Foundations Chapter 40: Mobility and Immobility PDF

CHAPTER 40 UNIT 4 PHYSIOLOGICAL INTEGRITY SYSTEMIC EFFECTS OF IMMOBILITY SECTION: BASIC CARE AND COMFORT Integumentary CHAPTER 40 Mobility and...

CHAPTER 40 UNIT 4 PHYSIOLOGICAL INTEGRITY SYSTEMIC EFFECTS OF IMMOBILITY SECTION: BASIC CARE AND COMFORT Integumentary CHAPTER 40 Mobility and Increased pressure on skin, which is aggravated by Immobility metabolic changes Decreased circulation to tissue causing ischemia, which can lead to pressure injury Mobility is freedom and independence in Respiratory purposeful movement. Mobility refers to Decreased respiratory movement resulting in decreased oxygenation and carbon dioxide exchange adapting to and having self-awareness of the Stasis of secretions and decreased and weakened environment. Functional musculoskeletal and respiratory muscles, resulting in atelectasis and hypostatic pneumonia nervous systems are essential for mobility. Decreased cough response Immobility is the inability to move freely and Cardiovascular independently at will. The risk of complications Orthostatic hypotension increases with the degree of immobility and Less fluid volume in the circulatory system Stasis of blood in the legs the length of time of immobilization. Periods Diminished autonomic response of immobility or prolonged bed rest can cause Decreased cardiac output, leading to poor cardiac effectiveness, which results in increased major physiological and psychosocial effects. cardiac workload Increased oxygenation requirement Cutaneous stimulation in the form of cold Increased risk of thrombus development and heat applications helps relieve pain and Metabolic promotes healing. Promoting venous return Altered endocrine system is another key component of reducing the Decreased basal metabolic rate complications of immobility. Changes in protein, carbohydrate, and fat metabolism Decreased appetite with altered nutritional intake Negative nitrogen balance Mobility and immobility Decreased protein resulting in loss of muscle Loss of weight Alterations in calcium, fluid, and electrolytes Immobility can be the following. Resorption of calcium from bones Temporary (following knee arthroplasty) Decreased urinary elimination of calcium, resulting Permanent (paraplegia) in hypercalcemia Sudden onset (a fractured arm and leg following a motor-vehicle crash) Elimination Slow onset (multiple sclerosis) GENITOURINARY Body mechanics involves coordination between the Urinary stasis musculoskeletal and nervous systems, and the use of Change in calcium metabolism with hypercalcemia, alignment, balance, gravity, and friction. resulting in renal calculi Movement depends on an intact skeletal system, skeletal Decreased fluid intake and increased use of indwelling muscles, and nervous system. urinary catheters, resulting in urinary tract infections Assessment focuses on mobility, range of motion GASTROINTESTINAL (ROM), gait, exercise status, activity tolerance, and body Decreased peristalsis alignment while standing, sitting, and lying. Decreased fluid intake Constipation, increasing the risk for fecal impaction FACTORS AFFECTING MOBILITY Alterations in muscles Injury to the musculoskeletal system Poor posture Impaired central nervous system Health status and age FUNDAMENTALS FOR NURSING CHAPTER 40 Mobility and Immobility 227  Musculoskeletal ASSESSMENT/DATA COLLECTION Decreased muscle endurance, strength, and mass AND PATIENT-CENTERED CARE Impaired balance Integumentary Atrophy of muscles Decreased stability Maintain intact skin. Altered calcium metabolism ASSESSMENT Osteoporosis Observe the skin for breakdown, warmth, and Pathological fractures change in color. Contractures Look for pallor or redness in fair-skinned clients, and Foot drop purple or blue discoloration in dark-skinned clients. Altered joint mobility Observe bony prominences. Check skin turgor. Neurologic/Psychosocial Use a pressure injury risk scale (Norton or Braden). Altered sensory perception Assess at least every 2 hr. Ineffective coping Observe for urinary or bowel incontinence. CHANGES IN EMOTIONAL STATUS: Depression, alteration NURSING INTERVENTIONS in self-concept, and anxiety Identify clients at risk for pressure injury development. Position using corrective devices (pillows, foot boots, BEHAVIORAL CHANGES: Withdrawal, altered sleep/wake trochanter rolls, splints, wedge pillows). pattern, hostility, inappropriate laughter, and passivity Turn every 1 to 2 hr, and use devices for support or per protocol. Developmental Teach clients who can move independently to turn at INFANTS, TODDLERS, AND PRESCHOOLERS least every 15 min. Slower progression in gross motor skills and intellectual Provide clients who are sitting in a chair with a device and musculoskeletal development to decrease pressure. Body