1. بسم الله الرحمن الرحيم

2. Mobility & Immobility

3. Mobility & Immobility Mobility & Immobility
Objectives:
Define mobility, immobility, bed rest and disuse atrophy.
State the causes of impaired physical mobility.
List the factors affecting the severity of physical impairment due to immobility.
Discuss the effect immobility on physiological and psychological condition of clients.

4. Mobility & Immobility Continue:
List the items of ass. for mobility and immobility
Give examples of NANDA nursing diagnosis related to impaired mobility.

5. Mobility & Immobility Outlines:
Definitions mobility, immobility, bed rest and disuse atrophy.
Causes of impaired physical mobility.
Factors affecting the severity of physical impairment due to immobility.
Effect immobility on physiological and psychological condition of clients.

6. Mobility & Immobility Mobility & Immobility
The items of ass. for mobility and immobility
Examples of NANDA nursing diagnosis related to impaired mobility.

7. Mobility & Immobility
Mobility refers to: a person's ability to move about freely.
Immobility refers to: the inability to move about freely.
NANDA definition of immobility: is a state in which the individual experiences or is at risk of experiencing limitation of physical movement.
Bed rest: is an intervention in which the client is restricted to bed for therapeutic reasons.

8. Mobility & Immobility

9. Mobility & Immobility

10. Mobility & Immobility

11. Mobility & Immobility
Disuse atrophy: has been used to describe the pathological reduction in normal size of muscle fibers after prolonged inactivity from bed rest, trauma, casting, or local nerve damage.
*Causes of impaired physical mobility:
prescribed restriction of movement in the form of bed rest.

12. Mobility & Immobility
Physical restriction of movement through the use of external devices (e.g. cast, or traction).
Voluntary restriction of movement, or impairment or loss of motor function.

13. Mobility & Immobility
*Factors affecting the severity of physical impairment due to immobility:
Client’s age.
Client’s overall health.
Degree of immobility experienced.

14. Mobility & Immobility
Effect of immobility on physiological condition of clients including changes in the following systems:
Metabolic.
Respiratory.
Cardiovascular.
Musculoskeletal.
Integumentary.
Urinary elimination.

15. Mobility & Immobility Metabolic changes:
Immobility disrupts normal metabolic functioning including:
Metabolic rate.
Metabolism of carbohydrates,fats, and protein.
Fluid and electrolyte imbalances.
Calcium imbalance.
GIT disturbances (anorexia, diarrhea, fecal impaction, and constipation).

16. Mobility & Immobility A deficiency of calories and protein causing:
Anorexia.
Negative nitrogen balance.
Weight loss.
Decreased muscle mass.
Weakness result from tissue catabolism.
Protein loss leads to decreased muscle mass, especially in the liver, heart, lungs, GIT, and immune system.

17. Mobility & Immobility
Increase of calcium release to circulation causing hypercalcemia if the kidney are unable to respond appropriately.

18. Mobility & Immobility Mobility & Immobility
Respiratory changes:
Hypostatic pulmonary complications:
pneumonia
Leads to O2 , prolong recovery, and add to the client’s discomfort.
Decline in the client’s ability to cough productively Increase of mucus distribution in the bronchi especially in supine, prone, or lateral position Mucus accumulation in the airways. Because the mucus is an excellent media for bacterial growth hypostatic pneumonia result.

19. Mobility & Immobility Cardiovascular changes:
The three major changes are:
Orthostatic hypotension.
Increased cardiac workload.
Thrombus formation.

20. Mobility & Immobility
Orthostatic hypotension: is a drop of 25 mm Hg systolic and of 10 mm Hg diastolic in blood pressure when the client rises from a lying or sitting position to a standing position.
Causes of Orthostatic hypotension in immobilization
Decreased circulating fluid volume.
Pooling of blood in the lower extremities.
These factors result in decreased venous return followed by a decrease in cardiac output which is reflected by a decreased in blood pressure increasing heart workload.

21. Mobility & Immobility Thrombus formation: A thrombus:
is an accumulation of platelets, fibrin, clotting factors, and the cellular elements of the blood attached to the anterior wall of a vein or artery, sometimes occluding the lumen of the vessels.

22. Mobility & Immobility Factors that can cause thrombus formation:
Loss of integrity of the vessel wall (e.g., atherosclerosis).
Abnormalities of blood flow (e.g., slow blood flow in veins associated with bed rest and immobility).
Alterations in blood constituents (e.g., a change in clotting factors or increased platelet activity).

23. Mobility & Immobility Musculoskeletal changes:
Immobility lead to permanent impairment of mobility which causing:
Loss of endurance (staying power) of the muscles.
Decreased muscle mass.
Atrophy.
Decreased stability.
Impaired calcium metabolism.
Impaired joint mobility.

24. Mobility & Immobility Integumentary changes:
A pressure ulcer, or decubitus ulcer, is the consequence of ischemia and anoxia to tissue. Tissues are compressed, blood diverted, and blood vessels powerfully constricted by continual pressure on the skin and underlying structures; thus cellular respiration is impaired, and cells die.

25. Pressure Areas

27. Mobility & Immobility Urinary elimination changes:
In the upright position, urine flows out of the renal pelvis and into the ureter and bladder because of gravitational forces.
In recumbent or flat position, the kidneys and the ureters move toward a more flat surface. Urine format by the kidney must enter the bladder against gravity. Because the peristaltic contractions of the ureters are insufficient to overcome gravity, the renal pelvis may fill before urine enters the ureters (Urinary stasis).

28. Mobility & Immobility Urinary stasis increases the risk of:
Urinary tract infection.
Renal calculi.
Renal calculi:
Are calcium stones that lodge in the renal pelvis and pass through the ureters.
Causes of renal calculi in immobilized client:
Altered calcium metabolism.
The resulting hypercalcemia.

29. Mobility & Immobility
Predisposing factors with renal calculi formarion:
Fluid intake diminish.
Other causes, such as fever.
Increase the risk for dehydration.
As a result of previous factors, urinary output declines on or about the fifth or sixth day.
Urine become highly concentrated.

30. Mobility & Immobility Causes of urinary tract infection:
Concentrated urine.
Poor perineal care after bowel elimination, particularly in women.
Use of an indwelling urinary catheter.

31. Mobility & Immobility Psychosocial effects of immobility: Depression.
Behavioral changes.
Changes in the sleep-wake cycle.
Impaired coping.

32. Mobility & Immobility Assessment clients for mobility:
Range of motion.
Gait.
Exercise and activity tolerance.
Body alignment:
Standing.
Sitting.
Lying.

33. Mobility & Immobility Assessment clients for immobility:
*Physiological effect on different body systems as mentioned before.
*Psychosocial factors.

34. Mobility & Immobility
Examples of NANDA nursing diagnosis related to impaired mobility:
See the following slide.

35. Risk for fluid volume deficit r/t decreased fluid intake
Mobility & Immobility
Impaired physical mobility r/t reduced range of motion, bed rest, decreased strength.
Ineffective breathing pattern r/t decreased lung expansion, accumulation of pulmonary secretions, improper body positioning.
Impaired skin integrity r/t restricted mobility, pressure on skin’s surface, shearing force.
Risk for fluid volume deficit r/t decreased fluid intake
Ineffective individual coping r/t reduced activity level, social isolation

36. Thanks