Mobility and Immobility Flashcards
mobility
a person’s ability to move freely
- nonverbal gestures
- self-defense
- ADLs
- recreational
- satisfaction of basic needs
- expression of emotion
factors affecting mobility and activity
- developmental
- nutrition
- lifestyle
- stress
- environment
- diseases and abnormalities
diseases and abnormalities
- bones, muscles and nervous system
- pain
- trauma
- respiratory system
- circulatory
- psychological/social
immobility
a person’s inability to move about freely
- may involve a specific part of the body due to injury
- may involve the lower part of the body: paraplegia
- may involve one side of the body: hemiplegia
- may involve entire body from the neck down: quadriplegia aka tetraplegia
bedrest
restricts patients to bed for therapeutic reasons
- sometimes prescribed for selected patients
- reduces physical activity and O2 demand of the body
- reduces pain
- allow ill or debilitated patients to rest
- allows exhausted patients to rest
- duration depends on illness or injury and prior 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
reduced functional capacity –> altered metabolism –> numerous physiological changes
(move less -> lower metabolism -> many changes)
effects of immobility
- musculoskeletal
- lungs
- heart and vessels
- metabolism
- integument
- gastrointestinal
- genitourinary
- psychological
immobility common effects on body systems - chart
musculoskeletal system:
- brittle bones,
- contractures,
- muscle weakness and atrophy,
- footdrop
nervous system:
- lack of stimulation,
- feelings of anxiety,
- feelings of isolation,
- confusion,
- depression
digestive system:
- decreased appetite and low fluid intake
- constipation and/or bowel obstruction
- incontinence
- electrolyte imbalance
integumentary system:
- decreased blood flow
- pressure ulcers
- infections
- skin breakdown and pressure ulcers
cardiovascular system:
- blood clots
- reduced blood flow
respiratory system:
- pneumonia
- decreased respiratory effort
- decreased oxygenation of blood
urinary system:
- reduced kidney function
- incontinence
- urinary tract infection
- urinary retention
musculoskeletal assessments
- activity intolerance
- anthropometric measurements: BMI, weight, body measurements
- nutrition: protein important to keep muscle mass, also help prevent skin breakdown
(for every week on bedrest, a person loses 10% of their muscle mass)
bone resorption
- osteoclasts: move along surface of bone, dissolving grooves into bone with acid and enzymes. Dissolved material, including calcium, is passed through osteoclasts and into bloodstream for reuse by the body.
- osteoblasts: occurs when bone is injured, added bone strength is required and calcium is elevated in the bloodstream. Deposits calcium into the bone
(osteoclasts - dissolve bone (clast means to break),
when on bedrest, osteoclasts come in and dissolve the bone, calcium is released into the bloodstream,
osteoblasts - try to deposit calcium back into the bone (blast means to grow))
osteoporosis
risk factors:
- sex (females more affected than males, especially after menopause)
- insufficient exercise or too much exercise
- poor diet (low in Ca and protein)
- smoking
(osteoclasts cause a person to have osteoporosis (poro means porous),
exercise, adequate diet, calcium and vitamin D used to help stave off osteoporosis (body can’t store calcium w/o vitamin D, have to have vitamin D to convert calcium to the way that it is stored),
vitamin D - get through sunlight, dairy, green leafy vegetables, eggs, fish, supplements)
change in bone density with age - picture
bone density is strongly linked to estrogen
- bone mass increases until age 30 which is peak bone mass
- bone mass stays the same from 30-50 which is menopause
- from 50 onward, bone mass stays about the same with hormone replacement, but thins without it
- when bone mass stays above fracture threshold, bones resist fractures
- fractures may occur easily if bone mass drops below fracture threshold
range of motion
maximum amount of movement available at a joint
- joints not moved are at risk for contractures (can begin forming within 8 hrs)
- range of motion (ROM) exercises improves joint mobility
- ROM exercise is the easiest intervention to maintain or improve joint mobility
- ROM exercises can be coordinated with other activities
ROM exercises
- active ROM: done by patient
- active assist ROM: done by patient but with help
- passive ROM: done by nurse or other caregiver, continuous passive motion (CPM)
(if pt reports pain or muscle spasms during ROM exercises, we need to discontinue it immediately bc don’t want to cause injury)
ROM
- 3x a day: after bath, mid day, bedtime
- start gradually and move slowly using smooth motions
- support the extremity
- stretch the muscle only to the point of resistance/pain
