Mobility & Immobility

Course Student Learning Objectives

• Define mobility and immobility.

• List the common causes of immobility.

• Discuss the benefits and hazards of bed rest.

• Describe complications associated with immobility.

• Discuss the impact immobility has on psychosocial function.

• Discuss appropriate nursing interventions that can be implemented to prevent complications caused by immobility.

• Discuss the function of the skin.

• List and describe the classifications of wounds including the four stages of pressure ulcers.

• Discuss the contributing factors for pressure ulcer formation and the susceptible body areas.

• Identify priority nursing interventions for an immobilized client including comfort measures, pressure relief, nutritional support, treatment of ulcers.

• Differentiate between clean and sterile dressing changes.

• Discuss the Braden Scale used for predicting pressure ulcer risk.

• Discuss client education regarding ulcer prevention and develop teaching plan for patient and family/caregiver.

• Describe essential information needed when describing/charting wounds.

Mobility and Immobility

Mobility

• Definition: Ability to move freely within the environment.

  • Occurs when a person has no physical or psychological factors that limit movement.

• Importance of Regular Exercise and Nutrition: Essential for maintaining mobility.

• Factors Affecting Bone and Joint Function:

  • Bone mineral content is critical for the function of bones and joints.

  • Adequate intake of calcium, phosphorus, and Vitamin B is important for maintaining bone resilience.

Immobility

• Definition: Occurs when a person cannot move his or her entire body or a specific part.

• Effects of Immobility:

  • Affects every body system.

  • Joints become less flexible and elastic.

  • Impairs the ability to complete activities of daily living (ADLs).

• Aging Effects on Mobility:

  • After age 30, aging changes that affect mobility begin.

  • Between ages 40 to 60, muscle tone and bone density decrease.

  • Women experience a rapid decline in bone mass at menopause.

  • Aging leads to postural changes and chronic joint disorders.

Benefits and Hazards of Bed Rest

Bedrest Benefits

• Supports a weak, febrile, or exhausted patient.

• Relieves edema and decreases pain.

• Promotes healing and tissue repair by decreasing metabolic needs, which also reduces the body’s oxygen requirements and avoids dislodging a deep vein thrombosis (DVT).

Bedrest Hazards

• Muscle Atrophy:

  • Breakdown of muscle mass to obtain energy due to lack of movement.

  • Results from fibrotic changes that occur when the patient is immobile.

• Joint Contractures:

  • Tightening of muscles and tendons around joints, leading to immobility of joints.

• Thromboembolic Disease:

  • Formation of blood clots due to decreased blood flow. Most patients will be started on blood thinners or anticoagulants to prevent.

• Muscle Weakness:

  • Generalized weakness due to lack of physical activity.

Complications Associated with Immobility

Cardiovascular Complications

• Venous Stasis:

  • Due to heart's inability to compensate for bodily demands, leading to pooling of blood and edema.

• Decreased Cardiac Reserve:

  • Without muscle activity, the heart cannot pump effectively, leading to increased risk of edema.

• Risk for Thrombosis:

  • Increased risk due to compression and injury of small vessels in legs.

  • Blood clots form faster with stasis and vessel injury, increasing the risk for DVT.

• Orthostatic Hypotension:

  • Inability to properly regulate blood pressure; results in dizziness and light-headedness, particularly when a patient tries to ambulate post-surgery.

• Interventions:

  • Have clients dangle their lower extremities before standing to prevent orthostatic hypotension; always avoid massaging lower extremities due to risk of dislodging a DVT.

Respiratory Complications

• Decreased Lung Expansion:

  • Immobility results in shallow breaths, requiring more effort for breathing; diaphragm is affected by chest wall pressure from lying supine.

• CO2 Build Up:

  • Less activity leads to decreased carbon dioxide production, leading to decreased stimulation of breathing.

• Interventions:

  • Assess for signs of oxygen deprivation, encourage turning, coughing, and deep breathing every two hours.

  • Increase fluid intake to at least 2000 cc, change position every two hours, use incentive spirometry, and assist with chest physical therapy.

Metabolic Complications

• Decreased Metabolic Rate:

  • Protein and glycogen synthesis decrease, while fat stores increase.

• Stress Response:

  • Triggers hormone release; increased excretion of calcium leading to fracture risk with minimal trauma.

