Mobility and immobility
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Mobility and Immobility. NUR216 Fall 2006 Kelli Shugart RN, MS. Mobility. Physiology and principles of body mechanics Alignment: posture Balance Gravity and friction. Regulation of Movement. Bones Joints Ligaments Tendons Cartilage Skeletal muscle. Muscle Movement and Posture.

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Mobility and Immobility

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Mobility and immobility

Mobility and Immobility

NUR216

Fall 2006

Kelli Shugart RN, MS


Mobility

Mobility

  • Physiology and principles of body mechanics

  • Alignment: posture

  • Balance

  • Gravity and friction


Regulation of movement

Regulation of Movement

  • Bones

  • Joints

  • Ligaments

  • Tendons

  • Cartilage

  • Skeletal muscle


Muscle movement and posture

Muscle Movement and Posture

  • Musculoskeletal function

  • Nervous system


Factors impacting immobility

Factors Impacting Immobility

  • Extent and duration of immobilization

  • Age of individual

  • Physical condition

  • Nutritional intake


Pathological influences on mobility

Pathological Influences on Mobility

  • Postural abnormalities

  • Impaired muscle development

  • CNS damage

  • Musculoskeletal trauma


Systemic effects of immobility

Systemic Effects of Immobility

  • Metabolic

  • Respiratory

  • Cardiovascular

  • Musculoskeletal

  • Muscle effects

  • Skeletal effects


Systemic effects of immobility cont d

Systemic Effects of Immobility Cont’d

  • Urinary and bowel elimination

  • Integumentary

  • Gastrointestinal

  • Genitourinary


Psychosocial and developmental effects

Psychosocial and Developmental Effects

  • Infants, toddlers, preschoolers

  • Adolescents

  • Adults

  • Older adults


Assessment

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


Assessment cont d

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


Physiological assessment

Physiological Assessment

  • Metabolic: anthropometric measurements, wound healing,

  • Respiratory system: ventilatory status, breath sounds

  • Cardiovascular system: BP, pulse, peripheral circulation, signs of DVT


Physiological assessment cont d

Physiological Assessment cont’d

  • Musculoskeletal: ROM; muscle strength, tone, and mass (disuse atrophy)

  • Integumentary: color, integrity, turgur

  • Elimination: I&O


Psychosocial assessment

Psychosocial Assessment

  • Reaction to immobility

  • Developmental stages

  • Client expectations


Nursing diagnoses

Nursing Diagnoses

  • Activity intolerance

  • Ineffective breathing pattern

  • Risk of disuse syndrome

  • Impaired physical mobility

  • Impaired skin integrity

  • Social isolation


Planning

Planning

  • Goals and outcomes

    ~ Client’s skin remains dry and intact

  • Setting priorities

  • Continuity of care


Implementation health promotion

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


Implementation health promotion cont d

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”


Prevention of the hazards of immobility

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


Prevention of respiratory problems

Prevention of Respiratory Problems

  • Cough and deep

  • Ambulate ASAP

  • Fluid intake

  • Incentive spirometer


Prevention of the hazards of immobility cont d

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


Prevention of the hazards of immobility cont d1

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


Prevention of the hazards of immobility cont d2

Prevention of the Hazards of Immobility cont’d

  • Elimination

    ~ Hydration

    ~ I&O

    ~Nutritional intake: fiber

  • Psychosocial

    ~Orientation

    ~Communication

    ~Client participation


Prevention of the hazards of immobility cont d3

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’


Positioning

Positioning


Transfer techniques

Transfer Techniques

  • In bed

  • Bed to chair

  • Bed to stretcher


Implementation restorative care

Implementation: Restorative Care

  • Instrumental activities of daily living

  • Physical and occupational therapy

  • Exercises-ROM

  • Ambulation: canes, walkers, crutches


Evaluation

Evaluation

  • Client care

  • Client expectations


Review

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


Review1

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.


Review2

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.


Review3

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.


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