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Physiologic Disabilities
Common Problems
&
Interventions
COMMON PROBLEMS
Five major problems :
1. PAIN
2. STIFFNESS
3. DECREASE IN MUSCLE
STRENGTH
4. LOSS OF DEXTERITY
5. LOSS OF LOCOMOTOR
ABILITY
PAIN
 Pain is the priority problem.
STIFFNESS
 Decreased flexibility
 Can be a result of pain, or of
disuse or it can be a result of
pathophysiologic chang...
DECREASE IN MUSCLE
STRENGTH
 a primary problems, as with
some myopathic and
neuropathic disorders, or it
can result from...
LOSS OF
DEXTERITY
 skilful use of hands or body
LOSS OF LOCOMOTOR
ABILITY
 Temporary or complete loss
of the ability to move freely
from one place to another or
care fo...
System Involved:
Complications of
Immobility
CARDIOVASCULAR
Mechanism:
Failure of vessels in legs to
assume or maintain a state of
vasoconstriction, resulting in
poo...
Potential Complication:
Deep vein thrombosis (DVT)
Pulmonary embolism (PE)
Increase work load on heart
Diminished card...
RESPIRATORY
Mechanism:
Decrease movement
Decrease stimulus to cough
Decrease depth of ventilation
Potential Complication:
Pooling of secretions in
bronchi, bronchioles
Hypostatic pneumonia
SKIN
Mechanism:
Pressure or shearing forces
(two or more tissue layers
sliding on each other or tissue
sliding on anothe...
Potential Complication:
Skin breakdown
(abrasion or decubitus
ulcer)
GASTROINTESTINA
L
Mechanism:
Decrease bowel mobility
Change in dietary habits
Disadvantageous
positioning for defecati...
Potential Complication:
Constipation
Impaction
MUSCULOSKELETAL
MUSCLES
Mechanism:
Disuse
Potential Complication:
Atrophy
Weakness
JOINTS
Mechanism:
Limited motion leads to
muscle, tendon shortening
Potential Complication:
Contracture
Fibrosis or bo...
BONES
Mechanism:
Disruption of balance of
osteoblastic/osteoclstic
activity with destruction of
bone matrix and release ...
URINARY
Mechanism:
Increase urinary pH, increased
citric acid
Poor bladder emptying
Potential Complication:
Renal ston...
NEUROLOGIC
Mechanism:
Loss of normal stimuli
Potential Complication:
Confusion
Restlessness
Forgetfulness
COMMON
INTERVENTIONS
Common interventions:
1. Rest, activity, joint protection,
energy conservation
2. Assistive, supportive, and
safety device...
6. Positioning and transfer
7. Exercise
8. Medications
9. Surgical interventions
 Rest, activity, joint
protection, energy
conservation
REST
 A therapeutic measure used in
many inflammatory and trauma...
Two Forms of Rest:
1. Absolute rest or no activity.
2. Partial rest or limited
activity.
Nurse’s responsibility in helping
the patient rest:
 Help patient understand the
meaning of “rest” as it applies
to him o...
 Teach the patient how to
effectively use body parts
not required to rest.
 Gradually return functions
to the patient wh...
ACTIVITY
 Activity, particularly in chronic
conditions, must be balanced with
adequate rest.
 Individuals who have pain...
• Nurses can help patients
determine their activity needs
in the following ways:
Teach the patient the
advantages of cont...
Help the patient work out an
activity schedule
approximating rest/activity
requirements at home.
Help the patient work t...
Joint Protection & Energy
Conservation
 Individual with joint involvement
and /or activity intolerances can
learn to pro...
Techniques:
 Avoid positions of possible
joint deformity
 Avoid holding muscles or
joints in one position for a
long time
 Use the strongest joints for all
activities
 Use joints in their best
position, maintaining good
standing and sitting p...
Nursing Intervention:
 Teach the patient to recognize
the symptoms of overactivity.
 Teach the patient appropriate
energ...
Assistive, supportive, and
safety devices
Assistive devices
 Viable for individuals who
have impairement of upper
and/o...
Some assistive devices for persons with
motor impairments:
Supportive devices
 Ambulatory aids
 Usually recommended for
persons who cannot bear
weight on one or more
joints of th...
•Some considerations
regarding choice of device
include:
Axillary crutches
Walkers
Canes
Safety devices
 Enhance function and
prevent accidents when
normal function,
balance, or dexterity are
compromised.
Application of heat and
cold
Heat
 Used for relieving stiffness
and relaxing muscles and
for analgesic effect and
sedat...
 Heat may be applied in a
variety of ways:
Dry heat
Moist heat
Cold
 Helpful in reducing or
preventing swelling,
reducing pain, and
relieving stiffness
Heat and cold should be
applied with caution to any
individual with decreased
sensation, because that
person will not be ...
 Nursing intervention with
heat and cold include:
Helping patient determine
which type of application
works best
Instru...
Instructing patient about
timely application of heat
and cold depending on
patient’s particular needs.
Assisting the pat...
Traction
 Used to help reduce contractures
or to relieve pain in the presence
of muscle spasm.
 It can be applied inter...
Splinting and bracing
 Purposes:
 Stabilize or support a joint
 Protect a joint or body part from external
trauma
 Me...
 When patients need to use
braces or splints, nurses need to:
Inspect patient’s skin after the
orthosis has been applied...
Instruct the patient in the
proper appllication and
care of th eorthosis
Assist the patient to make
the psychologic adju...
•Types of splints and braces and
their function:
 Spring-loaded braces
 Oppose the action of unparalyzed
muscles and act...
Functional splints
 Maintain the joint or limb in a
usable position to enable the
body part to be used correctly
Dynami...
Positioning and transfer
Exercise
 Exercise is a prescribed form
of activity designed to
accomplish the following:
Preserve joint mobility
Main...
Medications
 antiinflammatory analgesics
Teach patients the expected
effects of the drugs
How to use them appropriatel...
Use of narcotic analgesics in
chronic inflammatory
musculoskeletal conditions is
generally contraindicated.
Promoting nutrition
 important for individuals with musculoskeletal
problems for anyone else
 Patient should pay partic...
Nurses can help in the following
ways:
 Teach patient the importance of a well-
balanced diet
 Teach patients the import...
Surgical interventions
Indication period:
 Two categories:
 Those who have suffered trauma such
as a fracture
 Those w...
•Four major objectives of
orthopaedic treatment:
1. Restoration or maintenance of function
of a body part
2. Prevention of...
 It is important that those
caring for the patient know
and understand what the
expected outcomes are so
that care may be...
Types of surgery:
 Arthrotomy
=opening of a joint
• Arthroplasty
=reconstruction of a joint
 Synovectomy
=removal of part or all of
the synovial membrane
• Osteotomy
=cutting a bone to change
its alignment
 Arthrodesis
=causing the bones of a joint to
grow together by removing
articular hyaline cartilage,
introducing bone gra...
Physiologic Disabilities
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Physiologic Disabilities Common Problems & Interventions

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Transcript of "Physiologic Disabilities"

  1. 1. Physiologic Disabilities Common Problems & Interventions
  2. 2. COMMON PROBLEMS
  3. 3. Five major problems : 1. PAIN 2. STIFFNESS 3. DECREASE IN MUSCLE STRENGTH 4. LOSS OF DEXTERITY 5. LOSS OF LOCOMOTOR ABILITY
  4. 4. PAIN  Pain is the priority problem.
  5. 5. STIFFNESS  Decreased flexibility  Can be a result of pain, or of disuse or it can be a result of pathophysiologic changes
  6. 6. DECREASE IN MUSCLE STRENGTH  a primary problems, as with some myopathic and neuropathic disorders, or it can result from prolonged bed rest or immobility
  7. 7. LOSS OF DEXTERITY  skilful use of hands or body
  8. 8. LOSS OF LOCOMOTOR ABILITY  Temporary or complete loss of the ability to move freely from one place to another or care for one’s self.
  9. 9. System Involved: Complications of Immobility
  10. 10. CARDIOVASCULAR Mechanism: Failure of vessels in legs to assume or maintain a state of vasoconstriction, resulting in pooling of venous blood.
