Basic Human Needs Mobility & the Hazards of Immobility

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

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

Principles of Body Mechanics Alignment Balance Gravity Friction

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

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

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

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

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

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

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

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

Nursing Process & Immobility Assessment Assess immobilized client for hazards of immobility ROM exercises (P&P pgs. 1435-1439)

Nursing Process: Nursing Diagnosis You tell me!!!

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

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)

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

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)

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

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

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

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

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?

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

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

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

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.