aligned with line of gravity, resulting in Limit sitting in a chair to 1 hr. Instruct clients to shift unbalanced posture their weight every 15 min. Use a therapeutic bed or mattress for clients in bed for ADOLESCENTS an extended time. Imbalanced growth spurt possibly altered with immobility Monitor nutritional intake. Delayed development of independence Provide skin and perineal care. Social isolation ADULTS Respiratory Alterations in every physiological system Maintain airway patency, achieve optimal lung expansion Alterations in family and social systems and gas exchange, and mobilize airway secretions. Alterations in job identity and self-esteem ASSESSMENT OLDER ADULTS Complete every 2 hr. Alterations in balance resulting in a major risk for falls Observe chest wall movement for symmetry. and injuries Auscultate lungs and identify diminished breath sounds, Steady loss of bone mass resulting in weakened bones crackles, or wheezes. Decreased coordination Observe for productive cough, and note the color, Slower walk with smaller steps amount, and consistency of secretions. Alterations in functional status Increased dependence on staff and family, which can NURSING ACTIONS become long-term Reposition every 1 to 2 hr. Remove abdominal binders every 2 hr and replace correctly. Use chest physiotherapy. Auscultate the lungs to determine the effectiveness of chest physiotherapy or other respiratory therapy. Monitor the ability to expectorate secretions. Use suction if unable to expectorate secretions. CLIENT EDUCATION Turn, cough, and breathe deeply every 1 to 2 hr while awake. Yawn every hour while awake. Use an incentive spirometer while awake. Consume at least 2,000 mL fluid per day, unless intake is restricted. 228 CHAPTER 40 Mobility and Immobility CONTENT MASTERY SERIES  Cardiovascular Elimination Maintain cardiovascular function, increase activity Maintain urinary and bowel elimination. tolerance, and prevent thrombus formation. ASSESSMENT ASSESSMENT Assess I&O. Measure orthostatic blood pressure and pulse (lying to Assess the bladder for distention. sitting to standing), and assess for dizziness. Observe urine for color, amount, clarity, and frequency. Palpate the apical and peripheral pulses. Auscultate bowel sounds. Auscultate the heart at the apex for S3 (an early Observe feces for color, amount, frequency, indication of heart failure). and consistency. Palpate for edema in the sacrum, legs, and feet. NURSING ACTIONS Palpate the skin for warmth in peripheral areas to Maintain hydration (at least 2,000 mL/day unless fluid include the nose, ear lobes, hands, and feet. is restricted). Assess for deep-vein thrombosis by observing the calves Give a stool softener, laxative, or enema as needed. for redness and palpating for warmth and tenderness. Provide perineal care. Measure the circumference of both calves and thighs Teach bladder and bowel training. and compare in size. Insert a straight or indwelling catheter to relieve or NURSING ACTIONS manage bladder distention. Increase activity as soon as possible by dangling feet on Promote urination by pouring warm water over the side of bed or transferring to a chair. perineal area. Change position as often as possible. CLIENT EDUCATION: Consume a diet that includes fruits Move the client gradually during position changes. and vegetables and is high in fiber. Instruct clients to avoid the Valsalva maneuver. Give a stool softener to prevent straining. Musculoskeletal Teach range of motion (ROM) and antiembolic exercises (ankle pumps, foot circles, knee flexion). Maintain or regain body alignment and stability, decrease Use elastic stockings. skin and musculoskeletal system changes, achieve full or Use sequential compression devices (SCDs). optimal ROM, and prevent contractures. Increase fluid intake if no restrictions. ASSESSMENT Administer low-dose heparin or enoxaparin Assess ROM capability. subcutaneously prophylactically. Assess muscle tone and mass. Contact the provider immediately if there is absence of a Observe for contractures. peripheral pulse in the lower extremities or assessment Monitor gait. data that indicates venous thrombosis. Monitor nutritional intake of calcium. CLIENT EDUCATION Monitor use of assistive devices to assist with ADLs. Perform isometric exercises to increase activity tolerance. NURSING ACTIONS Avoid placing pillows under the knees or lower extremities, Make sure clients change position in bed at least every 2 hr crossing the legs, wearing tight clothes around the and perform weight shifts in the wheelchair every 15 min. waist or on the legs, sitting for long periods of time, and Encourage active or provide passive massaging the legs. ROM two or three times/day. A continuous passive motion (CPM) device might Metabolic be prescribed. Develop an