Mobility and ImmobilityMobility and Immobility
NUR216 NUR216
Fall 2006Fall 2006
Kelli Shugart RN, MSKelli Shugart RN, MS
MobilityMobility
Physiology and principles of body mechanicsPhysiology and principles of body mechanics
1.1. Alignment: postureAlignment: posture
2.2. BalanceBalance
3.3. Gravity and frictionGravity and friction
Regulation of MovementRegulation of Movement
BonesBones JointsJoints LigamentsLigaments TendonsTendons CartilageCartilage Skeletal muscleSkeletal muscle
Muscle Movement and PostureMuscle Movement and Posture
Musculoskeletal functionMusculoskeletal function Nervous systemNervous system
Factors Impacting ImmobilityFactors Impacting Immobility
Extent and duration of immobilizationExtent and duration of immobilization Age of individualAge of individual Physical conditionPhysical condition Nutritional intakeNutritional intake
Pathological Influences on Mobility Pathological Influences on Mobility
Postural abnormalitiesPostural abnormalities Impaired muscle developmentImpaired muscle development CNS damageCNS damage Musculoskeletal traumaMusculoskeletal trauma
Systemic Effects of ImmobilitySystemic Effects of Immobility
MetabolicMetabolic RespiratoryRespiratory CardiovascularCardiovascular MusculoskeletalMusculoskeletal
1.1. Muscle effectsMuscle effects
2.2. Skeletal effectsSkeletal effects
Systemic Effects of Immobility Systemic Effects of Immobility Cont’dCont’d
Urinary and bowel eliminationUrinary and bowel elimination IntegumentaryIntegumentary GastrointestinalGastrointestinal GenitourinaryGenitourinary
Psychosocial and Developmental Psychosocial and Developmental EffectsEffects
Infants, toddlers, preschoolersInfants, toddlers, preschoolers AdolescentsAdolescents AdultsAdults Older adultsOlder adults
AssessmentAssessment MobilityMobility1.1. Bed restBed rest
a. a. Decrease activity and O2 demandDecrease activity and O2 demandbb. Reduce pain. Reduce painc. c. RestRest
• Results from prescription of BRResults from prescription of BR• Physical restriction because of external devicePhysical restriction because of external device• Voluntary restrictionVoluntary restriction• Impairment to skeletal or motor functionImpairment to skeletal or motor function* Muscular deconditioning may occur in a matter of days. * Muscular deconditioning may occur in a matter of days. * Individuals on BR lose muscle strength at a rate of 3% QD* Individuals on BR lose muscle strength at a rate of 3% QD
Assessment cont’dAssessment cont’d
Range of motion (ROM)Range of motion (ROM) GaitGait Exercise and activity toleranceExercise and activity tolerance
1.1. Activity tolerance- amt of exercise or activity Activity tolerance- amt of exercise or activity that a person is able to perform. that a person is able to perform.
aa.. Physiological, emotional, and Physiological, emotional, and developmental factors influence tolerancedevelopmental factors influence tolerance
Body alignment: standing, sitting, lyingBody alignment: standing, sitting, lying
Physiological AssessmentPhysiological Assessment
Metabolic: anthropometric measurements, Metabolic: anthropometric measurements, wound healing, wound healing,
Respiratory system: ventilatory status, breath Respiratory system: ventilatory status, breath soundssounds
Cardiovascular system: BP, pulse, peripheral Cardiovascular system: BP, pulse, peripheral circulation, signs of DVTcirculation, signs of DVT
Physiological Assessment cont’dPhysiological Assessment cont’d
Musculoskeletal: ROM; muscle strength, tone, Musculoskeletal: ROM; muscle strength, tone, and mass (disuse atrophy)and mass (disuse atrophy)
Integumentary: color, integrity, turgurIntegumentary: color, integrity, turgur Elimination: I&OElimination: I&O
Psychosocial AssessmentPsychosocial Assessment
Reaction to immobilityReaction to immobility Developmental stagesDevelopmental stages Client expectationsClient expectations
Nursing DiagnosesNursing Diagnoses
Activity intoleranceActivity intolerance Ineffective breathing patternIneffective breathing pattern Risk of disuse syndromeRisk of disuse syndrome Impaired physical mobilityImpaired physical mobility Impaired skin integrityImpaired skin integrity Social isolationSocial isolation
PlanningPlanning
Goals and outcomesGoals and outcomes
~ Client’s skin remains dry and intact~ Client’s skin remains dry and intact Setting prioritiesSetting priorities Continuity of careContinuity of care
Implementation: Health PromotionImplementation: Health Promotion
Lifting techniquesLifting techniques ExerciseExercise1.1. Improves cardiac outputImproves cardiac output2.2. Decreasing resting heart rateDecreasing resting heart rate3.3. Increasing respiration rate and depthIncreasing respiration rate and depth4.4. Decreasing work of breathingDecreasing work of breathing5.5. Increase basal metabolic rateIncrease basal metabolic rate6.6. Increase use of glucose and fatty acidsIncrease use of glucose and fatty acids
Implementation: Health Promotion Implementation: Health Promotion cont’dcont’d
