Alterations In Mobility and Coordination

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Alterations In Mobility and Coordination

• NursingII
• Mary Ellen Santucci DNSc, RN

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Assessment of the Client

• Subjective Data
• Objective Data
• Diagnostic Evaluations

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Subjective Data

• Pain
• Altered Sensations

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Objective Data

• Posture
• Gait
• Bone Integrity
• Joint Function
• Muscle Strength and Weakness
• Skin
• Neurovascular status

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Diagnostic Evaluations

• Radiographic Studies
• Computerized Tomography
• Magnetic Resonance
• Arthrography
• Bone Densitometry

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Diagnostics

• Bone Scan
• Arthroscopy
• Arthrocentesis
• EMG
• Biopsy

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Planning and Interventions

• Biological disabilities
• Psychosociocultural and spiritual problems
• Specific interventions

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Biological Disabilities

• pain and stiffness
• decrease muscle strength
• loss of dexterity and locomotion

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Psychosociocultural and spiritual problems

• reaction to disability and chronicity
• dependence, independence and interdependence
• assistive, supportive and corrective devices
• socioeconomic impact
• family relationships

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Specific Interventions

• physical therapy and activity
• heat and cold
• traction casts
• diet
• psychological and social support
• surgical intervention

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Physical therapy

• ROM
• Exercise
• Walker
• Cane
• Wheelchair
• Heat and Cold

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Traction and Cast

• Cast Care
• Applying a Cast
• Bivalving a Cast
• Compartment Syndrome
• Home Care
• Removing a Cast

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Traction

• Types of Traction
• Skin
• Bucks Traction
• Skeletal Traction
• PIN CARE
• Pressure Ulcers
• Pneumonia
• Constipation
• Urinart Stasis and Venous Stasis

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Surgical Intervention

• Joint Replacement (See Plan of Care 61-1)
• Arthroscopy
• Open Reduction Internal Fixation

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Specific Alterations

• Degenerative and Inflammatory Joint Disorders
• Trauma
• Infections

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Degenerative and Inflammatory Joint Disorders

• Osteoarthritis
• Gout
• Osteoporosis

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Osteoarthritis

• Degenerative Joint Disease
• Risk Factors
• Increased age
• Genetic Predisposition
• Gender and hormonal Factors
• Obesity
• mechanical Factors
• Prior Inflammatory Disease

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Osteoartritis

• Management
• Pharmacologic
• Medical
• Surgical

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Gout

• Defect in Purine Metabilism
• Oversecretion of Uric Acid
• Uric Acid Crystals in the Synovial Fluid
• Prescence of Tophi
• Pharmacology
• colchine
• probenecid
• allopurinal

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Osteoporosis

• Reduction in total bone mass and a change in bone
  structure
• Loss of Height
• Kyphosis (Dowager Hump)
• Risk for Fracture
• Calcium Supplement, HRT, Vitamin D
• Decreased ETOH, decreased Caffiene
• Decreased Carbonated Beverages, No Smoking

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Trauma

• Sprains
• Contusions
• Soft Tissue Injury
• Dislocations
• Fractures
• Amputations

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Sprains, Contusions, Soft Tissue Injury

• Cold
• Heat
• Support
• Antiinflammatories

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Dislocations

• Replace Location
• Support

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Fractures

• See Chart 63-1 Types of Fractures
• Align
• Immoblize
• Complications
• Shock
• Fat Embolism
• Compartment Syndrome
• Reflex Sympatheitic Dystrophy
• Infection

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Amputations

• See Figure 63-15 for types of amputations
• Closed Rigid Cast Dressing
• Soft Dressing
• Pain
• Wound Healing
• Stump Wrapping
• Stump Care
• Prosthesis

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Pharmacotherapeutics

• Antiinflammatories
• Pain Medications
• Antibiotics
• Vitamins
• Calcium
• Antigout
• Vascular Drugs (Trental)

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Discharge Planning

• Role Changes
• Americans with Disabilities Act
• Office of Vocational rehabilitation
• Assistive Devices
• Home Care
• Support Groups