mobility & immobility
DESCRIPTION
Musculo skeletal systemTRANSCRIPT
MOBILITY & IMMOBILITY
MOBILITY DEFINITION
The ability to move freely,
easily, rhythmically and purposefully
in the environment.
The ability to move also
influences persons self-esteem. It
depends on a sense of independence
and a feeling of usefulness.
IMMOBILITY
Refers to a reduction in the
amount and control of
movement a person has. It is the
inability to move the whole
body or its part.
Factors affecting mobility1.Age It generally affects the activity
level and general mobility. As people get older, activity level get slow down.
2.Lifestyle People learn early in life often
from families, the value of activity in relation to health. some people participate in physical activities regularly in an effort to maintain or improve health.
3.Energy level It influences an individual’s
mobility. people demonstrate different energy level at different times.
4.Fear & pain These can limit mobility.
5.Disability
A disability is a persistent
mental or physical weakness that
prevent a person from caring out the
normal activities of life.
BODY MECHANICSBody mechanics is
defined as using alignment,
posture and balance in a
coordinated in a coordinated
effort to perform activities
such as lifting, bending and
moving.
POSTURE
It is defined as the position in
which the various parts of the
body are held when sitting,
standing, and lying down.
POSTURAL ABNORMALITIESKYPHOSIS
It is an abnormal condition of the vertebral column characterized by increased convexity in the thoracic spine.
LORDOSISIt is an abnormal condition of
the vertebral column characterized by an exaggerated curvature of the lumbar spine.
SCOLIOSIS
It is an abnormal condition of
the vertebral column
characterized by a lateral
deviation.
PRINCIPLES OF BODY MECHANICS1. Proper balancing of all body parts
helps to conserve energy.2. Stability of the body part is
maintained by having a greater base of support.
3. Injury and strain on the lower back can be avoided by performing pelvic tilt before the activity.
4. Facing the direction of work will helps to avoid the chances of injury.
5.Initiating movement requires more energy than maintaining the movement of an object.
6.Moving an object on a level surface requires less effort.
7.Reducing friction between the object moved and the surface on which it is moved requires less energy.
8.Holding an object close to the body requires less energy than holding it farther away.
9.Muscle strain can be avoided by
using the strong leg muscle when
lifting, pushing and pulling.
10.Smooth continuous movements
are easier and safer than sudden
sharp or uncontrolled movements.
11.Using rhythmic movements at
normal speed requires less energy.
Maintenance of Normal Body Alignment
Assess the situation carefully before acting. Careful planning is very important.Maintain good body posture in all activities. Stand with a wide base of support. The greater the base of support the more stable the body is.
Use the stronger, longer and larger
muscles of the body which include the
shoulders, upper arms, thighs and hips.
This helps to reduce muscle strain.
While lifting, moving or carrying an
object, keep it close to the body to
prevent unnecessary strain on the
muscle. This brings centre of gravity of
the object close to the centre of gravity
of the body.
Avoid unnecessary reaching for an
object. Flex the knees to come close to
the object. Adjust the bed/table to the
proper height.
Keep work close to the body. E.g: Sit
close to the desk when performing a
task at a desk.
Slide, roll, push or pull the object rather
than lifting it in order to reduce the
energy needed to lift the weight against
the pull of gravity.
Use the weight of the body to pull or
push an object.
Face the area of direction of motion,
using the muscles of the lower
extremities and shifting body weight for
lifting, pushing and pulling activities.
This will reduce the chances of injury.
For lifting, moving or carrying heavy
objects use both hands and arms.
While changing the direction of
movement turn the whole body.
Avoid sudden jerky movements.
To lift heavy objects, try to get help
from a co-worker.
Squat to lift heavy objects from the floor. Push against the strong hip and thigh muscles to raise oneself to standing position.Pelvic tilt before activity will help to protect the lower back from injury.Energy requirement will be less to keep an object moving than to initiate a movement.
Less effort and energy is required to
move an object on a level surface.
Energy expenditure can be minimized by
reducing the friction between the object
moved and the surface on which it is
moved.
Use of rhythmic movements at a normal
speed to reduce energy.
Always assume a starting position,
which will allow freedom of movement
in range, direction and position.
Bend hips and knees to alter position of
the body. Use elbows, hip and knees as
levers when lifting.
