MOBILITY AND IMMOBILITY

Group 1

Copyright 2008 by Pearson Education, Inc.

MOBILITY AND IMMOBILITY

Mobility is the ability to move freely, easily, rhythmically and purposefully in the environment.
Immobility refers to a reduction in the amount and control of movement a person has.
Copyright 2008 by Pearson Education, Inc.

Four Basic Elements of Normal Movement

Body alignment (posture) Joint mobility Balance Coordinated movement

Copyright 2008 by Pearson Education, Inc.

Body Alignment/Posture
Brings body parts into position that promotes optimal balance and body function Person maintains balance as long as line of gravity passes through center of gravity and base of support

Copyright 2008 by Pearson Education, Inc.

Joint Mobility
ROM is maximum movement possible for joint ROM varies and determined by:
Developmental patterns Presence or absence of disease Physical activity

Copyright 2008 by Pearson Education, Inc.

Balance
Smooth, purposeful movement Result of proper functioning of:
Cerebral cortex
Initiates voluntary movement

Cerebellum
Coordinates motor activity

Basal ganglia
Maintains posture

Copyright 2008 by Pearson Education, Inc.

Coordinated Movement
Complex mechanisms Proprioception
Awareness of posture, movement, changes in equilibrium Knowledge of position, weight, resistance of objects in relation to body

Copyright 2008 by Pearson Education, Inc.

Factors Affecting Body Alignment and Mobility

Growth and development Nutrition, personal values and attitudes External factors
i.e., Temperature, humidity, availability of recreational facilities, safety of the neighborhood

Prescribed limitations
i.e., Casts, braces, traction, activity restrictions including bed rest
Copyright 2008 by Pearson Education, Inc.

Factors Affecting Body Alignment, Mobility, and Daily Activity Level

Spinal rotation precedes locomotion.

Copyright 2008 by Pearson Education, Inc.

Assessment of Activity and Exercise

Nursing History Physical Examination: - Body alignment (line of gravity, center of
gravity, base of support) Gait Appearance and movement of joints Capabilities and limitations for movement Muscle mass and strength Activity tolerance Problems related to immobility
Copyright 2008 by Pearson Education, Inc.

RANGE OF MOTION (ROM)

1. Active ROM done by the client 2. Passive ROM done by health care provider 3. Active Resistive done by client against a weight or force 4. Active Assistive done by stronger arm and leg to weaker arm and leg

Copyright 2008 by Pearson Education, Inc.

Isotonic (Dynamic) Exercise

Muscle shortens to produce muscle contraction and active movement Increase muscle tone, mass, and strength Maintain joint flexibility and circulation HR and CO quicken increase

Copyright 2008 by Pearson Education, Inc.

Isometric (Static or Setting) Exercise

Muscle contraction without moving the joint (muscle length does not change) Involve exerting pressure against a solid object Produce a mild increase in HR and CO No apparent increase in blood flow to other parts of the body
Copyright 2008 by Pearson Education, Inc.

Isokinetic (Resistive) Exercise

Muscle contraction or tension against resistance Can either be isotonic or isometric Person moves (isotonic) or tenses (isometric) against resistance An increase in blood pressure and blood flow to muscles occurs

Copyright 2008 by Pearson Education, Inc.

Effect on Musculoskeletal System

Exercise
Maintain size, shape, tone, and strength of muscles (including the heart muscle) Nourish joints Increase joint flexibility, stability, and ROM Maintain bone density and strength

Immobility
Disuse osteoporosis Disuse atrophy Contractures Stiffness and pain in the joints

Copyright 2008 by Pearson Education, Inc.

Effects on the Cardiovascular System

Exercise
Increases HR, strength of contraction, and blood supply to the heart and muscles Mediates harmful effects of stress

Immobility
Diminished cardiac reserve Increased use of the Valsalva maneuver Orthostatic hypotension Venous vasodilation and stasis Dependent edema Thrombus formation
Copyright 2008 by Pearson Education, Inc.

Leg Veins
Inactive Person

Active Person

Copyright 2008 by Pearson Education, Inc.

Effect on the Respiratory System

Exercise
Increase ventilation and oxygen intake improving gas exchange Prevents pooling of secretions in the bronchi and bronchioles

Immobility
Decreased respiratory movement Pooling of respiratory secretions Atelectasis Hypostatic pneumonia

Copyright 2008 by Pearson Education, Inc.

Pooling of Secretions: Immobile Person

Copyright 2008 by Pearson Education, Inc.

Effects on the Metabolic/Endocrine System

Exercise
Elevates the metabolic rate Decreases serum triglycerides and cholesterol Stabilizes blood sugar and make cells more responsive to insulin

Immobility
Decreased metabolic rate Negative nitrogen balance Anorexia Negative calcium balance

Copyright 2008 by Pearson Education, Inc.

Effects on the GI System

Exercise
Improves the appetite Increases GI tract tone Facilitates peristalsis

Immobility
Constipation

Copyright 2008 by Pearson Education, Inc.

Effect on the Urinary System

Exercise
Promotes blood flow to the kidneys causing body wastes to be excreted more effectively Prevents stasis (stagnation) of urine in the bladder

Immobility
Urinary stasis Renal calculi Urinary retention Urinary infection

Copyright 2008 by Pearson Education, Inc.

Pooling of Urine

Copyright 2008 by Pearson Education, Inc.

Other Effects of Exercise and Immobility

Evidence that certain types of exercise increase spiritual health Immobility causes reduced skin turgor and skin breakdown

Copyright 2008 by Pearson Education, Inc.

Safe Practice for Positioning, Moving, Lifting, Ambulating Clients

Correct body mechanics required for nurse to prevent injury Correct body alignment for the client also so that undue stress is not placed on the musculoskeletal system

Copyright 2008 by Pearson Education, Inc.

General Guidelines for Moving and Lifting

Before moving, assess If indicated, use pain relief modalities Prepare any needed assistive devices Plan around encumbrances Be alert to the effects of any medications Obtain required assistance Explain the procedure to the client
Copyright 2008 by Pearson Education, Inc.

General Guidelines for Transferring a Client

Plan what to do and how to do it Obtain essential equipment before starting Remove obstacles Explain transfer to client and assistive personnel Support or hold client rather than equipment Explain what client should do Make written plan, including clients tolerance

Copyright 2008 by Pearson Education, Inc.

General Guidelines for Ambulating

Assess the amount of assistance the client will require Assess for signs and symptoms of orthostatic hypotension Prepare client for ambulation Apply transfer or walking belt Physically support client Obtain assistance to follow with wheelchair or assist with physical support Teach client to correctly use mechanical aids
Copyright 2008 by Pearson Education, Inc.

Traction:
TRACTION: - The act of pulling and drawing associated with counter traction. TYPES OF TRACTION: A. Manual Traction B. Skeletal Traction C. Skin Traction.
Copyright 2008 by Pearson Education, Inc.

Traction:
I. Manual Traction: - A pulling force applied by the hands of the operator. II. Skeletal Traction: - A pulling force applied directly to the bones using wires, pins, tongs. A. Kirschners Wire Holder it is thinner than the steinmanns pin. - For the affection of the radius and ulna.
Copyright 2008 by Pearson Education, Inc.

Traction:
B. Stainmanns Pin Holder it is for the affection of the humerous, femur, tibia and fibula. C. Crutchfield Tong for the affection of the upper dorsal cervical spine. - Inserted at the parietal area. D. Balanced Skeletal traction for the affection of the hips or femur.
Copyright 2008 by Pearson Education, Inc.

Traction:
E. Overhead Traction supracondylar fracture of the humerous. F. 90 90 Degrees traction subtrochanteric and proximal 3rd fracture of femur. G. Halo Pelvic Traction for C type scoliosis.
Copyright 2008 by Pearson Education, Inc.

Traction:
H. Halo Femoral Traction for S type scoliosis. I. Bohler Braun Splint to support the lower leg. - For fracture of proximal 3rd and middle 3rd of tibia or fibula.

Copyright 2008 by Pearson Education, Inc.

Traction:
III. Skin traction. - Pulling force is applied to the skin, transmitted to the muscle, then to the bones. A. Adhesive use adhesive tape, elastic bandage, wooden spreader and wadding sheet. B. Non Adhesive use for canvass, slings, leathers, straps with buckels, laces and ribbons and metal spreader.
Copyright 2008 by Pearson Education, Inc.