  11. 11. Potential Complication: Deep vein thrombosis (DVT) Pulmonary embolism (PE) Increase work load on heart Diminished cardiac output Decreased ability to adapt to erect posture
  12. 12. RESPIRATORY Mechanism: Decrease movement Decrease stimulus to cough Decrease depth of ventilation
  13. 13. Potential Complication: Pooling of secretions in bronchi, bronchioles Hypostatic pneumonia
  14. 14. SKIN Mechanism: Pressure or shearing forces (two or more tissue layers sliding on each other or tissue sliding on another surface) disrupting or decreasing circulation to an area.
  15. 15. Potential Complication: Skin breakdown (abrasion or decubitus ulcer)
  16. 16. GASTROINTESTINA L Mechanism: Decrease bowel mobility Change in dietary habits Disadvantageous positioning for defecation
  17. 17. Potential Complication: Constipation Impaction
  18. 18. MUSCULOSKELETAL MUSCLES Mechanism: Disuse Potential Complication: Atrophy Weakness
  19. 19. JOINTS Mechanism: Limited motion leads to muscle, tendon shortening Potential Complication: Contracture Fibrosis or bony ankylosis around joints
  20. 20. BONES Mechanism: Disruption of balance of osteoblastic/osteoclstic activity with destruction of bone matrix and release of calcium. Potential Complication: Osteoporosis
  21. 21. URINARY Mechanism: Increase urinary pH, increased citric acid Poor bladder emptying Potential Complication: Renal stones Urinary stasis
  22. 22. NEUROLOGIC Mechanism: Loss of normal stimuli Potential Complication: Confusion Restlessness Forgetfulness
  23. 23. COMMON INTERVENTIONS
  24. 24. Common interventions: 1. Rest, activity, joint protection, energy conservation 2. Assistive, supportive, and safety devices 3. Application of heat and cold 4. Traction 5. Splinting and bracing
  25. 25. 6. Positioning and transfer 7. Exercise 8. Medications 9. Surgical interventions
  26. 26.  Rest, activity, joint protection, energy conservation REST  A therapeutic measure used in many inflammatory and traumatic conditions of the musculoskeletal system.  However, too much rest can at times be as detrimental as too much activity.
  27. 27. Two Forms of Rest: 1. Absolute rest or no activity. 2. Partial rest or limited activity.
  28. 28. Nurse’s responsibility in helping the patient rest:  Help patient understand the meaning of “rest” as it applies to him or her.  Take over functions for the patient that would require use of body part beyond limits prescribed.
  29. 29.  Teach the patient how to effectively use body parts not required to rest.  Gradually return functions to the patient when rest is no longer required.
  30. 30. ACTIVITY  Activity, particularly in chronic conditions, must be balanced with adequate rest.  Individuals who have pain with certain activities or increase pain and stiffness following certain activities must learn to recognize their tolerances and adapt their ADL accordingly.
  31. 31. • Nurses can help patients determine their activity needs in the following ways: Teach the patient the advantages of continuing, but modifying, activity Help the patient identify his or her own activity tolerances
  32. 32. Help the patient work out an activity schedule approximating rest/activity requirements at home. Help the patient work through concerns about not being able to perform all activities he or she believes are necessary or desired.
  33. 33. Joint Protection & Energy Conservation  Individual with joint involvement and /or activity intolerances can learn to protect their joints and themselves from overuse, misuse, and stress by becoming aware of and practicing joint protection and energy conservation techniques.
  34. 34. Techniques:  Avoid positions of possible joint deformity  Avoid holding muscles or joints in one position for a long time
  35. 35.  Use the strongest joints for all activities  Use joints in their best position, maintaining good standing and sitting posture  Conserve energy
  36. 36. Nursing Intervention:  Teach the patient to recognize the symptoms of overactivity.  Teach the patient appropriate energy conservation and joint protection techniques.  Encourage the patient to use those techniques in ADL.
  37. 37. Assistive, supportive, and safety devices Assistive devices  Viable for individuals who have impairement of upper and/or lower extremity function.
  38. 38. Some assistive devices for persons with motor impairments:
  39. 39. Supportive devices  Ambulatory aids  Usually recommended for persons who cannot bear weight on one or more joints of the lower extremities
  40. 40. •Some considerations regarding choice of device include: Axillary crutches Walkers Canes
  41. 41. Safety devices  Enhance function and prevent accidents when normal function, balance, or dexterity are compromised.