- encourage active ROM if possible
contractures
shortening of the muscle
(people with contractures of the hand can use a brace(?) that holds the hand open,
foot drop isn’t a contracture but be sure to put boots on people on bedrest to prevent foot drop)
respiratory assessment
- lung sounds
- O2 sats
- respiratory rate
- activity tolerance (SOB)
- chest x-ray
- arterial blood gases
(check lung sounds every time indicated, never a bad time to check, important not to skip)
incentive spirometer
the point is to get good deep breaths,
has a goal marker, piston rises with each deep breath,
(inhaling and getting good chest expansion is what makes it work, not exhaling)
cardiac assessment
- blood pressure
- pulse rate
- heart sounds
- activity tolerance (BP, HR, chest pain)
- calf pain (laying still means pt becomes higher risk for DVT)
deep vein thrombosis (DVT)
decreased muscle activity -> pooling of blood -> clot formation -> DVTs
- ambulation
- TED hose
- SCDs
(blood clots in veins,
heat, pain, swelling will occur,
one of main reasons to get patients up and moving (early ambulation) = prevent DVT)
TED hose
thrombo-embolic deterrent hose
- post surgical
- non-walking patients
(measure to get right size, come in thigh or calf length,
don’t want bunching at thighs (or anywhere))
sequential compression devices (SCDs)
- sleeves around the legs
- alternately inflate and deflate
- post surgical/circulatory disorders
metabolism assessment
- decreased appetite
- weight loss
- muscle loss
- weakness
- labs
integument assessment
- skin assessment
– color changes
– integrity - nutrition
- incontinence
pressure injury
impairment of the skin as a result of prolonged ischemia (decreased blood supply) in tissues
- develops when pressure on the skin is greater than the pressure inside the small peripheral blood vessels supplying blood to the skin
- inflammation
- forms over bony prominences
- the longer pressure is applied, the greater risk of injury
- pressure ulcers begin with reddish areas and may develop into large open and deep wounds
gastrointestinal assessment
- bowel sounds
- abdominal palpation
- bowel habits (last bowel movement)
- I & O
(when less movement, metabolism slows down, and constipation could occur)
genitourinary assessment
- I & O
- palpate abdomen
- incontinence
- urine (color, smell, clarity?)
(calcium is #1 culprit of kidney stones,
bones breaking down = calcium going into bloodstream)
urinary stasis
when the renal pelvis fills before urine enters the ureters because peristaltic contractions of the ureters are insufficient to overcome gravity
(when laying down, urine sits still in renal pelvis and bladder, and calcium comes in and can cause kidney stones and UTI)
urinary elimination changes
immobility (decreased activity) -> decreased fluid intake -> dehydration -> concentrated urine -> increased risk for UTI and kidney stones
psychosocial assessment
- mood
- orientation
- speech
- affect
- sleep
psychosocial effects
- social isolation
- loneliness
- decreased coping
- depression
- anxiety
- withdrawal
- delirium
benefits of mobility
- strengthen muscles (especially those of the abdomen and legs)
- joint flexibility (especially that of the hips, knees, and ankles)
- stimulates circulation (which helps prevent phlebitis and the development of clots)
- prevents constipation (the movement of the abdominal muscles stimulates the intestinal tract)
- prevents osteoporosis (due to the mineral loss from the bones when they do not bear weight)
- stimulates the appetite
- prevents urinary incontinence and infection (when patients are able to go to the bathroom on their own, incontinence is reduced)
- relieves pressure (on the body and skin, helping to prevent pressure injuries)
- improves self-esteem (and the patient’s feeling of independence)
- decreases anxiety and depression (induced by hospitalization)
ambulation
best intervention to prevent immobility complications
(want to return pt to as normal a lifestyle as possible as quickly as possible)
wheel dial outside of room
- mobility level 1 dependent
- mobility level 2 moderate assistance
- mobility level 3 minimum assistance
- mobility level 4 modified independent
restraints
any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move arms, legs, body, or head freely
(application of a force that cannot be easily removed,
without the individual’s permission)
non-violent restraints
- actions impede medical care
- lack of awareness of potential harm to self and others
- unable to follow commands and comply with safety instructions
- attempts to pull out tubes, drains or other lines/devices medically necessary for treatment
- requires every 2 hours monitoring and documentation
- new order required every calendar day
- when discontinuing, date and time must be documented
