good morning this is Miss Liebert I am um teaching Mobility I'll be lecturing um and recording this um Mobility lecture um for level one um if you have any questions after you review uh listen to my lecture my phone number is 504-319-8797 um I'm going to pull up the slides so you'll be seeing them and I will be stopping um in the middle and and coming back and finishing the last hour so the first hour and the second hour so the first hour we are going to be talking about activities and um performance and um the second hour we will be more into the factors of immobility immobility and how it affects um your patient when they're immobile and they're in the um in the bed and um they can't get up so let me share the screen and we'll go from here okay so hopefully everyone can see this okay so um Mobility is a purposeful uh physical movement including gross simple move gross uh simple movements find kind complex movements and um and coordination so you cannot um actually move if you don't have that gross movements like your body walking uh your large bones and in five movements would be things like the tips of your fingers the joints and your fingers Etc and you have to have coordination so you have to have coordination also you have to be able to walk straight and bend over and things like that so that is well mobility and we're going to be discussing that okay um we're going to be talking about exercise first and activity is an exercise pattern it's a routine routine excuse me of exercise activity Leisure Recreation includes uh your ADLs getting up in the morning brushing your teeth washing your face it requires energy right um it's a type of quality movement um it includes maybe um doing some light Sports things like that physical activities any bodily movement that produces your skeletal muscles that results in any type of energy you expend whereas exercise is a subset of physical activity it's planned it's structured you decided to um every Monday Wednesday Friday go to the gym and work out that is exercise considered exercise where physical activity is any type of bodily movement okay there's different types of exercises these are just for you to know so when you're talking to your patient you can share this with them if needed first of all you have isotonic which is just a running walking and swimming it does cause muscle contraction and it does change in the muscle length so anything that changes in a muscle muscle length and muscle contraction is good for your body it will strengthen your muscles as well as your um your um and give your bones um support so um enhanced circulation of course you have to have circulation and it helps with good respiratory function it also increases the muscle mass and tone and strength it promotes the osteoblastic um activity where it actually helps with um the forming the bone with osteoblastic it gives it helps support that and also combats um osteoporosis um so um osteoplastic is when you increase bone formation into cells and it prevents osteoporosis and that's what you want to do especially as you get older so these things happen remember that if you have muscles the muscles in your body that you have they have to be strong and they have to support your bones um your bones in your body is just like you see a skeleton hanging on one of those um poles in an Anatomy they're movable and you can move them around they're very um flexible and you to for you to have support with those you have to have your muscles so you have to have good muscles and good blood flow so you got to have good circulatory system if any of those things shut down or you're mobile and are not working sufficiently then you're going to have trouble with exercise or you're just going to have trouble with just Mobility getting up getting out of the bed for instance if you have an accident or you sprain or strain we're going to talk about that in a minute the area of your muscle or a ligament you're going to have trouble walking so you have to have that good support of the ligaments and the muscles and just remember that they all work together okay another type of exercise is isometric it's a Kegel exercise if it's where the muscle contracts without moving the joint okay it involves alternatively tightening and tensing the muscles um without moving the body Port Parts it again increase uses that muscle tone and that strength and it decreases that muscle waste and you don't want to have any muscle wasting you don't want to have any osteoporosis and these exercises help with this it increase the circulation and like I talked about a second ago you got to have a good blood flow increase so circulation isokinetic is a resistive exercise it involves muscles that contract tension of resistance so you would tighten maybe increase a person tenses against something resistant so you may stand up and push your hands up against the wall and push and release and push and release you can put your hands on the side of your chair right now and just put up your palms down on each side and push and release and that's an isokinetic exercise an aerobic exercise of course is any activity which is the amount of oxygen taken in it's greater or equal to the amount of the body requires it improves cardiovascular fitness and um what happens is it'll um it'll help with cornea the cardiovascular system so then again with an aerobic exercise it increases the cardiovascular system it increases the blood flow where is that blood flow going and where's that good oxygen going it's applying throughout the body it's going into to the muscles is supporting the muscles to be stronger decrease any muscle mass and it increases the activity of the bones the red blood supply is in your bone so it all works together and it increases and it helps prevent any osteoporosio process and increases that osteoblastic activity so all these type of exercises anytime you have anything that tightens and contracts and it actually helps the muscles strengthen the muscles it's good for the body it's good for your patient okay you have range of motion exercises you have this active range of motion patients move all the joints through their range of motion on assistive so they can do it you can just sit there and you can move your arms and legs up and down same with your hands you can move your arms up and down you can move your hands your legs your feet you can do that voluntarily yourself passive range of motion is patience unable to do it so you have to do it for them so you're they're unable to move independently so the nurse moves each joint and that's passive range of motion active assistive is both so maybe they had a broken arm so they're not in their left arm so they're not able to move their left arm or maybe their shoulder is had surgery but they're not able to move their wrist so the left wrist so they're able to move freely all the other joints but they're not able to move their left hand or wrist so you're going to have to have help them so that's an active assistive and self-range emotion okay the unaffected side you have to assist with Act of a passive range of motion exercises to prevent any complications of immobility like I just talked about they should not be done they should be done to the point of resistance um if the patient has experienced any pain you should stop you should do these at least three times a day at least twice a week if you can um at least twice a day I'm sorry three times if necessary and twice a day um older adults they're not necessary can we uh actually do the full range of motion they may be able to move their arm up only at a certain degree so maybe only halfway or at a 30 degree or or 80 um I'm sorry not the full 90 degree um or 180 all the way around maybe they can't twist their Wrist all the way around but they can move it only back and maybe just forward and maybe just a little bit forward so whatever you talk to your patient communicate with them whatever they can do however they can move to whatever degree that's where you're going to do the exercise you don't want to push anything you don't want the patient to experience any pain and you do not want to go to the point of non-resistance okay um also with the um go back up a minute and talk about um your patient um the point of resistance and Beyond some peop some patients you will find um in some like especially nursing homes hospitals or the patients come from the nursing home and they go to the hospital they will have contractures so I always explain to students that sometimes they're contract maybe they'll give an example of their hand as contracted down it's from lack of exercises from lack of Mobility it's from the patient being in the bed and you'll see maybe the legs will be contracted up maybe their feet will be in a prone position so their feet are high or extended out they're not up in uh where you can pull you extend and flex the position so they're only in that extended position they can't Flex their foot up also with their hands they have them they're damp they're contracted this way if they're contracted all together like this you do not want to push the hand up straight that hurts because the fibrous tissue around them is contracted down okay so the um the the around the fibrous tissue around has there been in this this state for a while so the physical therapy will come in so it may be like for example you'll see maybe a little towel on their hands so they're