HLTEN504A - INCP

1. HLTEN504A - INCP • Mobility

2. Mobility All routine activities of daily living require energy expenditure and the ability to move freely Energy in exercise requires a normal musculoskeletal and nervous systems, plus a supply of energy which is promoted by an effective cardio-pulmonary system.

3. Terms Impaired physical mobility • A state in which the individual experiences a limitation of ability for independent physical movement. Impairment • Is any loss of abnormality of psychological, physiological or anatomical structure or function Disability • Is any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal Handicap • Is a disadvantage for a given individual, resulting from impairment or a disability, that limits or prevents the fulfilment of a role that is normal for than individual

4. Processes that can alter mobility • Neuromuscular diseases • Musculoskeletal diseases • Pain • Postural hypotension • Cardiac disease • Respiratory disease • Perceptual/ cognitive impairment • Physical feature of environment • Characteristics of the carers • Availability of social supports • Equipment function and maintenance

5. Mobility assessment Includes range of motion, gait and exercise assessments Range of motion • Is the maximum amount of movement possible at a joint, which is also limited in its direction by ligaments, muscles and construction of the joint

6. Gait Gait is the manner of walking and includes rhythm, cadence and speed. Assessing gait allows the nurse to observe balance, posture and ability to walk Normal gait: • Smooth, free coordinated movement • Symmetrical arm swing • Heel gently strikes floor with knee extended, weight then smoothly transferred towards toes with knee slightly flexed • Balanced • Head erect and central • Body erect • ‘Normal” also implies that an individual may perform self-care without pain, discomfort, shortness of breath, sweating, tachycardia, palpitations, and undue effort

7. Gait abnormalities May occur when: • Disorder of musculoskeletal system • E.g. unilateral hip dislocation produces a distinct ‘waddle’ with each step • Neurological disorder • Staggering, ataxic or ‘scissor’ gait • Result from pain or discomfort due to lesion on foot, or from ill-fitting and uncomfortable footwear

8. Gait changes noted in elderly population • Mild rigidity • Less automatic movements • Decreased speed and amplitude of automatic movements • Less able to use gravity • Increased muscle activity in gait cycle • Less accuracy and speed of movements – especially in hips • Decreased swing to stance ration • Deceased vertical displacement • Breaded stride width • Increased toe-floor clearance • Decreased heel-floor angle • Slower cadence • Decreased rotation of hips and shoulder • More abnormalities in posture

9. Exercise Exercise is the physical activity for: • Coordinating the body • Improving health • Maintaining fitness • Providing therapy for correcting a deformity • Restoring the overall body to a maximal state of health

10. Effects of exercise Cardiovascular system • Increased cardiac output • Improved myocardial contraction • Strengthening cardiac muscle • Decreased resting heart rate • Improved venous return Pulmonary system • Increased respiratory rate and depth followed by quicker return to resting state • Improved alveolar ventilation

11. Effects of exercise Metabolic system • Increased metabolic rate • Increased triglyceride breakdown • Increased gastric motility • Increased production of heat Musculoskeletal system • Improved muscle tone and muscle tolerance to exercise • Increased joint mobility • Possible increase in muscle mass • Reduced bone loss

12. Effects of exercise Psychosocial system • Improved tolerance to stress • Reports ‘feeling better’ • Reports of decrease in illness e.g. colds and flu Activity tolerance • Improved tolerance • Decreased fatigue

13. Active exercise • Active exercise uses isotonic and isometric components • Benefits of active exercise: • Promotes and maintains muscle tone • Influences the size and strength of muscles, and prevents atrophy • Stimulated circulation • Increased oxygen uptake • Aids in prevention of constipation • Prevents degeneration of bone tissue • Prevent postural deformities • Promotes flow of urine into and from bladder • Stimulates nervous system

14. Passive exercises Passive exercises help prevent contractile deformities caused by shortening of the capsule, ligaments and muscles that control the joint: • Only the normal range of movement in any joint is used • The part that is being exercised is adequately supported • Slow movements that move to the point of resistance but they should not be forced and they should not cause pain • Keep the patient warm as warmth facilitated muscle movement

15. Range of movement Tabbner’s 2005, p. 584

16. Nursing plan for immobilised patient • Maintain proper body alignment • Regain proper body alignment or optimal level of body alignment • Reduce injuries to the skin and musculoskeletal systems resulting from improper body mechanics or alignment • Achieve full or optimal range of joint motion • Prevent contractures

17. Assisting the immobilised patient • Maintain proper body alignment. • Regain proper body alignment or optimal level of body alignment. • Reduce injuries to the skin and musculoskeletal systems resulting from improper body mechanics or alignment. • Achieve full or optimal range of joint movement. • Prevent contractures.

18. Complications of immobility • Heart • Increased workload • Increased resting workload • Increased heart rate • Increased stroke volume • Increased cardiac output • Results in reduced diastolic pressure and shortening of diastolic phase, which interferes with coronary perfusion.

19. Complications of immobility • Heart/ circulation/ respiratory/ digestion • Hypovolemia- fluid shifts • Blood hypercoagulability • Orthostatic hypotension • Pulmonary ventilation • Inadequate management of respiratory secretions • Decreased ventilation • Gastrointestinal system • Diminished intake • Reduced intake slowed peristalsis

20. Complications of immobility • Musculo-skeletal • Decreased tonic contractions • Decreased isotonic contraction = reduction in work tolerance and endurance • Loss of muscle strength • Generalised muscle weakness • Muscle pain • Instability loss of confidence • Contractures • Osteoporosis reduction of bone tissue

21. Complications of immobility • Urinary/ kidneys • Bladder distention • Urinary stasis • Urinary tract infection • Stone formation • Continence issues

22. Complications of immobility: • Psychosocial • Emotional response • Feeling of a loss of control • Changes in self-perception • Cognitive and sensory changes • Interpersonal & social problems

23. Complications of immobility Integumentary system / skin • The development of pressure ulcers (also referred to as pressure sores or decubitus ulcers or bed sores)

24. Interventions to prevent complications of immobility • Active /passive movement • Positioning (body alignment) • Using equipment (foot boards, bed cradles) • No prolonged pressure to back of legs • Ambulate slowly and encourage the patient • Nurse in seated position to prevent pulmonary stasis • Deep breathing and coughing exercises • Monitor fluid intake

25. Interventions to prevent complications of immobility • Urinary – adequate fluid intake • Don’t postpone elimination • Encourage to empty bladder completely • Constipation • Nutritional fibre • Fluids • Maintain normal routine

26. Interventions to prevent complications of immobility • Psycho-social • Assist in decision making • Change environment • Provide newspapers, radio, TV etc • Pursue hobbies • Flexible visiting hours • Nurse patient relationship