Use mechanical devices when
appropriate.
General Instructions in Moving and Lifting clients
Plan the movement of the client ahead
of time and be sure the path is clear.
Face the direction in which the
movement will be made, to avoid
twisting of the vertebral column.
Place the feet comfortably apart to
provide a wide base of support.
Flex the knees and hip joints but keep
the trunks as vertical as possible.
Keep the client as close to the body as
possible.
Avoid jerking and twisting during the
lift.
Heavy clients should be moved in bed
by sliding them rather than lifting them.
Assistance should be requested when
lifting or moving heavy clients.
The height of the bed should be
adjusted to a height that permits the
nurse to keep her back as erect as
possible when moving the client in bed.
This reduces injury to the lower back.
The client is moved to the edge of the bed before he is lifted from the bed.This helps the nurse to keep her trunk more erect.When moving a client by more than one person, each worker should support the clients body sections.
Head, shoulders and chestHipsThighs and ankles.
In order to coordinate the movements
of the workers the leader gives signal as
1, 2, 3.During each count the workers
should perform a particular procedure.
Encourage the client to use his/ her
abilities if not contraindicated.
Observe for symptoms of orthostatic
hypotension.
Do not support the client under his
armpits because it may cause injury to
major nerves and blood vessels.
Always lock the wheels of the bed and
stretcher prior to transferring the client
to increase the static friction between
the wheels and the floor.
HAZARDS OF IMMOBILITYMusculoskeletal system Effects
AtrophyIt is the decrease in size of a
normally developed tissue /organ as a result of inactivity or diminished function.Disuse osteoporosis:
Demineralization of bones take place because of continues immobility.
Contracture
It is the abnormal
shortening of muscle fibers or
their associated connective
tissue, resulting in resistance to
stretching and eventually to
flexion and finally to permanent
fixation.
Reversible contractureIt is the shortening of
a muscle which can be corrected by exercise.
Non- Reversible contracture
It is one in which the
muscle or tendon becomes
permanently fixed/frozen.
Foot Drop
It is the contracture
deformity in which the muscle of
the anterior foot lengthens and
the muscles of the plantar
flexion and the achilles tendon
shorten, resulting in plantar
flexion of the foot.
Wrist DropIt is the contracture deformity
of the wrist in the flexed position. In this, there is flexion of the wrist and fingers and opposition of the thumb.Stiffness and pain in the joints
Without movement the connective tissue in the joints get immobile, in addition bone demineralization result in deposition of calcium to the joints.
Integumentary System EffectsPressure Ulcer
It is any lesion caused by unrelieved pressure that leads to damage of the underlying tissue.
Shear A strain produced by
pressure in the structure of a substance, when its layers are laterally shifted in relation to each other.
Excoriation
It is an injury to the epidermis caused by abrasion, scratching, a burn or chemicals, such as sweat, wound drainage, feces or urine coming in contact with skin.Maceration It is a softening of the epidermis caused by a prolonged contact with moisture such as from a wet sheet or diaper.
Cardiovascular System EffectsOrthostatic intolerance
It is a drop in systolic B.P by 20mm Hg or more, and a drop in diastolic blood pressure by 10mm Hg or more for 1 to 2 min after a client stands up.Deep Vein Thrombosis
It is the formation of thrombus or blood clot in the lumen of a deep leg vein such as tibial, popliteal, femoral or iliac vein.
Pulmonary EmbolismIt is the blockage of pulmonary
blood vessel by an embolus resulting in the blockage of blood flow and oxygen to the lung tissue supplied by the particular blood vessel.Dependent edema
Increased venous pressure causes extravasations of blood to interstitial part resulting edema.(in lower limbs)
Venous vasodilatation and stasis.
Skeletal muscles(insufficient contraction
or atrophy) cannot assist in pumping blood
back to heart result in pooling of blood in
lower limbs causing vasodilatation,
engorgement and stasis of blood in lower
limbs .
Thrombus formation
Impaired venous return,
hypercoagulability of blood and injury to
vessel wall causes thrombus formation and
thrombo phlebitis(inflammation of vein)
Respiratory System EffectsHypostatic Pneumonia
It is an inflammation
of the lungs caused by stasis of
secretions which become a
medium for bacterial growth.