individualized program Reduce skin injury and maintain metabolism. for each client. Older adult clients can require a program that addresses the aging process. ASSESSMENT Cluster care to promote a proper sleep-wake cycle. Record anthropometric measurements of height, weight, Request physical therapy for clients and skin folds. who have decreased mobility. Assess I&O. Assist client with ambulation. Use assistive devices Assess food intake. (gait belts, walkers, canes, or crutches) as needed. Review urinary and bowel elimination status. Assess wound healing. CLIENT EDUCATION Auscultate bowel sounds. Perform ROM while bathing, eating, grooming, Check skin turgor. and dressing. Review laboratory values for electrolytes, blood total protein, and BUN. NURSING ACTIONS Provide a high-calorie, high-protein diet with vitamin B and C supplements. Monitor and evaluate oral intake. For clients who cannot eat or drink, provide enteral or parenteral nutritional therapy. FUNDAMENTALS FOR NURSING CHAPTER 40 Mobility and Immobility 229  Cane instructions Involve clients in daily care. Maintain two points of support on the ground at all times. Provide stimuli (books, crafts, television, Keep the cane on the stronger side of the body. newspapers, radio). Support body weight on both legs. Help clients maintain body image by performing or Move the cane forward 15 to 25 cm (6 to 10 in). assisting with hygiene and grooming tasks (shaving or Next, move the weaker leg forward toward the cane. applying makeup). Finally, advance the stronger leg past the cane. Have nurses and other staff interact on a routine and informal social basis. Crutch instructions Recommend a referral for consultation (psychological, Do not alter crutches after fitting. spiritual, or social worker) for clients who are not Follow the prescribed crutch gait. coping well. Support body weight at the hand grips with elbows flexed at 20° to 30°. Developmental Hold the crutches in one hand and grasp the arm of the chair with the other hand for balance while sitting and Continue expected development and achieve physical and rising from a chair. mental stimulation. The tripod position is the basic crutch stance. The client Infancy through school age should place the crutches 15 cm (6 in) in front of and ASSESSMENT 15 cm (6 in) to the side of each foot to provide a wide ◯ Gross motor skills, and intellectual and base of support. musculoskeletal development Crutch gait: client alternates weight from one leg to the ◯ Body alignment and posture other as well as on the crutches. ◯ Developmental tasks specific to age The client should stand with a straight back, hips, head NURSING ACTIONS and neck and should not place any weight on the axillae. ◯ Implement activities that stimulate physical and Types of gaits psychosocial systems. Increase mobility, and involve ◯ Four-point gait requires the client to bear weight play therapists in age-appropriate activities. on both legs. The client alternates each leg with the ◯ Use measures to prevent falls. opposite crutch so three points of support are on the ◯ Develop strategies for maintaining or enhancing the floor at all time. developmental process. ◯ Three-point gait requires the client to bear all weight ◯ Teach families that their perception of immobility can on one foot while using both crutches. The affected affect progress and ability to cope. leg should never bear weight or touch the ground. ◯ Encourage parents to stay with children. ◯ Two-point gait requires the client to have partial ◯ Incorporate children’s involvement, if age-appropriate, weight bearing on both feet. The client moves a in their treatments. crutch while moving the opposite leg at the same ◯ Place children in a room with others who are age- time. This is to mirror the movements of normal arm appropriate. and leg motion during walking. Adolescents Psychosocial ASSESSMENT ◯ Growth and development specific to age Maintain an acceptable sleep/wake pattern, achieve ◯ Level of independence socialization, and complete self-care independently. ◯ Social activities ASSESSMENT NURSING ACTIONS Assess emotional status. ◯ Initiate care that facilitates independence. Assess mental status. ◯ Involve adolescents in decision-making for ADLs. Assess behavior and decision-making skills. ◯ Provide stimuli to promote socialization (interaction Monitor mobility status. with peers, use of adolescents’ activity room). Observe for unusual alterations in sleep/wake pattern. Adults Assess coping skills, especially for loss. ASSESSMENT Monitor activities of daily living (ADLs). ◯ All physical systems Assess for family support and relationships. ◯ Family relationships Monitor social activities. ◯ Social status NURSING ACTIONS ◯ Meaning of career/job Assist in using usual coping skills or in developing new NURSING ACTIONS coping skills. ◯ Provide care that promotes activity in all Maintain orientation to time (clock and calendar with physical systems. date), person (call by name and introduce self), and ◯ Discuss with families the importance of interaction place (talk about treatments, therapy, length of stay). with clients. Develop a schedule of therapies, and place it on a ◯ Discuss social involvement. calendar for clients. ◯ Discuss the meaning of career/job. Arrange for clients who have limited mobility to be in a semiprivate room with an alert roommate. 