NUR2356_Module 04_Faculty Topics (2) (2).docx

Module 04***- The Effects of Immobility***

What body systems need to be functional for activity to occur? Coordination between the musculoskeletal and nervous system. For movement to occur each piece of the system must be intact in order for the client to sit, stand and move.

Define the following:

  • Body Mechanics
  • Body alignment
  • Balance
  • Coordination
  • Joint movement   * Flexion   * Extension   * Abduction   * Adduction   * Circumduction   * Internal and External rotation   * Opposition

Factors Affecting Mobility:

  • Developmental Age
  • Nutritional Status
  • Lifestyle choices
  • Stress
  • Environment
  • Diseases   * Rheumatoid arthritis   * Osteoarthritis   * Osteoporosis to name a few
  • Disorders of the Central Nervous System
  • Other Disease processes

Hazards of Immobility with nursing interventions to prevent the hazards from occurring:

  • Effect on Musculoskeletal system   * 12% loss of muscle strength per week   * Osteoporosis   * Change in calcium metabolism leading to possible formation of renal calculi   * Impaired balance   * Foot drop   * Altered joint mobility   * Pathological fractures   * Decreased stability

Purposes for positioning your patient:

  • Prevent skin breakdown
  • Prevent muscle discomfort
  • Prevent damage to superficial nerves and blood vessels
  • Prevent contractures

List common positioning devices and their purpose:

  • Trochanter roll
  • Hand roll
  • Abduction pillow
  • Cradle boots
  • Foot board

Review the advantages and disadvantages of different positions in bed for a patient limited to bed rest.

Moving and transferring the patient safely:

  • Transfer board
  • Mechanical Lift
  • Transfer belt

Gait and strength training:

  • Range of motion exercises
  • Dangling
  • Assisting with walking   * Canes   * Walkers   * Crutches
  • Effect on Respiratory system   * Decrease in the depth of respiration   * Pooling of secretions in the airways   * Decrease ability to effectively cough   * Leads to atelectasis

Common nursing interventions:

  • Turn, Cough and Deep breath every 2 hours
  • Incentive spirometer every 2 hours while awake
  • Use chest physiotherapy
  • Encourage fluid intake of at least 2000 mL per day unless contraindicated
  • Assess lungs, cough and sputum production at least every shift
  • Effect on the Circulatory system   * Increases the workload of the heart   * Promotes venous stasis   * Orthostatic hypotension   * Risk of thrombus formation

Nursing interventions:

  • Increase client’s activity as soon as possible
  • Assess for peripheral, sacral and pedal edema
  • Assess calves for signs and symptoms of thrombus formation (redness, warmth and tenderness)
  • Measure circumference of both calves and compare size
  • Use TED hose or Sequential Compression device
  • Administer low dose heparin
  • Effect on Metabolism   * Drop in the metabolic rate   * Can stimulate a stress response   * Decreased appetite   * Weight loss   * Bone loss from calcium reabsorption

Nursing interventions:

  • Provide high calorie, high protein diet
  • Vitamin and mineral supplement
  • I & O
  • Calorie Count
  • Effect on the Integumentary system   * External pressure leads to compressed capillaries in the skin   * Leading to tissue ischemia and eventual necrosis

Nursing interventions

  • Change positions as indicated by skin assessment with position change
  • Assess the client for pressure ulcer risk
  • Teach client to shift weight every 15 minutes if possible
  • Use positioning devices as needed
  • Assess skin and provide skin and perineal care as needed
  • Effect on the gastrointestinal System   * Slows peristalsis   * Constipation   * Paralytic Illeus

Nursing interventions:

  • Maintain hydration
  • Include fresh fruit and vegetables in diet
  • Promote as normal as possible position for elimination as possible
  • Effects on the Genitourinary system   * Stagnant urine leading to increase in urinary tract infections   * Kidney stone formation

Nursing interventions:

  • Encourage fluid intake
  • Bladder training
  • Assess for urinary retention using a bladder scanner
  • Promote urination by pouring warm water over the perineum area
  • Psychological effects of immobility   * Isolation   * Mood change   * Depression   * Anxiety

Nursing interventions:

  • Involve clients in daily care
  • Provide stimuli such as newspapers, TV, magazines
  • Assist with grooming and hygiene such as shaving and makeup
  • Involve the client in planning of daily routine
  • Maintain orientation to time such as a clock, and calendar

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