Mobility and Immobility

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Introduction. Name: Margrethe Truelsen Age: 32Come from Denmark (small country in northern Europe)?Educated nurse, graduated in 2006Worked 6 months in a medical ward, gastro-intestinal unitCame to Taizhou, China, 10 months agoHusband works at pharmaceutical company in TaizhouHave a son 1?

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Mobility and Immobility

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1. Mobility and Immobility Lecture in Basic Nursing, Thursday October 11. 2007, Margrethe Truelsen

2. Introduction Name: Margrethe Truelsen Age: 32 Come from Denmark (small country in northern Europe)? Educated nurse, graduated in 2006 Worked 6 months in a medical ward, gastro-intestinal unit Came to Taizhou, China, 10 months ago Husband works at pharmaceutical company in Taizhou Have a son 1½ year old

3. Introduction There are 2 purposes of this lecture 1) To teach you Basic Nursing. 2) To train your English skills. Therefore please let me know if I speak too fast or if there are specific words that you do not understand. I will try my best to speak slowly and explain the words.

4. Mobility/immobility Content of lecture Introduction 4 nursing principles Physical environment in the hospital The hospital bed – making the bed Bodymechanics Different positions in the bed Moving the patient Immobility – introduction Consequences of immobility - pneumonia - urinary tract infection - constipation - thrombosis - sleeplessness and depression - footdrop and contractures - pressure ulcer Activity Influence of the environment on activity Questions and case

5. The 4 nursing principles Health Promotion Disease Prevention Health Restoration Suffering Relief One important task for the nurse is to create and ensure the optimal environment for these principles to take place.

6. The physical environment in the hospital The patient's unit The hospital bed and its surroundings. The hospital bed is an important work tool for the nurse, but it is also a private resting place for the patient. The hospital bed has several functions to ease the work of the nurse and to increase the comfort for the patient. It is important for the nurse to create a clean, tidy and inviting environment for the patient.

7. The physical environment in the hospital The hospital bed – making the bed 1) Bring all required linen and accessories. 2) Raise the bed to a comfortable height and lower the siderails. 3) Remove the dirty linen and avoid shaking it to prevent the spread of microorganisms. 4) Do not place dirty linen on the floor. 5) Do not hold dirty linen against your uniform. 6) Put on the clean sheet. Place and fold the sheet as shown on the picture. Remember to fix the sheet very tight to avoid wrinkles. 7) Put on blanket-cover and pillow-case.

8. Body Mechanics The basic components used in movement of the human body is Bones Muscles Joints Tendons and ligaments Muscles are attached to the bones through tendons and ligaments. Muscles can either be contracted or relaxed. When a patient is resting in the bed it is important that the muscles can relax and that the joints are placed in natural positions without any strain.

9. Positions A – Supine position B – Lateral position C – Lateral position D – Prone position E – Sim's position F – Fowler's position

10. Positions Fowlers position is good for patients that have trouble breathing, such as Lung patients. The arms can be supported by pillows, this will ease the respiration further. Trendelenberg positions is used for patients with anaphylactic shock or in other cases where the venous blood-flow need to be quickly increased.

11. Body Mechanics Gravity influences all work and movement of the body. When standing up, the center of gravity is in the middle of the body near the sacral-region. To keep a good balance, one can either place the center of gravity low or widen the base of support (spread the legs). This is important knowledge for the nurse because this is a way to use the correct muscles to complete a task safely and efficiently, without undue strain on any muscle or joint.

12. Moving the patient Moving the patient from supine to lateral or prone position. Helping the patient to sit up. Moving the patient upwards in the bed.

13. Moving the patient Helping a weak patient from the bed to a wheelchair. Moving a passive patient from the bed to a wheelchair.

14. Immobility Many hospitalised patients are immobile to some extent. Some patients suffer from total immobility, which means that they are unable to leave the hospital bed and need help and support for every activity. Immobility can lead to many bad conditions for the human body. Immobility has big impact on for instance the blood-circulation and the muscles.

15. Consequences of immobility Pneumonia: The chest movement is impaired in the lying position and the muscles are weakened. This leads to low respiration-frequency and bad coughing- reflex. This causes secretion to stagnate in the lung and thereby a high risk for infection. Urinary Tract Infection (UTI): The flow from the kidneys is diminished, because of the changed influence of gravity. This also affects the bladder, that can not be properly emptied. The urine-retention can then cause an infection.