230 CHAPTER 40 Mobility and Immobility CONTENT MASTERY SERIES  Older adults Make sure the provider has written a prescription that ASSESSMENT includes the following. ◯ Balance ◯ Location ◯ Coordination ◯ Duration and frequency ◯ Gait ◯ Specific type (moist or dry) ◯ Functional status ◯ Temperature to use ◯ Level of independence HEAT ◯ Social isolation Monitor bony prominences carefully because they are NURSING ACTIONS more sensitive to heat applications. ◯ Plan care with clients and families to increase Avoid the use of heat applications over metal devices independence with ADLs and decision-making skills. (pacemakers, prosthetic joints) to prevent deep ◯ Teach the staff to facilitate clients’ independence in tissue burns. all activities. Do not apply heat to the abdomen of a client who is ◯ Provide stimuli (a clock, newspaper, calendar, pregnant to prevent harm to the fetus. weather status). Do not place a heat application under a client who is ◯ Encourage families to visit to maintain socialization. immobile because this can increase the risk of burns. ◯ Plan for staff to spend some time talking and Do not use heat applications during the first 24 hr after listening to clients. a traumatic injury, for active bleeding, noninflammatory edema, or some skin disorders. Application of heat and cold SUPPLIES THERAPEUTIC EFFECTS Heat application Heat MOIST Increases blood flow Warm compresses: towel, bath thermometer, hot water, Increases tissue metabolism plastic covering, hot pack or aquathermia pad (with Relaxes muscles distilled water), tape Eases joint stiffness and pain Warm soaks: water, bath thermometer, basin, waterproof pads Sitz baths: specific chair, tub, or basin (disposable or Cold built-in), bath thermometer, bath blanket, towels Decreases inflammation Prevents swelling DRY Reduces bleeding Hot pack (disposable or reusable) or an aquathermia pad Reduces fever with distilled water, and a pillowcase Diminishes muscle spasms Warming blanket Decreases pain by decreasing the velocity of nerve conduction Cold application MOIST Cold water compresses PATIENT-CENTERED CARE Cold soaks DRY CONSIDERATIONS Ice bag, ice collar, ice glove, or a cold pack FOR CLIENTS AT RISK FOR INJURY FROM HEAT/COLD Cooling blanket Use extreme caution with clients who are very young or fair-skinned, and older adults because they have fragile skin. NURSING ACTIONS Clients who are immobile might not be able to move away Apply to the area. from the application if it becomes uncomfortable. They are Make sure the call light is within reach, and instruct at increased risk for skin injuries. clients to report any discomfort. Clients who have impaired sensory perception might not Assess the site every 5 to 10 min to check for feel numbness, pain, or burning. the following. Use minor temperature changes and short-term ◯ Redness or pallor applications of heat or cold for best results. ◯ Pain or burning Avoid long applications of either heat or cold because ◯ Numbness this can result in tissue damage, burns, and reflex ◯ Shivering (with cold applications) vasodilation (with cold therapy). ◯ Blisters Do not use cold applications for clients who have cold ◯ Decreased sensation intolerance, vascular insufficiency, open wounds, and ◯ Mottling of the skin disorders aggravated by cold (Raynaud’s phenomenon). ◯ Cyanosis (with cold applications) FUNDAMENTALS FOR NURSING CHAPTER 40 Mobility and Immobility 231  Discontinue the application if any of the above occur, Perform hand hygiene. or remove the application at the predetermined time Assess circulation and skin prior to application. (usually 15 to 30 min). Measure around the largest part of the thigh to Document the following. determine the stocking size. ◯ Location, type, and length of the application Apply the sleeves to each leg. Position the opening at ◯ Condition of the skin before and after the application the client’s knees. ◯ Client’s tolerance of the application Attach the sleeves to the inflator. Turn on the device. Monitor circulation and skin after application. Promoting venous return Remove every 8 hr for assessment of calves. Document the application and removal of the stockings. Elastic (antiembolic) stockings cause external pressure on the muscles of