Gastrointestinal Complications

• Effects on Peristalsis:

  • Immobility slows peristalsis, leading to constipation and difficulty evacuating stool; risk for developing paralytic ileus.

• Diminished Appetite:

  • Digestion slows, resulting in decreased calorie intake; muscle breakdown occurs as fuel source.

• Interventions:

  • Offer a protein-rich diet and ensure high-calorie, high-protein drinks for better healing.

  • Encourage fluids, particularly fruits and veggies; promote natural position and privacy for bowel movements.

Integumentary Complications

• Pressure Injuries:

  • Areas under pressure become susceptible to decreased blood flow, leading to ischemia and skin breakdown over bony prominences.

• Complications:

  • Pressure injuries can lead to systemic infections such as osteomyelitis, which requires surgical intervention and prolonged antibiotic therapy.

Musculoskeletal Complications

• Atrophy:

  • Loss of muscle mass due to disuse; 10% muscle strength loss per week in bed.

• Contractures:

  • Stronger muscles pull joints into fixed positions.

  • Most common examples of contractures occur in the elbow from immobility.

• Interventions:

  • Assist with ambulation and standing when possible; provide passive range of motion (PROM) exercises to maintain joint mobility.

Urinary Complications

• Thrombus Formation:

  • Caused by slow blood flow due to bed rest.

  • Signs and symptoms include pain, edema, warmth, fever, and redness; immediate medical attention is necessary.

Pulmonary Emboli

• What are Pulmonary Emboli?

  • Clots that break away and block pulmonary arteries, disrupting blood flow to lung lobes.

  • Symptoms include shortness of breath, sudden chest pain, tachycardia, cyanosis, hemoptysis, and hypotension. Immediate medical assistance is necessary due to the risk of fatal outcomes.

Nursing Interventions for Immobility

General Interventions

• Turn clients every two hours to prevent skin breakdown.

• Maintain cleanliness in the bed to decrease the risk of skin maceration.

• Provide nutritional support, ensuring adequate intake of calories and nutrients, including protein.

• Keep the client active, either through ROM exercises or assisting them in movement as tolerated.

• Educate clients about the importance of nutrition and mobility in their recovery.

Braden Scale for Predicting Pressure Ulcer Risk

• A tool to assess risk based on several criteria: sensory perception, moisture, activity, mobility, nutrition, and friction & shear.

• Scoring:

  • Higher scores indicate lower risk; a score of 18 or lower indicates the need for preventive measures.

Skin and Wound Healing

Function of Skin

• Protects the body from injury, infection, and UV rays.

• Regulates temperature and provides sensory information.

• Synthesizes Vitamin D necessary for calcium absorption.

Wound Classification

• Acute Wounds: Heal within six months (e.g., surgical incisions, burns).

• Chronic Wounds: Persist beyond the normal healing time (>6 months).

• Wounds can be classified as open or closed based on whether there is a break in the skin.

• Other types include abrasions (superficial), punctures, lacerations, and contusions (bruises).

Pressure Ulcer Stages

• Stage 1: Intact skin with non-blanchable redness.

• Stage 2: Partial thickness loss of skin, may present as a blister.

• Stage 3: Full-thickness tissue loss, wherein muscle/tissue may be visible.

• Stage 4: Full-thickness loss with muscle and bone exposure.

• Unstageable: Base covered with slough or eschar; significant tissue loss.

Patient Mobility Techniques

Crutch Walking

• Proper crutch height and handgrip alignment are critical; elbows should bend at a 30-degree angle.

• Steps for crutch walking include starting with the non-injured leg moving ahead and ensuring the weight is shifted correctly.

Body Mechanics Principles

• Key concepts include alignment, balance, coordination, and joint mobility for effective patient movement and transfer.

Positioning Techniques

• Different positions include Fowler’s, lateral, prone, Sims’, and supine; methods for turning in bed and logrolling are essential for patient safety.

Patient Assistance Devices

• Transfer Boards: Allow safe sliding transfer of patients.

• Mechanical Lifts: Assist in transferring patients, especially those with obesity; promotes caregiver safety.

• Transfer Belts: Provides secure hold for assisting patients while ensuring comfort and safety.

Documentation Practices

Key Points for Charting

• Document current or chronic health problems, positioning at intervals, skin condition changes, dietary intake, and client activity levels.