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ImmobilityFundamentals of Nursing

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What two actions increase the risk of UTIs in an immobilized patient?
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Poor perineal care, insertion/use of indwelling catheter
Skin breakdown can occur in an elderly patient in ____ (what length of time).
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3 hours
What are psychosocial changes that can occur due to immobility?
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Sensory alteration, changes in sleep/wake pattern, depression, hostility, anxiety, fear, giddiness, decreased self-concept, withdrawal
Prolonged immobilization can impact a child's development of?
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Gross motor skills, musculoskeletal development, and intellectual development
Prolonged immobilization of adolescents can result in?
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Altered growth, decreased independence, social isolation
Adults who are immobilized are at risk for?
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Decreased in all physiological system function, loss of role/job, decreased self-concept
Immobilization of an older adult can result in?
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Decreased bone mass, functional losses
Assessment of client mobility focuses on?
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ROM, gait, exercise/activity tolerance, body alignment
When unsure of a client's mobility level, what order is the assessment performed?
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When the client is lying down, sitting in bed, transferred to a chair, and then while walking
The sagittal plane divides the body into?
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Left and right sides
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The frontal plane divides the body into?
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Front and back sides
The transverse plane divides the body into?
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Upper and lower halves
Which plane? Pronation, supination, internal and external rotation?
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Transverse
Which plane? Abduction, adduction, eversion, inversion?
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Frontal
Which plane? Flexion, extension, dorsiflexion, plantar flexion, and hip extension?
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Sagittal
Assessment of ____ is an important baseline to evaluate whether joint immobility has occurred.
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ROM
Altered body alignment, changes in visual field, and decreased level of independent function can occur from a flexion contracture of the ____.
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Neck
What should you do to assess the body alignment of an immobilized or unconscious client?
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Remove pillows/positioning supports, place client supine
Alignment should be assessed when a client is sitting if they have?
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Muscle weakness, muscle paralysis, or nerve damage
What are the contraindications for an assessment of alignment in the lying position?
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Impaired mobility (arthritis, traction), decreased sensation (CVA), impaired circulation (diabetes), lack of voluntary muscle control
How is the metabolic system assessed for changes due to immobility?
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Anthropometric measurements, I&O records, labs for electrolytes/serum protein/BUN, assess food intake/elimination
  
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