NURS 208: TOPIC 4 - MOBILITY/IMMOBILITY

What does mobility refer to?

A person’s ability to move freely.

What is another way to describe mobility?

Motion or movement.

What body systems must work together for mobility?

Muscles, skeleton, and nerves.

What is a nursing goal related to mobility?

To assist in preserving, maintaining, and restoring as much mobility and function as possible.

What nursing interventions support mobility?

Range of motion (ROM) exercises, positioning, and teaching patients how to use assistive devices.

What is the term for the ability to walk from place to place independently?

Ambulation.

What system is comprised of the muscles that provide the motor power or force for movement?

The muscular system

Besides movement, what two other functions do muscles perform?

Maintain posture and generate heat

Which two systems does the muscular system work with?

The skeletal system and the nervous system

Approximately how many muscles are in the human body?

More than 600

The muscular system accounts for about what fraction of a person’s body weight?

Half

When muscles contract across a joint, what do they create?

A force to pull against the skeleton

Why is it difficult to build and maintain muscles?

Because muscles are always working and have a high demand for oxygen and glucose

What are the four properties of a muscle?

Contractibility, Excitability, Extensibility, Elasticity (CEEE)

What is contractibility in muscles?

The ability of a muscle to shorten (contract) and then relax

What is excitability in muscles?

The ability of muscle fibers to receive and respond to nerve or hormone stimulation; a resting muscle is negatively charged, and when stimulated, it becomes positively charged and active

What is extensibility in muscles?

The ability of a muscle to stretch (extend), which occurs simultaneously as other muscles contract; ex: hamstrings stretch when walking

What is elasticity in muscles?

The ability of a muscle to bounce back or recoil to its original state after being contracted or extended; example: after stretching, muscle returns to original length

What are the three main types of muscle?

Cardiac, smooth, skeletal

Where is cardiac muscle located and is it voluntary or involuntary?

Located only in the heart, involuntary

Where is smooth muscle located and is it voluntary or involuntary?

Located in blood vessels and visceral organs, involuntary

What are some examples of smooth muscle functions?

Digestion, blood flow, respiration, peristalsis

Where is skeletal muscle located and is it voluntary or involuntary?

Attached to the skeleton (bones) by tendons, voluntary

What role does the skeletal system play in supporting the body?

It supports the soft tissues of the body.

How does the skeletal system protect the body?

It protects crucial components of the body, such as organs.

How does the skeletal system allow movement?

It furnishes surfaces for the attachment of muscles, tendons, and ligaments, making movement possible.

What storage functions does the skeletal system provide?

It provides storage areas for minerals and fat, which are critical for overall health.

What role does the skeletal system play in blood production?

It produces blood cells.

What does it mean when skeletal muscles are described as antagonistic?

They work in opposite directions.

What structure connects muscles to bones?

Tendons.

What role do joints play in movement?

They act as pivot points for movement.

How does movement occur between muscle, tendon, bone, and joint?

The muscle pulls on the tendon → the tendon pulls the bone → the bone moves at the joint.

What type of joint is the elbow?

A hinge joint.

What type of joint is the hip?

A ball and socket joint.

What is essential to life?

Mobility

What helps people complete many daily tasks?

Mobility serves many purposes in daily life

What does physical movement have an impact on?

Every organ in the body

What is the role of neurons in muscle contraction?

They conduct impulses from one part of the body to another.

What does the afferent (sensory) nervous system do?

It conveys information from receptors in the periphery to the central nervous system (CNS).

What is an example of the afferent system at work?

Stretching your arm.

What happens to information once it reaches the CNS?

It is processed, leading to a response.

What do efferent (motor) neurons do?

They convey the response from the CNS to skeletal muscles by way of the SNS.

How does the CNS ultimately allow movement?

By sending instructions (signals) to the muscles, which then contract to produce movement.

How can being a young patient affect mobility?

They may not have met developmental milestones, which can limit certain movements and physical abilities.

How does aging affect mobility in older adults?

Older adults may lose flexibility and bone mass, which increases the risk of osteoporosis, experience changes in posture and gait, have reduced strength, and may have a limited ROM.

What role does muscle mass, speed, and reaction time play in mobility?

Reduced muscle mass, slower speed, and delayed reaction time can all decrease mobility and make movement less efficient.

How can problems with the muscular, skeletal, or nervous systems affect mobility?

Problems in these systems can directly limit a person’s ability to move properly and perform daily activities.

Can issues in other body systems affect mobility?

Yes

How does depression influence mobility?

It can negatively affect body processes and reduce a person’s motivation and ability to move.

In what ways can occupation impact mobility?

Because physically demanding jobs may increase movement, while sedentary jobs may reduce physical activity.

How does culture affect mobility?

Cultural beliefs and practices can influence physical activity, exercise habits, and overall movement patterns.

How can family attitudes toward exercise affect mobility?

They can shape a person’s values and motivation toward staying active, affecting their willingness to move.

How do fatigue and stress influence mobility?

They can reduce energy, making it harder for a person to move efficiently or maintain physical activity.

How can weather affect mobility?

Weather conditions, such as extreme heat, cold, or rain, can affect a person’s willingness or ability to go outside and move.

What are some prescribed treatments that can influence mobility?

Ordered bedrest may cause problems even as it helps.

How can restraints affect a patient’s mobility?

They contribute to a decrease in mobility.

Which types of medications can contribute to decreased mobility?

