Mobility And Immobility Flashcards
Mobility
Nonverbal gestures
Self defense
ADLs
Recreational
Satisfaction of basic needs
Expression of emotion
What are factors that can affect mobility and activity?
Developmental
Nutrition
Lifestyle
Stress
Enviroment
Diseases and abnormalities
Diseases and abnormalities that can affect the ability to move
Bones, muscle and nervous
Pain
Trauma
Respiratory system
Circulatory
Psychological/social
Paraplegia
Paralysis lower part of the body
Hemiplegia
Paralysis Half of the body
Quadriplegia / tetraplegia
Person paralyzed from the neck down
What can be the good points of bed rest?
Reduces pain
Allows patient to rest
Reduce physical activity and O2 demand
What can the duration of bed rest be?
Duration depends on illness or injury and proper state of health
Physical causes of immobility
Bone fracture
Surgical procedure
Major sprain or strain
Illness/disease
Cancer
Aging process
Psychosocial causes of immobility
Stress/depression
Decreased motivation
Hospitalization
Long term care facility residents
Voluntary sedentary lifestyle
Prolonged immobility ( bad effects of bed rest)
Reduced functional capacity
..
Altered metabolism
..
Numerous physiological changes
What are common effects of bed rest?
Weakened muscles
Weakened joint/ stiffness
Bones will break down
Skin break down
Blood clots
Etc
See slide 11
How much muscle mass does a person lose on bed rest?
For every week 10%
Anthropometric measurement
Body weight, bmi, body measurements
What is important for a person who is on bed rest to have in their diet?
Protien
Osteoclast
Dissolve bone “clast” to break
Osteoblast
To grow——- deposits calcium into the bone
Why would an immobile person have decrease bone mass?
Osteoclast come in and they start to wear down the bone
Osteoporosis
Bone that has a plot of dead spaces “porous”
What is the primary cause of osteoporosis?
Insufficient excercise or too much excercise
Who is prone to osteoporosis?
Females(after menopause)
Excercise (too little too much)
Poor diet (low in CA and protien)
Smoking
What can be done to a patient to avoid osteoporosis?
Excercise, ROM
Adequate died
Calcium and vitamin d
What we must have with calcium
Vitamin D!!!
What are some sources of vitamin d?
The sun
Dairy milk, cheese, yogurt
Green leafy vegetables
Eggs
Fish
Or supplements
What is bone density strongly link to?
Estrogen- that’s why in women we see a peak in our 30s and a drop off after menopause
Contractures
It is when a joint fixates in a specific place
What can improve joint quality and is the easiest intervention to maintain or improve joint mobility?
ROM
Active ROM (AROM)
Done by the patient
ex patient does 15 shoulder raises on his own
Active assist ROM
Done by patient but with help
Ex. Patient can’t do complete shoulder raises so he gets assistance
Passive ROM
Done by nurse or caregiver
Continuous passive motion machine (CPM)
How many times a day should ROM be practiced?
3 times a day
After bath
Mid day
Bedtime
What should you do if a person reports pain or muscle spasms during ROM?
D/C immidietly!!
During ROM
Start gradually and move slowly using smooth motion
Support extremity
Stretch the muscles only to the point of resistance/pain
Encourage active ROM
What kind of assessments is important to do when we have a patient who can not move?
Respiratory
Cardiac
Metabolism
Integument
Gastrointestinal
Genitourinary
Urinary stasis
psychosocial
Respiratory assessment
Lung sounds
O2 sats
Respiratory rate
Activity tolerance (SOB)
Chest X-ray
Arterial blood gases
What can be critical to watch on a patient?
Respiratory rate -make sure to count every single time
Cardiac assessment
BP
Pulse rate
Heart sounds
Activity tolerance (what goes up when they move around
calf pain
What does calf pain indicate?
DVT (deep vein thrombosis)
DVT
Describes muscle activity>
Pooling of blood>
Clot formation >
DVTs
What is the big worry about DVT?
It can go to the lungs and cause a pulmonary embolism (can be deadly) depending where they lay
How can we prevent DVTs?
Ambulation
TED hose
SCDs
Why do we encourage early ambulation?
To prevent DVT
TED Hose
Thrombosis-Embolic deterrent hose
Post surgical
Non walking patients
Always measure right away
Check for skin break down
SCDs
Sequential compression devices
Sleeves around the legs alternately inflate and deflate
Post surgical/ circulatory disorders
Compress and sequence to push blood back up to the heart to prevent blood clots
What happens if patient soils TED hose?
Change it and wash it
What happens when SCDs are soiled
Change it and throw it away
Metabolism assessment
Decreased appetite
Weight loss
Muscle loss
Weakness
Labs
Integumentary assessment
Skin assessment
Color changes
Integrity
Nutrition
Incontinence
PREVENT skin break down
What kind of nutrition should an immobile patient have?
HIGH PROTIEN
For gastrointestinal assessment what do we want to make sure of?
That the patient has good and active bowel sounds -if there is no sound it can indicate constipation which can lead to a bowel obstruction
Genitourinary assessment:
During bone break down calcium gets released into the blood. What does this have to do with the Genitourinary assessment?
Kidney stones
1) calcium is the number one culprit of kidney stones
When a person is laying down the urine settles in the renal area. What happens when the urine is still?
It grows bacteria
It becomes more concentrated
Calcium build up in urine
Perfect enviroment to develop kidney stones and UTI
What psychosocial effects can someone who is immobile go through?
Loneliness
Delirium
Withdrawal
Decreased coping
Depression
Anxiety
Social isolation
Benefits of mobility
Strengthen muscles
Joint flexibility
Stimulates circulation
Prevents constipation
Prevents osteoporosis
Stimulates the appetite
Prevents urinary incontinence and infection
Relieves pressure
Improves self esteem
Decreases anxiety and depression
What is the best intervention to prevent immobility complications?
Ambulation
What does mobility level 1 mean (red)
Dependent
What does mobility level 2 mean (orange)
Moderate assistance
Mobility level 3 (yellow)
Minimum assistance
Mobility level 4 (green)
Modified independent Level 4 (green)
Restraints
Any manual method, physical or mechanical device, material or equipment that immobilizes or reduces the ability of a patient to move arms legs bodu or head freely
Application of a force that can not easily removed without individual permission
WHY would you use a Non violent restraint?
Actions impede medical care
Lack of awareness of potential harm self and others
Unable to follow commands and comply with safety instructions
Can pull out tubes drains or other lines
Requires every 2 hours monitory and documentation
When discontinuing date and time must be documented
Restraint types
Extremity
Mitten
Posey
Belt
Papoose or mummy restraint
Used in pedi population
Covenants restraint policies
Prior to restraining
Reorientation
Limit setting
Use of sitter
Increased observation and monitoring
Change the patients physical environment
Review and modification of medication regimens
Ex turning on the lights changing the blinds
How can you discontinue the restraints
A trial is the best way like during abed bath, med admin and during feeding to see if they can feed themselves
Which restraint can be of risk of strangulation?
Posey- watch carefully!
Interventions for immobility
ROM
Reposition
Neutrino/hydration/toileting
Releases at the earliest possible time
