Immobility & Rehabilitation Nursing PDF

Immobility and Rehabilitation Fundamental Nursing II Faculty of Nursing/ Suez Canal University First year, 2nd semester, 2023-2024 By Dr. Shereen Abd El-Moniem Ahmed Associate. prof.Of Medical Surgical and CriticalNursing ...

Immobility and Rehabilitation Fundamental Nursing II Faculty of Nursing/ Suez Canal University First year, 2nd semester, 2023-2024 By Dr. Shereen Abd El-Moniem Ahmed Associate. prof.Of Medical Surgical and CriticalNursing  Outline ❑ Introduction ❑ Definition of rehabilitation ❑ Goals of rehabilitation ❑ Principles of rehabilitation ❑ Types of rehabilitation ❑ Rehabilitation nursing ❑ Role of nurse in rehabilitation ❑ Definition of mobility &imobility ❑ Effects of immobility ❑ Nursing process  Introduction Rehabilitation is the process that helps the client to achieve an acceptable quality of life with dignity, self respect and independence. Rehabilitation depends primarily on the client itself The patient must be an active participant in the rehabilitation goal setting and in the rehabilitation process, then can the patient achieve the desired level of self sufficiency. 3 Definitions ▪ 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. Immobility may involve a specific part of the body due to injury may involve lower part of body (paraplegia) may involve one side of body (hemiplegia) or may involve entire body from the neck down (quadriplegia)  Factors affecting the severity of physical impairment due to immobility: 0 Patient’s age. o Patient’s overall health. o Degree of immobility experienced. Causes of Immobility Physical Environmental Neurological Psychological/Social Medication  Causes of Immobility Physical examples: a bone fracture a surgical procedure a major sprain or strain cancer the aging process Causes of Immobility Environmental examples: side rails on a bed restraints on bed or chair  Causes of Immobility Neurological examples: brain damage due to Brain trauma or illness stroke cerebral palsy spinal injuries Causes of Immobility Psychological/Social examples: stress decreased motivation hospitalization, long term care facility residents a lifestyle that is sedentary created by a voluntary or involuntary action  Causes of Immobility Medication examples: those that induce a comatose state sedatives narcotics  Effects of Immobility The loss of the force of gravity acting on our body in an upright position due to immobility greatly affects our natural body functions Effects of Immobility Musculoskeletal System Decrease in tonus the resting tension in a muscle that determines tonicity or firmness Muscular atrophy a decrease in the size of a muscle. Muscles lose strength, endurance and mass very quickly when inactive Effects of Immobility Musculoskeletal System Demineralization bone is a living tissue and requires muscle activity and weight bearing to provide for the formation of new bone growth immobility results in a loss of calcium in the bones due to lack of activity and weight bearing. this can lead to osteoporosis and possible spontaneous fractures. Effects of Immobility Musculoskeletal System Plantar flexion of ankle (foot drop) caused by improper positioning of the foot or resulting from a heavy blanket on the foot putting excessive weight or stretching at the ankle joint lose the ability to move the ankle into dorsiflexion Effects of Immobility Musculoskeletal System Contracture is a permanent shortening/tightening of a muscle due to prolonged immobility fibrous tissue replaces muscle cells that eventually waste away, weaken and lose flexibility contractures can cause a loss of function Musculoskeletal System Assessment Anthropometric measurements ROM measurements Interventions Active and passive ROM Individualized, progressive exercise program Effects of Immobility Cardiovascular System the immobilized body initially pools blood in the trunk of the body causing : increased workload to the cardiovascular system increased heart rate increased stroke volume pooling of blood in the veins of lower extremities  Effects of Immobility Cardiovascular System phlebitis is an inflammation of a vein. This frequently is the result of immobilization thrombus a blood clot that originates at the site of obstruction embolism a blood clot that dislodged from a site of origin & moved within the system until it became “stuck”, causing an obstruction  Effects of Immobility Cardiovascular System orthostatic hypotension a drop in systolic blood pressure of 20 mmHg upon moving to an upright position (sitting or standing) dizziness, fainting, pale, sweating, fast heart beat  Cardiovascular System Assessment BP measurements with postural changes Monitor pulse Monitor for edema Watch for s/s of DVT Interventions “Dangling” feet before standing Prevent venous stasis Exercise ROM Anti-embolic stockings (TED hose, SCD’s) Never massage extremities Observe for s/s DVTs (warmth, redness, +Homans)  Effects of Immobility Respiratory System initially: when a person is immobilized, the bodies metabolism decreases unless there is an infection this results in a decreased demand for oxygen the respirations will be slow and shallow decrease in oxygen & increase in carbon dioxide in the blood due to poor gas exchanges an inability to deep breathe & cough adequately results in respiratory secretions pooling in the lungs this may lead to respiratory infections (hypostatic pneumonia) Effects of Immobility Respiratory System prolonged immobility causes: atelectasis collapsed small air sacs within the lungs that are responsible for providing oxygen to the blood and removing the carbon dioxide from the blood. atelectasis results in obstructions of the smaller airways increased respiratory rate  Respiratory System Respiratory assessment Observe chest movements Auscultate for pulmonary secretions Check O2 saturations Observe for respiratory difficulties Respiratory interventions Chest physiotherapy (CPT) Maintain patent airway Incentive spirometer Effects of Immobility Integumentary System (Skin) skin breaks down easily when circulation is impaired and new cells can’t regenerate common effect of immobility and skin breakdown is a pressure ulcer this is due to the compression of the body soft tissue and/or bony prominence compressed between mattress or adaptive devices Pressure Areas  Effects of Immobility Integumentary System (Skin) pressure ulcers begin with reddish areas and may develop into large open and deep wounds conditions that put patients at risk for pressure ulcers include: