Mobility and Immobility Slideshow PDF

MOBILITY AND IMMOBILITY CHAPTER 38 & 39 NURS 300  OBJECTIVES- IMMOBILITY 1.) Discuss physiological and pathological influences on mobility. 2.) Identify changes in physiological and psychosocial function associated with immobility. 3.) Explain the factors a...

MOBILITY AND IMMOBILITY CHAPTER 38 & 39 NURS 300  OBJECTIVES- IMMOBILITY 1.) Discuss physiological and pathological influences on mobility. 2.) Identify changes in physiological and psychosocial function associated with immobility. 3.) Explain the factors associated with sound clinical judgement and critical thinking in caring for patients who are immobile. 4.) Assess for correct and impaired body alignment and mobility. 5.) Analyze assessment cues to form appropriate nursing diagnoses for patients with impaired mobility. 6.) Explain the importance of involving patients and their assessment data in setting priorities regarding a plan of care focused on immobility. 7.) Discuss a nurse’s role in the prevention of deep vein thrombosis (DVT) in patients with reduced mobility. 8.) Select patient-centered interventions for improving or maintaining patients’ mobility 9.) Evaluate patient outcomes for improving or maintaining mobility. TERMINOLOGY Mobility Ability to move about freely Patients may experience mobility and immobility in degrees Immobility Inability to move about freely Musculoskeletal deconditioning and lack of activity can result in a series of symptoms often referred to as hazards of immobility Bed rest An intervention that restricts patients for therapeutic reasons  SYSTEMIC EFFECTS OF IMMOBILITY Metabolic Respiratory Endocrine, calcium absorption, and GI function Atelectasis and hypostatic pneumonia Cardiovascular Musculoskeletal changes Orthostatic hypotension Loss of endurance and muscle mass and decreased Thrombus stability and balance Muscle effects Skeletal effects Loss of muscle mass Impaired calcium absorption Muscle atrophy Joint abnormalities Urinary elimination Integumentary Urinary stasis Pressure ulcer Renal calculi Ischemia RESPIRATORY CHANGES Immobile patients are at high risk for developing pulmonary complications Atelectasis - collapse of alveoli Hypostatic pneumonia - inflammation ofagg the lung from stasis or pooling of secretions this causes a of bacteria brewing  METABOLIC CHANGES Changes in mobility alter Endocrine metabolism – Decreases metabolic rate; alters metabolism of carbs, fats, & proteins; causing fluid, electrolyte, & calcium imbalances Calcium resorption - Release of Ca into circulation, if kidneys unable to respond, hypercalcemia results. Pathological fractures occur if Ca resorption continues as the patient remains on bed rest or continues to be immobile important factor of skeletal system GI system - decreased mobility vary. constipation is a common symptom, pseudodiarrhea results from fecal impaction liquid stoolpassing around the feces  PSYCHOSOCIAL EFFECTS Immobilization changes Pt’s daily routine, and the Pt has more time to worry about disability. Withdrawn patients often do not want to participate in their own care. Emotional and behavioral responses Hostility, giddiness, fear, anxiety Sensory alterations Altered sleep patterns Changes in coping Depression, sadness, dejection  CARDIOVASCULAR CHANGES pressure drops when we stand up Orthostatic hypotension – Drop of BP greater than 20 mm Hg in systolic pressure or 10 mmHg in diastolic pressure with symptoms of dizziness, light-headedness, nausea, tachycardia, pallor or fainting with change from supine to standing Increased cardiac workload – As immobilization increases, cardiac output falls, decreasing cardiac efficiency & increasing workload thrombosus stops DVT's foomb Mingus Thrombus formation - Accumulation of platelets, fibrin, clotting factors, & cellular elements of blood attached to interior wall of a vein or artery, which sometimes occludes the lumen of the vessel. Virchow’s Triad - three factors contribute to venous thrombus mmonly1. damage to the vessel wall (e.g., injury during surgical procedures) if round 2. Alterations of blood flow (e.g., slow blood flow in calf veins associated with bed rest), and 3. Alterations in blood constituents (e.g., a change in clotting factors or increased platelet activity). Pnairaves MUSCULOSKELETAL CHANGES Muscle effects Lean body mass loss - Because of protein breakdown, the patient loses lean body mass. Muscle weakness/ atrophy Skeletal effects Disuse osteoporosis - When disuse osteoporosis occurs, the patient is at risk for pathological fractures. Joint contracture - an abnormal and possibly permanent condition characterized by fixation of the joint. Footdrop - Foot is permanently fixed in plantar flexion. Ambulation is difficult with the foot in this position because the patient cannot dorsiflex the foot.  