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HLTEN504A - INCP. Mobility. 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.

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HLTEN504A - INCP

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Hlten504a incp

HLTEN504A - INCP

  • Mobility


Mobility

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.


Terms

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


Processes that can alter mobility

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


Mobility assessment

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


Hlten504a incp

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


Gait abnormalities

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


  • Gait changes noted in elderly population

    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


    Exercise

    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


    Effects of exercise

    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


    Effects of exercise1

    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


    Effects of exercise2

    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


    Active exercise

    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


    Passive exercises

    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


    Range of movement

    Range of movement

    Tabbner’s 2005, p. 584


    Nursing plan for immobilised patient

    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


    Assisting the immobilised patient

    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.


    Complications of immobility

    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.


    Complications of immobility1

    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


    Complications of immobility2

    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


    Complications of immobility3

    Complications of immobility

    • Urinary/ kidneys

      • Bladder distention

      • Urinary stasis

      • Urinary tract infection

      • Stone formation

      • Continence issues


    Complications of immobility4

    Complications of immobility:

    • Psychosocial

      • Emotional response

      • Feeling of a loss of control

      • Changes in self-perception

      • Cognitive and sensory changes

      • Interpersonal & social problems


    Complications of immobility5

    Complications of immobility

    Integumentary system / skin

    • The development of pressure ulcers (also referred to as pressure sores or decubitus ulcers or bed sores)


    Interventions to prevent complications of immobility

    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


    Hlten504a incp

    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


    Hlten504a incp

    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


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