Activity, Immobility, and Safe Movement Overview

Foundation and Alterations of Movement

  • Musculoskeletal System: Serves as the framework for movement; compromised by bone fragility, flaccidity, or hypotonicity.

  • Nervous System: Controls posture, balance, and gait; alterations include hemiparesis, hemiplegia, paraplegia, and quadriplegia.

  • Cardiopulmonary System: Circulates oxygen and nutrients; alterations include compromised cardiac function, decreased tissue perfusion, and diminished respiratory capacity.

Systemic Effects of Immobility

  • Musculoskeletal: Results in weakness, decreased muscle/bone mass, atrophy, and contractures.

  • Nervous: Can alter proprioception and equilibrium.

  • Cardiopulmonary: Leads to increased cardiac workload, decreased lung expansion, pooling of secretions, and circulatory stasis. Pooled blood and weak calf muscles may lead to deep vein thrombosis (DVT).

  • Metabolic & Nutrition: Reduced Basal metabolic rate (BMR), protein catabolism (negative nitrogen balance), anorexia, and nausea.

  • Elimination: Urinary stasis, renal calculi, urinary tract infections (UTIs), and gastrointestinal hypomotility.

  • Integumentary: Pressure on bony prominences causes tissue ischemia, potentially leading to necrosis and pressure injuries.

  • Psychosocial: Sensory deprivation, isolation, altered self-concept, and disturbed sleep/rest patterns.

Nursing Diagnosis and Assessment Data

  • Impaired Mobility: Supported by data such as left-sided weakness or impaired visual-spatial perception.

  • Risk for Fall: Supported by altered mobility or history of cerebrovascular accident.

  • Activity Intolerance: Supported by deconditioning, shortness of breath, oxygen saturation below 90%90\%, or pulse rate above 100100 with activity.

Implementation and Safe Client Movement

  • Exercise Types: Includes isotonic, isometric, aerobic, anaerobic, and active/passive range-of-motion.

  • Positioning and Aids: Use of pillows, splints, braces, handrolls, and trochanter rolls. Logrolling is used for spinal alignment.

  • Client Handling: Mechanical lifts are the preferred transfer method; trapeze and top side rails help clients with some mobility.

  • Cardiopulmonary Interventions: Raising the head of the bed, deep-breathing exercises, incentive spirometer use, and application of antiembolism hose or sequential compression devices (SCDs).

  • Skin and Nutrition: Turn immobile clients at least every 2 hours2\,\text{hours}; provision of lean protein and adequate fluid intake.

Questions & Discussion

  • Practice Question: The nurse explains that isotonic exercises involve muscle contraction with movement. What is an example of an isotonic exercise?

    • Correct Answer: Running.

  • Knowledge Check: Where should the nurse stand to best support the client during a logroll procedure?

    • Correct Answer: On the side of the bed opposite the direction the client is being turned.

  • Knowledge Check: How should a nurse prioritize care to prevent negative effects of immobility?

    • Prioritization Sequence: Interventions include teaching deep breathing, using mechanical lifts, placing pillows under bony prominences, and ambulation.