Musculoskeletal/Mobility – Stroke Nursing Care in Med-Surg

00:01 Hey. Welcome to our last system.

00:03 We're going to look at the musculoskeletal and mobility as far as our nursing priorities for a patient after stroke.

00:09 Now, our goal here is to promote optimum mobility and function.

00:13 Everybody wants that.

00:14 Now, the symptoms are caused from the stroke from motor neuron destruction in the pyramidal pathways.

00:20 Those are the nerve fibers that come from your brain, pass through the spinal cord, to the motor cells.

00:25 So, after a stroke, patients are most likely to experience motor function impairment in mobility.

00:31 So mobility, respiratory function, swallowing, speech, gag reflex, and self-care abilities, they're all impacted by that.

00:39 So when we say mobility, we're not just saying walking, right? Want you to be aware that the destruction of those motor neurons can impact all of those areas.

00:49 So, early and safe mobility for joints and muscles will help minimize any deformities and help improve function of the patient.

00:57 So the idea is as soon as we can get them active, we do.

01:01 Now that might just mean range of motion in the bed until we can actually get them up and move them around.

01:07 Because range of motion and positioning in the most acute phases, where the goal is to keep them as mobile as early as possible, because we don't want them to get kind of stuck in a position.

01:19 So, in the very, very acute phases, as soon as we can, we'll start working with them to move those joints.

01:26 Physical therapy will assist with this, but we're with the patient, as nurses, longer and more often than physical therapy are. So, you work with them, but you also help remind the patient of the range of motion activities that they need to practice.

01:41 Then as the patient progresses, you teach them to do those exercises on their own, depending on which part of their body is most affected.

01:49 So these are kind of the motor deficits. You have muscle tone and akinesias.

01:54 Let's look at muscle tone.

01:56 The muscles can weaken and lose mass.

01:59 So since he has right-sided weakness, if we're not right on top of it, Mr. Johnson can -- his leg muscles can get very weak.

02:07 They'll even start to lose mass.

02:09 Think about if someone had been like in a cast for a long period of time.

02:12 Once you take that cast off their leg one leg where the cast was will look smaller than the other leg.

02:19 Akinesias are different, "A" means without, "kinesia" means movement, so akinesia means the patient can't move their voluntary muscles as they wish.

02:32 So they can't move their leg as much as they want.

02:34 They can't move their arm as much as they want, depending on which side was affected.

02:39 So, initially, it'll look like hyporeflexia.

02:42 The muscles might be kind of flaccid. These are in the first days after the stroke, depending on the amount of nerve damage.

02:49 But as it progresses, the muscles might become kind of spastic because you've got interruptions in those upper motor neurons.

02:57 So, initially, a patient after a stroke may experience hyporeflexia, so the muscles are kind of flaccid maybe in the first days or weeks.

03:06 Depends on how severe the stroke was.

03:08 Then they moved from that hypo, meaning low or less reflexes, to hyperreflexia, where they were kind of spastic as the body is healing and trying to receive itself.

03:21 So you might see some paralysis deformities.

03:24 Maybe you've seen somebody in the community or in the hospital, but they have some pretty specific deformities or contractures on the weaker paralyzed side.

03:33 So you may notice the patient's hand or arm comes up like this on their weak side.

03:38 If it was Mr. Johnson, he experienced a contraction -- remember, he had a right side impacted, so you might see it kind of turned.

03:45 I can't even get my wrist into that position.

03:49 So we've got a picture for you there to get a better idea.

03:52 But these are muscles that were not used and they end up just kind of tightening up.

03:56 It looks very abnormal. Once you've seen it, you won't forget what it looks like.

04:01 They can have an internal rotation of the shoulder.

04:04 They have flexion and contractures of the hand, the wrist, the elbow.

04:07 They've got external rotation of the hip, and the plantar flexion of the foot.

04:11 So you can see that where people, their foot, and their leg even looks very different than from a normal walk or a normal leg.

04:19 So you're going to collaborate with physical therapy. See, we don't want this to happen to a patient.

04:24 We want to prevent this and with the level of care, we can help most every patient make some progress.

04:31 Now, if there's severe damage, we can't completely resolve it, but we can do our very best to help minimize the impact of this.

04:39 So, take a look at that picture.

04:42 Think through your mind if you've ever seen anyone with these type of deformities.

04:46 You want to be set in your mind that these deformities or contractures are what we're trying to avoid, or minimize for any patient after a stroke.