Paralysis : due to inability for spontaneous movement and inability to recognize pressure when taking place Medications : may alter the ability for movement or recognition of pressure points Restraints: the inability for spontaneous movement and the restraint may be the cause of pressure points Obesity: more heat and moisture are created and this can lead to quick skin break down. this patient may be less active and create more friction when they do move emaciated/malnourished: with little tissue over the bony prominences, the areas are at risk for pressure ulcers developing patients incontinent of feces and/or urine: will create a site of bacteria accumulation that will create skin break down  Integumentary System Assessment Assess positions and the risks with each position Identify clients at risk Observe for skin breakdown Stage 1 Stage 2 Stage 3 Stage 4 Interventions Prevention Identify at risk clients Daily skin exam Change positions every 2 hours Massage Skin care products (lubricate and protect) Stimulate circulation Pressure support devices Integumentary System Treat skin breakdowns Keep area dry and clean Change dressings prn Debridement of ulcer Must debride to healthy tissue Remove scar Increase protein, calories, vitamins Protein= 2-4 times normal Calories= 1 1/2 times normal Vitamin C= wound healing  Effects of Immobility Urinary System positioning patients in a supine position leads to residual urine in the calyces of the kidneys impeding the urine’s normal flow of gravity to the bladder the supine position also causes residual urine to accumulate in the bladder, as it is difficult to empty the bladder from this position Effects of Immobility Urinary System stasis of urine leads to: infections of the urinary system the development of stones within the urinary system bladder distention and incontinence of urine Assessment Analysis of Intake and Output (I & O) Proper perineal care Signs and symptoms of UTI Interventions Force fluids Record I & O Strain urine if there are stones  Effects of Immobility Gastrointestinal (GI) System immobility decreases the muscle activity in the GI system leads to constipation and impaction of stool weak muscles make it difficult to eliminate stool from the supine position into a bedpan  Effects of Immobility Gastrointestinal (GI) System appetite is often reduced when immobilized, creating nutritional deficiencies that may lead to fatigue and depression Gastrointestinal System Assessment Assessing BM’s daily Observe for passage of liquid stool Interventions Record daily LBM Encourage fluids Administer enemas, prn Digital removal of fecal impactions  Effects of Immobility Psychosocial Aspects becoming immobile drastically changes a persons life whether sudden or gradual onset, the response varies per individual  Effects of Immobility Psychosocial Aspects mental attitude & motivation suffer & the patient may experience: exaggerated emotional responses disorientation feelings of dependency inability to sleep well fear  Psychosocial Responses Assessment Assess for behavioral changes Any changes in sleep-wake cycle Decreased coping abilities Signs and symptoms of depression Interventions Socialization Meaningful stimuli Maintain body image Avoid sleep interruptions Utilize resources, I.e. pastoral care or social services Nursing Intervention  Assessment of Impaired Mobility Underlying conditions affecting mobility? ROM;? What is range (degrees)? Gait steady? Standing erect? Immobility effects on body systems? Psychosocial effects? Developmental effects? Client expectations?  Nursing Diagnosis Ineffective Breathing Patterns related to immobility Risk for Impaired Skin Integrity related to immobility Risk for Injury related to impaired movement Rehabilitation Copyright © 2017, Elsevier Inc. All Rights Reserved. 46 Copyright © 2017, Elsevier Inc. All Rights Reserved. 47 Copyright © 2017, Elsevier Inc. All Rights Reserved. 48 Copyright © 2017, Elsevier Inc. All Rights Reserved. 49  Goals of rehabilitation 1. Improve client's ability 2. Improve client's quality of life 3. Provide family centered care 4. Achieve wellness 5. Provide culturally competent care. 9 Copyright © 2017, Elsevier Inc. All Rights Reserved. 51 Copyright © 2017, Elsevier Inc. All Rights Reserved. 52 Copyright © 2017, Elsevier Inc. All Rights Reserved. 53 Copyright © 2017, Elsevier Inc. All Rights Reserved. 54 Copyright © 2017, Elsevier Inc. All Rights Reserved. 55 Copyright © 2017, Elsevier Inc. All Rights Reserved. 56  Rehabilitation nursing Rehabilitation nursing has defined as “the diagnosis and treatment of human response of individuals and groups to actual or potential health problems stemming from altered lifestyle”. The rehabilitation nurse is registered nurse with a specialty with in the profession in which many functions are applied to clients ,families and communities requiring rehabilitation services. 57  Function of the rehabilitation team 1. Establishing realistic goals with the client and family 2.Ensuring continuity of care and coordination of available resources 3.Serving as a mechanism to evaluate the progress of the patient and the quality of care. 58 Copyright © 2017, Elsevier Inc. All Rights Reserved. 59 Copyright © 2017, Elsevier Inc. All Rights Reserved. 60 Copyright © 2017, Elsevier Inc. All Rights Reserved. 61 62 Basic nursing activities in rehabilitation *Establish an effective relationship with the client and significant others to facilitate the development of a plan of care. *Collect appropriate assessment data for each rehabilitative client ,determine significant problems establish nursing diagnosis ,and set goals and identify outcomes and evaluation of care within the limit of available economic resources. 63  Basic nursing activities in rehabilitation (Cont.) *Coordinate and collaborate with interdisciplinary team in assessing ,planning ,implementing and evaluating the individual's care *Participate with client ,family and other health professional in collaborative decision making that reflects the understanding that care should be culturally sensitive ,ethical, legal ,informed, compassionate ,and humane. 64 Basic nursing activities in rehabilitation (Cont.) *Develop a discharge plan in collaboration with the client and family *make referrals to appropriate institutions and community agencies involved in the delivery of rehabilitation care *Educate the client and their significant others ,the knowledge and skills that promote adaptation to disability and chronic illness. 65 Thank You ? 54