(monitor and document every 2 hrs, must have new order for restraints every calendar day)
restraint types
- extremity: aka soft wrist extremity, just on wrist
- mitten: good for someone wanting to scratch or pick at their skin
- posey: like a band across left to right, pic is laying down
- belt: placed at waist like a belt
papoose or mummy restraint
for kids
wraps around them
covenant’s restraint policies
prior to restraining, alternatives must be attempted:
- reorientation: “you’re not in 1922, it is 2022, you’re in covenant hospital”
- limit setting: we can’t have you pulling this tube out. do your best not to or we may need to use restraints
- use of sitter: having a person sit in and remind them not to do specific things
- increased observation and monitoring
- change the patient’s physical environment: sit them in Barton chair and roll them out to nurse’s station
- review and modification of medication regimens: make sure not on any meds that can cause confusion or their symptoms
alternative measures
- orient family and patient to environment
- offer diversionary activities: have them fold towels, color, something tactile
- use calm simple statements
- promote relaxation techniques
- attend to needs: have them use the bathroom
- use of glasses/hearing aids
(try to have family member stay)
alternative measures - modify the environment
- increase or decrease the light
- place personal items within reach
- place near nurses station
- reduce environmental noise
- keep call button accessible
- use special furniture accordingly (bed alarms)
alternative measures
- camoflage IV lines and tubes
- encourage family to stay with pt and bring familiar objects from home
- orient pt to person, place and time
- involve patient in conversation
- give pt something to do
restraint guidelines
- practitioner must order prior to applying
- in emergencies, may apply but practitioner must be notified immediately
- a new order must be obtained daily
- must be d/ced at earliest possible time
- monitoring varies depending on patient needs and situational factors (could be continuous, every 15 min or every 2 hrs)
- assessment includes vital signs, hydration and circulation, skin integrity and patient’s level of distress
(no telephone orders - have to be put in EMR by provider, if not put in, have to call them again bc illegal to keep restrained w/o orders,
want to d/c restraints and see what they do - in situations where going to be in there for a long time, ex: bed bath, long med admin,
don’t tie restraints to moveable part of bed)
risks of using restraints
- increase in injury or death
- loss of self-esteem
- humiliation
- fear
- anger
- increased confusion and agitation
make sure all other measures have been taken to avoid restraints
complications of restraints
- impaired skin integrity
- lower extremity edema
- altered nutrition
- physical exhaustion
- social isolation
- immobility complications
- death
intervention application
- restrict movement as little as is necessary
- make sure restraint fits properly
- always tie (slip knot or bow tie) to bed frame/mattress springs
- always explain the need for restraint
- never leave patient unattended without the restraint
- pad bony prominences
- document, document, document
assessment
- regularly assess the need for continued use of restraints
- inspect placement area of restraint
- assess patient’s behavior
- assess circulation, motion, sensation
- make sure restraint fits properly
- vital signs
document assessment!
assessment
- inspect skin color and edema
- palpate for skin temp
- palpate pulse
- check capillary refill
- mental status
- if they are able to respond, ask them to move the limb
- if they are able to respond, ask if they have tingling (should have good sensation, no tingling in fingers)
interventions
- ROM
- reposition
- nutrition/hydration/toileting
- release at the earliest possible time
documentation
- any medical evaluation for restraint
- description of the patient’s behavior and the intervention used
- any alternatives or other less restrictive interventions attempted
- patient’s condition or symptom that warranted the use of restraints
- patient’s response to the intervention used and rationale for continued use of the intervention
- individual patient assessments and reassessments
- the intervals for monitoring
- revisions to the plan of care
document
- patient’s behavior and staff concerns regarding safety risks to the patient, staff and others that necessitated the use of restraint
- injuries to the patient
- death associated with the use of restraint
- the identity of the practitioner who ordered the restraint
- orders for restraint
- notification of the use of restraint to the attending physician
- consultations
- patient/family teaching
- response when restraint removed
