MOBILITY.ppt

8/14/2019 MOBILITY.ppt

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Group 1

MOBILITY ANDIMMOBILITY

Copyright 2008 by Pearson Education, Inc.


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MOBILITY AND IMMOBILITY

Mobilityis the ability to move freely,

easily, rhythmically and purposefully in

the environment.

Immobilityrefers to a reduction in theamount and control of movement a

person has.



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Four Basic Elements of

Normal Movement

Body alignment (posture)

Joint mobility

Balance Coordinated movement


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Body Alignment/Posture

Brings body parts into position that

promotes optimal balance and body

function

Person maintains balance as long as line

of gravity passes through center of gravity

and base of support


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Joint Mobility

ROM is maximum movement possible for

joint

ROM varies and determined by:

Developmental patterns

Presence or absence of disease

Physical activity


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Balance

Smooth, purposeful movement

Result of proper functioning of:

Cerebral cortex Initiates voluntary movement

Cerebellum

Coordinates motor activity

Basal ganglia

Maintains posture


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Coordinated Movement

Complex mechanisms

Proprioception

Awareness of posture, movement, changes inequilibrium

Knowledge of position, weight, resistance of

objects in relation to body


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Factors Affecting Body Alignment

and Mobility

Growth and development

Nutrition, personal values and attitudes

External factors

i.e., Temperature, humidity, availability ofrecreational facilities, safety of theneighborhood

Prescribed limitations i.e., Casts, braces, traction, activity

restrictions including bed rest


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Factors Affecting Body Alignment,

Mobility, and Daily Activity Level

Spinal rotation precedes locomotion.


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Assessment of Activity and

Exercise

Nursing History

Physical Examination:

- Body alignment (line of gravity, center ofgravity, base of support)

Gait

Appearance and movement of joints

Capabilities and limitations for movement Muscle mass and strength

Activity tolerance

Problems related to immobility


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RANGE OF MOTION (ROM)

1. Active ROM done by the client

2. Passive ROM

done by health care provider3. ActiveResistive done by client against a weight or force

4. ActiveAssistive

done by stronger arm and leg to weaker armand leg



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Isotonic (Dynamic) Exercise

Muscle shortens to produce muscle

contraction and active movement

Increase muscle tone, mass, and strength

Maintain joint flexibility and circulation

HR and CO quicken increase


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Isometric (Static or Setting)

Exercise

Muscle contraction

without moving the joint

(muscle length does not

change)

Involve exerting pressure

against a solid object

Produce a mild increase

in HR and CO

No apparent increase in

blood flow to other parts

of the body


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Isokinetic (Resistive) Exercise

Muscle contraction or tension against

resistance

Can either be isotonic or isometric

Person moves (isotonic) or tenses

(isometric) against resistance

An increase in blood pressure and bloodflow to muscles occurs


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Effect on Musculoskeletal

System

Exercise

Maintain size, shape,

tone, and strength of

muscles (including theheart muscle)

Nourish joints

Increase joint

flexibility, stability, andROM

Maintain bone density

and strength

Immobility

Disuse osteoporosis

Disuse atrophy

Contractures Stiffness and pain in

the joints


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Effects on the Cardiovascular

System

Exercise Increases HR,

strength of contraction,and blood supply to

the heart and muscles Mediates harmful

effects of stress

Immobility Diminished cardiac

reserve

Increased use of the

Valsalva maneuver

Orthostatichypotension

Venous vasodilation

and stasis Dependent edema

Thrombus formation


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Leg Veins

Active

Person

Inactive

Person


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Effect on the Respiratory

System

Exercise

Increase ventilation

and oxygen intake

improving gas

exchange

Prevents pooling of

secretions in the

bronchi and

bronchioles

Immobility

Decreased respiratory

movement

Pooling of respiratorysecretions

Atelectasis

Hypostatic pneumonia


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Pooling of Secretions:

Immobile Person


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Effects on the

Metabolic/Endocrine System

Exercise

Elevates the metabolic

rate

Decreases serumtriglycerides and

cholesterol

Stabilizes blood sugar

and make cells more

responsive to insulin

Immobility

Decreased metabolic

rate

Negative nitrogenbalance

Anorexia

Negative calcium

balance


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Effects on the GI System

Exercise

Improves the appetite

Increases GI tract tone

Facilitates peristalsis

Immobility

Constipation


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Effect on the Urinary System

Exercise

Promotes blood flow to

the kidneys causing

body wastes to be

excreted more

effectively

Prevents stasis

(stagnation) of urine in

the bladder

Immobility

Urinary stasis

Renal calculi

Urinary retention Urinary infection


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Pooling of Urine


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Other Effects of Exercise and

Immobility

Evidence that certain types of exercise

increase spiritual health

Immobility causes reduced skin turgor and

skin breakdown


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Safe Practice for Positioning,

Moving, Lifting, Ambulating Clients

Correct body mechanics required for nurse

to prevent injury

Correct body alignment for the client also

so that undue stress is not placed on the

musculoskeletal system


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General Guidelines for

Moving and Lifting

Before moving, assess

If indicated, use pain relief modalities

Prepare any needed assistive devices Plan around encumbrances

Be alert to the effects of any medications

Obtain required assistance Explain the procedure to the client


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Transferring a Client

Plan what to do and how to do it

Obtain essential equipment before starting

Remove obstacles

Explain transfer to client and assistive personnel

Support or hold client rather than equipment

Explain what client should do

Make written plan, including clients tolerance


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Ambulating

Assess the amount of assistance the client willrequire

Assess for signs and symptoms of orthostatichypotension

Prepare client for ambulation

Apply transfer or walking belt

Physically support client

Obtain assistance to follow with wheelchair orassist with physical support

Teach client to correctly use mechanical aids


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Traction:

TRACTION:

- The act of pulling and drawing associated

with counter traction.