the lower extremities to promote Positioning techniques blood return to the heart. To reduce compression of leg veins SCDs and IPC have plastic or fabric sleeves that wrap around the leg and secure with hook-and-loop closures. CLIENT EDUCATION: Avoid the following. The sleeves are then attached to an electric pump that Crossing legs alternately inflates and deflates the sleeve around the leg. Sitting for long periods These machines are set to cycle, typically a 10- to Wearing restrictive clothing on the lower extremities 15-second inflation and a 45- to 60-second deflation. Putting pillows behind the knees Positioning techniques reduce compression of leg veins. Massaging legs ROM exercises cause skeletal muscle contractions, which promote blood return. Specific exercises that help ROM exercises prevent thrombophlebitis include ankle pumps, foot Hourly while awake. circles, and knee flexion. Antiembolic stockings and SCDs require a prescription. CLIENT EDUCATION: Perform the following. Clients who are immobile should perform leg exercises, Ankle pumps: Point the toes toward the head and then increase their fluid intake, and change positions frequently. away from the head. When suspecting poor venous return or possible thrombus, Foot circles: Rotate the feet in circles at the ankles. notify the provider, elevate the leg, and do not apply Knee flexion: Flex and extend the legs at the knees. pressure or massage the thrombus to avoid dislodging it. COMPLICATIONS PATIENT-CENTERED CARE Thrombophlebitis, deep-vein thrombosis Antiembolic stockings Thrombophlebitis and deep-vein thrombosis are EQUIPMENT: Tape measure inflammation of a vein (usually in the lower extremities) that result in clot formation. PROCEDURE Perform hand hygiene. MANIFESTATIONS: Pain, edema, warmth, and erythema Assess skin, circulation, and presence of edema in the legs. at the site Measure the calf and/or thigh circumference and the ASSESSMENT: Another assessment method for clients length of the leg to select the correct size stocking. prone to thrombosis is to measure bilateral calf and thigh Turn the stockings inside to the heel. circumference daily. Unilateral increase is early indication Put the stocking on the foot. of thrombosis. Pull the remainder of the stocking over the heel and up the leg. NURSING ACTIONS Smooth any creases or wrinkles. Notify the provider immediately. Remove the stockings every 8 hr to assess for redness, Position the client in bed with the leg elevated. warmth, or tenderness. Avoid any pressure at the site of the inflammation. Make sure the stockings are not too tight over the toes. Anticipate giving anticoagulants. Keep the stockings clean and dry. Clients who are postoperative or have specific needs can need a second Pulmonary embolism pair of hose. A pulmonary embolism is a potentially life-threatening Document the application and removal of the stockings. occlusion of blood flow to one or more of the pulmonary arteries by a clot. The clot or embolus often originates in SCDs the venous system of the lower extremities. EQUIPMENT MANIFESTATIONS: Shortness of breath, chest pain, Tape measure hemoptysis (coughing up blood), decreased blood pressure, Sequential stockings and rapid pulse PROCEDURE NURSING ACTIONS 232 CHAPTER 40 Mobility and Immobility CONTENT MASTERY SERIES  NURSING ACTIONS Active Learning Scenario Prepare to give thrombolytics or anticoagulants. Position client in a high-Fowler’s position. A nurse is reviewing the effects of immobility Obtain pulse oximetry. on various body systems with a group of newly Administer oxygen. licensed nurses. Use the ATI Active Learning Prepare to obtain blood gas analysis. Template: Basic Concept to complete this item. Monitor vital signs frequently. RELATED CONTENT: List at least two effects of immobility on the cardiovascular system and at least two on the respiratory system. Application Exercises 1. A nurse is caring for a client who has been 4. A nurse is evaluating a client’s understanding sitting in a chair for 1 hr. Which of the following of the use of a sequential compression device. complications is the greatest risk to the client? Which of the following client statements A. Decreased subcutaneous fat indicates client understanding? B. Muscle atrophy A. “This device will keep me from C. Pressure injury getting sores on my skin.” D. Fecal impaction B. “This device will keep the blood pumping through my leg.” C. “With this device on, my leg 2. A nurse is caring for a client who is postoperative. muscles won’t get weak.” Which of the following interventions should D. “This device is going to keep my the nurse take to reduce the risk of thrombus joints in good shape.” development? (Select all that apply.) A. Instruct the client not to perform the Valsalva maneuver. 