16. Consequences of immobility Constipation: The abdominal muscles are weakened and the intestinal movement are slowed. This means that the stool will be in the colon for a long period and the fluid will be absorbed. This leads to constipation, because the stool becomes very hard and is moving very slow. Thrombosis: The muscles controlling the venous pumps in the legs are weakened and this leads to blood pooling in the veins. This can cause blood clotting and a Deep Vein Thrombosis (DVT) can form. The DVT block the vein and prohibits blood to flow back to the heart.

17. Consequences of immobility Sleeplessness and depression: When a person is immobile for a longer period, the mind can be affected as well as the body. In the hospital environment there is not much to stimulate the senses and this lack of stimulation can cause sleeplessness or even depression. Footdrop and contractures: The muscles are greatly affected by immobility. When a muscle is not used it will loose mass and strength – called muscle-atrophy. The joints are also affected by immobility. The connective tissue becomes in-elastic and fiber-like and the movement of the joint is diminished. This is called a contracture, and often happens in the knee, the hip or the foot. When the foot is affected it is called footdrop.

18. Consequences of immobility Pressure Ulcer: This is a very common but also very serious consequence of immobility. It is a very painful condition for the patient and since it can be prevented, it is important for the health staff, especially the nurses to be aware of the development of pressure ulcers. When the tissue underlying the skin does not get enough oxygen, ischeamia occurs. If the ischeamia last more than 2-3 hours there will be damage to the tissue and the cells (necrosis). When a patient is immobile in the bed or in a wheelchair, there are certain points where the pressure on the skin is high. And there are risk of developing pressure ulcers on these sites.

19. Pressure Ulcer There are different stages in the development of a pressure ulcer. 1) Local redness, warmth and edema of the skin. 2) Skin is destroyed superficially. Appears like an abrasion or a blister. 3) Skin severely damaged with necrosis of the subcutaneous tissue. 4) Severe necrosis and also damage to the sorrounding tissues, such as muscle or bone. In this stage there is also a high risk of infection.

20. Pressure Ulcer Healing of: For the ulcer to heal, it requires a lot of energy from the body. New tissue has to be rebuild and it requires oxygen and nutrients. Therefore the blood-flow to the ulcer needs to be good. It is very important that the patient gets a good diet with lots of protein and vitamins. Prevention of: The most important is to prevent the ulcers from developing. The best way to do this is by relieving the pressure on the ”high risk” areas. The nurse must encourage the patient to move and change position often. Or if the patient is incapable of moving, the nurse must move him and relieve the pressure fx by using pillows.

21. Activity Different people have very different needs for activity in their lives. Some people are very physically active and other people have other interests and ways to fill their life. When a patient comes into the hospital and experience a loss of mobility/activity, it is important that the nurse cooperates with the patient in setting reasonable goals for the future. The nurse must find out what is important for the patient and which activities he enjoys doing. That way it is easier for the nurse to motivate the patient and the patient will enjoy the rehabilitation.

22. Activity Activities can be all kind of things depending on the condition of the patient. For the very weak patient very simple things such as brushing his teeth or putting on clothes can be an exhausting activity. In the hospital most activities revolve around the activities of daily living, which is the skills a person needs to do to take care of himself. Although activities can also be other things such as sports, reading, watching TV or creative doings such as drawing, painting, dancing and so on.

23. Influence of the environment on activity The idea of activities as an important part of rehabilitation is not new. In the 1850's Florence Nightingale thought that the environment surrounding the patient is very important for well-being and activity. Nightingale arranged that the patients could do sports, read and play theatre as a part of their rehabilitation. She also made sure that the environment was colourful with flowers, paintings and nice furniture. This stimulated the senses of the patients and made them feel better and more active. The environment and the atmosphere has big influence on patients. In a nice environment they are more likely to feel safe and have confidence.

24. Case Ms Ping is 78 years old. She has been admitted in your ward for approximately 1 week. She has suffered a stroke and is very weak. She is lying in bed all day and has lost a lot of strength. She is conscious and she can communicate fine. She is not in severe pain and is capable of moving a little, but she needs help to sit up. Today it is your job to take care of Ms Ping. When you enter the room you can hear secretion in her lungs, when she breathes. ”How are you today ?” you ask. ”Not well, I haven't slept all night !” she answers.

25. Questions How will you answer Ms Ping ? What questions will you ask ? What will you pay special attention to when you care for Ms Ping ? How will you prevent that she suffers from any consequences of immobility ? Which activities will you suggest for Ms Ping and how will you motivate her ?

26. Questions about the lecture Did You understand anything ? How was the language – too complicated, many foreign words ? How was the subject ? Too complicated, too simple ? How was the slides ? Too much text or too simple ?

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