TYPES OF TRACTION:

A. Manual Traction

B. Skeletal TractionC. Skin Traction.



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Traction:

I. Manual Traction:

-A pulling force applied by the hands of

the operator.

II. Skeletal Traction:

- A pulling force applied directly to the

bones using wires, pins, tongs.

A. KirschnersWire Holderit is thinner

than the steinmannspin.

- For the affection of the radius and ulna.Copyright 2008 by Pearson Education, Inc.


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Traction:

B. Stainmanns Pin Holder

it is for the affection of the humerous,

femur, tibia and fibula.

C. Crutchfield Tongfor the affection of the

upper dorsal cervical spine.

- Inserted at the parietal area.

D. Balanced Skeletal traction

for the affection of the hips or femur.



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Traction:

E. Overhead Traction

supracondylar fracture of the humerous.

F. 9090 Degrees tractionsubtrochanteric and proximal 3rdfracture

of femur.

G. Halo Pelvic Tractionfor C type scoliosis.



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Traction:

H. Halo Femoral Traction

for S type scoliosis.

I. Bohler Braun Splintto support the lower leg.

- For fracture of proximal 3rdand middle

3rd

of tibia or fibula.



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Traction:

III. Skin traction.- Pulling force is applied to the skin,

transmitted to the muscle, then to the

bones.A. Adhesiveuse adhesive tape, elastic

bandage, wooden spreader and wadding

sheet.

B. Non Adhesiveuse for canvass, slings,

leathers, straps with buckels, laces and

ribbons and metal spreader.Copyright 2008 by Pearson Education, Inc.


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Traction:

A. Adhesive.

1. Dunlop Tractionaffection of the

supracondylar of the humerus.

2. Zero Degrees Tractionaffection of the

surgical neck of the humerus and the

shoulder joint.

3. Bucks Extension Traction affection of

the hip and the femur.



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Traction:

4. Bryant TractionAffection of the hip and femur for

children below 3 yrs. Old.

- Also for congenital hip dislocation.5. Boot Cast Traction

for post poliomyelitis with residual

paralysis of the hip and knee.6. Modified Bucks Extension Traction.

- Use of foam instead of plaster (same

indication). Copyright 2008 by Pearson Education, Inc.


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Traction:

Non Adhesive

1. Head Halter Tractionfor cervical spine

affection.

2. Pelvic Girdle Tractionfor lumbo sacral

spine affection.

- For herniated nucleus pulposus.



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Traction:

4. Cotrel Traction

A combination of head halter and pelvic

girdle traction.

for scoliosis.

5. Hammock Suspension Traction

For affection of pelvis.For malgained fracture (double fracture

of the pelvic ring).



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Question 1

To increase stability during clienttransfer, the nurse increases the base ofsupport by performing which of the

following?

1. Leaning slightly backward.

2. Spacing the feet farther apart.

3. Tensing the abdominal muscles.

4. Bending the knees.


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Rationales 1

1. Leaning backward actually decreasesbalance.

2. Correct.A key word in the question is

base, and the feet provide thisfoundation.

3. Tensing abdominal muscles alone does

not affect the base of support.4. Bending the knees does not affect thebase of support.


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Question 3

Which of the following statements from a client withone weak leg regarding use of crutches when usingstairs indicates a need for increased teaching?

1. Going up, the strong leg goes first, then the weakerleg with both crutches.

2. Going down, the weaker leg goes first with bothcrutches, then the strong leg.

3. The weaker leg always goes first with both crutches.4. A cane or single crutch may be used instead of bothcrutches if held on the weaker side.


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Rationales 3

1. This is correct.

2. This is correct.

3. Correc t.Although the crutches (or cane) are

always used along with the weaker leg, theweaker leg should go down the stairs first. The

stronger leg can support the body as the

weaker leg moves forward. All of the other

statements are correct.

4. This is correct.


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Question 4

Because the client weighs 250 pounds, the nurseshould provide the unlicensed assistive personnel(UAP) with instructions that reflect an awareness ofworkplace injury. Which of the following is mostappropriate?

1. Using proper body mechanics will prevent you frominjuring yourself.

2. You are physically fit and at lesser risk for injury whentransferring the client.

3. Use the mechanical lift and another person to transferthe client from the bed to the chair.

4. Use the back belt to avoid hurting your back.


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Rationales 4

1. It is generally accepted that proper bodymechanics alone will not prevent injury.

2. Incorrect.

3. Correct.It is prudent for nurses to understand

and use proper body mechanics at all times todecrease risk, while keeping in mind theimportance of assistive devices and help fromother staff. While, many work settings do notyet have no manual lift and no solo liftpolicies and resources in place.

4. Incorrect.


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Question 5

The client is ambulating for the first time aftersurgery. The client tells the nurse, I feel faint.The best action by the nurse includes which ofthe following?

1. Find another nurse for help.

2. Return the client to her room as quickly as

possible.3. Tell the client to take rapid, shallow breaths.

4. Assist the client to a nearby chair.


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Rationales 5

1. Leaving the client creates unsafe conditions as

the client may faint before being able to return

to her room.

2. The client may faint before being able to returnto her room.

3. Rapid, shallow breathing (hyperventilation)

may increase the dizziness.

4. Correct.Placing the client in a safe position is

the best maneuver.

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