Issues of Mobility and Immobility

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Issues of Mobility and Immobility
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Definitions

• Mobility
• Persons ability to move about freely
• Immobility
• Inability to move about freely

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Some Things to Know

• Body alignment
• Body balance
• Coordinated body movement
• Friction
• Exercise and activity

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Principles Related to Friction

• The greater the surface area of an object to be
  moved, the greater the friction.
• A passive or immobilized client produces greater
  friction to movement.
• Friction can be reduced by lifting rather than
  pushing a client.

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Purpose of Exercise and Activity

• Conditioning the body
• Improving health
• Maintaining fitness
• Therapeutic measure

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Activity Tolerance

• What is it?
• What can influence activity tolerance?

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Coordinated Movement

• What body systems are involved in coordinated
  movement?
• What is proprioception?

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Principles of Body Mechanics

• Wide base of supports --gt ? stability
• Lower center of gravity --gt ? stability
• Equilibrium of an object is maintained as long as
  line of gravity passes through base of support
• Facing direction of movement prevents abnormal
  twisting of upper torso
• Dividing balanced activity between arms and legs
  ? risk of back injury (use of largest and
  strongest muscle groups)

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Principles of Body Mechanics

• Leverage, rolling, turning or pivoting requires
  less work than lifting
• When friction between object to be moved and
  surface on which it is moved is reduced, less
  force is required to move the object
• Reducing the force of work reduces the risk of
  injury
• Good body alignment reduces fatigue of muscle
  groups
• Alternating periods of rest and activity helps to
  reduce fatigue

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Things that Influence Body Mechanics

• Pathological conditions
• Developmental changes
• Behavioral aspects
• Environmental issues
• Cultural and ethnic influences
• Family and social support

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Pathological Conditions

• Postural abnormalities
• Congenital
• Acquired
• Disorders of bones, joints, muscles
• Injury
• disease
• CNS damage
• Musculoskeletal trauma
• Muscle atrophy

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Developmental Changes

• Greatest change and impact observed in children
  and elderly

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Behavioral Aspects

• More likely to incorporate change if supported by
  others
• Must assess knowledge of exercise and activity,
  barriers to program, and current exercise program
• Must reach stage of readiness to change behavior

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Environmental Issues

• Work site
• Many employees dont get adequate activity
• Schools
• Increase in childhood obesity
• Community
• Support of physical fitness can be instrumental
  in promoting health

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Cultural and Ethnic Influences

• Assess cultural practice
• What are motivators
• What disease entities are associated with
  different cultural and ethnic origins

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Family and Social Support

• Motivational
• Parental support
• Family activities

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Assessment

• Posture/positioning
• Standing
• Sitting
• recumbent
• Mobility
• Range of motion
• Gait
• Exercise and activity tolerance

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Nursing Diagnoses R/T Mobility Alterations

• Activity intolerance
• Disturbed body image
• Ineffective coping
• Impaired gas exchange
• Risk for injury
• Impaired physical mobility
• Imbalanced nutrition more than body requirements
• Acute or chronic pain
• Impaired skin integrity

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Planning

• Consider pre-existing health concerns
• Gain knowledge of home environment
• Include family
• Monitor client and supervise assistive personnel
• Prevent complications and potential injury

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Implementation

• Health promotion
• Body mechanics
• Maintenance of musculoskeletal system and joint
  mobility
• Walking
• Restorative and continuing care
• Assistive devices
• Bedrest

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Range of Motion

• Maximum amount of movement available at a joint
  in one of three planes of the body
• Active or Passive
• Assessing
• Stiffness, swelling, pain, limited movement,
  unequal movement
• Benefits
• Reduce hazards of immobility

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Evaluation

• Client is only one who will know the
  effectiveness and benefits of activity and
  exercise.
• Comparison of actual outcomes to expected
  outcomes

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Physiological Effects of Immobility

• Systemic effects
• Metabolic
• Respiratory
• Cardiovascular
• Musculoskeletal
• Muscle effects
• Skeletal effects
• Urinary elimination
• Integumentary

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Assessing Physiological Effects

• Metabolic
• Anthropometric data
• Fluid balance
• Appetite
• Respiratory
• Q 2 hour assessment
• Inspection
• Auscultation

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Assessing Physiological Effects

• Cardiovascular
• Monitor BP, apical and peripheral pulses, s/s of
  venous stasis
• Orthostatic hypotension
• Presence of edema
• Presence of DVT
• Musculoskeletal
• Muscle tone and strength
• ROM

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Assessing Physiological Effects

• Integumentary
• Continuous surveillance of skin condition
• Elimination
• IO Q shift

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What Assessment Technique /or Equipment Should
Be Used?

• Muscle atrophy
• Orthostatic hypotension
• Thrombosis
• Urinary retention
• Fecal impaction
• Atelectasis

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Psychosocial and Developmental Effects of
Immobility

• Psychosocial
• Emotional
• Behavioral

• Developmental
• Infants, toddlers, pre-schoolers
• Adolescents
• Adults
• Older adults

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Assessing Psychosocial Effects

• Observe for
• Abrupt personality changes
• Acute confusion
• Change from usual coping pattern
• Changes in sleep-wake cycle

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Assessing Developmental Effects

• Childs development
• Regression or slowing
• Adult
• Change in family function
• Older adult
• Change in health, independence and functional
  status

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Nursing Diagnoses R/T Effects of Immobility

• Ineffective airway clearance
• Ineffective breathing pattern
• Risk for disuse syndrome
• Risk for deficient fluid volume
• Risk for infection
• Impaired physical mobility
• Disturbed sleep pattern
• Social isolation
• Impaired urinary elimination

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Interventions to Reduce Hazards of Immobility

• Metabolic
• High protein, high calorie diet with vitamin B
  and C supplements
• Respiratory
• Promote chest and lung expansion
• Prevent stasis of pulmonary stasis
• Chest physiotherapy
• Maintaining a patent airway

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Interventions to Reduce Hazards of Immobility

• Cardiovascular
• Reduce orthostatic hypotension
• Reducing cardiac workload
• Prevent thrombus formation
• Musculoskeletal
• Exercise to prevent muscle atrophy
• AROM or PROM

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Interventions to Reduce Hazards of Immobility

• Integumentary
• Positioning, skin care, therapeutic devices to
  relieve pressure
• Early identification of high-risk clients
• Education
• Elimination
• Promote hydration and prevent urinary stasis,
  calculi, and infections
• Monitoring output of urine and feces

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Interventions to Reduce Hazards of Immobility

• Psychosocial changes
• Anticipate changes
• Encourage client interaction with staff
• Provide stimuli
• Encourage client participation in care decisions
• Developmental changes

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Positioning

• To obtain proper body alignment
• Positioning devices
• Pillows, footboard, trochanter roll, hand roll,
  splints, trapeze bar
• Body positions
• Supine
• Prone
• Fowlers
• Sims
• Lateral (side-lying)

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Transfer Guidelines

• Proper body mechanics
• Raise side rail on side opposite nurse
• Raise bed to comfortable level
• Determine need for assistance
• Explain procedure and describe what is expected
  of client
• Assess correct body alignment and pressure areas
  after each transfer

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Types of Transfers

• Moving clients
• Up in bed
• To side-lying position
• To side of bed
• Transfer from bed to chair
• Transfer from bed to stretcher

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