NSG 326 Adult Health IMobilityPathological Influences on MobilitySystemic Effects of ImmobilityNursing AssessmentSlide 6Nursing DiagnosesPrevention Hazards of Immobility: Nursing ActionsSlide 9Slide 10OsteomalaciaOsteoporosisSlide 13Etiology & PreventionClinical ManifestationsDiagnostic StudiesSlide 17Nursing & Collaborative ManagementSlide 19Slide 20GoutSlide 22Nursing Management & Collaborative CareSlide 24Osteoarthritis [OA]: “degenerative joint disease”Slide 26EtiologySlide 28Slide 29Slide 30Slide 31Collaborative CareSlide 33Slide 34Nursing ManagementSlide 36PlanningImplementationSlide 39Rheumatoid Arthritis (RA)RA: Ulnar DriftRheumatoid ArthritisSlide 43Slide 44Slide 45Slide 46Diagnosis of RASlide 48Slide 49Nutritional TherapySlide 51Nursing Plan of CareNursing InterventionsSlide 54Plan ImplementationSlide 56Slide 57Slide 58Slide 59Slide 60Slide 61Slide 62Myths & Misconceptions of RA Walker-Cillo, G. & Killian, M. (2010). Myths and misconceptions about rheumatoid arthritis. American Nurse Today, 5(7), 8-10Slide 64Dr. Kathleen A. Ennen, PhD, RN, CNEPrepared by Dr. K. A. EnnenNSG 326 Adult NSG 326 Adult Health IHealth IMobility & ImmobilityMobility & Immobility2MobilityMobilityBody mechanicsBody mechanicsAlignment & postureAlignment & postureBalanceBalanceGravity & frictionGravity & frictionRegulation of movementRegulation of movementBones, joint, ligaments, tendons, cartilage, skeletal muscleBones, joint, ligaments, tendons, cartilage, skeletal muscleMuscle Movement & PostureMuscle Movement & PostureMusculoskeletal functionMusculoskeletal functionNervous systemNervous system3Pathological Influences on Pathological Influences on MobilityMobilityPostural abnormalitiesPostural abnormalitiesLordosis, kyphosis, scoliosis, clubfootLordosis, kyphosis, scoliosis, clubfootImpaired muscle developmentImpaired muscle developmentCNS damageCNS damageMusculoskeletal traumaMusculoskeletal trauma4Systemic Effects of Systemic Effects of ImmobilityImmobilityMetabolicMetabolicCalcium resorption; GI functionCalcium resorption; GI functionRespiratoryRespiratoryCardiovascularCardiovascularOrthostatic hypotension; thrombusOrthostatic hypotension; thrombusMusculoskeletalMusculoskeletalImpaired calcium metabolism & joint abnormalitiesImpaired calcium metabolism & joint abnormalitiesSecondary Osteoporosis; joint contractureSecondary Osteoporosis; joint contractureUrinary & bowel eliminationUrinary & bowel eliminationUrinary stasis & Renal calculiUrinary stasis & Renal calculiDecreased peristalsis; constipationDecreased peristalsis; constipationIntegumentaryIntegumentaryPressure ulcerPressure ulcerPsychosocial Psychosocial5Nursing AssessmentNursing AssessmentRange of Motion (ROM)Range of Motion (ROM)GaitGaitExercise abilitiesExercise abilitiesActivity toleranceActivity toleranceBody alignmentBody alignmentwalking, standing, sitting, & lying.walking, standing, sitting, & lying.7Nursing DiagnosesNursing DiagnosesImmobilized clientImmobilized clientImpaired bed mobilityImpaired bed mobilityImpaired wheelchair mobilityImpaired wheelchair mobilityMost common generalMost common generalImpaired physical mobilityImpaired physical mobilityRisk for disuse syndromeRisk for disuse syndromeImmobility affects multiple body systemsImmobility affects multiple body systemsPotential NDx extensivePotential NDx extensive8Prevention Hazards of Prevention Hazards of Immobility: Nursing ActionsImmobility: Nursing ActionsNutritional needs – protein, calories, fluids, fiberNutritional needs – protein, calories, fluids, fiberLung expansion – Cough, deep breathe; incentive spirometerLung expansion – Cough, deep breathe; incentive spirometerClient movement – ambulation; prevent postural hypotension and Client movement – ambulation; prevent postural hypotension and decubitus ulcers; transfer techniquesdecubitus ulcers; transfer techniquesTED hose TED hose Trapeze barTrapeze barROM exercisesROM exercisesHygiene careHygiene careClient participation & communicationClient participation & communicationADLs & IADLsADLs & IADLs11OsteomalaciaOsteomalaciaRare condition of adult bone associated with Vitamin D Rare condition of adult bone associated with Vitamin D deficiencydeficiencyDecalcification & softening of boneDecalcification & softening of boneCalled “Rickets” in childrenCalled “Rickets” in childrenVitamin D is required for the absorption of calcium from the Vitamin D is required for the absorption of calcium from the intestineintestineClinical featuresClinical featuresLocalized bone pain, difficulty rising form a chair & difficulty Localized bone pain, difficulty rising form a chair & difficulty walkingwalkingDietary intake of eggs, low-fat milk, fish, & vegetables Dietary intake of eggs, low-fat milk, fish, & vegetables encouragedencouragedExposure to sunlight is also valuable, along with weight-bearing Exposure to sunlight is also valuable, along with weight-bearing exercise.exercise.12OsteoporosisOsteoporosisPorous bone; chronic progressive metabolic Porous bone; chronic progressive metabolic bone diseasebone diseaseLow bone mass & structural deterioration of bone Low bone mass & structural deterioration of bone tissue leading to bone fragilitytissue leading to bone fragility10 million persons; 80% women10 million persons; 80% womenCosts > $13 billionCosts > $13 billion1.5 million fractures/year1.5 million fractures/year““Silent thief”Silent thief”Robs skeleton of banked resourcesRobs skeleton of banked resources14Etiology & PreventionEtiology & Prevention Risk factors [see Table 64-13, p. 1687 Lewis]Risk factors [see Table 64-13, p. 1687 Lewis]Female gender, increasing age, family H/O, white Female gender, increasing age, family H/O, white or Asian race, early menopause, H/O anorexia or or Asian race, early menopause, H/O anorexia or oophorectomy, sedentary lifestyle, & insufficient oophorectomy, sedentary lifestyle, & insufficient dietary calciumdietary calciumCigarette smoking and alcoholismCigarette smoking and alcoholismDecrease risk with regular weight-bearing Decrease risk with regular weight-bearing exercise, fluoride ingestion, & vitamin D exercise, fluoride ingestion, & vitamin D ingestion.ingestion.15Clinical ManifestationsClinical ManifestationsBack painBack painLoss of