trying to contract their hands out and then maybe you'll see a bigger a bigger little towel that's rolled up into their hands so it's a little bit bigger and bigger so they can get their hands extended out again because they're in that flexion State the same with the feet the same with the legs maybe their arms are contracted up and little by little the physical therapists work with them that is something a physical therapists do they're trained to do that um you are only going to exercise the point to that resistance so if like I said if the hand can only go extend out a little bit you need to talk to your patient read the notes find out what they can and cannot do before you go in there and exercise with your patients well some people people say well miss Liebert I'm not going to do that as a physical therapist job no it's not because physical therapists may be coming in once or twice but they will not come in that third time or maybe they're only coming in in the morning and then it's up to the nurse to go in there and do maybe some extensions or leg lifts or have the patient get up and walk around the room or whatever the doctor and the physician ordered in a physical therapist and the other health care providers have worked together and you'll read those notes and you'll go in there and you will be doing these exercises so you have to know what's going on with your patient you have to know how to do these exercises okay benefits of physical activity of course it does really good things for you it lowers your blood pressure and your heart rate it improves your cholesterol your lipoprotein you see reactive protein your coronary or it helps a coronary artery disease it helps with a diabetic patient it decreases their insulin level it helps with weight management you want to get some of that weight off of the patient that'll help with diabetes also it preserves the bone mass with the patient um it reduces the risk of the osteoporosis and the risk of falling when a patient falls lots of times you'll hear oh I was walking and I fell and I tripped or I fell and then my broke my hip lots of times they have bad osteoporosis and if it's severe enough the bones in the hip will break and then they fall so it's because they fell because of the osteoporosis so you want to prevent that by doing activity it increases joint flexibility it increases range of motion it just improves balance agility coordination as a patient gets older they lose some of their coordination they lose some of their balance so it's good for them to do some type of physical activity even if it's in the chair even if it's balancing on something even if it helps with the coordination I know lots of patients will just do elderly patients will just bring their hands up to their nose like this this is a type of coordination exercises some type of balance exercises so you need to incorporate all that into the plan of care with your patient depending on what's going on with your patient right and that's what you're gonna you're gonna plan your care here's some special considerations you want to consider as you're speaking and helping your patients with mobility issues any and activity issues anyone over 35 that's sedentary they should actually get medical consult before starting any type of activity you know of course you need to warm up and you need to um end with a cool down five to ten minutes stretching before five to ten minutes is recommended stretching after they should wear proper clothes something loose something that breathes a little bit during plenty of fluids make sure that if um weight after meals before you don't want to have a big meal and go exercise um so you want to wait not on a full full stomach if they have any pain any pressure in their chest any dizziness any shortness of breath any lightheadedness you advise them that they need to stop what they're doing stop the exercise and do not do it again until they have went to their physician to make sure that they're okay before they continue you on with their activities or exercise if whether it's just a daily walk all the way to an intense aerobic exercise okay so make sure you can tell them these things the benefits also is that they prevent and improve anxiety depression Mobility activity will actually help with anything any type of anxiety disorders I give an example even if you're nervous for taking your test with anxiety for students it's good to just take a walk I tell my students walk around on the hallways walk outside get some fresh air breathe it enhances all that energy it makes you feel better it lowers the anxiety people are depressed it'll go in and help with depression and it also helps with dementia I've seen studies and read studies where you have a cognitive declining if you get up and move around and actually walk outside it's a sensory thing but it's also where it just improves the cognition and it decreases any incidence of dementia it can okay so all these things exercise physical activity and physical exercise can help overall it just improves your quality of life okay so this is all we have to talk about with different types of exercise like I said the isokinetic and isometric you just have no FYI you should know how to benefit uh the benefits of all the activities and your nursing responsibilities so you can counsel your or adapt and maintain um a schedule a physical activity if your patient is you're helping them with some with an activity you can enhance and help them and assist them you can help them engage in this activity but it's whatever the doctor ordered you also can talk about misconceptions because a lot of times people post things up on on the internet and it may not be true so if they're asking questions you can verify it you can give them handouts from the American Heart Association all you have to do is go online the hospitals have things that you're able to um print out and give to them about any type of Mobility exercise things that you want them to know and do as far as that goes along with the program that the physician has given them it does not qualify you to supervise or plant any intense exercise program that is for the physician the physical therapist to do and what you can do actually is just enhance um your whatever they talk about and supervise and answer any questions okay um on this slide right here I thought I took it off but I will let you know chapter 44 is not the correct chapter um excuse me for that but you need to go in in your book and look at preventing back injuries and look at the steps for that as far as how you bend and I am recording so usually in the classroom I stand up and demonstrate all this um I will not be doing it now but you can look in your book and it's the same thing in your book and it tells you basically you want to save your back so you don't want to use your back you want to actually um Bend and use your knees to bend so you're going to use your legs and your knees a lot to um do this um to prevent the back injuries you don't want to use your back and pull your back out um so they do have all different ways to pull the patient up lift the patient out of the chair so you need to out of with the bed to the chair and pull get a have a patient transfer and you will be going over that in your clinical area and so you need to coordinate coordinate it with the book and you'll be able to see um what goes on um and how to do this to prevent any back injuries okay so now we're going to go on and um we're going to talk about sprains and strains I do have a pamphlet that's attached to um that is on your um modules and you can read through that it's just a nice um extra um reading um that tells you it lays everything out as far as Springs and strains and different kinds and different degrees and what you do after it I'll be talking from that pamphlet some but it basically in your book The main thing you need to know what is the definition of a sprain and what is the definition of a strain because you may have a patient come in especially if you're working like in the ER or some time of some place of acute set setting where the patient will come in and they will diagnose it whether it's a sprain or strain they will do some x-rays a doctor will come in and evaluate it but a sprain is an injury to a ligament okay it's a strong band of tissue it's connected to the bone into an in um to another bone to another at the Joint okay so um these are your degrees of course it's common sense that the first one would be a little tearing it's mild the second degree is a more broad range damage moderate um to severe pain and swelling of course you're going to have joint stability with the first one but you are going to have a little moderate pain and it's going to get worse and then um the third of course it's severe the ligament is completely torn away and ruptured it it's very painful the tissues are often damaged it takes a long time to um actually heal from um any type when you have a sprain any type it involves some type of ligament or joint if it is torn and it's a third degree and they have to go in and repair the ligament around that's attached to the Bone it takes a long time guys and um it will it's better actually if you just do a clean bone break which just cracks because the bone actually heals faster where the ligaments especially for that third degree it takes a long time but remember that a sprain is an injury to a ligament