Mobility: Basic Human Needs and Hazards

Basic Human Needs: Mobility & Hazards

• Mobility is essential for performing Activities of Daily Living (ADL).
• Mobility helps in satisfying basic needs.
• Mobility helps with self-defense.
• Mobility is important to express emotions and participate in recreational activities.
• Intact and functioning musculoskeletal and nervous systems are vital for mobility.

Principles of Body Mechanics

• Proper alignment of the body is important.
• Balance is an important principle of body mechanics.
• Unsteady patients have an unbalanced center of gravity, predisposing them to falls.
• Friction is a force that opposes movement.

Pathological Influences on Mobility

• Postural abnormalities can negatively impact mobility.
• Impaired muscle development can negatively impact mobility.
• Damage to the central nervous system (CNS) can negatively impact mobility.
• Direct trauma to the musculoskeletal (M/S) system can negatively impact mobility.

Systemic Changes with Immobility

• Metabolic changes can include affected endocrine metabolism and a decreased Basal Metabolic Rate (BMR).
• Immobility disrupts normal metabolic functioning.
• GI tract functionality is affected by immobility.

Negative Nitrogen Balance

• Immobility leads to muscle atrophy and negative nitrogen balance.
• Muscle atrophy, in turn, leads to increased weakness and further loss of mass.
• Nutritional intake may also be reduced because immobility can cause anorexia, thereby exacerbating muscle wasting.

Respiratory Changes

• Lack of exercise and movement increases the risk for respiratory issues.
• Atelectasis, or the collapse of alveoli, could lead to partial lung collapse.
• Hypostatic pneumonia, the inflammation of lung tissue due to stasis or pooling of secretions.
• Decreased oxygenation, prolonged recovery, and increased discomfort may result from respiratory changes due to immobility.

Cardiovascular Changes

• Orthostatic hypotension can occur.
• The heart's workload increases due to decreased venous return.
• Immobility poses a risk for thrombus formation.

Musculoskeletal Changes

• Immobility leads to muscle atrophy.
• Skeletal effects include disuse osteoporosis, contractures, and foot drop.

Urinary Elimination Changes

• Stasis and pooling of urine in the renal pelvis increases the risk of infection and renal calculi.
• Dehydration and decreased urine output are risks.
• Increased risk for UTIs with foley catheter use.

Other Changes

• Integumentary changes that occur: implement risk assessment tools for skin breakdown, and implement proper skin hygiene.
• Psychosocial effects like depression may occur from immobility.
• Developmental changes many occur.

Nursing Process & Immobility

• Assessment of the client.
• Assessment of immobilized clients for hazards of immobility.
• Range of Motion (ROM) exercises.

Nursing Diagnosis

• Determine the nursing diagnosis for immobility.

Implementation

• Health promotion should be implemented.
• Acute care implementation includes focusing on these systems: metabolic, respiratory, cardiovascular, musculoskeletal, and elimination.

Metabolic System

• Evaluate muscle atrophy.
• Monitor Intake & Output (I&O).
• Monitor lab data (BUN, albumin, protein, electrolytes).
• Assess wound healing and edema.
• Assess for dehydration (skin turgor, mucous membranes).
• Assess nutritional status (protein and vitamin supplements, enteral feedings, TPN).

Respiratory System

• Frequent respiratory assessment is key.
• Ascultate lung sounds and inspect chest wall movement.
• Promote lung expansion and stasis of pulmonary secretions.
• Implement deep breathing and coughing exercises.
• Use Incentive spirometer, chest physiotherapy, suctioning and hydration.
• Positioning every 2 hours is important.

Cardiovascular System

• Monitor vital signs.
• Assess for orthostatic changes (Baseline BP).
• Perform peripheral pulse assessment.
• Assess for edema.
• Prevent thrombus formation.
• Assess for VTE/DVT (Calf circumference).

Prevent Thrombus Formation

• Administer anticoagulants (Lovenox, Heparin).
• Apply TED Stockings.
• Implement calf pumping exercises.
• Apply sequential compression stockings.

