
-client's body size
-ability to follow instructions
-activity tolerance
-muscle strength
-joint mobility
-prescence of paralysis
-level of comfort
-presence of orthostatic hypotension
-the technique with which the family is familiar
-the space which will be needed to maneuver
-the # of assistants needed
-skill and strength of nurse
what should the goal for clients be who require passive ROM exercises after a disability?
a progression to active-assistive ROM, and later, to active ROM excercises
these crutch gaits are used by clients with paralysis of the legs and hips
the swing gaits
which of the two crutch "swing" gaits are easier to do?
the swing-to gait
this is the most elementary and safest of the crutch gaits
the four-point alternate gait
the proper standing position with crutches is called ________.
the tripod (triangle) position
describe the tripod position
the crutches are placed about 6" in front of the feet and about 6" laterally from the feet
some safety measures to consider when using crutches are:
-keep crutch tips dry and clean
-inspect crutch tips regularly and replace them if worn
-maintain an erect posture as much as possible
-bear the weight on your hands instead of on your axillae
-follow the pattern of exercise developed for you to strengthen your arm muscles before beginning crutch walking
-take steps of a comfortable distance
-wear a shoe with a low heel that grips the floor and adjust shoelaces to appropriate length

what is crutch palsy?
a weakness of the muscles of the forearm, wrist, and hand
the shoulder rest on crutches should be adjusted to what height in relation to the client?
you should be able to fit 3 finger widths between the crutch and the axilla, that is 2.5-5 cm
in what position should the client be standing with crutches to determine proper height of the shoulder rests and the hand grips?
the client stands upright and grasps the hand grips with arms bent at 30 degrees and with the crutches about 4" in front of feet and 6" lateral to feet
when doing passive ROM with people with flaccid paralysis, what is particularly important to avoid?
avoid moving or forcing a body part beyond the existing range of motion because joints can be dislocated without their awareness
if muscle spasticity occurs while providing passive ROM exercises, what should you do?
stop the movement temporarily, but continue to apply slow, gently pressure on the part until the muscle relaxes; then proceed with motion
if a contracture is present, how should you provide passive ROM exercises?
apply slow firm pressure, without causing pain
why should the use of seat belts on wheelchairs be used with caution?
they are a form of restraint and must be used in accordance with policies and procedures that apply to rules of restraints
how should you move a wheelchair into an elevator?
back the wheelchair into the elevator, rear large wheels first
when transfering a client into a wheelchair, what safety precautions should be used?
-always lock brakes when transfering
-raise the footplates before transfer
-lower the footplates and place client's feet on them after tranfer
-ensure the client is positioned well back in the seat of the wheelchair
when using a wheelchair on an incline, what precaution should be taken?
place your body between the wheelchair and the bottom of the incline
how often should the skin surfaces of infants and children who are confined to bed be checked?
at least 3 times in each 24 hour period
habitually poor standing and sitting posture might produce an exaggerated curvature of the spine. this is known as______.
how is someone's center of gravity affected when they lift an object?
it is shifted in the direction of the object lifted
you should maintain a distance of at least ______ between the feet in all positions while lifting.
vital capacity may be reduced in an inactive person. why is that?
-while lying down, the body presses against the rigid bed which curtails chest movement.
-the abdominal organs press against the diaphram, further restricting lung movement.
-muscle atrophy might also contribute to it.
-without periodic stretching, the intercostal joints may become fixed in an expiratory phase of respiration
normal resting ventilation is how much?
what type of joint is the neck?
a pivot joint
where are your ball-and-socket joints found?
in the hips and shoulders
what type of joint is the thumb?
a saddle joint
what type of joint is the wrist?
a condyloid joint
where are your gliding joints found?
in the trunk, the foot, and the intertarsal joints

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