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
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)
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