and then you have a strain so the strain is the damage to the muscle where a sprain is the ligament The Strain is a muscle fiber to the fibers it attaches to the muscle to the Bone and for the strain it's a torn muscle a pulled muscle a rupture tendon you hear that a lot of groin muscle and football okay that's a strain and so you first degree is just a little tissue just like the sprain you have some tenderness in an intimate and moderate pain um to slight pain a second degree is the torn muscle where you're going to have more swelling more degree of pain and it's going to be more moderate with the third it's just completely torn it's ruptured completely and it will take a long time and sometimes actually you will have suffer from The Strain the muscle strain if it's torn severely for a long period of time and sometimes it takes a long time reminds me of an example of that is an Achilles tendon when you tear the Achilles tendon um you it takes a long time for that area to heal maybe a few years and I've known patients and actually family members that have had this that have had these Achilles tendon tears and they never really recovered fully they walk and all but it's not a full recovery so you have to be very careful so a Spain a sprain and a strain know the difference and then your treatment it's in your book you can read it's very simple very easy to remember that you have rights you need to rest ice compression and Elevate you need to know this and to elevate your um as important and the ice um it's five to ten minutes it's not very long that you're going to put this ice on it's intermittent on and off and you need to rest and um the article will say a long time ago um we um it you would say rest was the thing to do that you would have to rest a lot I mean like maybe two or three days don't put any weight on it but now as you can read an article it will say that they're up after 48 Hours putting some uh weight on the um on it and they won't wait enough for immobility you know how they want you up and out of the bed now and that's how they basically want you um up and out of the bed because they want that cardiovascular system working they want you to stop perfusing they want that oxygen they want you to breathe they get all that good oxygen and get all those good blood cells to your areas of your muscles and into your bones and into your nervous system because all of that has to be intact and work together right I talked about that earlier so to do that as soon as they get you up and moving it's going to push some perfusion down in that area in the blood the goods blood supply to help heal and that's how you heal so you're not going to rest uh as long as they used to and you can read that in your book it gives you the guidelines and then there's ice that you're going to put on it intimate list guidelines are in your book and then you put have a compression you want to have compression but when you go to bed you don't want to have a compressed so if you have an Ace bandage you want to take it off when you're at in bed and in elevation and you have guidelines for that in your book and you want to elevate it okay so make sure you remember rice and what you need to do for each individual one and how long Etc okay so now we're going to talk about the other example or I want I want to back up a minute I had two exemplars underneath your um mobility and one was brain and strains which I just spoke about and the other one was osteoarthritis and this is we're going to talk about the pathology of osteoarthritis and we're going to talk about the common forms of it and what happens and then I'm going to give you some examples and um a nursing process that you would go through to help patients with osteoarthritis so this is actually another um exemplore exemplars are just examples that we give so when you see the word example what it means these two examples that's brains and strains I'm giving you and also the other one is um osteoarthritis excuse me just one moment some water okay um so the pathology um for osteoarthritis is the cartilage covers the ends of the bones and allows it to glide back and forth okay sew it on each other without any friction as time that can wear and as it wears it's like a shock absorber and as it wears it could be from all types of risk factors but as it wears all down um if you have this problem which I did and I'll show you some pictures because I had total knee replacement and as time goes on you just bone on bone so when that happens as the cartilage breaks down the bone rubs against each other and it irritates the synovial joints well then they get red and they get inflamed and they cause inflammation and cause swelling stiffness pain and um you have these little Bursa sacs around and you have something called a baker's cyst and it also can fill up fill up a fluid around your knee and it can give you very very bad pain and so with that you need to if this happens as it could be from um a lots of activity we repetitive it could be from age related it's usually over 65 happens to 50 percent of the population and for me I'll give you the example I play tennis a lot I ran track I played ball when I was younger and as time went on I just it just wore down in a cartilage in the actually the um that's over the joint just wore and so it was bone on bone and it was causing a lot of pain and I was getting a lot of inflammation in there so that's what happened to me and a few years back and so um it broke down the cartilage and it affected my walking and it was very painful and at first you know you just put a brace on and you try to live with it but you have these bouts of uh where it gets severe where you can't walk or you you know needing a cane or whatever so you opt out there's different types of things you can do for it which we're going to talk about but basically sometimes the end result is a total knee replacement and that is what I had so some of the risk factors are age I was older and it's wear and tear Sports I did a lot of sports so as time went on uh it could be from an accident it could be just from the disease process gout malformation of a joint it could be hereditary it could be from um you know um from birth it could be uh something going on from a birth defect it could be from diabetes um it could be from obesity lots of times if you're overweight it'll put a lot of pressure on the knees the knees support your whole body a lot in your knees are a big deal guys they do a lot of support you know they Bend you bend you stoop down you can Squat and if they're flexible and so as time goes on if you use like I'm saying sports or an accident you can have that breakdown and you can get osteoarthritis the preventions you want to prevent it by maybe having an ideal body weight by losing weight doing moderate exercises um you know your posture can play a role in that keep in your body in line erect um do things like uh Pilates and things like that um you also can have decrease a repetition stress on it like I give you an example I always think about catchers catchers get these problems for baseball because they always squatting and catching it's up and down up and down that repetitive stress if you have that kind of problem osteoarthritis you're not going to be able to do that but over the years if you catcher sometimes that's going to happen to them so that's a good example example of that for me it was exercise but also was hereditary and um so and as time went on it just kind of wore out and um you can have stiffness and um pain and crepitus and prejudices well if you put your hand over your knee and you move your knee uh joint back and forth you can feel it like a little crunching in there so what happens what happens is you have from this you have a decreased range of motion um it decreases your ADLs you can't do a lot in long term you get anxiety you can get depression and you really can't do any of the activities okay I had um over the time when I had this problem I kind of fought it and I did different things that to try to help it out before I actually had to have the knee replacement so it was about three years before I did have the knee replacement and in the meantime of course I had a diagnostic test the ultrasound the blood tests the physical exams I tried to go to physical therapy I did pharmacological therapy I took um you know pain relievers um and acetaminophen but I also had the topical creams I had um also I did like anti-inflammatories prescription ones also I had some cortisone injections I even had a gel injection where it puts the gel into the joint and it all lasted for a while but eventually the inevitive inevitable was that I had to have a total knee replacement um I did the hot and cold conferences is I tried to strengthen my legs with some core exercises and some bands I did all of those I did the rest I did the elevation I did it all and then eventually I just had to have that total knee replacement okay so I'm going to show you guys some pictures of um my knees and then I'm going to talk to you about um what you can do to prevent it in a post-op care for this okay so here's my knee after the surgery so you see a side view of it and that's titanium the white that's lighten up and you see they cut the bottom of the bone off where all the osteoarthritis is and they actually drill a pin into the bone which by the way was very painful after all the uh medication