5. A nurse is instructing a client, who has an injury B. Apply elastic stockings. of the left lower extremity, about the use of a cane. Which of the following instructions should C. Review laboratory values for total protein level. the nurse include? (Select all that apply.) D. Place pillows under the client’s A. Hold the cane on the right side. knees and lower extremities. B. Keep two points of support on the floor. E. Assist the client to change positions often. C. Place the cane 38 cm (15 in) in front of the feet before advancing. 3. A nurse is planning care for a client who is on D. After advancing the cane, move bed rest. Which of the following interventions the weaker leg forward. should the nurse plan to implement? E. Advance the stronger leg so that it A. Encourage the client to perform aligns evenly with the cane. antiembolic exercises every 2 hr. B. Instruct the client to cough and deep breathe every 4 hr. C. Restrict the client’s fluid intake. D. Reposition the client every 4 hr. FUNDAMENTALS FOR NURSING CHAPTER 40 Mobility and Immobility 233  Application Exercises Key Active Learning Scenario Key 1. A. The client is at risk for decreased subcutaneous Using the ATI Active Learning Template: Basic Concept fat due to altered mobility. However, there is RELATED CONTENT another risk that is the priority. B. The client is at risk for muscle atrophy due to altered mobility. Cardiovascular system However, there is another risk that is the priority. Orthostatic hypotension C. CORRECT: The greatest risk to this client is injury Less fluid volume in the circulatory system from skin breakdown due to unrelieved pressure Stasis of blood in the legs over a bony prominence from prolonged sitting in Diminished autonomic response a chair. Instruct the client to shift his weight every Decreased cardiac output leading to poor cardiac 15 min and reposition the client after 1 hr. effectiveness, which results in increased cardiac workload D. The client is at risk for fecal impaction due to altered mobility. However, there is another risk that is the priority. Increased oxygenation requirement Increased risk of thrombus development NCLEX Connection: Basic Care and Comfort, Mobility/ ® Immobility Respiratory system Decreased respiratory movement resulting in decreased oxygenation and carbon dioxide exchange 2. A. The Valsalva maneuver increases the workload of the Stasis of secretions and decreased and weakened respiratory heart, but it does not affect peripheral circulation. muscles, resulting in atelectasis and hypostatic pneumonia B. CORRECT: Elastic stockings promote venous Decreased cough response return and prevent thrombus formation. C. A review of the client’s total protein level is important for NCLEX® Connection: Basic Care and Comfort, Mobility/Immobility evaluating his ability to heal and prevent skin breakdown. D. Placing pillows under the knees and lower extremities can impair circulation of the lower extremities. E. CORRECT: Frequent position changes prevents venous stasis. NCLEX® Connection: Basic Care and Comfort, Mobility/ Immobility 3. A. CORRECT: Encourage the client to perform antiembolic exercises every 1 to 2 hr to promote venous return and reduce the risk of thrombus formation. B. Instruct the client to cough and deep breathe every 1 to 2 hr to reduce the risk of atelectasis. C. Increase the client’s intake of fluids, unless contraindicated, to reduce the risk of thrombus formation, constipation, and urinary dysfunction. D. Reposition the client every 1 to 2 hr to reduce the risk for pressure injuries. NCLEX® Connection: Basic Care and Comfort, Mobility/ Immobility 4. A. Assess the skin under the sequential pressure device every 8 hr to check for manifestations of a thrombus and skin breakdown. B. CORRECT: Sequential pressure devices promote venous return in the deep veins of the legs and thus help prevent thrombus formation. C. Continuous passive motion machines, not sequential pressure devices, provide some muscle movement that can assist in preserving some muscle strength. D. Continuous passive motion machines, not sequential pressure devices, exercise the knee joint after arthroplasty. NCLEX® Connection: Basic Care and Comfort, Mobility/ Immobility 5. A. CORRECT: The client should hold the cane on the uninjured side to provide support for the injured left leg. B. CORRECT: The client should keep two points of support on the ground at all times for stability. C. The client should place the cane 15 to 25 cm (6 to 10 in) in front of their feet before advancing. D. CORRECT: The client should advance the weaker leg first, followed by the stronger leg. E. The client should advance the stronger leg past the cane. NCLEX® Connection: Basic Care and Comfort, Mobility/ Immobility 234 CHAPTER 40 Mobility and Immobility CONTENT MASTERY SERIES