Immobility and Nursing Interventions

Activity, Mobility, and Safe Movement

Effects of Immobility

• Musculoskeletal System:

  • The nervous system impacts equilibrium and balance.
  • Balance issues lead to an increased risk of falls and the need for fall precautions.

• Cardiopulmonary System:

  • Immobility can lead to decreased lung expansion, causing secretions to pool and potentially leading to pneumonia.
  • Maintaining homeostasis is crucial for proper bodily function.
  • Circulatory stasis can occur, where blood is not moving, increasing the risk of deep vein thrombosis (DVT) and pulmonary embolism.
    • A DVT is characterized by a red, warm, hot, and painful leg.
    • Treatment involves blood thinners like TPA.
  • Activity and tolerance decrease due to the patient's unwell state.

• Nutrition:

  • Metabolism of protein leads to a negative nitrogen balance if dietary protein is insufficient.
  • Immobility can lead to depression, which can result in decreased eating and poor nutrition.

• Elimination:

  • Immobility causes problems with peristalsis (intestinal movement), leading to constipation.
  • Interventions include increasing water and fiber intake, and possibly using laxatives or enemas.
  • Urinary stasis can occur.
  • Immobility can lead to kidney stones.
    • Treatment involves increased fluid intake to flush out the stones, but in extreme cases, extraction may be necessary.
    • Further research should be done on the care of a patient with renal stones.
    • Passing kidney stones can be very painful.
  • Hypomotility of the GI tract can result.

• Skin:

  • Pressure from bony prominences can cause tissue ischemia (tissue death) and lead to pressure ulcers.
    • Common areas include heels, sacrum, and elbows.
  • Interventions include turning and repositioning the patient, using pressure-relieving support surfaces, and ensuring adequate blood supply to the area.
  • Assessment is crucial.

• Psychological Impact:

  • Isolation and sensory deprivation can occur.
  • The use of a Hoyer lift may be necessary for patients with impaired mobility.

• Nursing Diagnosis for Immobility:

  • Risk for falls related to altered mobility.
  • Elevated heart rate due to the heart working harder.

  Early ambulation: Early ambulation is key to avoiding immobility issues, especially in post-operative patients..

Implementation and Evaluation

• Types of Exercises:
  • Isotonic Exercises: Active muscle movement involving the musculoskeletal system (e.g., using your hand or arm).
  • Isometric Exercises: Tension and relaxation of muscles without joint movement (e.g., Kegel exercises).
  • Aerobic Exercise: Requires oxygenation and involves cardio-pulmonary activity.
  • Anaerobic Exercise: Builds power without oxygen (e.g., weightlifting).
• Pain Assessment:
  • Use the PQRST method:
    $P = Provocation/Palliation$
    $Q = Quality$
    $R = Region/Radiation$
    $S = Severity (0-10 scale)$
    $T = Timing/Treatment$
• Ambulation Aids:
  • Orthopedic and assistive devices such as crutches, walkers, canes, splints, traction, braces, or casts.
  • Mechanical lifts (e.g., Hoyer lift). Height lifts are commonly used in facilities.
• Safety:
  • Prioritize safety for both the patient and the nurse.
  • Mechanical lifts are the preferred method for transfer.

Interventions

• Cardiopulmonary System:
  • Encourage ambulation, movement, and passive range of motion exercises.
• Skin Integrity:
  • Be mindful of bony prominences and pressure points.
  • Implement two-hourly rounding and repositioning.
• Psychological Support:
  • Encourage family and friend contact.
  • Promote patient participation and independence.
• Nutrition:
  • Ensure patients eat their meals, offering lean proteins and smaller, more frequent meals.
  • Involve patients in meal planning.
  • Increase fluid intake.
• Elimination:
  • Implement toileting programs, especially for stroke or quadriplegic patients.
  • Consider patient preferences regarding bedpans.
  • Increase fiber intake.
  • Treat constipation if it develops.
• Psychological:
  • Explain the care to the patients.
  • Explain what's happening.
  • Address if they have support.