1. Basic Human Needs Mobility & the Hazards of Immobility

2. Mobility serves many purposes
Performance of ADL
Satisfaction of basic needs
Self-defense
Expression of emotion
Recreational activities
Need intact & functioning M/S & nervous system to achieve mobility

3. Principles of Body Mechanics
Body 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

4. Principles of Body Mechanics
Alignment
Balance
Gravity
Friction

6. Regulation of Movement
Skeletal system
Skeletal system functions
Characteristics of bone, joints,ligaments, tendons, cartilage
Skeletal muscle
Muscle tone
Nervous system

8. Pathological Influences of Mobility
Postural Abnormalities
Impaired Muscle Development
Damage to CNS
Direct Trauma to M/S System

12. Systemic Changes Associated With 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

14. Respiratory Changes
Lack of exercise & movement put client at risk for:
Atelectasis-Collapse of alveoli leading to partial collapse of lung
Hypostatic Pneumonia- Inflammation of lung tissue from stasis or pooling of secretions
Both decrease oxygenation, prolong recovery, & add to discomfort

18. Cardiovascular Changes
Orthostatic hypotension
Increased workload of heart due to decrease in venous return to the heart
Risk for thrombus (Virchow’s Triad)

22. Musculoskeletal Changes
Muscle effects (muscle atrophy)
Skeletal effects- Disuse osteoporosis, contractures and foot drop

25. Urinary Elimination Changes
Stasis 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

26. Other Changes
Integumentary changes (Risk assessment tool for skin breakdown, proper skin hygiene)
Psychosocial effects (Depression from immobility)
Developmental Changes

27. Nursing Process & Immobility
Assessment
Assess immobilized client for hazards of immobility
ROM exercises (P&P pgs )

28. Nursing Process: Nursing Diagnosis
You tell me!!!

29. Implementation Health Promotion Acute Care: Metabolic system
Respiratory system
Cardiovascular system
Musculoskeletal system
Elimination system

30. Metabolic 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)

31. Respiratory 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

32. Cardiovascular 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 DVT (Calf circumference)

33. Prevent Thrombus Formation
Anticoagulants (Heparin, Lovenox)
TED Stockings
Calf pumping exercises
Sequential compression stockings

38. Musculoskeletal System
Assessment of muscle tone, strength, loss of muscle mass, contractures
Assess for risk of disuse osteoporosis
Assessment of ROM
Passive ROM for all immobilized joints
Physical therapy consult
Prevent foot drop and contractures

43. Elimination System I&O each shift
Assess for fluid & electrolyte imbalances
Bowel assessment
Adequate hydration
Incontinent considerations
Assess bladder distention

44. Positioning techniques
Footboard
Trocanter roll
Trapeze bar
Pillows
Splints
Abductor pillow
ROM exercises

50. Practice Scenario
A 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?

51. Practice Question
Which nursing assessment of the immobilized client would prompt the nurse to take further action?
A. Client complaining of fatique
B. Urinary output of 50 ml/hr
C. White blood cell count of 9.5
D. Absence of bowel sounds

52. Practice 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

53. Practice Question
Which of the following clients is most at risk for thrombus formation?
A. Client with renal failure
B. Client with severe abdominal pain
C. Client with a total hip replacement
D. Client with right sided heart failure

54. Practice Question
Which 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.