Transcript B. - Wolters Kluwer Health

Chapter 22
Mobility and Safety
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Age-Related Changes That Affect Mobility
and Safety
• Degenerative changes in bones, muscles, joints and
connective tissue
• Central nervous system changes: slowed reaction time,
body sway
• Osteopenia and osteoporosis
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is True or False.
Exercise programs to increase strength and endurance in
the older adult population may help delay the onset of
the age-related functional consequences of decreased
strength and endurance.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
True.
Age-related changes in skeletal muscles, which are
controlled by motor neurons, directly affect all activities
of daily living. The end result of these age-related
changes is a decline in motor function and a loss of
strength and endurance, even in healthy older adults.
Exercise programs to increase strength and endurance
may help delay the onset of the age-related
consequences of disability and loss of function.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Which statement about osteoporosis is true?
A. Primary osteoporosis occurs with pathologic problems.
B. Secondary osteoporosis occurs as a result of age-related
changes.
C. Osteoporosis can cause serious negative functional
consequences even in the absence of additional risk
factors.
D. Estrogen levels have a minimal impact on the
development of osteoporosis.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
C. Osteoporosis can cause serious negative functional
consequences even in the absence of additional risk
factors.
Osteoporosis is a gradual loss of bone mass that affects all
adults to some degree and is strongly associated with
low-trauma fractures in older adults. Osteoporosis is
classified as primary when it is associated with agerelated changes and as secondary when it is caused by
medications or pathologic disturbances.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Risk Factors That Affect Mobility and
Safety
• Impaired Musculoskeletal Function
– Inactivity
– Inadequate protein
– Vitamin D intake
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Risk Factors That Affect Mobility and
Safety (cont.)
• Osteoporosis and Fractures
– Inadequate calcium and vitamin D intake
– Lack of weight-bearing activity
– Female gender
– Small bones
– Increased age
– Tobacco smoking
– Excessive alcohol drinking
– Certain medications
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Risk Factors That Affect Mobility and
Safety (cont.)
• Falls
– Pathologic conditions and functional impairments
– Medication effects
– Physical restraints
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Which statement related to risk factors for falls and the
older adult is true?
A. Falls are most often the result of an isolated risk factor.
B. The risk of falling increases in proportion to the number
of risk factors.
C. Risk factors for falls do not vary according to the
environment.
D. Functional abilities of the older adult are not considered
a risk factor for falls.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
B. The risk of falling increases in proportion to the number
of risk factors.
Falls are the result of a combination of risk factors rather
than one isolated risk factor, and the risk of falls
increases in proportion to the number of risk factors.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Functional Consequences Affecting
Musculoskeletal Wellness
• Diminished muscle strength, endurance, and coordination
• Increased difficulty performing ADLs
• Increased susceptibility to falls
• Increased susceptibility to fall-related injuries, including
death
• Fear of falling
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Which statement related to musculoskeletal function and
the older adult population is true?
A. There is a greater decline in muscle strength in the
upper extremities.
B. Diminished muscle strength is attributed primarily to
age-related loss of muscle mass.
C. Older adults experience muscle fatigue after longer
periods of exercise than do younger adults.
D. Lifelong patterns of exercise and activity have little
effect on muscle strength.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
B. Diminished muscle strength is attributed primarily to
age-related loss of muscle mass.
Beginning at about the age of 40 years, muscle strength
declines gradually, resulting in an overall decrease of
30% to 50% by the age of 80 years, with a greater
decline in muscle strength in the lower extremities than
in the upper extremities.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Pathologic Condition Affecting
Musculoskeletal Wellness
• Osteoarthritis
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Assessment of Musculoskeletal
Function
• Assessment of overall musculoskeletal performance
• Risks for osteoporosis
– Intake of calcium and vitamin D
– History of fractures
• Identifying risks for falls and injury
• Assessing for safety of the environment
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Diagnoses
• Wellness nursing diagnosis: Readiness for Enhanced Self
Health Management
• Related to osteoporosis: Health-Seeking Behaviors,
Ineffective Health Maintenance
• Related to fall risks: Impaired Physical Mobility, Risk for
Falls
• Additional diagnoses that addresses fear of falling: Fear
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Planning for Wellness Outcomes
• Balance, Endurance, Mobility, Activity Tolerance
• Risk Control, Risk Detection
• Safety Behavior: Fall Prevention, Home Physical
Environment
• Coping, Fear Control, Comfort Level
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Interventions for Musculoskeletal
Wellness
• Teaching about exercise
• Teaching about osteoporosis
– Early detection and treatment
– Lifestyle interventions
– Nutritional interventions
– Medications
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Interventions for Musculoskeletal
Wellness (cont.)
• Implementing fall prevention programs
– Eliminating risks
– Using monitoring devices
– Addressing contributing factors
• Preventing fall-related injuries and death
– Hip protectors
– Environmental interventions
• Addressing fear of falling
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Which statement related to adequate calcium
supplementation and the older adult is true?
A. Calcium supplements are rarely necessary.
B. Calcium supplementation lowers the rate of fractures in
older adults.
C. Calcium supplements have few detrimental effects when
taken by older adults.
D. Absorption of calcium supplements is optimal at 1500
mg per dose.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
B. Calcium supplementation lowers the rate of fractures in
older adults.
A recent report from the U.S. Surgeon General
recommended a pyramidal treatment approach to
osteoporosis that includes physical activity, fall
prevention, and supplementation with calcium and
vitamin D as the foundation for fracture prevention.
Absorption of calcium supplements is optimal at no more
than 600 mg per dose.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Evaluation of Nursing Interventions
• Maintenance of highest level of safe mobility
• Incorporation of preventive measures in daily life to
ensure safety and prevent osteoporosis
• Expressed feelings of safety and improved quality of life
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins