mobility 1 Flashcards
what are the 4 elements of body movement?
posture alignment, joint mobility, balance, coordination
what is posture alignment?
all body parts in good alignment (head on top of shoulders, on top of spine, on top of legs) for good body mechanics
what can affect posture?
diseases, pregnancy, atrophy, obesity, fractures, ligament/soft tissue injuries, static posture (sitting or standing a long time)
what is joint mobility?
keeping joints flexible and functioning through full and range of motion
what can decrease joint flexibiliy?
age, injury, musculoskeletal injuries (ex: arthritis)
what is balance?
the ability to maintain the body’s centre of mass over its base
what system is balance ruled by?
vestibular system
what can decreased balance lead to?
increased risk of falls
what is coordination?
a persons ability to move with synchronicity, exchanging information through body systems
what is gait?
a persons stride
what is ergonomics?
applied science concerned with designing and arranging things people use in a way that eliminates or reduces discomfort
what is mobility?
the ability to move freely, easily, and independently
what is immobility?
the inability to move freely
what does prolonged immobility lead to?
reconditioning: clinical syndrome which results in a decreased functioning of multiple body systems
what are the musculoskeletal effects on immobility?
what are the clinical manifestations?
what are the nursing interventions?
decreased muscle mass, strength, endurance, and joint mobility
clinical manifestations: fatigue, atrophy, decreased stability and balance
nursing interventions: ROM, isotonic, and isometric exercises… frequent ambulation, splints, proper body alignment
what are the integumentary effects on immobility?
what are the clinical manifestations?
what are the nursing interventions?
decreased O2 and nutrients to the tissues, inflammation
clinical manifestations: abrasions, pressure sores, infection
nursing interventions: frequent skin assessment, repositioning every 2 hrs keeping area clean and dry
what are the respiratory effects on immobility?
what are the clinical manifestations?
what are the nursing interventions?
decreased lung expansion, hypoventilation, impaired gas exchange
clinical manifestations: pneumonia, hypoxemia (low levels of O2 in blood), pulmonary edema, pulmonary embolism
nursing interventions: frequent respiratory assessment, positioning to promote lung expansion, deep breathing exercises, frequent ambulation
what are the circulatory effects on immobility?
what are the clinical manifestations?
what are the nursing interventions?
decreased cardiac output, venous pooling, peripheral edema
clinical manifestations: thrombus formation, orthostatic hypotension
nursing interventions: frequent circulatory assessment, compression stockings, passive ROM exercises, BP assessment prior to ambulation
what are the gastrointestinal effects on immobility?
what are the clinical manifestations?
what are the nursing interventions?
decreased peristalsis, fluid intake, and appetite
clinical manifestations: abdominal discomfort, constipation, ileus (stop of movement in intestines), and aspirations
nursing interventions: frequent GI assessment, frequent ambulation, diet high in protein, fibre, and fluid
what are pathological influences on mobility?
conditions or illnesses that put the client at risk for decreased mobility
what are congenital abnormalities? example?
illness or condition someone is born with
ex: multiple sclerosis, muscular dystrophy
what are postural abnormalities? examples?
illness effecting someones posture
ex: lordosis and kyphosis
what is lordosis?
curvature of the lower spine
what is kyphosis?
curvature of the upper spine
what are illnesses affecting the CNS? examples?
stroke paralysis, ALS, head or spinal cord injury, parkinson’s
what are diseases affecting the musculoskeletal system?
osteoporosis, arthritis, fractures, muscle tears, dislocation of joints
what are some influences on mobility?
age, motivation, age, pain, surgery
what is the purpose and benefit to maintaining mobility?
patients often perceive their health status based on their mobility levels
how does immobility affect metabolism?
decreases metabolic rate, disrupts GI processes resulting in decreased appetite and slowing of peristalsis
what does decreased appetite lead to?
weight loss, muscle wasting, breaking down of amino acids… resulting in nitrogen
what are the consequences on immobility and its affect on the negative nitrogen balance?
negative nitrogen balance: when more nitrogen is excreted than ingested (more lost than taken in)
cause: decreased appetite due to decreased metabolic rate from immobility causes in decrease of amino acid breakdown that produces nitrogen… creating less nitrogen than is being ingested ACTIVATING TISSUE METABOLISM
what are the consequences of immobility on calcium reabsorption?
calcium reabsorption: loss of calcium from the bones
cause: calcium is released into the circulation and gets excreted by the kidneys… hypercalcemia may result if there is kidney impairment
what are the consequences of immobility on the respiratory system?
decreased mobility puts client at risk for atelectasis (collapsed alveoli), which can lead to hypostatic pneumonia… both cause decrease oxygenation
what is atelectasis?
collapsed alveoli
what are the consequences of immobility on the cardiovascular system?
puts patients at risk for orthostatic hypotension, increased cardiac workload, and thrombus formation
there is a decrease in the volume of blood circulating which pools the blood in the lower extremities… this puts patients at risk for clot formation and then possibly pulmonary embolisms
what are the consequences of immobility on the musculoskeletal system?
often leads to loss of endurance, strength, and muscle mass… decreased balance puts patients at risk for falls
skeletal system is impacted by the impaired calcium metabolism
what are the consequences of immobility on the urinary system?
often immobile patients are in the supine, lateral, and other position causing urine to be on a level plane as the kidneys, ureters, and bladder… this makes it more difficult for patients to empty their entire bladder (urine retention) causing an increased risk of UTI’s and renal calculi (kidney stones)
what is urinary stasis?
urine retention
what are the consequences of immobility on the integumentary system?
pressure injuries: caused by friction and shearing because the patient is unable to move themselves
what is shearing?
a combination of pressure and friction when a patient is unable to move themselves and is placed in the sitting position… the sliding down in their seat and pressure on their body causes sores
what are the consequences of immobility on ones psychosocial well-being?
cause a decrease in social interaction, loss of independence, changes in body image… all can lead to emotional and behavioural changes like hostility, depression, fear, and anxiety
what are the consequences of immobility on growth and development? (children, adolescents, and older adults)
children: significant delays in gross motor functions
adolescents: can lag in independence compared to peers, at risk for social isolation
older adults: increased physical dependance on others
what are the metabolic interventions for increasing mobility?
high protein diet (replenish depleted protein)
high calorie diet (meet metabolic needs)
vitamin C and zinc supplements (wound healing)
what are the respiratory interventions for increasing mobility?
change position every 2 hrs (allows lungs to re-expand and clears secretions)
chest physio (help drain secretions)
hydration (thin secretions)
suction secretions
assess RR, O2 sats, chest sounds
deep breathing and coughing
what are the cardiovascular interventions for increasing mobility?
mobilize as soon as possible
changing positions slowly (decreases orthostatic hypotension)
avoid valsalva (holding breath while bearing down, moving, pooping ect.)… increases intrathorcic pressure and decreases venous return and cardiac output
increase in ROM exercises decrease deep vein thrombosis and venous thromboembolisms
what are the musculoskeletal internventions for increasing mobility?
ambulation
ROM exercises to prevent muscle atrophy
isometric exercises (muscle tighten for 10sec then relax)
using proper support and alignment
what are the bodily elimination interventions for increasing mobility?
assessing urinary output and bowel movements
hydration
sitting or standing
diet rich in fibre, fruits and veggies (normalize peristalsis)
provide stool softeners, laxatives, enemas, suppositories
what are the integumentary interventions for increasing mobility?
repositioning every 2 hrs
limiting head of the bed at 30 degrees
good hygiene and skincare
support with pressure offloading device
what are the psychosocial interventions for increasing mobility?
providing a routine
minimize sleep interruptions
encourage family visits
why is exercise important?
helps limit effects of immobility
what are the 2 types of exercise?
aerobic and strength building
what are the 3 types of strength building exercise?
muscle strengthening, bone strengthening, post exercise recovery
what are muscle strengthening exercises? (3 types and examples)
isometric: contracts muscle without noticeable muscle shortening (kegals, plank)
isotonic: contracts muscle with muscle shortening and joint angle changing (lifting weights)
isokinetic: contracts and shortens muscle at a constant controlled rate (specialized dyanometers)
what are bone strengthening exercises? examples?
increasing strength of the bone mass
ex: running and jumping
what are post exercise recovery exercises? examples?
not overexerting muscles
stopping if there is pain
rest, stretch, and cool down
what are some benefits of exercise?
positive impact on cognition
reduce physical difficulties
prevents cardiovascular disease
decreases weight
increases mood
prevents diabetes
increases life expectancy
why is transferring, positioning, and ambulation so important?
prevents muscle discomfort, prevents repeating pressure leading to pressure ulcers, prevents superficial nerve and blood vessel damage, maintains muscle tone
what is the ACES assessment and why is it important?
A - alert and energetic enough to perform a transfer
C - cooperative
E - extremities working sufficiently enough to transfer
S - sits unsupported
important to assess if it is safe to move a patient
where do you raise the bed to when performing a transfer?
to waist height of the shortest nurse helping
what factors are important to note when performing a transfer?
degree of exertion permitted
patients tolerance to moving
ability to assist with move
weight of patient
nurses strength
the need for assistive devices
tubes, medical devices, IV’s, ect.
medication impairment (alertness, balance, ect)
what is High Fowler’s position?
head of bed - 60-90 degrees
used when - client having severe breathing impairment
what is Fowlers’ position
head of bed - 45-60 degrees (average 45 degrees)
used when - patients are experiencing chronic breathing problems (COPD, pneumonia) or heart problems
gravity pulls body down allowing for better lung expansion
what is Semi-Fowler’s position?
head of bed - 15-45 degrees (average 30 degrees)
used when - patients need pressure reduction… the higher you sit up, the more pressure on the coccyx
minimum requirement for when patient is at risk for aspirations
what is Orthopneic position?
the tripod position
when the person is leaning over the side of the bed or table
used to - help with chest expansion
what is Dorsal Recumbent position?
head and shoulders slightly elevated on pillow
what is Supine positon?
head and shoulders flat, feet flat
lying on back
no pillow
what is Prone position?
lying on tummy with head turned to one side
issues include:
- the pull of gravity on back causing curve (lordosis)
- causes strain on cervical and lumbar spine
- causes planter flexion
- inhibits chest expansion
used for - amputees, prevents hip flexion… also used in PEDS
what is Lateral postion?
side lying
reduces lordosis… promotes good back alignment
relieves pressure on sacrum and heels
what is the 30 degree Lateral position?
halfway between supine and lateral
has fewer pressure points (less pressure on greater trochanter and sacrum)
what is Sim’s Position (Semi-prone)
halfway between lateral and prone positions
used to maintain airway for unconscious people
used for enemas or if needing to reduce pressure on sacrum or greater trochanter
what is trandelenburg and reverse trandelenburg?
reverse trandelenburg: head of bed raised and foot lowered
- used to increase venous return
trandelenburg: foot of bed raised and head of bed lowered
- decreases venous return and increases venous drainage
what is a transfer or gait belt used for and how is it used?
aids in patient transfer and ambulation… maintains stability and reduces risk of falling
should be 2 finger breaths between body and belt
what is a friction reducing device (slliders) used for and how is it used?
used to reposition patient in bed or transfer
place slippery side away from patient’s body and centre device under patients shoulders, hips, and bum
remove slider when finished transferring
what is a cane used for and how is it used?
safe length is the distance between the floor and crease at wrist
held on the stronger side of the body
move cane with the weaker leg when walking
