Fundamentals of Nursing: Activity, Immobility, and Safe Movement

Chapter 28: Activity, Immobility, and Safe Movement

Normal Structure and Function of Movement

  • Musculoskeletal System: Serves as the framework for movement, providing structural support for the body.

  • Nervous System: Responsible for controlling movement, posture, balance, and gait.

  • Cardiopulmonary System: Circulates oxygen and nutrients essential for muscle function and overall bodily operation.

Altered Structure and Function of Movement

Musculoskeletal System

  • Bone Fragility: Increased susceptibility to fractures and reduced mechanical strength of bones.

  • Flaccidity or Hypotonicity: Reduced muscle tone that can manifest as weakness and inability to maintain posture.

Nervous System

  • Hemiparesis: Weakness on one side of the body, often resulting from neurological damage.

  • Hemiplegia, Paraplegia, and Quadriplegia: Severe forms of dysfunction, affecting one side (hemiplegia), lower half (paraplegia), or all limbs (quadriplegia).

Cardiopulmonary System

  • Compromised Cardiac Function: Potential heart issues leading to decreased physical capability and endurance.

  • Decreased Tissue Perfusion: Reduced blood flow to tissues, potentially leading to injury and organ dysfunction.

  • Diminished Respiratory Capacity: Decreased ability for the lungs to expand, impacting oxygen delivery to the body.

Assessment of Immobility Effects

Musculoskeletal System Effects

  • Weakness and Decreased Muscle Tone: Loss of strength, reducing the ability to perform activities of daily living (ADLs).

  • Decreased Bone and Muscle Mass: Atrophy occurs due to disuse, leading to reduced strength and resilience.

  • Muscle Atrophy: Reduction in muscle size and strength; a consequence of prolonged immobility.

  • Contracture: Shortening of the muscle or joint tissue, which can limit mobility and create pain.

Nervous System Effects

  • Altered Proprioception and Equilibrium: Disruption in the body’s ability to sense its position, which may lead to falls or instability.

Cardiopulmonary System Effects

  • Increased Cardiac Workload: The heart must work harder, increasing the risk of cardiovascular complications during immobility.

  • Decreased Lung Expansion: Affects gas exchange efficiency, can lead to atelectasis or pneumonia.

  • Circulatory Stasis: Slowed blood flow in veins, increasing risk for deep vein thrombosis (DVT).

  • Activity Intolerance: Patients may experience fatigue upon exertion, reflecting underlying deconditioning.

Nutritional Effects

  • Reduced Basal Metabolic Rate (BMR): Impacts energy requirements, often leading to weight gain or malnutrition if not addressed.

  • Negative Nitrogen Balance: Resulting from catabolism of protein when dietary protein is insufficient, leading to muscle wasting.

  • Potential for Anorexia and Nausea: Physiological and psychological impacts due to immobility and inactivity.

Elimination Effects

  • Urinary Stasis: Potential development of urinary tract infections and renal calculi due to poor urinary flow.

  • Gastrointestinal Hypomotility: Slowed digestion associated with immobility, leading to constipation.

Skin Effects

  • Tissue Ischemia Due to Pressure: Pressure on bony prominences leading to reduced blood flow and potential for skin breakdown.

  • Risk of Pressure Injuries: Skin breakdown can occur if pressure is not alleviated in immobile patients.

Psychosocial Impact

  • Isolation and Sensory Deprivation: Long periods of immobility may lead to feelings of loneliness, depression, and anxiety.

  • Altered Self-Concept: Patients may view themselves in a diminished capacity due to decreased mobility.

  • Disturbed Sleep and Rest Patterns: The health of rest cycles may be compromised, impacting recovery and overall well-being.

Nursing Diagnosis Examples

  • Impaired Mobility: For instance, a patient with left-sided weakness and impaired visual perception would be diagnosed as such.

  • Risk for Fall: Resulting from altered mobility contributing to increased vulnerability to falling, especially post-cerebrovascular accident.

  • Activity Intolerance: Identified by the deconditioning effects of bed rest and symptomatic shortness of breath. Indicators might include an oxygen saturation below 90% or a pulse rate exceeding 100 beats per minute with activity.

Planning Nursing Care

  • Addressing Nursing Diagnoses: Prioritize the most critical identified issues to create an effective care plan.

