Think about it? They dr. has ordered bed rest for a resident. What must you do to prevent complications of immobility?
Body System Complication Care/preventionIntegumentary (skin)MusclesJointsBonesGastrointestinalRespiratoryCardiovascular
Body System Complication Care/preventionIntegumentary (skin) Pressure Ulcers (decubitus ulcers) Turning q 2 hr. Skin careMuscles Atrophy- muscle wastes away ROMJoints Contracture-muscle shortens over joint, fixed & can’t ROM moveBones Brittle ROM AmbulationGastrointestinal Constipation Fecal impactionRespiratory Pneumonia Cough & Deep breathing Atelectasis Turning q 2 hr.Cardiovascular Thrombi TED hose, ROM, Ambulation Orthostatic /postural Hypotension Change position slowly Syncope –pass out Monitor VSUrinary UTI Increase fluid intake Renal calculi Toilet q 2 hr.
Think about it? A pt. has been on bed rest for 3 days. The RN asks you to assist the pt. with ambulation. You know orthostatic hypotension can occur when the pt. moves from lying to sitting to standing. The pt. is at risk for syncope. What questions can you ask the pt., to check for orthostatic hypotension?
Positioning Turn or reposition pt. every 2 hours Bed chair
Devices to prevent complicationsa. Bed board- prevent saggingb. Footboard- prevent plantar flexion/foot drop
c. Trocanter roll: prevent hip abductiond. Hip abduction wedge: prevent adduction
e. handrolls: prevent contracturesf. splints: prevent contractures
Bed cradles: prevents foot drop & touching wounds
Purpose of ROM: Allows for movement of joints to prevent complications such as atrophy and contractures. Required by OBRA
Types of ROM1. Active ROM- do by self2. Passive ROM-someone does for the pt.3.Active/Passive ROM-someone assists pt.
Rules of ROM: Done 2 times/day RN will direct you on joints to do ROM Expose part being exercised Good body mechanics-pt. & you Support above & below joint being exercised Move slowly and smoothly Do not force joint Stop if pain
Movements Abduction-move away from body Adduction-move towards body Extension-straighten a body part Flexion-bend a body part Hyperextension-excessive straightening Dorsiflexsion-bending backwards Rotation-turning joint Internal rotation-turning joint inward External rotation-turning joint outward Plantar Flexion-planting foot down Pronation-turning downward Supination-turning upwardDO NOT do Neck ROM without permission!
Think about it? The dr. orders passive ROM for your pt’s right knee. What safety rules do you need to follow when performing Passive ROM to the pt’s right knee?
Prosthesis Replacement of a missing part by an artificial substitute