Developmental Changes

Question 1

Infants, Toddlers, and Preschoolers

Answer 1

As a baby grows, musculoskeletal development permits support of weight for
standing and walking. Posture is awkward because the head and upper trunk
are carried forward. Because body weight is not distributed evenly along a line
of gravity, posture is normally off balance, and falls occur often. When an
infant, toddler, or preschooler becomes immobilized, it is usually because of
trauma or the need to correct a congenital skeletal abnormality. Prolonged
immobilization delays a child’s gross motor skills, intellectual development,
and musculoskeletal development.

Question 2

Adolescents

Answer 2

The adolescent stage usually begins with a tremendous increase in growth (see
Chapter 12). When the activity level is reduced because of trauma, illness, or
surgery, the adolescent is often behind peers in gaining independence and
accomplishing certain skills, such as obtaining a driver’s license. Social
isolation is a concern for this age-group when immobilization occurs.

Question 3

Adults

Answer 3

An adult who has correct posture and body alignment feels good, looks good,
and generally appears self-confident. The healthy adult also has the necessary
musculoskeletal development and coordination to carry out ADLs (see Chapter
13). When periods of prolonged immobility occur, all physiological systems are
at risk. In addition, the role of the adult often changes with regard to the family
or social structure. Some adults lose their jobs, which affects their self-concept.

Question 4

Older Adults

Answer 4

A progressive loss of total bone mass in older adults results from decreased
physical activity, hormonal changes, and bone resorption. The effect of bone
loss is weaker bones. Older adults often walk more slowly, take smaller steps,
and appear less coordinated. Prescribed medications often alter their sense of
balance or affect their blood pressure when they change position too quickly,
increasing their risk for falls and injuries (see Chapter 27). The outcomes of a
fall include not only possible injury but also hospitalization, loss of
independence, psychological effects, and quite possibly death. Older adults often experience functional status changes secondary to
hospitalization and altered mobility status (Box 39.2). Immobilization of older
adults increases their physical dependence on others and accelerates functional
losses (Chase et al., 2018). Immobilization of some older adults results from
degenerative diseases, neurological trauma, or chronic illness. In some it occurs
gradually and progressively; in others, especially those who have had a stroke,
it is sudden. When providing nursing care for an older adult, encourage the
patient to perform as many self-care activities as possible, thereby maintaining
the highest level of mobility. Sometimes nurses inadvertently contribute to a
patient’s immobility by providing unnecessary help with activities such as bathing and transferring. Usual aging is associated with decreased muscle strength
and aerobic capacity, which become exacerbated if a patient’s nutritional state
is poor. A nutritional assessment needs to be included in the plan of care for the
older adult experiencing immobility.
• Anorexia and insufficient assistance with eating lead to malnutrition,
which contributes to the known problems associated with immobility.
• Improved nutrition increases patient’s ability to perform physical
reconditioning exercises (Kruschke and Butcher, 2017).
• There is a direct relationship between the success of older adults’
rehabilitation and their nutritional status (Barbour et al., 2017).