  • Inter-professional Collaboration: Essential when addressing complex mobility-related health problems.

  • Goal Setting: Establish short-term and long-term goals focused on mitigating specific nursing diagnosis issues.

Implementation and Evaluation

Musculoskeletal and Nervous System Interventions (1 of 18)

  • Early Ambulation: Encouraging movement as soon as it is safe to promote recovery and prevent complications.

  • Isotonic, Isometric, Aerobic, and Anaerobic Exercises: Different types of exercises tailored to maintain or enhance muscle strength and endurance.

  • Range-of-Motion Exercises: Active or passive movements designed to maintain joint function and flexibility.

  • Pain Assessment and Treatment: Essential for effective management and to encourage participation in rehab.

Interventions with Positioning Devices (2 of 18)

  • Pillows, Splints, and Braces: Used to maintain proper body alignment and support, preventing contractures and promoting comfort.

  • Hand Rolls: Used to maintain hand function, preventing flexion contractures.

Mobility Techniques (3 of 18)

  • Trochanter Rolls and Logrolling: Techniques to reposition immobile patients while maintaining spinal alignment.

  • Fall Prevention: Identifying and implementing strategies to reduce fall risk across care settings.

  • Ambulation Aids: Utilization of devices to assist with movement.

Use of Transfer Belts (4 of 18)

  • Application Techniques: Secure application of transfer belts to the patient with the caregiver standing on the patient’s weaker side for additional support.

  • Proper Grip: Holding the gait belt firmly at the back of the patient's waist ensures stability during transfers.

Use of Canes (5 of 18)

  • Proper Cane Use: Patients should hold the cane on the stronger side and follow a specific sequence while walking (cane first, then weak leg, strong leg).

Use of Crutches (6 of 18)

  • Types of Crutches: Underarm and forearm (Lofstrand) crutches tailored for different levels of mobility impairment.

  • Crutch Gait Variations: Explanation of two-point, three-point, and four-point walking patterns to enhance ambulation safety.

Ascending and Descending Stairs with Crutches (7-8 of 18)

  • Ascending Stairs: Patients must transfer weight from crutches to unaffected leg, then align crutches with the unaffected leg on the stair.

  • Descending Stairs: The reverse; weight is shifted from the unaffected leg to the crutches before stepping down.

Use of Walkers (9 of 18)

  • Walker Technique: Instructions for using a walker effectively to maximize stability and safety, including the mechanics of moving a walker forward and stepping into the device.

Mechanical Lifts (10 of 18)

  • Preferred Transfer Method: Designed to assist with patient transfers safely, allowing limited mobility patients to participate in movement with supportive harnesses while minimizing caregiver injury.

Safe Patient Movement (11 of 18)

  • Lift Equipment Usage: Maximizes patient assistance and reduces injury risks for nursing staff; educating patients on using top side rails and trapezes for mobility.

Cardiopulmonary System Interventions (12-13 of 18)

  • Promoting Lung Expansion: Techniques to encourage proper respiratory function include raising the head of the bed, encouraging coughing and deep-breathing, and regular repositioning.

  • Deep Vein Thrombosis Prevention: Techniques such as leg exercises, passive range of motion, and usage of antiembolism gear are crucial.

Nutritional Interventions (14 of 18)

  • Dietary Guidance: Focus on providing lean protein meals, smaller and frequent meal distributions, and involving patients in dietary choices for better engagement.

  • Fluid Intake: Ensuring patients drink adequately to maintain hydration.

Elimination Interventions (15 of 18)

  • Strategies to Support Elimination: Adequate fluid intake, positioning changes, and a structured toileting program to prevent stasis and constipation.

Skin Integrity Interventions (16 of 18)

  • Turning Schedule: Regular repositioning at least every 2 hours to prevent bedsores; additional use of pressure-relieving devices.

Psychosocial Interventions (17 of 18)

  • Social Support: Encouragement for maintaining contact with family and friends to mitigate feelings of isolation; providing explanations and reality orientation to the patient.

Evaluation (18 of 18)

  • Ongoing Assessment of Interventions: Regularly measuring the effectiveness of interventions against the goals set in the care plan ensuring optimal support for patients with limited mobility. Nurses must evaluate short- and long-term outcomes regularly to ensure patient safety and recovery efficiency.