  42. 42. Application of heat and cold Heat  Used for relieving stiffness and relaxing muscles and for analgesic effect and sedative effect.
  43. 43.  Heat may be applied in a variety of ways: Dry heat Moist heat
  44. 44. Cold  Helpful in reducing or preventing swelling, reducing pain, and relieving stiffness
  45. 45. Heat and cold should be applied with caution to any individual with decreased sensation, because that person will not be able to determine if damage is occurring.
  46. 46.  Nursing intervention with heat and cold include: Helping patient determine which type of application works best Instructing patient about safety precautions to be observed with that method
  47. 47. Instructing patient about timely application of heat and cold depending on patient’s particular needs. Assisting the patient with application.
  48. 48. Traction  Used to help reduce contractures or to relieve pain in the presence of muscle spasm.  It can be applied intermittently or constantly and usually in the form of skin traction, that is Buck’s extension, Russell traction, or pelvic traction.
  49. 49. Splinting and bracing  Purposes:  Stabilize or support a joint  Protect a joint or body part from external trauma  Mechanically correct dysfunction such as footdrop by supporting the joint in its functional position  Assist patients to exercise specific joints
  50. 50.  When patients need to use braces or splints, nurses need to: Inspect patient’s skin after the orthosis has been applied for a short time to be certain it has caused no skin irritation Notify orthotist if adjustments in the orthosis need to be madee to make it more comfortable or relieve chafing
  51. 51. Instruct the patient in the proper appllication and care of th eorthosis Assist the patient to make the psychologic adjustment to wearing the orthosis
  52. 52. •Types of splints and braces and their function:  Spring-loaded braces  Oppose the action of unparalyzed muscles and act as partial functional substitutes for paralyzed muscles  Resting splints  Maintain a limb or joint in a functional position while permitting the muscles around the joint to relax
  53. 53. Functional splints  Maintain the joint or limb in a usable position to enable the body part to be used correctly Dynamic splints  Permit assisted exercise to joints, particularly following surgery to finger joints
  54. 54. Positioning and transfer
  55. 55. Exercise  Exercise is a prescribed form of activity designed to accomplish the following: Preserve joint mobility Maintain muscle tone Strengthen selected muscle groups
  56. 56. Medications  antiinflammatory analgesics Teach patients the expected effects of the drugs How to use them appropriately How to recognize side effects or toxic effects.
  57. 57. Use of narcotic analgesics in chronic inflammatory musculoskeletal conditions is generally contraindicated.
  58. 58. Promoting nutrition  important for individuals with musculoskeletal problems for anyone else  Patient should pay particular attention to avoiding weight gain  For many individuals with mobility problems, however, the problem of weight and mobility becomes a vicious circle.  This cycle can be broken only by weight loss through a properly supervised reduction diet.
  59. 59. Nurses can help in the following ways:  Teach patient the importance of a well- balanced diet  Teach patients the importance of restricting weight gain  Encourage patients to select food wisely  Encourage the patient family to bring home cooked food if the patient is not eating hospital food particularly following surgery when the patient needs to maintain a positive nitrogen balance
  60. 60. Surgical interventions Indication period:  Two categories:  Those who have suffered trauma such as a fracture  Those who require an elective orthopaedic procedure for correction of deformity, relief of pain, or restoration of musculoskeletal function .
  61. 61. •Four major objectives of orthopaedic treatment: 1. Restoration or maintenance of function of a body part 2. Prevention of deformity 3. Correction of deformity if it already exists 4. Development of the patient’s powers of compensation and adaptation if loss of function or permanent deformity is not preventable
  62. 62.  It is important that those caring for the patient know and understand what the expected outcomes are so that care may be adapted to achieving them.
  63. 63. Types of surgery:  Arthrotomy =opening of a joint • Arthroplasty =reconstruction of a joint
  64. 64.  Synovectomy =removal of part or all of the synovial membrane • Osteotomy =cutting a bone to change its alignment
  65. 65.  Arthrodesis =causing the bones of a joint to grow together by removing articular hyaline cartilage, introducing bone grafts, and stabilizing with external fixation • Tendon transplants =moving a tendon from its usual position
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