wore from the initial surgery and then on the uh FEMA bone they we in uh they put that um at the Joint at the Joint ending right there that's all titanium wrapped around so it'll slide easy and it's really been very good you know it's long healing process um the initial healing was probably about three or four weeks and then Physical Therapy where I was really walking better and probably I would say a full year before you really feel like you're able to move around without having thinking about I had knee surgery okay but as time went on um it got better but it it's a long time a lot of physical therapy so here's my knee after winter Staples and swell swollen really bad and then another and I have these um TED hose on and the reason why I have those on is to prevent clots right and so you're going to be putting those on your patients a lot and you really need to know in your book it gives you steps on how to put those on and take them off and um an instructor will talk to you about that in profusion also but I'm letting you know in Mobility that you need to know taking on and putting off these hoes in the correct way procedure to do it and why they do them is to prevent blood clots because you have decrease in Mobility but also as your healing kindness whenever they manipulate the bone the bone has what red blood cells in it and it's very vascular and you don't want to form any blood clots from the surgery so you have this um you wear these hose and I I wore them for like two months so it's a long time okay okay so here's after in the steri strips steri strips on after they took out and then there's another view of my knee and that was as it was healing and so um it like I said it took a good while but you know it was worth it okay um now I'm having trouble with my other knee but I've had two surgeries in it but it's it seems like it's okay we did some repairs and hopefully we're preventing to have another knee surgery because I really don't want to have to go through that I don't care to have surgery like most people so on assessment when you've taken care of your patient with osteoarthritis whether they have or had not had a surgery you want to ask them about what kind of movement they're having with osteoarthritis any pain any assistive devices they need remember I told you I used a support for the money I used a cane every now and again before I even had the surgery after I had a walker in the game for a long time so you have to know what the patient's doing at home and what they're doing to take care of themselves okay and diagnosing when a diagnose them of course it would be maybe about pain immobility um lifestyle Styles what are they doing what are they not doing what have they done before what can't they do now I mean I did have a lot of trouble walking I was walking for a limp for about a year and I just kind of muddled around the best I could to try to not prevent all that total knee but of course as you can see I had to have it so goals what will your patient do will they take their medications range of motion activity depending on whether or whether they're not had any surgery non-pharmalogical management some type of weight loss if they if they need that if they're obese or they what kind of exercise are they doing if they did have the surgery what are they doing after for the surgery are they going to physical therapy is Home Health coming in things like that implementation when they're in a hospital you want to promote comfort for them you want to give them their pain meds if needed you wanted like this is where you would do that um active passive range of motion make sure they can move all their limbs they can move but of course I couldn't move my right knee so it was immobile so I had to just do maybe some leg lifts or just um at the very beginning and just do some slides with my foot you know just to keep the movement and what the physical therapist gave me for um exercises of course getting up there once you up I was up right away I had surgery in the evening I was like wanted one in the afternoon I didn't finish at like five in that eight o'clock Physical Therapy had me up walking down all so they get you up quick so you want to reiterate that you want to promote that and you want to make sure that they're doing what they need to do and what the physician and physical therapy um has prescribed for them to do their their regime um promote a balanced nutrition you know they want to have a lot of protein and but just an overall good balanced diet at first but promote the protein because protein enhances healing maybe some extra protein shakes if needed if they're not eating or if they're nauseated don't feel like or maybe you know after surgery sometimes you just don't feel like having anything to eat so that's when a good protein shake would come into handy um on evaluation you want to evaluate what can and they can't do what are they in too much pain maybe they're in so much pain after surgery they can't even brush their teeth so then as they go home you would get the family member involved about how are they going to get their food to them they can't mobilize around the house as readily how are they going to urinate do they have a bedside commode do we need to order one can we bring that home so they can get up and they can make it easy and more comfortable and they don't have to walk down a long haul or they cannot get up the stairs right away so you need to if they have a two-story house so you need to find out all these things on evaluation any changes that need to be made or modified if they had surgery or even if they didn't even if it's just a laparoscopic procedure that they're doing just to do a repair you the first couple of it you know they may have restrictions you need to find out what they are and who's going to help them at home always remember to include the family members when you going through all these steps of the nursing process especially when you join your teaching you always want to have somebody in there so they can understand what the patient needs and what needs to be done to help the patient you know to improve and to get better and get them back to the optimum level of what they were doing in their quality of life of what they were doing before this injury or before they had these problems or what level can they get to when they get home okay all right so now this is immobility and um I'm going to try to stop a moment and I'm going to um let's see take a second and get rid of this and I am going to open this up if I can and yeah I pause the screening and I'm going to pause recording and I will be right back for immobility okay hopefully um hi guys back for the second half of Mobility um where I'm going to be talking about immobility and the effects of immobility and what happens um when a patient is um immobile and cannot move for um whatever type of any type of reason I'm going to go through that um I'm going to pull up the PowerPoint hold on a moment and um share give me a second guys and resume share so let me share my PowerPoint um um let's try a new share I didn't come up [Music] um second and control the PowerPoint okay I'm hoping that everyone can see this and go okay so um I this uh this section is talking about everything for immobility now remember um we talked about the mobility and the factors of activity exercise um different types of exercise how to care for a patient when you're talking to them and teaching them about exercise in I talked about my exemplars which was sprains and strains and about how to prevent any back injuries um you also need to know about positioning as far as you're going to go open in clinical but you need to review that as far as um moving a patient um rolling a patient how to move a patient up into bed log rolling the patient the steps to log rolling the steps I had told you about for TED hose as far as putting on anti-anabolic stockings to prevent blood clots um and why are you putting them on you need to know that all these things because when you're in a hospital all these things I'm telling you right now that I'm highlighting on you're going to be doing those these things the first semester in the hospital so you need to know the reasons why you're doing them and that's why I'm telling you to do that you know so it's important that you know this the second half and then we talked about Osteo um arthritis of course and um the factors and the risk factors and I told you a story about myself Etc so this next um this next section is immobility and an immobility its inability to move freely um it could be partial like a broken arm broken leg something like that or you can have complete paralysis for me from maybe ALS maybe um some type of accident where you inquired a back injury a football injury some type of sports injury so of course the greater the extent the duration of the immobility the greater the consequences doesn't it make sense you have more problems the greater the more extent okay so um reasons for Mobility you can have severe pain um I I worked at a pain um with pain doctors and so they had um severe pain um lots of pain so that stopped them being immobile in you know having immobility problems um they couldn't bend or because because of the back they couldn't do the ADLs when we talked about that things like that um impaired and musculoskeletal nervous system remember I told you that you have to have an intact on nervous