chap. 29 - physical activity & immobility

factors affecting mobility

• developmental considerations

• physical health

• mental health

• lifestyle

• attitude + values

• fatigue + stress

• external factors 

integumentary effects of immobility

• pressure ulcers

• decreased skin elasticity

psychosocial effects of immobility

• depression

• altered sleep pattern

metabolic effects of immobility

• increased risk for electrolyte imbalance

• unregulated body temperature

respiratory effects of immobility

• atelectasis

• decreased depth + RR

cardiovascular effects of immobility

• orthostatic hypotension

• thrombus

• increased cardiac workload

musculoskeletal effects of immobility

• muscle mass loss

• muscle atrophy

• joint abnormalities

• decreased stability + balance

gastrointestinal effects of immobility

• decreased peristalsis

• disturbance in appetite

• altered digestions + absorption

urinary effects of immobility

• urinary stasis/infection

• decreased bladder muscle tone

• renal calculi

body alignment: standing

• head erect + midline

• face forward, same direction as feet

• chest up + forward

• symmetrical body parts

• spine straight w/ normal curvatures

• feet flat on floor

• arms hang comfortably at sides

• center of gravity at midline

• abdomen comfortably tucked

body alignment: sitting

• head erect

• neck + vertebral column straight

• thighs parallel + horizontal

• feet are on floor

abduction

away from body

adduction

toward body

external rotation

outward, away from center

internal rotation

inward, toward center

extension

 increasing the angle between 2 adjoining bones

flexion

decreasing angle between 2 adjoining bones (bending)

plantar flexion

foot + toes toward sole of foot

dorsiflexion

foot + toes upward toward ankle

supination

front surfaces face up

pronation

front faces down

functional ability

• mobility

• unsteady gait

• unfamiliar setting

• use of supportive devices

• potential risks for falls 

ROM exercises outcomes

• patient completes exercises

• patient maintains or improves joint mobility 

• muscle strength is improved or maintained 

• muscle atrophy + contractures are prevented

helping falling patient

• stand w/ feet wide apart — 1 foot in front 

• guide patient to floor

• prevent injury to head or extremities 

• call for help

• DO NOT leave patient

anti-embolic stockings

for patients at risk for venous stasis, deep-vein thrombosis (DVT), thrombophlebitis 

• increases velocity of blood flow in superficial + deep veins and improves venous valve function

• promotes venous return to the heart

• physician's order required 

sequential compression devices

fabric sleeves containing air pockets that apply pressure to legs 

• pressure is brief + intermittent 

• pushed blood from smaller blood vessels into deeper vessels + into femoral veins 

• enhances blood flow + venous return 

• prevents thrombosis 

safe patient handling

• proper body mechanisms

• correct ergonomics

• special equipment

• no manual lifting policy w/o assistive devices 

equipment / assistive devices

• gait belts

• stand assist + repositioning aids

• friction-reducing sheets

• mechanical lateral-assist devices

• transfer chairs

• powered repositioning lifts

• powered full-body lifts

assessment before transferring

• LOC + ability to follow directions 

• ability to assist w/ moving and need for assistive devices

• equipment or medical devices hooked up to patient

ambulation

• have patient sit on side of bed + dangle for few mins before standing 

• watch for postural hypotension → dizziness, lightheadedness, nausea, tachycardia pallor

• stand on WEAK side, provide support at the waist

• begin walking 

cane walking

• patient stands w/ weight evenly distributed between the feet and cane 

• cane on strong side of patient (COAL – cane opposite affected leg)

• advance cane + weak leg forward at same time (4 in.)

• shift weight onto cane + weak leg as strong leg steps forward

• maintain upright posture

• AVOID heavily leaning over cane

crutch walking

• types → 4-point gait, 3-point gait, 2-point gait

• support body weight at hand grips w/ elbows at 30 degrees

• position crutches on unaffected side when sitting or rising from chair 

• DO NOT lean on crutches for full body support

• keep elbows close to sides

4-point gait

resembles “normal walking”

• left crutch advanced followed by right leg

• right crutch is advanced followed by left leg 

3-point gait

most used

• both crutches advanced forward

• weak leg then strong leg

walker

• hold grips w/ elbows flexed at 30 degrees

• push walker forward, keep back straight 

• place weak leg inside walker, keeping walker in place

• step forward w/ strong leg into walker, keeping walker still 

• AVOID pushing walker too far out 

• ALWAYS look forward, NOT at ground/feet