Traction:
A. Adhesive. 1. Dunlop Traction affection of the supracondylar of the humerus. 2. Zero Degrees Traction affection of the surgical neck of the humerus and the shoulder joint. 3. Bucks Extension Traction affection of the hip and the femur.
Copyright 2008 by Pearson Education, Inc.

Traction:
4. Bryant Traction Affection of the hip and femur for children below 3 yrs. Old. - Also for congenital hip dislocation. 5. Boot Cast Traction for post poliomyelitis with residual paralysis of the hip and knee. 6. Modified Bucks Extension Traction. - Use of foam instead of plaster (same indication).

Copyright 2008 by Pearson Education, Inc.

Traction:
Non Adhesive 1. Head Halter Traction for cervical spine affection. 2. Pelvic Girdle Traction for lumbo sacral spine affection. - For herniated nucleus pulposus.

Copyright 2008 by Pearson Education, Inc.

Traction:
4. Cotrel Traction A combination of head halter and pelvic girdle traction. for scoliosis. 5. Hammock Suspension Traction For affection of pelvis. For malgained fracture (double fracture of the pelvic ring).
Copyright 2008 by Pearson Education, Inc.

Question 1
To increase stability during client transfer, the nurse increases the base of support by performing which of the following?
1. 2. 3. 4. Leaning slightly backward. Spacing the feet farther apart. Tensing the abdominal muscles. Bending the knees.
Copyright 2008 by Pearson Education, Inc.

Rationales 1
1. Leaning backward actually decreases balance. 2. Correct. A key word in the question is base, and the feet provide this foundation. 3. Tensing abdominal muscles alone does not affect the base of support. 4. Bending the knees does not affect the base of support.
Copyright 2008 by Pearson Education, Inc.

Question 3
Which of the following statements from a client with one weak leg regarding use of crutches when using stairs indicates a need for increased teaching? 1. 2. 3. 4. Going up, the strong leg goes first, then the weaker leg with both crutches. Going down, the weaker leg goes first with both crutches, then the strong leg. The weaker leg always goes first with both crutches. A cane or single crutch may be used instead of both crutches if held on the weaker side.

Copyright 2008 by Pearson Education, Inc.

Rationales 3
1. This is correct. 2. This is correct. 3. Correct. Although the crutches (or cane) are always used along with the weaker leg, the weaker leg should go down the stairs first. The stronger leg can support the body as the weaker leg moves forward. All of the other statements are correct. 4. This is correct.
Copyright 2008 by Pearson Education, Inc.

Question 4
Because the client weighs 250 pounds, the nurse should provide the unlicensed assistive personnel (UAP) with instructions that reflect an awareness of workplace injury. Which of the following is most appropriate?

1.
2.

3.
4.

Using proper body mechanics will prevent you from injuring yourself. You are physically fit and at lesser risk for injury when transferring the client. Use the mechanical lift and another person to transfer the client from the bed to the chair. Use the back belt to avoid hurting your back.
Copyright 2008 by Pearson Education, Inc.

Rationales 4
1. It is generally accepted that proper body mechanics alone will not prevent injury. 2. Incorrect. 3. Correct. It is prudent for nurses to understand and use proper body mechanics at all times to decrease risk, while keeping in mind the importance of assistive devices and help from other staff. While, many work settings do not yet have no manual lift and no solo lift policies and resources in place. 4. Incorrect.
Copyright 2008 by Pearson Education, Inc.

Question 5
The client is ambulating for the first time after surgery. The client tells the nurse, I feel faint. The best action by the nurse includes which of the following? 1. Find another nurse for help. 2. Return the client to her room as quickly as possible. 3. Tell the client to take rapid, shallow breaths. 4. Assist the client to a nearby chair.
Copyright 2008 by Pearson Education, Inc.

Rationales 5
1. Leaving the client creates unsafe conditions as the client may faint before being able to return to her room. 2. The client may faint before being able to return to her room. 3. Rapid, shallow breathing (hyperventilation) may increase the dizziness. 4. Correct. Placing the client in a safe position is the best maneuver.
Copyright 2008 by Pearson Education, Inc.