Clinical Management: Functional Mobility Notes

Concept of Mobility

  • Definition: Purposeful physical movement, including gross and simple movements, and coordination.

Mobility Continuum

  • Mobility: The ability to move freely.

  • Immobility: The inability to move freely.

  • Characteristics: Mobility and immobility are endpoints, with varying degrees of altered mobility between them. Some clients may fluctuate between mobility levels, while others remain static.

Populations at Risk for Altered Mobility

  • Older adults and children

  • Individuals with chronic or congenital conditions

  • Those with orthopedic injuries (e.g., head injuries)

  • Patients on certain medications

  • Individuals with prolonged inactivity

Changes in Older Adulthood

  • Loss of bone mass, particularly in older women.

  • Joint and disk cartilage dehydrates, resulting in decreased flexibility.

  • Older adults are at a higher risk for falls due to diminished muscle tone.

Mobility in Infants and Children

  • Ossification: Begins during embryonic development and continues until ages 18-21.

  • Growth plates help absorb shock and protect joints.

  • Children's bones are more pliable, increasing the risk of greenstick fractures.

Consequences of Immobility

  • Oxygenation & Hemostasis: Reduced lung expansion can lead to atelectasis and decreased gas exchange, resulting in hypoxemia and skin breakdown.

  • Perfusion: Decreased cardiac return reduces cardiac output and contraction.

  • Immunity, Inflammation, & Infection: Prolonged pressure and reduced perfusion can lead to skin breakdown.

  • Fluid & Electrolyte Balance: Immobility can cause complications such as constipation, renal calculi, urinary stasis/infection.

  • Musculoskeletal Effects: Muscle atrophy occurs without contractions or weight-bearing, potentially causing contractures or muscle shortening, and demineralization leading to osteoporosis.

Altered Mobility

  • Musculoskeletal Trauma: Occurs when tissue is subjected to excessive force.

    • Severity factors: Amount of force and location of impact.

    • Types of trauma: Soft tissue injuries, fractures, and complete amputations.

Soft Tissue Injury Types

  • Contusion: Bleeding into soft tissue that can lead to a hematoma, causing swelling and discoloration.

  • Sprain: Injury involving ligaments, typically due to twisting or overstretching.

    • Grades:

    • Grade 1: Some swelling; slight tearing.

    • Grade 2: More severe tearing; noticeable bruising and swelling.

    • Grade 3: Complete tear; severe symptoms requiring immobilization.

  • Strain: Microscopic tears in muscles often caused by inappropriate lifting or sudden movements.

Fractures

  • Definition: A disruption in the continuity of bone due to stress exceeding its resistance.

    • Causes: Can be traumatic (accidental), non-accidental (abuse), or due to congenital/chronic conditions like osteogenesis imperfecta, cancer, or arthritis.

Types of Fractures

  • Greenstick: An incomplete fracture seen in children.

  • Transverse: Occurs straight across the long axis of the bone.

  • Oblique: Fractured at an angle not perpendicular to the long axis.

  • Spiral: Caused by a twisting force.

  • Comminuted: Multiple small fragments between large segments.

  • Compound (Open): Bone pierces the skin, which carries a high risk of infection.

  • Simple (Closed): Skin remains intact.

Clinical Manifestations of Fractures

  • Deformity, muscle contraction at the injury site, loss of function, crepitation, and non-specific signs such as pain, tenderness, and edema.

Diagnostic Evaluation of Fractures

  • Physical examination: Compare with unaffected extremity.

  • X-ray: Most useful diagnostic tool.

  • Laboratory studies: CBC, hemoglobin, and hematocrit.

Emergency Management for Fractures

  • Stop bleeding, immobilize the affected part without realignment, perform neurovascular checks, apply ice packs, and monitor for shock.

General Management of Fractures

  • Control pain and hemorrhage, reduce and immobilize the fracture, prevent complications and restore function.

Fracture Reduction Techniques

  • Closed Reduction: Manipulation of bone fragments followed by immobilization.

  • Traction: Applying force to align bones, can be manual or skeletal, with various settings for weight and stabilization.

Surgical Management of Fractures

  • Open Reduction/Internal Fixation (ORIF): Surgical incision for repair using internal fixation devices under general anesthesia.

  • External Fixation: Stabilizes fractures using external devices, requires close monitoring of neurovascular status and pin sites.

Complications of Fractures

  • Fat Embolism Syndrome (FES): Fat globules enter circulation, risking vascular occlusion.

  • Deep Vein Thrombosis (DVT) & Pulmonary Embolism: Requires prevention strategies.

  • Compartment Syndrome: Increased pressure compromises neurovascular function; requires immediate intervention such as fasciotomy if continued pressure lasts over 6 hours.

Manifestations of Compartment Syndrome

  • Six Ps: Paresthesia, Paralysis, Pain (intensifies with passive range of motion), Pallor, Pulselessness, and Pressure.

  1. Question: A nurse is assessing an older adult patient. Which of the following findings would indicate a higher risk for falls?

    • A) Increased muscle tone

    • B) Decreased bone mass

    • C) Improved joint flexibility

    • D) Enhanced coordination

    • Answer: B) Decreased bone mass

    • Explanation: Loss of bone mass, particularly in older adults, leads to an increased risk for falls due to diminished stability and support.

  2. Question: During a health assessment of a child, the nurse notes that the child has experienced recurrent sprains. Which of the following factors might be contributing to this condition?

    • A) Higher ligamental flexibility

    • B) Increased muscle strength

    • C) Ossification process not completed

    • D) Dehydration of cartilage

    • Answer: C) Ossification process not completed

    • Explanation: The ossification process continues until ages 18-21, making children's ligaments and joints more vulnerable to injuries such as sprains.

  3. Question: A patient has been immobile for an extended period. Which of the following complications can arise from prolonged immobility?

    • A) Increased cardiac output

    • B) Improved lung expansion

    • C) Muscle atrophy

    • D) Enhanced renal function

    • Answer: C) Muscle atrophy

    • Explanation: Immobility leads to muscle atrophy due to lack of contractions or weight-bearing activities.

  4. Question: A nurse is caring for a patient with a diagnosis of compartment syndrome. Which of the following assessments is most crucial for the nurse to monitor?

    • A) Increase in muscle strength

    • B) Level of consciousness

    • C) Neurovascular status in the affected limb

    • D) Patient's pain rating

    • Answer: C) Neurovascular status in the affected limb

    • Explanation: Monitoring neurovascular status is critical in compartment syndrome to detect any compromise in neurovascular function, as complications can lead to severe outcomes if not addressed promptly.