1.1. Increase gastric motilityIncrease gastric motility
2.2. Improved muscle toneImproved muscle tone
3.3. Increased joint mobilityIncreased joint mobility
4.4. Reduce bone lossReduce bone loss
5.5. Decrease fatigueDecrease fatigue
6.6. Reports of decrease in illnessReports of decrease in illness
7.7. Reports of “feeling better”Reports of “feeling better”
Prevention of the Hazards of Prevention of the Hazards of ImmobilityImmobility
MetabolicMetabolic
~ Nutritional needs: protein, calories, vitamins ~ Nutritional needs: protein, calories, vitamins (B and C)(B and C)
Respiratory systemRespiratory system
~ Promotion of chest and lung expansion~ Promotion of chest and lung expansion
~ Removal of secretions~ Removal of secretions
~ Maintenance of patent airway~ Maintenance of patent airway
Prevention of Respiratory ProblemsPrevention of Respiratory Problems Cough and deepCough and deep Ambulate ASAPAmbulate ASAP Fluid intakeFluid intake Incentive spirometerIncentive spirometer
Prevention of the Hazards of Prevention of the Hazards of Immobility cont’dImmobility cont’d
Cardiovascular systemCardiovascular system
~ Reducing orthostatic hypotension~ Reducing orthostatic hypotension
~ Reducing cardiac workload: discourage ~ Reducing cardiac workload: discourage Valsalva maneuverValsalva maneuver
~ Preventing thrombus formation: medication, ~ Preventing thrombus formation: medication, exercise, fluids, TED stockings, pneumatic exercise, fluids, TED stockings, pneumatic compression, positioningcompression, positioning
Prevention of the Hazards of Prevention of the Hazards of Immobility cont’dImmobility cont’d
Musculoskeletal systemMusculoskeletal system
~ ROM~ ROM
~ Isometric exercise~ Isometric exercise Integumentary systemIntegumentary system
~ Turning every 1 to 2 hours~ Turning every 1 to 2 hours
~Hygienic care~Hygienic care
~Protection: preventive aids~Protection: preventive aids
Prevention of the Hazards of Prevention of the Hazards of Immobility cont’dImmobility cont’d
EliminationElimination~ Hydration~ Hydration~ I&O~ I&O~Nutritional intake: fiber~Nutritional intake: fiber PsychosocialPsychosocial~Orientation~Orientation~Communication~Communication~Client participation~Client participation
Prevention of the Hazards of Prevention of the Hazards of Immobility cont’dImmobility cont’d
PositioningPositioning
~ Supports: footboards, trochanter rolls, hand ~ Supports: footboards, trochanter rolls, hand rolls, and splintsrolls, and splints
~ Trapeze bar~ Trapeze bar
~ Bed position: Fowler’s, supine, prone, side-~ Bed position: Fowler’s, supine, prone, side-lying, Sims’lying, Sims’
PositioningPositioning
Transfer TechniquesTransfer Techniques
In bedIn bed Bed to chairBed to chair Bed to stretcherBed to stretcher
Implementation: Restorative CareImplementation: Restorative Care
Instrumental activities of daily livingInstrumental activities of daily living Physical and occupational therapyPhysical and occupational therapy Exercises-ROMExercises-ROM Ambulation: canes, walkers, crutchesAmbulation: canes, walkers, crutches
EvaluationEvaluation
Client careClient care Client expectationsClient expectations
ReviewReview
Cane (948)Cane (948)
~ Placed on stronger side. ~ Placed on stronger side.
~ Cane, weak leg, stronger leg…repeat…~ Cane, weak leg, stronger leg…repeat… Crutches (948)Crutches (948)
~ Measurement and axilla~ Measurement and axilla
~ Rubber tips prevent slipping, keep dry~ Rubber tips prevent slipping, keep dry
~ Basic crutch stance is the tripod position~ Basic crutch stance is the tripod position
ReviewReview
4 Point4 Point~ Gives stability but requires weight bearing on ~ Gives stability but requires weight bearing on
both legs.both legs. 3 Point3 Point~ Requires weight bearing on one leg. ~ Requires weight bearing on one leg. ~ Weight on both crutches and affected leg, then ~ Weight on both crutches and affected leg, then
uninvolved leg, repeat.uninvolved leg, repeat.~ During early phases the affected leg does not ~ During early phases the affected leg does not
touch. Progresses to touchdown then full wt.touch. Progresses to touchdown then full wt.
ReviewReview
2 Point2 Point
~ Requires at least partial wt bearing on both ~ Requires at least partial wt bearing on both legs.legs.
~ A crutch and opposing leg then the other ~ A crutch and opposing leg then the other crutch and opposing leg. Movement similar to crutch and opposing leg. Movement similar to arms swinging.arms swinging.
ReviewReview
Body mechanics (946)Body mechanics (946)1.1. Adequate helpAdequate help2.2. Keep body aligned. Avoid twisting.Keep body aligned. Avoid twisting.3.3. Flex knees; keep feet wide apartFlex knees; keep feet wide apart4.4. Position self close to patient.Position self close to patient.5.5. Person with heaviest workload coordinatesPerson with heaviest workload coordinates6.6. Proper position when pulling patient up in Proper position when pulling patient up in
bed. bed.
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