Nursing Therapeutics: Functional Ability, Mobility, and Immobility PDF

Nursing Therapeutics Functional Ability, Mobility, and Immobility Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Outline Functional Ability Mobility and Immobility Readings Definition De...

Nursing Therapeutics Functional Ability, Mobility, and Immobility Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Outline Functional Ability Mobility and Immobility Readings Definition Definition Giddens (4th edition, 2024): Scope of Concept Nature of Movement Functional Ability Attributes Pathological Influences on Concept 2. p 14 Lifespan Considerations Mobility Lifespan Considerations Potter and Perry (7th Context to nursing and Factors edition, 2025): healthcare Systemic effects of Mobility and Immobility immobility (chapter 46) Nursing Process  Learning Objectives Define and describe the concept of functional ability Discuss dimensions of functional ability including attributes and antecedents. Discuss lifespan considerations related to functional ability. Identify risk factors that may impair functional ability. Discuss functional assessment. Identify concepts related to functional ability Define mobility. Discuss normal physiologic processes and related concepts of functional ability Discuss mobility as related to activity and exercise including age related differences Notice risk factors/consequences for impaired mobility / activity Identify primary prevention strategies aimed at optimizing mobility Identify measures to optimize patient and care provider safety related to mobilizing patients. Assess for correct and impaired body alignment and mobility. 3 Functional Ability www.udst.edu.qa  Definition Functional ability is: The individual’s ability to perform the normal daily activities required to meet basic needs. This includes: The ability to perform usual roles in the family, workplace, and community To maintain health and well being It involve the cognitive, social, physical, and emotional ability to carry on the normal activities of life 5  Scope of Concept Function refers to Disability refers to the positive or the negative neutral interaction aspects to a between a person’s health person’s health condition and condition and social or physical ability to perform limitation social or physical It is not simply a matter of whether the individual can or does perform activities the activity but, instead: Under what circumstances? What type and amount of assistance? What length of time and with what degree of effort the person can or does perform the activity. All aspects of this concept presentation are based on these attribute and antecedent principals. 6 Attributes and Antecedents of Functional ability Attributes: The capacity to perform specific functional abilities The actual or required performance ability Antecedents: Development of physiologic processes; Neural, endocrine, musculoskeletal, metabolic Acquisition of developmental milestones and skills 7  Lifespan Considerations Functional ability changes across the lifespan influenced by: Developmental stage Achievement of developmental milestones Physical health Psychosocial health Cognitive ability Social and cultural factors 8  Lifespan Considerations-Growth and Development Infant / Toddler Function measured in Achievement of developmental milestones. / Preschool School age / Achievement in school / activities / social / Requires careful assessment. Adolescent Adults / Young and middle More complex / Requires careful assessment. adulthood Older adults / Functional ability measured in safe and effective ability to perform ADLs Old age 9  Context to Nursing and Healthcare 1 2 Functional 3 Risk recognition Care Delivery assessment Notice Recognize Provide situations that when appropriate increase THE functional interventions risk for impairment to optimize functional exists functional impairment ability and minimize complications 10  1 Risk Recognition Early identification of Risk factors There are multiple risk factors for impaired functional ability Developmental abnormalities Trauma (physical or psychological) Disease (acute or chronic) Social and cultural factors Advanced age Cognitive function Mental health issues (especially depression) Comorbidities and socioeconomic factors Preclinical disability 11  2 Functional Assessment Comprehensive functional assessment is time-intensive and should be an interprofessional effort. The two basic types of assessment tools are self-report and performance based. Indications: In children who have delays in developmental milestones In adults who have loss of functional ability, change in mental status, or multiple health conditions, or in frail elderly persons living in a community setting 12  2 Functional Assessment Components Vision Social participation Hearing BADLs Mobility IADLs Fall History BADLs- Basic Activities of Daily Living Relate to personal care and mobility (personal care and Continence mobility and include eating as well as hygienic and grooming activities such as bathing, mouth care, dressing, and toileting.) Nutrition IADLS- Instrumental Activities of Daily Living Cognition Higher level skills related to function in the Affect community(managing money, grocery shopping, cooking, house cleaning, doing laundry, taking medication, using the telephone, and accessing transportation.). 13  2 Functional Assessment Conclusion Level of No assistance assistance or Partial assistance dependency Total assistance No difficulty Level of Some difficulty difficulty Unable to perform 14  3 Care Delivery The goal of care delivery is: ❖ Maintain optimal independent function ❖ Prevent functional decline for health-related quality of life Reduce risk Early detection and screening Management of function activity impairment involving multidisciplinary interventions 15  3 Care Delivery: Reducing risk Teach patients and families about factors associated with the maintenance of high-level functional ability. This includes: Well-balanced nutrition Regular physical activity Routine health checkups Stress management Regular participation in meaningful activity Fall prevention measures Avoidance of tobacco and other substances associated with abuse 16  3 Care Delivery: Interventions Interventions to Manage Functional Impairment: ❖ Requires a multidisciplinary approach Interprofessional collaborative practice Each health care discipline contributes to management but in differing roles ❖ Interventions depend on the underlying cause of impairment (e.g., visual, mobility, cognitive, mental health) 17  3 Care Delivery: Nursing Interventions ❖Self-care assistance for BADLs and IADLs Dressing, toileting, bathing, ambulating, shopping, cooking, and eating ❖Fall prevention ❖Exercise therapy ❖Teaching safe use of assistive devices 18  Quick Quiz What are the three dimensions of nursing care related to functional ability? A. Risk recognition, functional assessment, and communication B. Risk recognition, functional assessment, and individualized care planning C. Functional assessment, personal hygiene, and communication D. Functional assessment, communication, and individualized care planning 19 20  Activity # 1 Amal is a healthy 20-year-old who has recently been doing gymnastics, fell of the uneven bars and broken her RT arm and left ankle in RTA. In this small group activity, take 15 minutes to discuss any interventions you can think of to assist Amal with BADL and IADL's and why. 21 Mobility and Immobility www.udst.edu.qa  Definition Mobility is the ability to move easily Immobility is the inability to move about and independently. freely Mobility is purposeful ✓May be individual patient limitation or ✓To maintain optimal physical prescribed limitations mobility, the musculoskeletal and (e.g. Bed rest = an intervention that nervous systems of the body must restricts patients for therapeutic reasons be intact and functioning Bed rest An intervention that restricts patients for therapeutic reasons 23  Scope of Concept Illnesses, surgery, injuries, pain, and aging can impair mobility. Care includes positioning the patient so Nurses need to that optimal body alignment is know how to care attained, as well as moving and for patients who are transferring patients when they cannot immobile do so independently. 24 Physiology and principles of body mechanics ❖ Alignment and balance Body alignment, posture, center of gravity ❖ Gravity and friction Weight and gravity Friction and surface area Shear and pressure ulcers Figure 45-07. Correct body alignment when standing 25  Physiology and principles of body mechanics: Alignment and balance Correct body alignment The terms body alignment and reduces strain on posture are analogous: refer to musculoskeletal structures, the positioning of the joints, minimizes the risk of injuries and tendons, ligaments, and muscles falls, while standing, sitting, and lying. aids in maintaining adequate Being in correct body alignment muscle tone, means that the individual's center contributes to balance. of gravity is stable. 26  Physiology and principles of body mechanics: Alignment and balance Why Sitting is bad for you – Murat Dalkilinc https://www.youtube.com/watch?v=wUEl8KrMz 14 5.04 minutes 27  Physiology and principles of body mechanics: Alignment and balance Balance is required for maintaining a static position (e.g., sitting), moving (e.g., walking), and performing ADLs. Impaired balance is a major Disease, injury, pain, physical threat to mobility and physical development (e.g., age), safety and contributes to a fear life changes (e.g., pregnancy) of falling and self-imposed medications (e.g., in which dizziness or activity restrictions (McMahon & drowsiness is an adverse effect) deconditioning (as a result of Fleury, 2012) prolonged immobility) can compromise the ability to remain balanced. 28 Pathological Influences on Mobility Postural abnormalities Congenital or acquired postural abnormalities affect the efficiency of the musculoskeletal system, as well as body alignment, balance, and appearance. During assessment, the nurse observes body alignment and range of motion Impaired muscle development Example: The muscular dystrophies are a group of familial disorders that cause degeneration of skeletal muscle fibers Central nervous system (CNS) damage Trauma from a head injury, ischemia from a stroke or cerebrovascular accident (CVA), hemorrhage, tumor, or bacterial infection such as meningitis can damage the cerebellum or the motor strip in the cerebral cortex Musculoskeletal trauma Direct trauma to the musculoskeletal system can result in bruises, contusions, sprains, and fractures 29  Lifespan Considerations Infants, Prolonged immobility can delay gross toddlers, motor skills, intellectual development, or preschoolers musculoskeletal development May affect adolescent growth patterns Adolescents and ability to gain independence; social isolation can occur Physiological systems are at risk Adults Changes occur in family and social structures Physical activity decreases Hormonal changes occur Seniors Bone reabsorption is common Chronic health issues- cardiopulmonary Encourage as much self-care as possible 30  Related Concepts / Terms Activity / Exercise Unstructured (usual Activities of Daily Living, health maintenance) Structured (Physical activity for conditioning the body, improving health & maintaining fitness) Activity Tolerance Type & amount of exercise or work that a person is able to perform Activity intolerance An individual has insufficient physiological or psychological energy to endure or complete required or desired daily activities. 31  Factors that Affect Mobility- Activity / Exercise Patterns Physical factors: body alignment, muscle strength, coordination, anatomical abnormalities Physiological Factors o Cardiopulmonary status Emotional Factors o Mood, motivation Developmental Factors o Age, pregnancy Environment (community, resources, culture) 32  Did you know? Lack of physical activity Muscular deconditioning (can occur to any individual regardless of age.) Muscle strength drop 3% per day Disease atrophy 33  Activity: What are the systemic effects of immobility: Metabolic Respiratory Cardiovascular Musculoskeletal Urinary Elimination Integumentary Psychosocial www.udst.edu.qa  Quick Quiz The nurse notices an increased respiratory rate, decreased oxygen saturation, and increased sputum in an immobilized postoperative patient. The noted change is consistent with which one of the following? ‫مريض مابعد الجراحة وغير متحرك‬ A. Atelectasis ‫ انهيار يحدث لجزء من‬:‫انخماص الرئة‬ B. Hypertension ‫الرئة أو أكملها‬ C. Orthostatic hypotension D. Formation of a thrombus Clot or thrombus ‫يعني تكون جلطة‬ 35 36 Nursing Process: Assessment Patient expectations Mobility Range of motion (ROM Gait Exercise and activity tolerance Body alignment Standing Sitting Lying Immobility and physiological assessment Metabolic: anthropometric measurements, wound healing Respiratory system: respiratory rate, breath sounds, lung expansion Cardiovascular system: blood pressure (BP), pulse, peripheral circulation, signs of deep vein thrombosis (DVT Musculoskeletal: ROM; muscle strength, tone, and mass, activity intolerance Integumentary: colour, integrity, turgor Elimination: habits, intake 37 Nursing Process: Assessment Immobility and psychosocial assessment Abrupt changes in cognition Mental health concerns Social isolation Behaviour changes Sleep–wake cycle Immobility and developmental assessment Young child Family assessment Older person Nursing Process: Diagnosis Examples of nursing diagnoses 1.Activity intolerance 2.Ineffective airway clearance 3.Ineffective individual coping 4.Risk for disuse syndrome 5.Impaired physical mobility 6.Impaired skin integrity 7.Disturbed sleep pattern 8.Social isolation 9.Impaired urinary elimination 38 39 Nursing Process: Planning Goals and outcomes – Quantify subjective findings Setting priorities – Consider the patient’s tolerance level Collaborative care – Physical therapy – Respiratory Therapy – Occupational therapy – Social services – Patient and family needs 39 Goal is: measure the effectiveness of specific interventions designed to promote body alignment, improve mobility, and protect the patient from hazards of immobility www.udst.edu.qa.41 Nursing Process: Implementation Primary Prevention Actue Care Health promotion: Metabolic systems: High-protein, high-calorie, vitamin B, vitamin C Respiratory system: Promotion of chest and lung expansion Maintenance of patent airway Exercise Cardiovascular system Optimal nutrition Reducing orthostatic hypotension Falls prevention Preventing thrombus formation: medications, exercise, fluids, compression stockings, measures pneumatic compression, positioning Musculoskeletal system Prevention of work- ROM related musculoskeletal Elimination system injuries Hydration Nutritional intake: fiber o Lifting technique Integumentary system These are for both Pressure ulcer patients and Reposition and turning every 1 to 2 hours healthcare workers!! Hygiene care Protection: preventive aids Psychosocial changes Socialization Patient’s orientation Communication Patient participation Developmental changes in children Age-appropriate activities. 41.42 Nursing Process: Implementation Positioning devices and Other Techniques techniques Transfer techniques: Supports: pillows, foot In bed boot, trochanter rolls, Bed to chair sandbags, hand rolls, Bed to stretcher hand-wrist splints Repositioning patients Trapeze bar Restorative care Bed positions: Fowler’s, Instrumental activities of daily living supine, prone, side- Occupational therapy or physiotherapy lying, Sims’ Joint mobility Exercises: ROM Walking Canes Walkers Crutches 42 Copyright © 2017, Elsevier Inc. All rights reserved. 43 Nursing Process: Implementation Figure 36-12. When helping a patient walk, the nurse uses a gait belt and walks slightly behind the patient's side. (From Sorrentino, S. A., Wilk, M. J., & Newmaster, R. (2009). Mosby's Canadian textbook for the support worker (2nd ed., p. 439, Fig. 24-22). Toronto: Elsevier.) 43 Copyright © 2017, Elsevier Inc. All rights reserved. 44 Nursing Process: Implementation Transfer Techniques Unn Figure 36-06. STEP 1C(5) Nurse Unn Figure 36-07. STEP 1C(7) Nurse Unn Figure 36-09. STEP 1C(11) Nurse eases patient into flexes hips and knees, aligning knees with rocks patient to standing position. chair. patient's knees. 44 Copyright © 2017, Elsevier Inc. All rights reserved. 45 Nursing Process: Implementation Restorative care Figure 36-17. Patient using a quad cane. Figure 36-15. Patient using a two-wheeled walker. 45 Copyright © 2017, Elsevier Inc. All rights reserved. 46 Nursing Process: Implementation Safety Alert: Risk for falls Reduced quality of life Increase morbidity Increased mortality Increased health care costs 46 Copyright © 2017, Elsevier Inc. All rights reserved. 47 Nursing Process: Implementation Risk for injury: Falls- Interventions Reduce or eliminate causative or contributing factors Improve strength and endurance ROM and strengthening exercises Gradual increase distance and speed of walking Collaborate with Health Care Team re. alterations in diet, medications etc. Minimize risk Orientate to environment Declutter / improve lighting Handrails etc. Teach patient how to safely use assistive devices Consult physio (Exercise to strengthen arms and shoulders) Consult OT (properly measure and fit walker) Instruct client to wear shoes that are nonslip and fit properly 47 Copyright © 2017, Elsevier Inc. All rights reserved. 48 Nursing Process: Evaluation Patient care Compare the patient’s progress to goals and outcomes. Modify the care plan as needed. Notify the health care provider if the patient’s oxygenation declines. Patient expectations Readiness to learn 48  Summary Attributes and Antecedents of Functional ability Context to Nursing and Healthcare (Three dimensions: Risk recognition, functional Functional assessment, and individualized care planning). ability The ability to move easily and independently. Body alignment Pathological influences on mobility Bed rest Mobility and Systemic effects of immobility immobility Psychological effects of immobility Developmental changes Nursing process 49  References Giddens, J.F. (2024). Concepts for nursing practice (4th.). Toronto, Ontario: Mosby. Potter, P, Perry, A.G., Stockert, P, Hall, A., Astle, B.J., & Duggleby, W. (2025). Canadian Fundamentals of Nursing (7th ed.). Toronto, Ontario: Mosby. 50 NEXT WEEK- PRESENTATIONS DUE 51