Medications that could sedate contribute to a decrease in mobility.

How can medical equipment affect mobility?

Equipment used could contribute to a decrease in mobility.

Which specific types of equipment may decrease mobility?

IV lines, Foley catheters, and SCDs.

What is immobility?

It is the inability to move one or more body parts.

Can immobility be temporary or permanent?

Yes, immobility can be temporary (e.g., after surgery), long-term, or permanent (e.g., ALS).

What are the effects of prolonged immobility on the body?

It negatively affects all major body systems in a critical cascade of dependency.

What are the initial impacts of immobility on joints?

They include stiffness, pain, and limited ROM, especially in the shoulders, elbows, hips, knees, and ankles.

What happens to joints during prolonged immobilization?

Fibrofatty connective tissue and abnormal adhesions form within and between joints, restricting nourishment to the joints.

How does prolonged bedrest, standing, or sitting affect blood flow?

It slows blood flow (venous stasis), increasing the risk for blood clots.

What are the benefits of mobility to the cardiovascular system?

Increased efficiency of the heart, decreased HR and BP, increased blood flow to all body parts, improved venous return, and increased circulating fibrinolysin.

How does immobility affect the cardiovascular system?

Causes deconditioning, activity intolerance, tachycardia, increased diastolic pressure, orthostatic hypotension, and makes the heart work harder.

What substance increases in circulation with mobility and helps break up small clots?

Fibrinolysin.

What is orthostatic hypotension?

A condition in which BP drops when moving from a supine to an upright position due to inadequate neurovascular adjustments.

What happens to neurovascular adjustments during periods of immobility in orthostatic hypotension?

Normal neurovascular adjustments to maintain systemic BP do not occur.

Why does blood pressure drop in orthostatic hypotension?

Because of a lack of vasoconstriction when moving from supine to upright position.

What are the clinical manifestations of orthostatic hypotension?

Dizziness, confusion, lightheadedness, blurred vision, weakness, fatigue, nausea, tachycardia, palpitations, headache.

How can symptoms of orthostatic hypotension be relieved?

By sitting or lying flat.

Which population is at high risk for falls due to orthostatic hypotension?

Older adults.

Why does DVT occur?

It occurs when immobility impairs venous return to the heart, causing blood to stay stagnant in the veins of the extremities.

What can stagnant blood in the veins lead to?

It can create blood clots.

Where do clots from DVT typically develop?

They often develop in a deep vein, commonly in the thigh or calf.

What can happen if a thrombus from DVT breaks free?

It can travel to the lungs and become a pulmonary embolism (PE).

Why is DVT significant in hospitalized patients?

It is one of the most common preventable causes of hospital-related death, especially among older adults.

How can the risk of DVT complications be reduced?

By measures following surgery or trauma to improve venous return and prevent clot formation.

What is Virchow’s triad?

A set of 3 factors that contribute to the formation of deep vein thrombosis (DVT).

What are the three components of Virchow’s triad?

Hypercoagulability, venous stasis, and vessel wall injury.

How does hypercoagulability contribute to DVT?

It makes the blood thicker, increasing the risk of clot formation.

How does venous stasis contribute to DVT?

Blood is not moving properly, which allows clots to form.

How does vessel wall injury contribute to DVT?

It impairs circulation, making it easier for clots to develop.

What condition is primarily associated with Virchow’s triad?

Deep vein thrombosis (DVT).

How can Virchow’s Triad be prevented?

By addressing its three components: stasis of blood, hypercoagulability, and endothelial injury.

How can venous stasis be reduced to prevent Virchow’s triad?

Increase venous return through movement to activate muscles as pumps (leg exercises, ROM), use TED hose or SCDs if the patient cannot move easily, and assess peripheral tissue perfusion.

How can the coagulability of blood be decreased to prevent Virchow’s triad?

Maintain adequate hydration, use anticoagulant drugs to decrease clotting.

• Commonly prescribed medications include Heparin, Warfarin (Coumadin), Clopidogrel (Plavix), Enoxaparin (Lovenox), Aspirin (ASA), Apixaban (Eliquis), and Rivaroxaban (Xarelto).

How can trauma or injury to blood vessels be minimized to prevent Virchow’s triad?

Promote proper positioning to enhance venous return (elevate feet), keep legs uncrossed, avoid placing pillows under knees, and pad siderails.

What should you do if you suspect your patient has a DVT?

Use caution.

Which action should not be done on a patient with a suspected DVT?

Do not massage the affected area.

Can you place an SCD or TED hose on the affected area of a suspected DVT?

No

Is it safe for a patient with a suspected DVT to be mobile?

Mobility may potentially dislodge a clot; the patient needs to stay on bedrest.

Who should you alert if a patient is suspected to have a DVT?

Alert the MD.

What are the benefits of mobility to the respiratory system?

Improved alveolar ventilation, decreased work of breathing, improved diaphragmatic excursion

What effects does immobility have on the respiratory system?

Shallow respirations, decreased oxygen exchange, pooling of secretions in the bottom of the lungs

What complications can result from pooling of secretions due to immobility?

Atelectasis and pneumonia

What are the benefits of mobility to the musculoskeletal system?

Increased muscle efficiency (strength) and flexibility, increased coordination, reduced bone loss, and increased efficiency of nerve impulse transmission.

What happens to bones and muscles when a person is immobile?

It causes bone demineralization, which can lead to osteoporosis, and can also cause contractures.