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Physiologic Disabilities


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Physiologic Disabilities Common Problems & Interventions

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Physiologic Disabilities

  1. 1. Physiologic Disabilities Common Problems & Interventions
  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
  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