system and you have to have a good blood flow Supply good perfusion to um to your muscles and they cannot be impaired um that happens you're going to have immobility problems generalized weakness elderly just being weak maybe from some disease process arthritis osteoarthritis um weakness just generalized weakness um Can Happen that can you cause immobility psychosocial problems we talked about depression and anxiety both of those can lead to immobility infectious process if you have a bad infection it can lead to immobility I've seen that happen so I'm going to tell you another story my husband fell off a roof um about um a few good years 10 years so and I have some pictures I'm going to show you so what happened to him is he had a compound um fracture and what that means is that his he fell 15 feet and he landed on his leg and on his foot his leg the right side that's where all the pressure pressure went so it snapped and down at the lowest area of the leg by the ankle um he had a compound fracture where the actually the only thing that was holding the leg on I'll show you the first picture was the um so you can see the area where um right up in here I'm going to pay attention to that area but that's actually where broke and opened and just the skin was actually holding on and some of his ligaments because the bones had snapped completely the the um the fibula bone and the tibia were completely broken and uh off so he had six surgeries so I'm just going to show you these pictures but at the time they sew in the back but remember this is a long way to get perfusion down by the ankles so he had some issues with healing the healing process but as he moved on uh with this little process this did not heal right here so he had to go back to the hospital and I thought maybe because it wasn't healing that they had the plates they had put in that possibly that was causing that not to heal and it they thought maybe potentially he would get an infection so they operated on him again and they went in and they took out the plates and they put in external fixation and I'll show you what that looks like and this is an external fixation if you can see the rod going in above the area and then there's a ride down here you cannot see this going in below the area and what they did is they took the plates out and then they put they drilled into the bone top and bottom and this is an external fixation and they tightened it so that the bone could stay intact okay so the plates are going so and then this then they opened it all up and I debrided it so this is all the tissue and then this is the bone right here and this just shows how it wasn't healing and it opened it all up and they had to get it to heal outside in because you know your skin your your when you have an infection or not an infection but you just have a wound uh healing it here and you learn that about you know tissue um integrity and you have um the tissue heals from inside out and so they're going to try to heal them from inside out and then here's another after he had about four or five surgeries he had to have a he end up having to have a skin flap um like the bone wasn't um healing so they had to take some synthetic bone and bone out of his hip and put it in to have it heal um and then they had to do end up doing a flap so he had about six different surgeries it took about a year for all this to happen it was a long long process a couple of times they thought they were going to have to cut off his foot um twice when he first had the injury in another time because it just wasn't healing but he went to a specialist at Ochsner and they they took care of it and then they did a skin flap to close up that was another issue that it wouldn't heal and remember one of the reasons why is because his leg was elevated so much so he wasn't getting a lot mobility and so the perfusion was minimal and so it wasn't um he wasn't perfusion as a perfusing as well and so that caused some of the problems because he wasn't up on it of course when I showed you that internal external fixation he had he wasn't mobile at all he was up in a scooter or he but there was no weight-bearing so when you wait bare you're getting perfusion so you're not getting any perfusion no oxygenation so it's it's tough to heal that area especially as low as it is the doctor had even said if he would have broke it mid calf or up he would have healed a lot quicker and a lot better so that's his story and you can think about that as I'm talking about different incidences of patients with immobility okay here's another picture of his immobility and see you can see where they did the flap and they did the flap right here and they brought everything over and then this is the fibula right here and they went in actually after all was said and done and they went in and they put another um plate right there again so he still has the plate on the small bone and um and then this they just repaired with a synthetic bone okay and he walks with a limp and he has a lot of trouble a lot of arthritis in that area especially when it's cold so he has he's walking on the limp all the time but when it's giving him problems he does so it has given him some immobility problems remember when I was talking about earlier about how um you know a patient who had sprains and strains and stuff like that may not have fully recovered well he didn't really fully recover it still hurts him a lot so and it's all the ligaments and around the bone you know and um the arthritis from the bone so benefits of bed rest so of course he got some benefits of bed rest at the very beginning because when you are lying in bed at the very beginning like even when I had my knee surgery it was good for me to do rest but actually Mobility get up get that perfusion going but it gives me better rest periods because in the benefits of this is because it reduces the just what it says right here the need for the body cells the oxygen so it reduces metabolism so what happens it goes all the activity goes to the area of that's um impaired and starts healing right um it directs all that energy solicit to Healing rather than toward other activities and it reduces the pain you know when you elevate and you put ice on it and you rest and it decreases the need for any type of maybe more pain meds um it also relieves edema of course when you elevate you'll be leaving edema and you don't want that edema all the time you want to decrease that and um it helps in that way also so that's the benefits of better US general assessment you want to ask the patient um presence of pain what kind of pain are you having with any type of Mobility injury problems um changes in Mobility what problems do you have what's your balance from we talked about that balance coordination um are you able to get out of the bed you know someone who's been in the bed for a while or they've had surgery and they've been in a bed for 24 hours when you go to get up if you haven't been in your bed for a while we sick or something you've got to get up and you kind of you know sometimes it takes a little while to get up and get your bearings and sit on the side of the bed so you know you're going to learn how to get the patient up in the bed it's in the book and you can like just if a patient's been there a while you're gonna set them up you know and we're going to talk about that in a moment and slowly and sit them on the side of the bed etc um any presence of shortness of breath any chest pain with movement um that can be indicative of some type of blood clot possibly do they have any history of Falls um have they Fallen before is that how they got to the hospital did they always fall um do they have some type of osteoarthritis um whatever the case may be you can read in a chart also and then but you also need to get a history from the patient that's why you should you need to have when you join your assessment you have to be a good communicator because you have to get all the information from patient patient family because something can be in a chart and it could be could have been charted wrong so you have to verify all that ability to complete activities a daily limit remember we talked about that what type of activities can they do what they can't do they might not be able to get up and fix their own meals because they might not be able to stand a long time that's an example of that we're going to talk with Superman and muscle skeletal activities remember I told you how you have to have good intact muscles so you can have good Mobility so you have decreasing the muscle mass it causes a decrease in the muscle fiber I spoke about that while in the first hour um the first section so as much as 20 percent loss can start after a week so after a week you're having problems with um uh immobility you can have this loss of 20 that's pretty quick after a week of bed rest it results in a decrease of muscle strength I remember when my husband had this problem with his leg his calf got really small why because he wasn't walking he wasn't uh he didn't have he couldn't do any weight bearing so the muscles started wasting away so now it's back to normal but at the time the muscle in the calf got very very small and it was very significant because it took a long time for it to heal so because of that weight bearing all the things I talked about earlier she was having muscle loss and he had decreased strength of course decreased