URINARY ELIMINATION CHANGES Urinary stasis – When pt is flat, kidneys & ureters move toward a more level plane. Urine formed by kidney enters bladder unaided by gravity. Peristaltic contractions of ureters are insufficient to overcome gravity, renal pelvis fills before urine enters ureters. Increases risk of UTI & renal calculi. Renal calculi - calcium stones that lodge in renal pelvis or pass through ureters. Immobilized patients are at risk for calculi because they frequently have hypercalcemia. Infection – poor perineal care, use of indwelling catheters in immobilized pts., decreased fluid intake leading to concentrated urine. INTEGUMENTARY CHANGES pressure the Pressure Injury – an impairment of the skin that results from prolonged ischemia (decreased blood supply) in tissues Preventing a pressure ulcer is much less expensive than treating one; therefore preventive nursing interventions are imperative. Older adults at greater risk Prevalence of pressure ulcers is highest in long-term care facilities with facility-acquired being the highest in adult intensive care units  CASE STUDY Ms. BW, who is 82, is admitted for a fractured right hip. She is on complete bed rest awaiting surgery. Sergio is the nursing student assigned to Ms. Thomas. Ms. BWs’ mitral valve was replaced 2 months ago, and since the time of that surgery, she has been on anticoagulants. She has had type 2 diabetes mellitus for the past 10 years and is a smoker. She weighs 195 lbs and is 5′7″ tall. She lives by herself, and she attends Mass daily. Her pain is 6 on a scale of 1 to 10. What complications and special areas of concern can you identify for Ms. BW? lives alone how to best her and her status of diabetes and lab results before administering anti MOBILITY ASSESSMENT coagulants Range of Motion (ROM) – perform passive or active ROM Contractures: develop in joints not moved periodically through their full ROM Gait - A particular manner or style of walking Assessing a Pt’s gait allows you to draw conclusions about balance, posture, safety, & ability to walk without assistance Exercise - physical activity for conditioning the body, improving health, & maintaining fitness and Intolerance Activity Tolerance -o the type and amount of exercise or work that a person is able to perform Body Alignment – sitting, standing, lying down Balance - occurs when a wide base of support is present, the center of gravity falls within the base of support, & a vertical line falls from the center of gravity through the base of support SAFETY GUIDELINES Communicate clearly. Mentally review transfer steps. Assess patient mobility and strength. Determine assistance needed. Arrange equipment. Evaluate body alignment. Understand use of equipment. Educate patient.  SPASTICITY IN PEOPLE WITH IDD People with cerebral palsy, brain injuries and neuromuscular disorders can often develop spasticity or hypertonicity in their extremities, neck and torso Can cause discomfort and difficulty with mobility or movement, speaking , eating, dressing and hygiene Can lead to contractures that are usually permanent, so extra time and caution are important steps to take. Treating the underlying spasticity can be of great help in preventing contractures and relieving pain Escude, 2019 THERAPEUTIC BASICS FOR IDD WITH ABNORMAL MOVEMENT PATTERNS Reposition at least every two hours Pressure redistribution is important for preventing injuries (address pressure from wheelchairs, orthotics and braces, etc.) Maintain body alignment as much as possible New or worsening movement issues could be due to medication side effects Escude, 2019  PHYSICAL INACTIVITY AND OBESITY IN INDIVIDUALS WITH IDD Physical inactivity and obesity are prevalent among people with IDD and are associated with cardiovascular disease, diabetes, constipation, osteoporosis, early mortality, and other health risks. Being underweight, with its associated health risks, is also common Environmental and social factors often contribute to obesity and low physical activity rates A health promotion program can improve attitudes toward physical activity and satisfaction with life, but people with IDD often have difficulty finding programs that will accommodate their needs Canadian consensus Guidelines 2018  Monitor weight trends regularly and assess risk status using body mass index, waist circumference, or waist-hip ratio measurement standards PHYSICAL Counsel patients and their caregivers annually regarding targets for an optimal diet and level of INACTIVITY AND physical activity using general population guidelines by age. Advise patients regarding possible changes to OBESITY IN their daily routines to meet these targets INDIVIDUALS Address modifiable risk factors for obesity such as medications and environmental or social barriers to WITH IDD optimal diet and physical activity For anyone who is not meeting diet and physical activity targets, refer to interprofessional health promotion resources (eg, dietitians, support workers, and community programs adapted for people with IDD Canadian consensus Guidelines 2018