Mobility and Immobility

1. Mobility and Immobility NUR216 Fall 2006 Kelli Shugart RN, MS

2. Mobility • Physiology and principles of body mechanics • Alignment: posture • Balance • Gravity and friction

3. Regulation of Movement • Bones • Joints • Ligaments • Tendons • Cartilage • Skeletal muscle

4. Muscle Movement and Posture • Musculoskeletal function • Nervous system

5. Factors Impacting Immobility • Extent and duration of immobilization • Age of individual • Physical condition • Nutritional intake

6. Pathological Influences on Mobility • Postural abnormalities • Impaired muscle development • CNS damage • Musculoskeletal trauma

7. Systemic Effects of Immobility • Metabolic • Respiratory • Cardiovascular • Musculoskeletal • Muscle effects • Skeletal effects

8. Systemic Effects of Immobility Cont’d • Urinary and bowel elimination • Integumentary • Gastrointestinal • Genitourinary

9. Psychosocial and Developmental Effects • Infants, toddlers, preschoolers • Adolescents • Adults • Older adults

10. Assessment • Mobility • Bed rest a. Decrease activity and O2 demand b. Reduce pain c. Rest • Results from prescription of BR • Physical restriction because of external device • Voluntary restriction • Impairment to skeletal or motor function * Muscular deconditioning may occur in a matter of days. * Individuals on BR lose muscle strength at a rate of 3% QD

11. Assessment cont’d • Range of motion (ROM) • Gait • Exercise and activity tolerance • Activity tolerance- amt of exercise or activity that a person is able to perform. a. Physiological, emotional, and developmental factors influence tolerance • Body alignment: standing, sitting, lying

12. Physiological Assessment • Metabolic: anthropometric measurements, wound healing, • Respiratory system: ventilatory status, breath sounds • Cardiovascular system: BP, pulse, peripheral circulation, signs of DVT

13. Physiological Assessment cont’d • Musculoskeletal: ROM; muscle strength, tone, and mass (disuse atrophy) • Integumentary: color, integrity, turgur • Elimination: I&O

14. Psychosocial Assessment • Reaction to immobility • Developmental stages • Client expectations

15. Nursing Diagnoses • Activity intolerance • Ineffective breathing pattern • Risk of disuse syndrome • Impaired physical mobility • Impaired skin integrity • Social isolation

16. Planning • Goals and outcomes ~ Client’s skin remains dry and intact • Setting priorities • Continuity of care

17. Implementation: Health Promotion • Lifting techniques • Exercise • Improves cardiac output • Decreasing resting heart rate • Increasing respiration rate and depth • Decreasing work of breathing • Increase basal metabolic rate • Increase use of glucose and fatty acids

18. Implementation: Health Promotion cont’d • Increase gastric motility • Improved muscle tone • Increased joint mobility • Reduce bone loss • Decrease fatigue • Reports of decrease in illness • Reports of “feeling better”

19. Prevention of the Hazards of Immobility • Metabolic ~ Nutritional needs: protein, calories, vitamins (B and C) • Respiratory system ~ Promotion of chest and lung expansion ~ Removal of secretions ~ Maintenance of patent airway

20. Prevention of Respiratory Problems • Cough and deep • Ambulate ASAP • Fluid intake • Incentive spirometer

21. Prevention of the Hazards of Immobility cont’d • Cardiovascular system ~ Reducing orthostatic hypotension ~ Reducing cardiac workload: discourage Valsalva maneuver ~ Preventing thrombus formation: medication, exercise, fluids, TED stockings, pneumatic compression, positioning

22. Prevention of the Hazards of Immobility cont’d • Musculoskeletal system ~ ROM ~ Isometric exercise • Integumentary system ~ Turning every 1 to 2 hours ~Hygienic care ~Protection: preventive aids

23. Prevention of the Hazards of Immobility cont’d • Elimination ~ Hydration ~ I&O ~Nutritional intake: fiber • Psychosocial ~Orientation ~Communication ~Client participation

24. Prevention of the Hazards of Immobility cont’d • Positioning ~ Supports: footboards, trochanter rolls, hand rolls, and splints ~ Trapeze bar ~ Bed position: Fowler’s, supine, prone, side-lying, Sims’

25. Positioning

26. Transfer Techniques • In bed • Bed to chair • Bed to stretcher

27. Implementation: Restorative Care • Instrumental activities of daily living • Physical and occupational therapy • Exercises-ROM • Ambulation: canes, walkers, crutches

28. Evaluation • Client care • Client expectations

29. Review • Cane (948) ~ Placed on stronger side. ~ Cane, weak leg, stronger leg…repeat… • Crutches (948) ~ Measurement and axilla ~ Rubber tips prevent slipping, keep dry ~ Basic crutch stance is the tripod position

30. Review • 4 Point ~ Gives stability but requires weight bearing on both legs. • 3 Point ~ Requires weight bearing on one leg. ~ Weight on both crutches and affected leg, then uninvolved leg, repeat. ~ During early phases the affected leg does not touch. Progresses to touchdown then full wt.

31. Review • 2 Point ~ Requires at least partial wt bearing on both legs. ~ A crutch and opposing leg then the other crutch and opposing leg. Movement similar to arms swinging.

32. Review • Body mechanics (946) • Adequate help • Keep body aligned. Avoid twisting. • Flex knees; keep feet wide apart • Position self close to patient. • Person with heaviest workload coordinates • Proper position when pulling patient up in bed.