endurance so all those things can happen because when you lose that muscle mass you don't have anything to hold on with those bones and come weak and fragile dysus osteoporosis we talk about that it's a decrease in the bone density is caused by bone reabsorption it's a lack of weight-bearing like I just talked about so the muscle gets stronger the muscle the muscle gets smaller I mean and it decreases the activity and just like I taught gave you the example about my husband that's usually what happens and contractions we talked about that early as you're in the bed you have this fibroless activity and it increases the amount of fibrous connective tissue remember I told talk to you about the hand and it was being contracted and remember that the fixation joints whenever that there's shortening in the flex of muscles because the flexor muscles are stronger than the extension so this is extension this is flexion and that reminds me when you go to your book you have to go through and usually I'll stand up with the whole class and we do this flexion extension of every and you'll do this in with your clinical instructure instructor and go over these things but this is flex extension flexion extension flexion okay this is um flexion this is um I mean extension this is flexion okay flexion down and when your foot is prone position it's in a flexion and when you pull your foot back up in a straight position I'll talk about that in a moment that's an extension so remember that the Sorting the of the flexor muscles the flexor muscles are stronger so everything wants to flex instead of extend so that's why the hands are this way so that fibrous connective tissue brings it down the flexion stronger so it brings it down and the foot drop flexion down on an extension so with foot drop you can have this a down where your feet are like this and that extended I mean that flexor instead of the extension mode so since you're laying in a bed in your feet are this way and then eventually they start to drop one of the reasons why because is the top sheets on real tight you need to loosen it up but as time goes on you not getting up you're not moving so you're not putting your foot flat on the ground so if you're not putting your foot flat on the ground it's going to pronate it's going to go down so when you go to put your foot down it does this okay where you can't stand like that you got to be able to have an extension okay you understand so you can look at it in your book so remember that sometimes they'll have a foot board at the end of the bed some people will have tennis shoes on why because it keeps the foot like this they'll have high tops on okay in the bed and that's why they have them on sometimes they'll put these boots on and then you have to do this push exercise exercise and that's called you know those flexion um resistance and that's a good resistance exercise and that's going to promote you know a contraction of the muscle so that's going to prevent any type of pronation and that's going to prevent any shortening of those flexor muscles and you're going to have an extension so they're not going to have any contractions so you have to that's a very important that the muscles stay intact and they're viable and they perform perfusing so that you're able to have this um a good vascular muscle strong no muscle wasting and that can all be done with exercising and Mobility and you think just because the patient is in the bed I think well I can't do anything well I I you can I just talked to you about that you're able to do that you're able to do range of motion exercises you're able to do those resistive exercises so anything that like I said earlier anything that contracts and release contract and release that's going to help okay that's going to prevent muscle wasting and it's going to help with the musculoskeletal effects so this is about oxygenation so the effects of oxygenation on immobility it affects all three parts of the respirations pulmonary ventilation inflow and outflow and the air between the atmosphere and the alveoli this is just a patho of everything the diffusion of the oxygen and carbon dioxide and you're going to have an instructor talk to you about oxygenation and you can pull this into the oxygenation lecture when she talks to you about it think about that you have diffusion with the alveoli and a pulmonary capillary capillaries and a transport of oxygen and carbon dioxide and a blood to and from the cells remember I'll talk to you about all those things so all these things are happening with oxygenation well if you lie in the bed and you're not moving a lot you're going to have a decrease of expansion of your lungs because you the bad presses against your chest and it decreases the movement so when you go home tonight lay in a bed flat and think about all these things I'm telling you so you're not taking really deep breaths and when you walk in you might feel yourself take a deep breath or when I'm talking you take a deep breath um and you feel air coming in and out you feel your lungs expanding when you're lying flat or lying in a bed in your mobile like when you're sleeping you're taking shallow breaths so as you take the abdominal organs pushing up against a diaphragm so what's happening is you have muscles that regulate your lungs so I didn't regulate your breathing muscles regulate all these all of this so as a muscles that they atrophy okay the effects of the respiratory muscles and it affects them then you have this reduce of this gas exchange in the alveoli well just talking about gave you the little pathos section where the blood and the mucus will just pull in there because you're not opening up all those alveolis all those little capillaries and um those surfactin and all that all those things that go down in the lower part of the lungs they're not opening up they're not breathing they're not exchanging any of the perfusing correctly so as you lie there just the Blood starts to pull in there you having less and less ventilation your coffin mechanism also when you start to cough if you lie down on your back and try to cough it's difficult so you can't clear the secretions and so when you can cannot clear the secretions you're having mucus and a mucus is falling back down into your lungs you know and going in a dependent position you can have trouble inhaling and exhaling and therefore you can't get out any mucus and so it goes down and it's a perfect medium and a perfect area to get an infection right so you can have atelectasis which is a collapse of the lobe or the entire lung it can go into hypostatic pneumonia the pulled secretions like I said is an excellent excellent medium for bacteria growth it impairs your oxygen and carbon dioxide Exchange in the alveoli and when that happens you're going to get pneumonia and if you have that I know lots of times when I was working as a nurse I would hear I had a patient couple of them come in from a nursing home caring for them or they broke their hip or they were in Mobile and they've been immobile at the nursing home or at the house and they come in and then they end up spending a couple of weeks at the hospital and they or they're at a long-term care facility here Miss Jones died because he had pneumonia well this is why because you're not moving the patient they're immobile they're not moving their body needs to move your body has to move even in the bed for these types of patients or any type of patient you need to roll the patient you need to put a pillow underneath their back if you're going to roll them on their back to get if they if for their knees if you want to roll them and for the knees you're going to put a pillow between their knees so because those are bony prominences so you want to get them off of the bony prominences so they don't have skin breakdowns now the issue we're going to talk about in a moment with immobility and so you want to do all these things to prevent the cubitus and you want to do it all the cupid is sores and breakdown of skin but you want to do this to keep these complications from happening and all you have to do is move the patient keep them moving Mobility is not just walking Mobility is moving the patient even if it's just around the bed sitting them up in a chair sitting them up in the bed having them sit up and turn on their side a little bit even if they just turn the shoulder this way that's going to help get them back off of that bed have them breathe better because they're sitting up in an upright position okay foreign this is perfusion we're going to talk about now and how it affects immobility affects perfusion it affects perfusion by it reduces the cardiac capacity it reduces the force of the cardiac contractions just like when you're in supine in your bed the heart starts to work harder why because you have a due to diminish cardiac reserve so when you're lying in the bed just like when you breathe and you breathe in Shallow your heart rate's decrease but over a longer period of time you have a reduced cardiac output so the heart muscle is not working as readily so it's the brain saying what's going on because the heart is not working as readily so the Supine position any lying in that position and it's not working as well and not so it starts to work harder because the brain's saying hey I'm supposed to be moving around and my muscles supposed to be moving more and it's not so what's going to happen so