Funds Ch. 16

Question Answer
List a few complications that can be seen from prolonged bed rest blood clots, pneumonia, bone demineralization, kidney stones, constipation, pressure sores, urinary retention, depression
muscle atrophy muscle decreases in size, tone, and strength
contractures shortening and tightening of the muscles due to disuse
bone demineralization can begin as early as _________ days of being immobile 2-3 days
venous stasis pooling of blood in the veins of the lower legs
Atelectasis the collapse of lung tissue affecting part or all of a lung
Turning the pt, every 2 hours, encouraging deep breathing exercises and coughing, using a spirometer Ways to prevent respiratory complications with immobility
How often should ROM be performed? At least once every 8 hours
Renal calculi kidney stones
Shearing occurs when the skin layer is pulled across muscle and bone in one direction while the skin slides over another surface, such as a bed sheet, in the opposite direction
placing the extremities in alignment to maintain the potential for their use and movement position of function
The nurse should assist a pt who recently had surgery and is getting out of bed for the first time to do what before rising quickly? dangle on the side of the bed and check bp and pulse for changes
Lying on back, arms at side Supine
Lying in back, arms at sides, legs apart, knees bent, flat feet Dorsal recumbent
Lying on back, arms at side, feet higher than head Tredelenburg
Lying on back, arms at side, head higher than feet Reverse tredelenburg
Lying on back or either side, supported by pillows Lateral
On stomach with head to side Prone
On back, legs in stirrups Lithotomy
Dorsiflexion Bending of the foot in an upward position
Plantar flexion Bending of the foot in a downward direction
Blood clots, pneumonia, bone demineralization, kidney stones, C, pressure ulcers, urinary retention, depression Hazards of immobility
Ways to prevent musculoskeletal complications Keep the body properly aligned
Campaign instituted in response to the significant # of musculoskeletal disorders reported by nurses ANA handle with care campaign
Area over a bony prominence that differs from surrounding tissue; may be blister-like or a discoloration Deep tissue injury
What position do you place a patient with wound dehiscence or evisceration in? Supine
Position that would would place a pt who is hemorrhaging in Fowlera??s

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