Musculoskeletal System

• Assessment of muscle tone, strength, loss of muscle mass, contractures.
• Assess for risk of disuse osteoporosis.
• Assessment of ROM including passive ROM for all immobilized joints.
• Physical therapy consult for:
• Prevent foot drop and contractures.

Elimination System

• Monitor I&O each shift.
• Assess for fluid and electrolyte imbalances.
• Perform bowel assessment.
• Ensure adequate hydration.
• Consider incontinent considerations.
• Assess bladder distension.

Positioning Techniques

• Use footboard, trapeze bar, pillows, splints and abductor pillow.
• Implement ROM exercises.

Implementation: Health Promotion

• Use a patient-centered approach.
• Use Proper body mechanics.
• Early ambulation is critical in acute care.
• Prescribe isometric exercises for patients who cannot tolerate increased activity.
• Implement Range of motion exercises include active, active assisted, and passive.
• Walking.

Additional Implementation Techniques

• Fowler's, Supine, Prone, Side-lying, and Sims' positions

Practice Scenario

• A 72-year-old client is recovering following abdominal surgery for colon cancer.
• Identify which hazards of immobility this client is at risk for and why.
• Determine how to prevent post-operative complications associated with this client's condition.

Addressing Immobility

• Nursing assessments to take further action with: client complaining of fatique, urinary output of 50 ml/hr, white blood cell count of 9.5 or absence of bowel sounds.
• During exercise sessions, assisting the client to dorsiflex and plantarflex the foot requires the client needs to exercise the foot to maintain function, the exercise activity as active range of motion
• Thrombus formation posses greatest risk in these types of patients; renal failure, severe abdominal pain, after a total hip replacement or right sided heart failure.
• When dealing with immobilized postoperative patients with rapid change you would note, Atelectasis.
• Ensure patients understand teaching for surgical patients: Elastic stocking understand can be evaluated correctly when the patient states, "I can remove them for 30 minutes every 8 hours.”
• Bronchioles may be blocked by secretions due to physiologic effects of immobility.

Back Injury in Healthcare and Prevention

• High-risk healthcare units for back injuries include those with frequent injury history, high proportions of dependent patients, lack of lifting equipment, and low staffing levels.
• Nursing Knowledge Base: safe patient handling includes- ergonomics assessment protocol, patient assessment criteria, algorithms for patient handling and movement, special equipment, back injury resource nurses, "after-action review" and no-lift policy.
• Implementation: health promotion includes- prevention of work-related musculoskeletal injuries, exercise and bone health in patients with osteoporosis.

Safe Patient Handling (SPH) Principles

• Safe manual handling techniques must be used in combination with equipment and technology for safe patient handling and movement.
• Four primary principles of manual patient handling that should be used in conjunction with SPH techniques when handling and moving patients.

SPH Principles and Aids

• Maintain a wide, stable base and keep work directly in front to avoid rotating the spine.
• Place the bed at the correct height (waist level for care, hip level for moving).
• Keep the patient close to the body to minimize reaching.
• SPH Aids: Powered, mechanical lifts, sit-to-stand lifts, friction-reducing devices, and transfer belts reduce friction and redistribute the load.

Techniques

• The transfer techniques include: Moving/repositioning patients, from bed to chair, and from bed to stretcher.
• Factors to consider should be to determine the patient's ability to assist, how to communicate actions to patient and what are the appropriate resources.

Clinical Management

Collaborative interventions could include assistive devices such as crutches, canes, walkers, wheelchairs, and prostheses.

• Walkers is a common tool
• Canes- should be used on the stronger side
• Crutches- measuring- distance between the crutch pad and the pt axilla us 1 ½ - 2 inches - crutch gait, Ascend and descend stairs and sitting in a chair.

Implementation Techniques

Helping a patient walk includes: assessing patient's ability to walk safely, evaluating environment for safety, assisting patient to sitting position, dangling patient’s legs over the side of the bed 1 to 2 minutes before standing and providing support at the waist so the patient's center of gravity remains midline (gait belt).