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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

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’

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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