Mobility (Class 14)

Mobility

Refers to a person’s ability to move about freely.

Immobility

Refers to the inability to move about freely.

Bed Rest

An intervention ordered by the provider that restricts a patient to the bed for therapeutic reasons and is sometimes prescribed for selected patients. Decreases the body’s oxygen need, reduces cardiac workload, reduces pain, l and allow the patient to get rest.

True

True or False: Clients experience a functional decline in the healthcare in the healthcare setting due to deconditioning.

Functional Decline

Loss of the ability perform self-care or activities of daily living. Loss of muscle tone, ROM, etc.

Deconditioning

Physiological change following a period of inactivity, bed rest, or sedentary lifestyle. Results in functional losses in such areas as mental status, degree of continence, and ability to accomplish activities of daily living.

Body Mechanics

Coordinated efforts of the musculoskeletal and nervous systems.

Alignment and Balance

This refers to posture and center of gravity.

Gravity

Weight force exerted on the body.

Friction

Force that occurs in a direction opposite to movement.

Skeletal System

* Provides attachments for muscles and ligaments
* Protects vital organs
* Aids in calcium regulation.
* Provides leverage for mobility.

Calcium and Phosphorus

What the bones are made of.

Types of Bones

Long, short, flat, and irregular

Joint

Where two or more bones are attached.

Skeletal Muscles

The working elements of movement because of their ability to contract/relax.

Nervous System

Transfers impulses from the nerve to the muscle.

Kyphosis

Increased convexity in the curvature of the thoracic spine. (Upper Spine)

Lordosis

Exaggeration of the anterior convex curve of the lumbar spine. (Lower spine.)

Scoliosis

Lateral S or C-shaped spinal column with vertebral rotation, unequal heights of hips and shoulders.

Metabolic Changes

* Decreased metabolism rate
* Impaired calcium resorption
* Constipation

Respiratory Changes

* Immobile patients are at high risk for developing pulmonary complications.
* Decreased respiratory movement
* Reduced lung capacity
* Pooling of respiratory secretions
* Hypostatic Pneumonia

Atelectasis

The tiny air sacks constrict and get stuck together.

Cardiovascular Changes

* Orthostatic hypotension
* Increased cardiac workload
* Thrombus formation

Musculoskeletal Changes

* Lean body mass loss
* Muscle weakness/atrophy
* Joint contracture

Urinary Elimination Changes

* Urinary stasis
* Increased risk for UTI
* Renal calculi
* Urinary retention
* Infection

Integumentary Changes

* Pressure ulcers
* Reduced skin turgor

Psychosocial Effects

* Hostility
* Giddiness
* Fear
* Anxiety
* Altered sleep patterns
* Depression
* Sadness
* Dejection

True

True or False: Older adults are more likely to decline faster.

Range of Movement (ROM)

The maximum amount of movement available at a joint in one of the three planes of the body: sagittal, transverse, or frontal. Active, active assisted, passive.

Passive

You are doing the ROM for the patient.

Contracture

Develop when a patient’s joints are not moved periodically, their body part gets stuck in that position. Commonly seen in: neck, shoulder, elbow, forearm, wrist, fingers, etc.

Activity Tolerance

The type and amount of exercise a patient is able to perform without undue exertion or edurance.

Activity Tolerance Factors

* Skeletal abnormalities
* Muscular impairment
* Endocrine or metabolic illnesses
* Hypoxemia
* Decreased cardiac function
* Decreased endurance
* Impaired physical stability
* Pain
* Sleep pattern stability
* Pain
* Sleep pattern disturbance
* Prior exercise patterns
* Infectious processes and fever
* Anxiety
* Depression
* Chemical addiction
* Motivation
* Age
* Sex
* Pregnancy
* Know patient limitations

Assessment findings that indicate the client is not tolerating the activity

* Dyspnea
* Chest pain
* Shortness of breath
* BP changes dramatically
* Respiration problems

Gait

The manner or style of walking. Impairments can shift the center of gravity and make falls more likely.

Nursing Diagnosis for Clients With Impaired Mobility

* Social isolation
* Impaired elimination
* Impaired physical mobility
* Risk for impaired skin integrity
* Ineffective airway clearance.

Blood Clot Intervention Methods

* Compression stockings
* Blood thinners

Fall

An event that results in a person coming to rest inadvertently on the ground, floor, or other lower level. A major health problem, ranking as the second leading cause of accidental or unintentional injury deaths worldwide.

True

True or False: Falls are the leading cause of both fatal and non-fatal injuries for those 65 years and older.

Intrinsic Factors

Predisposing factors (within the patient)

Extrinsic Factor

Increase the susceptibility of an individual to fall (environmental.)

Universal Fall Precautions

Apply to all patients regardless of fall risk. Ex:

* Familiarize the patient with their surroundings
* Have patient demonstrate call light use
* Maintain call within patient’s reach
* Non-slip footwear
* Keep hospital bed brakes locked
* Keep floors clean and dry
* Have sturdy handrails
* Place bed in lowest position.

Assisted fall

1. Stand with feet apart to provide a broad base of support.
2. Extend one leg and let the patient slide against it to the floor.
3. Bend knees to lower body as patient slides to the floor.

Walker

* A lightweight, movable device that stands about wait high with four widely placed sturdy legs.
* Used by patients with generalized lower extremity weakness or problems with balance.
* Cannot be used on stairs and wheels may contribute to a patient falling.

Cane

* Less bulky supportive device for patients that still have one strong side.
* Instruct patient to keep device on stronger side.
* Less stable and provide less support than other options, patients should be instructed that two points of support must be on the ground at all times when walking.

Physiological Changes in Older Adults Contributing to Falls

* Slowed reaction time
* Decreased bone bass
* Decreased ROM
* Less flexibility/strength
* Visual/hearing alterations
* Nocturia
* Impaired memory
* More medication use

Chemical Restraint

Medications administered to agitated patients to control unsafe physical movements and behaviors

Physical Restraints

Wrapped, buckled, or tied to a patient’s body to limit or restrict movement.

Seizure

A hyperexcitation and disorderly discharge of neurons in the brain leading to sudden, violent jerking, falling, etc.

Seizure Precautions

Guidelines to protect those with seizures from injury:

* Always have a pillow under the head
* Pad handrails to protect the head
* Have bed in lowest position
* Encourage side lying
* Have patient in loose clothing

False

True or False: You can administer chemical restraints on a patient FIRST.

Reasons for Restraints

* Patients removing medical devices.
* Confused or wandering patients.
* Patients ambulating without assistance constantly.
* Patients that pose a threat to themselves or others.

True

True or False: If a patient is being aggressive, you can apply restraints without a doctor’s order as long as they are notified within a timely manner.

False

True or False: Ativan is a good chemical restraint on older adults.