Basic Human NeedsBasic Human NeedsMobility & the Hazards of Mobility & the Hazards of ImmobilityImmobility

Mobility serves many purposesMobility serves many purposesPerformance of ADLSatisfaction of basic needsSelf-defenseExpression of emotionRecreational activitiesNeed intact & functioning M/S & nervous

system to achieve mobility

Principles of Body MechanicsPrinciples of Body MechanicsBody Mechanics-coordinated efforts of

M/S & nervous systems to maintain balance, posture & body alignment during lifting, bending, moving, & performing ADL’s

Proper use of body mechanics reduces risk for injury and ensures safe care

Principles of Body MechanicsPrinciples of Body MechanicsAlignment

Balance

Gravity

Friction

Regulation of MovementRegulation of MovementSkeletal systemSkeletal system functionsCharacteristics of bone, joints,ligaments,

tendons, cartilageSkeletal muscleMuscle toneNervous system

Pathological Influences of Pathological Influences of MobilityMobilityPostural AbnormalitiesImpaired Muscle DevelopmentDamage to CNSDirect Trauma to M/S System

Systemic Changes Associated Systemic Changes Associated With ImmobilityWith Immobility Metabolic changes: Endocrine metabolism affected (decrease in BMR) Disrupts metabolic functioning Fluid & Lyte Imbalances Decreased calories & protein Negative Nitrogen Balance Calcium Resorption affected Functioning of GI tract

Respiratory ChangesRespiratory ChangesLack of exercise & movement put client at

risk for:Atelectasis-Collapse of alveoli leading to

partial collapse of lungHypostatic Pneumonia- Inflammation of

lung tissue from stasis or pooling of secretions

Both decrease oxygenation, prolong recovery, & add to discomfort

Cardiovascular ChangesCardiovascular ChangesOrthostatic hypotension

Increased workload of heart due to decrease in venous return to the heart

Risk for thrombus (Virchow’s Triad)

Musculoskeletal ChangesMusculoskeletal ChangesMuscle effects (muscle atrophy)

Skeletal effects- Disuse osteoporosis, contractures and foot drop

Urinary Elimination ChangesUrinary Elimination ChangesStasis and pooling of urine in renal pelvis

leads to increased risk for infection and renal calculi

Risk for dehydration and decreased urine output

UTI’s due to foley catheter

Other ChangesOther ChangesIntegumentary changes (Risk assessment

tool for skin breakdown, proper skin hygiene)

Psychosocial effects (Depression from immobility)

Developmental Changes

Nursing Process & ImmobilityNursing Process & ImmobilityAssessmentAssess immobilized client for hazards of

immobilityROM exercises (P&P pgs. 1435-1439)

Nursing Process: Nursing Nursing Process: Nursing DiagnosisDiagnosisYou tell me!!!

ImplementationImplementationHealth PromotionAcute Care: Metabolic system Respiratory system Cardiovascular system Musculoskeletal system Elimination system

Metabolic SystemMetabolic System Evaluate muscle atrophy I&O Monitor lab data (BUN, albumin, protein,

electrolytes) Assess wound healing Assess edema Assess for dehydration (Skin turgor, mucous

membranes) Assess nutritional status (protein and vitamin

supplements, enteral feedings, TPN)

Respiratory SystemRespiratory System Frequent respiratory assessment Ascultate lung sounds Inspect chest wall movement Promote lung expansion and stasis of pulmonary

secrections Deep breathing and coughing exercises Incentive spirometer Chest physiotherapy Suctioning Hydration Positioning every 2 hours

Cardiovascular SystemCardiovascular System Vital sign monitoring Assess for orthostatic changes (Baseline BP) Reduce workload of heart Peripheral pulse assessment Assessment of edema (hearts inability to handle

increased work load) Prevent thrombus formation Assessment of VTE/DVT (Calf circumference)

Prevent Thrombus FormationPrevent Thrombus FormationAnticoagulants (Lovenox, Heparin)

TED Stockings

Calf pumping exercises

Sequential compression stockings

Musculoskeletal SystemMusculoskeletal SystemAssessment of muscle tone, strength, loss

of muscle mass, contracturesAssess for risk of disuse osteoporosisAssessment of ROMPassive ROM for all immobilized jointsPhysical therapy consultPrevent foot drop and contractures

Elimination SystemElimination SystemI&O each shiftAssess for fluid & electrolyte imbalancesBowel assessmentAdequate hydrationIncontinent considerationsAssess bladder distention

Positioning techniquesPositioning techniquesFootboardTrocanter rollTrapeze barPillowsSplintsAbductor pillow ROM exercises

Practice ScenarioPractice ScenarioA 72 year old client is recovering

following abdominal surgery for colon cancer. Which hazards of immobility is this client at risk for and why?

How would you as the nurse prevent post-operative complications associated with this client’s condition?

Clicker QuestionClicker QuestionWhich nursing assessment of the

immobilized client would prompt the nurse to take further action?

A. Client complaining of fatiqueB. Urinary output of 50 ml/hrC. White blood cell count of 9.5D. Absence of bowel sounds

Clicker QuestionClicker Question During an exercise session, the nurse assists the

client to dorsiflex and plantarflex the foot, explaining the client needs to exercise the foot to maintain function. The nurse recognizes this type of exercise activity as:

A. Active range of motion B. Passive range of motion C. Isometric exercise D. Isotonic exercise

Clicker QuestionClicker QuestionWhich of the following patients is most at

risk for thrombus formation?A. Patient with renal failureB. Patient with severe abdominal painC. Patient with a total hip replacementD. Patient with right sided heart failure

Clicker QuestionClicker QuestionWhich of the following is true concerning

the physiologic effects of immobility?A. Serum calcium levels decrease.B. Hypertension develops because of

increased cardiac workload.C. Caloric intake often increases.D. Secretions may block bronchioles.