what's going to happen is everything is going to come like it's going to be an experienced tachycardia and over a period of time so your pulse rate is going to increase because it's going to try to get that muscle working and how you prevent that get the patient to sit up in the bed if they can't get out if they can get out get them up sit them on the side of the bed if that's all they can do sit them in the chair if that's all they can do get them up have them walk Three Steps four steps have them walk through the bathroom have them walk around the room they don't have to go run a marathon they just need to get up and move around every couple of hours they need to be repositioned you prevent a lot of immobility if you do these simple steps take the time go in there and that happens that'll happen to that'll help decrease any tachycardia it'll prevent angina which is also called hardening of the arteries where your artery is just like I the blood will stay in there and then a lot of pathology goes into and Johnny you can look it up I'm not going to go into that but that's something that can happen as time goes on okay so you want to you don't want to reduce the cardiac capacity also you have Osteo static hypotension where the blood pools and the low extremities over time so you have decreased efficiency in the orthostatic neurovascular reflexes and that what that means is that when you're lying down for a long period of time mentioned it earlier when you go to sit up sit a patient up you have to sit them up then sit them up then have the legs Dangle on the end of the bed and after the legs dangled on the end of the bed then you try to get them up if they get dizzy lightheaded weak you need to sit them back down maybe lying back down you're going to learn all your positioning one is a Trendelenburg and you might have to lie and put the head of the bed down you're going to learn all that in your clinical area you need to review those you need to know them you need to know what positions to put what patient if you have something like this occurs okay where they can perfuse some of the blood back to the head and it gets to the head and it helps Supply the brain with blood and house with perfusion and then you may start the whole procedure all over again So eventually the patient will get up and the patient will walk you know how you get up real fast and go to walk around the room well that's how it happens if you're lying for a long time but if this occurs you place them down increase the cerebral perfusion like I said and then you're going to um start all over again but orthostatic hypotension okay and that can happen that affects perfusion you also have this venous vasodilation um and status where stasis where with the stasis where you have the skeletal muscles and everything works together remember and you have these skeletal muscles and you're lying in the bed what happens when you walk Well normally when you walk you are moving and the blood's going down you have one-way valves and the blood's coming back up because you're pushing it back up as you're walking as you're moving that's why if you sit a long time and get a little edema because that blood's not going back up and going through your body so if they're lying in the bed the same thing happens and if they're in there a day one two three days the muscles become atrophy and the skeletal muscles that's what happens they don't pump and then they can't pump the blood back up okay to your heart the blood pulls into the legs and you get an engorgement you can get edema and basal dilates an engorgement it pays a valves no longer work so you have a block a backup so everything's backing up and that's what happens lots of times when patients are in a wheelchair and they don't get up and they can't be mobile woman sleeping how do you do that you can't do anything you can't get them up and walk around yes you can you can stab them sit in a chair you can do leg lifts you can do foot exercises there's a whole list of exercises you can do with people in a chair and they don't have to move they even now have these things not enough hospital but you can buy where you put your feet on it and it moves your feet back and forth for you and there's all different types of movement and exercises to keep them mobile where it's not walking but it's mobility and they're pushing that that blood is going back up and it's going through the body and coming back out and that's what you want to happen okay metabolic changes so as you're lying or you have a decreased metabolic rate you're not moving around a lot um you've been can become anorexia and this is just for your own knowledge I put all this here so you can understand about the metabolic changes you start to lose uh calcium the reabsorption it increases and the calcium goes into your circulation it can lead to osteoporosis and then you can get kidney stones so the calcium floats to the blood and it goes into the kidneys and not only so not only just because of this fact is another Factor too but this is one of the ways that kidney stones can be developed then you have that nitrogen balance and the blood glucose goes off and the protein stores start to break down because you um as you're immobile as the uh as your muscles atrophy and then you can have anabolism and then you start to bottom line of that as you have lean uh body mass you have loss of the lean body mass so you have to see someone that has been in the bed for a while and mobile for a while or has been sick and hadn't been able to move a lot they start to lose their muscle mass and a lean body mass and it decreases the muscles and they have weakness and then that can go into poor healing and the albumin level will be off and um so that when you need to feed them more protein and because all your protein stores are breaking down so all these things things are happening in the body from loss of bone and from decrease in Mobility okay um if the patient complains of something sharp pains or anything like that in their flank area it could be from kidney stones and why it could be from calcium circulating in their blood and how do you find that out if they have a lot of calcium well you look at their blood work blood work is going to tell you a lot and you're going to be learning that some of that this semester but you're going to relearn a lot more through you go through the next couple of semesters and you're going to correlate it with the problems that your patients have and and the issues your patients have in this is elimination of course so you have urinary stasis and I also lecture elimination and I will have a uh in my elimination lecture you can see where um I'll talk about this a little bit so what happens is you have stagnation of the urine in the kidneys again you're lying in the bed you're not moving around a lot you're not urinating you or you even may have a catheter in but if you're not moving a lot maybe sometimes uh the catheter isn't flowing correctly that's something I'll talk about an elimination but if you have stasis and you have stagnant urine in your bladder your bladder loses the muscle tone when you for a long time so it makes a long time immobility so it makes it difficult for you to empty your bladder so if you're in a lying position it impedes the um the empty empty in your bladder and your kidneys so you can get urinary stasis and it can also have a formation of renal calculi which is kidney stones and you can also get a urinary tract infection so as the urine's lie in there and or even a catheter you can get a UTI from but even if you're lying there whether and whether or not you have a cathode the the and the urine is pulling you know you need to excrete the urine urine has toxins in it but it's going to go back up because it has nowhere else to go so it can cause a UTI can cause a bladder infection but also go back up to the tubes into the kidneys cause the kidney stones and it can cause kidney infection so again how would you prevent that get them up sitting in a position try to get in a urinate try to drink fluid but move them you might want to move their hips move them up move them back move them down and all the positions get them going maybe surely follow how many times they've urinated the Imp taken output daily because that's indicative of having a urinary retention which I'll talk about in elimination lecture and urinary stasis and you don't want that to happen because then you're going to have another infection and then you got something else to deal with see it's like a big Snowball Effect if you don't move them all these things happen and a whole body can start breaking down and you don't want that to happen one thing they could have came in there because they were immobile because maybe they're in a car accident and they broke both their legs well they can start having all these other issues and you don't want them to have all these other issues if if they're not being cared for so the way to prevent it is be a good nurse and care for them okay and make sure you're aware of what's going on with their body by looking at their Labs talking to the patient you see them when they urinate it when they had a bowel movement things like that okay so the renal calculated kidney stones kind of talked about that is an increased calcium in a urine and because I talked about that with the metabolic changes uh urinary stasis I talked about that it