Decreased respiratory movement:
Restricted lung movement and atrophy of respiratory muscles result in reduced vital capacity.Pooling of secretions
It interfere with gas exchangeAtlectasis
Partial or complete collapse of the lung. Occurs as a result of mucus block.
Gastro Intestinal System EffectsAnorexia
It is the Loss of Appetite.Hypo motility
It is the decreased peristalsis from lack of stimulation of the gastro colic reflex.Constipation
Occurs as a result of decreased peristalsis and colon motility.
Genito Urinary System EffectsUrinary tract infection
Urinary stasis favours
the growth of bacteria which can
cause urinary tract infection.
Renal Calculi
These are stones formed in the
kidney, when the excretion rates of calcium
or other minerals are high as when
osteoclastic activity releases calcium from
the bones during immobility.
Urinary stasis
It is stoppage or slowdown the
urine flow, as a result of decreased effect of
gravity, decreased muscle tone.Urinary retention
As result of decreased muscle tone
of bladder and inability to relax perineal
muscle.
Effects on Activities of Daily Living
Impaired mobility can
severely restrict the client’s ability to
perform normal daily activities either
temporarily or permanently.
Effects on Psycho neurologic system
Lower the person’s Self Esteem
Increased risk of Depression
Decreased social interaction
Nursing managementAssessingNursing HistoryPhysical examination
Body AlignmentAppearance and movement of jointsCapabilities and limitation for movementMuscle mass and strengthActivity toleranceProblems related to immobility
Nursing Diagnosis
Nursing diagnoses related to mobility focus
primarily on activity and mobility levels, and
the psychosocial impact that alterations in
mobility can have on a client and the client’s
family. Common NANDA nursing diagnoses
related to the risks resulting from altered
mobility include:
• Activity Intolerance related to bed rest and immobility, generalized weakness, sedentary lifestyle, and imbalance between oxygen supply and demand.• Impaired Physical Mobility related to
intolerance to activity or decreased strength, pain, perceptual or cognitive impairment, neuromuscular impairment, musculoskeletal impairment, and depression or severe anxiety.
• Self-Care Deficits related to inability to wash body or body parts, inability to obtain water source, activity intolerance, decreased strength and endurance, pain, and impaired transfer ability• Ineffective Health Maintenance related
to lack of or significant alteration in communication skills (written, nonverbal)
• Risk for Falls related to impaired mobility.
Alterations in family and social processes
may also result from immobility and
inactivity. Disruption in activity and mobility
leads to impairment of the ability to perform
one’s usual social, vocational, educational,
and family roles.
There are often changes in the client’s perception of role. Disturbed Body Image and Situational Low Self-Esteem can result from:
• Changes in physical abilities• Changes in family responsibilities• Lack of knowledge regarding rehabilitation• Fear (of falling)• Ineffective coping• Low self esteem• Powerlessness
PlanningImplementing Nursing strategies to maintain or
promote body alignment and mobility involve positioning clients appropriately, moving and turning clients in bed, transferring clients, providing ROM exercises, ambulating clients with or without mechanical aids.
Evaluation
ALTERATIONS IN MOBILITYSOFT TISSUE INJURIES
CONTUSIONS :Occurs when blood vessels
are damaged and broken as a result of
a blow to the skin (ecchymosis).
STRAINS : Are injuries that affect
muscles or tendons, thick bands that
attach muscles to bones. They occur
in response to a quick tear, twist or
pull of the muscle. Pain, weakness
and muscle spasms are common
symptoms of strain.
SPRAINS : Affect ligaments, thick bands of
cartilage that attach bone to bone; they
occur in response to a stretch or tear of
a ligament; an outside force displaces
the surrounding joint from its normal
alignment; bruising, swelling, instability
are common.
MANAGEMENT
RICERestIceIst 24-48hrs : cold 20-30min/application with
10-15 min break between 2 applicationsThen apply heat 20-30 min/applicationCompressionElevation of the affected part
TRACTIONTraction is the application of a pulling force to a part of the body.
Traction must be applied in the correct direction and magnitude to obtain its therapeutic effects.
Indications:
Traction is used to– To minimize muscle spasm.– To reduce align, and immobilize fractures– To reduce deformity .