Multidimensional Care (MDC) 1 MDC EXAM 2 REVIEW WITH VERIFIED ANSWERS -for 2020/2021 .

The effects of Immobility a) Interventions that improve flexibility • P.R.E.P.(Perform passive ROM, Reposition Q2HR, Encourage independent activity as much as possib le even in bedrest, Provide assistive devices) • Know examples of exercises for flexibility b) Assessment/ Findings of a patient with DVT • Assessment (1) Compare distal pulses for pulse quality, observe the color and temp. of extremities, evaluate sensation and motion, and determine speed of capillary refill. Compare calf circumferences. • Findings (1) Redness, warmth, tenderness, swelling (Thrombus formation), Peripheral and sacral edema. c) Identify patients at risk for skin breakdown • Older adults, immobile, cognitive impairments, incontinence, poor nutrition/ malnutrition. Medications may also cause vasoconstriction and result in poor tissue perfusion. 2. Benefits of Exercise a) Rationale for weight bearing exercise • Promotes bone reformation and growth (Makes bones stronger) • At least 3-5 times a week Identify benefits of exercise • Bone reformation and growth • Cardiovascular health promotion • Promotes balance and stability • Reduce stress and increase energy levels b) Identify benefits of exercise • Bone reformation and growth • Cardiovascular health promotion • Promotes balance and stability • Reduce stress and increase energy levels • Improves pulmonary circulation, skeletal development, skin tone • Reduces systemic inflammation c) Identify negative effects of immobility on musculoskeletal system • Osteoarthritis • Rheumatoid Arthritis • Loss of muscle strength • Impaired balance • Altered join mobility • Decreased stability • Osteoporosis • Depression, isolation, anxiety, and mood change • Can cause decreased peristalsis d) Explain ways to maintain proper posture for a client • Place the spine in a neutral position(Resting) • This allows the bones to be aligned, reduce stress and fatigue & muscle joints, and ligament can work efficiently • Avoid standing in 1 position for a long period of time • Do not lock your knees when standing • Keep core tight and don’t bend at the waist or neck • No slumping when sitting • Sit close to your work and use back support • Sit with feet flat on floor • Sleep on firm mattress • Do not wear high heels for a prolonged time, do not slump, and use a chair that supports your back. e) Identify interventions in minimizing contractures (which is a negative effect of immobility) • Gently straighten out contracted extremity, fingers. Etc • Mobility-encouraging interventions such as passive ROM, and rotation. Flexion and extension exercises • These interventions should be performed about every 2hrs and as needed if the contractures are present 3. Identify bed positions • Semi-fowlers: Patient is on their back with the head raised between 15 and 45 degrees. • High-fowlers: Patient is on their back with the head of the bed raised between 60 and 90 degrees. • Prone: Lying on the abdomen with the head turned to one side • Supine: Lying on the back • Sims: Patient lies on their side with the left thigh slightly flexed and the right thigh acutely flexed on the abdomen. • Trendelenburg's Position: Patient is on their back whose lower section is inclined 15-30 degrees so that the head is lower than the body. • Reverse Trendelenburg's Position: Patient is in the supine position with the feet facing downward and head is inclined 15-30 degrees. • Lateral Position: Side lying position, and a pillow is often placed between the legs for patient comfort 4. Identify proper body mechanics for moving the patients in bed • Transfer board • Mechanical lift • Transfer belt • What are the proper ways to move patients in bed? 5. Explain how to use walkers to the elderly • Push or lift your walker 6-12 inches forward • Make sure all 4 tips or wheels of your walker are touching the ground before taking a step • Step forward with your weak leg first • Then step forward with your other leg placing it in front of the weaker leg 6. Be able to assess client with diabetic neuropathy • Monofilament test: touch foot at the same time and have patient which time they were touched • Vibration perception: use a 128 hz tuning fork and ask the patient if they are able to feel vibrations • Look for ulceration or inspection of the feet 7. Assessment of pain and questions to ask • P: What causes the pain or when did it start? What makes it better and what makes it worse? • Q: How does the pain feel? • R: Where is the pain? Does it spread from one area to another? • S: How does the pain rate on a scale of 1-10, with ten being the worst pain? • T: When did the pain start? Is it sudden or gradual? Intermittent or constant 8. Teaching plan for patients with bunionectomy and healing • Allow them to walk with foot shoe or boot • Healing time is 6 to 12 weeks (healing time is slow due to less blood flow) • Use assistive devices for ambulatory until full weight bearing and allowed after surgery which is several weeks postop. • When educating patients and they do not follow recommendations, ask them to tell about their experiences. 9. Osteomy elitis a) Interventions in prevention and risk of osteomyelitis • Proper dental care • Maintaining clean & intact skin • Proper hand hygiene • Not leaving catheters in long tern •