activity and mobility

Activity, Immobility, and Safe Movement

Institution: Galen College of Nursing®
Course: NUR 155/156
Unit: 7

Normal Structure and Function of Movement

Musculoskeletal System:
- Function: Provides the framework for movement.
- Components: Bones, muscles, and joints.
Nervous System:
- Function: Controls movement, posture, balance, and gait.
- Components: Brain, spinal cord, and nerves.
Cardiopulmonary System:
- Function: Circulates oxygen and nutrients throughout the body.
- Components: Heart and lungs.

Altered Structure and Function of Movement

Musculoskeletal System:
- Bone Fragility: Increased risk of fractures.
- Flaccidity or Hypotonicity: Reduced muscle tone affecting mobility.
Nervous System:
- Conditions: Hemiparesis (weakness on one side), hemiplegia (paralysis on one side), paraplegia (paralysis of lower limbs), quadriplegia (paralysis of all four limbs).
Cardiopulmonary System:
  - Effects:
    - Compromised cardiac function, reducing circulation efficiency.
    - Decreased tissue perfusion, affecting oxygen delivery.
    - Diminished respiratory capacity, impacting breathing.

Assessment of Immobility Effects

Musculoskeletal System:
  - Weakness: Decrease in muscle strength.
  - Decreased Muscle Tone: Reduced responsiveness of muscles.
  - Decreased Bone and Muscle Mass: Loss due to lack of use.
  - Muscle Atrophy: Wasting away of muscle tissues.
  - Contracture: Shortening and hardening of muscles, tendons leading to deformity.
Nervous System:
- Proprioception and Equilibrium: Alterations leading to instability.
Cardiopulmonary System:
  - Increased Cardiac Workload: Heart must work harder.
  - Decreased Lung Expansion: Limited thoracic movement.
  - Pooling of Secretions: Risk of infection and respiratory complications.
  - Circulatory Stasis: Reduced blood flow, increasing DVT risk.
  - Activity Intolerance: General fatigue and inability to perform tasks.
Nutrition:
  - Reduced Basal Metabolic Rate (BMR): Slower metabolism due to inactivity.
  - Negative Nitrogen Balance: Decreased protein availability leads to muscle breakdown.
  - Potential for Anorexia and Nausea: Loss of appetite due to inactivity.
Elimination:
- Urinary Stasis: Can lead to UTIs and renal calculi.
- Gastrointestinal Hypomotility: Reduced digestive function.
Skin:
  - Pressure on Bony Prominences: Risk of ischemia and tissue damage.
  - Necrosis: Tissue death due to prolonged pressure.
  - Pressure Injuries: Breakdown of skin integrity.
Psychosocial Impact:
  - Isolation and Sensory Deprivation: Mental health declines.
  - Altered Self-concept: Low self-esteem due to incapacity.
  - Disturbed Sleep and Rest Patterns: Impact on recovery and health.

Nursing Diagnosis

Impaired Mobility:
- Supporting Data: Left-sided weakness, impaired visual spatial perception.
Risk for Fall:
- Supporting Data: Altered mobility due to cerebrovascular accident (stroke).
Activity Intolerance:
- Supporting Data: Results of deconditioning effects of bed rest, shortness of breath, oxygen saturation below 90%, pulse rates above 100 with activity.

Implementation and Evaluation of Care

Musculoskeletal and Nervous System Interventions:
  - Early Ambulation: Promotes mobility and prevents complications.
  - Isotonic Exercise: Involves muscle contraction with movement (e.g., running).
  - Isometric Exercise: Muscle tension without movement (e.g., planks).
  - Aerobic Exercise: Increases cardiovascular fitness and endurance.
  - Anaerobic Exercise: Involves short bursts of energy.
  - Active or Passive Range-of-Motion Exercises: Enhances joint mobility and prevents stiffness.
  - Pain Assessment and Treatment: Ensures adequate pain management for mobility participation.
Positioning and Support Devices:
  - Pillows: For comfort and proper alignment.
  - Splints and Braces: Provide support to weak limbs.
  - Hand Rolls: Prevent contractures.
  - Trochanter Rolls: Prevent external rotation of the hip joints.
  - Logrolling: Method for moving clients with spinal injuries.
  - Fall Prevention: Use of ambulation aids (crutches, walkers).
Use of Mechanical Lifts:
- Preferred Transfer Method: Safety for both client and caregiver.
- Ambulation Assistance: Client can walk while being supported by the lift.
Promoting Lung Expansion:
  - Head of the Bed: Raise if condition allows.
  - Coughing and Deep-Breathing Exercises: Essential for lung health.
  - Incentive Spirometer Usage: Encourages lung expansion.
  - Regular Position Changes: Prevents pulmonary complications.
Preventing Deep Vein Thrombosis (DVT):
  - Leg, Ankle, and Foot Exercises: Promote circulation.
  - Antiembolism Hose: Prevents blood clots.
  - Sequential Compression Devices: Aid in circulation.
Nutrition Interventions:
  - Lean Protein Meals: Important for tissue repair.
  - Smaller, Frequent Meals: More manageable for clients with reduced appetite.
  - Client Dietary Choices: Involvement fosters autonomy.
  - Increased Fluid Intake: Supports overall health.
Elimination Interventions:
  - Adequate Fluid Intake: Ensures hydration.
  - Position Changes: Facilitate voiding and bowel function.
  - Toileting Programs: Regular schedule for elimination help.
Skin Interventions:
  - Turning Clients: Every 2 hours at minimum to prevent sores.
  - Pressure-Relieving Mattresses: Use for at-risk clients.
  - Proper Positioning: To avoid pressure injuries.
  - Heel and Elbow Protectors: Reduce risk of pressure injuries.
Psychosocial Interventions:
  - Encourage Family Contacts: Combats feelings of isolation.
  - Provide Spiritual Support: Address emotional needs.
  - Minimize Disruption of Routine: Promote mental stability.
  - Explain Procedures: Reduces anxiety and promotes compliance.
Evaluation of Care:
- Continuous Evaluation: Necessary to assess effectiveness of interventions.
- Focus on Nursing Care Plan Goals: Both short-term and long-term objectives must be monitored for adequacy.