can form stones and I said the symptoms would be you would have flank pain nausea you could have vomiting you could have blood in the urine things like that so how are you going to know that the patient's telling you you observing it you're doing a good physical assessment bowel elimination I'm going to talk about this in in elimination but if you don't move you don't drink fiber you don't drink water and your immobile decrease activity constipated you can also get a fecal impaction which I'll mention in elimination fecal impaction is where if you're constipated for a long period of time this stool does not come out so it hangs out in a sigmoid colon and it's right there signal colon is right by the anus right as you would defecate at the very end but if it gets impacted and it can't get out still just kind of accumulates there and you have to do uh and you know these steps you have to go through for that so you don't want that to happen to your patient either it's some lack of exercise of course you're going to have muscle weakness remember all those muscles and you colon making you have peristalis movement well that's all decreased so you're not drinking as much fluid because if you have immobility problems more than likely it's because you had some type of injury or some type of disease process and so you're not you're in pain so you're not really feeling like drinking you know when you're not feeling good you don't want to drink a lot so you have decreased fluid that happens and then you can't also when you're lying in a bed you can't assume that normal position to defecate and as lack of privacy in the hospital so because of that you you people lots of people are are apprehensive to actually have a bowel movement they can't sit on a toilet it's uncomfortable sitting on a bedpan um and if you're in a room with someone else and even if you're in a private room people coming in and out um you never know when you're in the middle of trying to have a bowel movement somebody's walking in taking Vital Signs so um the way to stop that is have the patient talk to the nurse and let them know that they're trying to have a bowel movement so you can provide that privacy for them so um inability to that's inability to maintain any personal habits when you have any type of bowel elimination okay so this is depression and so you have these psychoneurological effects that go along with everything else so you have decreased quality and quantity of sensory sensory input the patient has increased awareness of limitations imposed immobility so take my husband for example if he was in the hospital for a long period of time in and out five times different different hospital events okay you have um you know you may be in there and you may be alone some of these patients are in there for a long period of time for him he wasn't in there for a long period of time but he knows limitations of immobility he ended up having some type of you know a little bit depression not much but just a little some anxiety because he ran his own business I'm just giving you an example think of a home owner who owns their own business and they have to go out make sure everybody's doing everything he's in construction doing their job every day and he's in the hospital would you have anxiety and depression of course because you got to get that that house bill right you got to get that project completed so that's an example of how you can have depression anxiety work related think about a gentleman man or woman or whoever who has um a job and they're the support they're the uh Breadwinners of the family and they hurt themselves and now they're in a hospital for six weeks or they're not because maybe they're in traction or they got in a car accident in heaven forbid or something serious happens now who's going to bring home the money who's going to pay the bills do you think they're having depression anxiety absolutely what can you do are they helpless and hopeless absolutely they're feeling this way so what are they going to sleep and have changes in their wake cycle and sleep patterns absolutely and so you're going to talk to these patients the best way is to communicate see what kind of resources you can get for them they have all kind of resources to help they have all get the family members involved gets a social worker involved see what can go on other health care providers help the patient out communicate with the patient that'll help them a lot if they have an increased awareness of limitation of their Mobility that will lead to all these social and emotional uh behaviors also when they have a sensory input if it's in a quiet atmosphere they want you know Hospital maybe they're there for a week they don't have what they need to have to uh enjoy life they may have a TV but they don't have the right channels they're watching or whatever you make sure they have a a plug for their phone so they can charge their phone maybe get their iPad in maybe get their computer any electronic device friends people still read newspapers books they can get all that in the hospital talk to the patient find out what they need to help them enhance their improve in their quality of life of what they can do not only physically but mentally is what I'm saying so this is a um a um a question and it would say a nurse is providing a range of motion exercise for a 53 year old female patient who is recovering from a stroke during the session the patient complains that she is too tired to go on what would be the priority nurse in action for the patients so select all that applies so what would you what would be your priority well would you stop performing the exercise would you decrease the number of repetitive performance would you re-evaluate the nursing Clinic care would you move the patient to the other side to perform the exercise would you assess the patient for other symptoms so the correct answer on here the correct answers version 1 2 stop performing exercise because they're telling you that they they complaining they too tired we want to find out so how you find out you're going to assess communicate verbalize assess their body see what's going on physical assessment assess them for other symptoms what's going on why are you feeling this way today my back hurts well then you're going to assess the back you're going to do a physical assess where does it hurt Etc then you're going to reevaluate the nursing care plan you're not gonna you're not gonna move the patient's other side to perform an exercise you want to stop it that tells you right there you're not going to degree some you want to stop it and then if all said and done and you find another problem the patients have and you want to then go notify the doctor but in the meantime you want to stop assess and then you want to reevaluate your care plan maybe the way they're doing exercising and don't know any correctly they're it's hurting their back so you want to reevaluate so you get physical therapy in there and say hey Miss Jones is doing this the wrong way so it's hurting her back so you can show her the correct way so the PT comes in and shows it a correct way and then you just reinforce it so now you know how the correct way is and so you're going to make sure she does it the correct way okay [Music] so these are nursing interventions and I have them in here I'm not going to go through them but it gives you as you do your readings first of all it's good for different for your plan of care things that you can do for your patient like there's your exercises but then it says you can turn every every two hours ambulate clients so um soon as possible and then um the fluids you're supposed to give them and push against the footboard look we talked about that right that was for um if you're not to have foot drop right and um high fiber diet so all these things I spoke about and how you can Implement them until you plan a care but also also also you can uh review these as you are studying and look at them and see like okay because our questions are all situational application you know what would I do if this if I needed if this patient had something wrong with their foot you know well you would put a footboard on you would put shoes on so you can go back and say oh just leave it at all these interventions that I could do for my patient let me look at them and see at the bottom of number 23 you have something called plexipulses sequential compressive devices you can look at that anti-embolic hoses remember we talked about that and then on the scds also put on you'll see them they lay around the foot in the leg and what they do or just around the legs I'm sorry we're going to calves and they expand and they're on a machine and you'll have to know how to operate the machine because if you're doing a bed bath or physical assessment you have to take them off look out their legs and look at their feet and put everything back on and so you want to know how to do all that before you get into the hospital so make sure you read about that and you want to do that that increases circulation it decreases the incident of having any type of blood clots okay so this is the end of my lecture okay um like I said I have my phone number it's the beginning if you have any um any questions please let me know and you can give me a call or you can put the questions on the discussion board and I will answer them okay all right thank you have a nice day