Basic Human Needs Mobility

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Basic Human NeedsMobility the Hazards of
Immobility
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Mobility serves many purposes

• Performance of ADL
• Satisfaction of basic needs
• Self-defense
• Expression of emotion
• Recreational activities
• Need intact functioning M/S nervous system to
  achieve mobility

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Principles of Body Mechanics

• Body Mechanics-coordinated efforts of M/S
  nervous systems to maintain balance, posture
  body alignment during lifting, bending, moving,
  performing ADLs
• Proper use of body mechanics reduces risk for
  injury and ensures safe care

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Principles of Body Mechanics

• Alignment
• Balance
• Gravity
• Friction

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Regulation of Movement

• Skeletal system
• Skeletal system functions
• Characteristics of bone, joints,ligaments,
  tendons, cartilage
• Skeletal muscle
• Muscle tone
• Nervous system

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Pathological Influences of Mobility

• Postural Abnormalities
• Impaired Muscle Development
• Damage to CNS
• Direct Trauma to M/S System

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Systemic Changes Associated With Immobility

• Metabolic changes
• Endocrine metabolism affected
• (decrease in BMR)
• Disrupts metabolic functioning
• Fluid Lyte Imbalances
• Decreased calories protein
• Negative Nitrogen Balance
• Calcium Resorption affected
• Functioning of GI tract

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Respiratory Changes

• Lack of exercise movement put client at risk
  for
• Atelectasis-Collapse of alveoli leading to
  partial collapse of lung
• Hypostatic Pneumonia- Inflammation of lung tissue
  from stasis or pooling of secretions
• Both decrease oxygenation, prolong recovery,
  add to discomfort

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Cardiovascular Changes

• Orthostatic hypotension
• Increased workload of heart due to decrease in
  venous return to the heart
• Risk for thrombus (Virchows Triad)

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Musculoskeletal Changes

• Muscle effects (muscle atrophy)
• Skeletal effects- Disuse osteoporosis,
  contractures and foot drop

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Urinary Elimination Changes

• Stasis and pooling of urine in renal pelvis leads
  to increased risk for infection and renal calculi
• Risk for dehydration and decreased urine output
• UTIs due to foley catheter

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Other Changes

• Integumentary changes (Risk assessment tool for
  skin breakdown, proper skin hygiene)
• Psychosocial effects (Depression from immobility)
• Developmental Changes

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Nursing Process Immobility

• Assessment
• Assess immobilized client for hazards of
  immobility
• ROM exercises (PP pgs. 1435-1439)

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Nursing Process Nursing Diagnosis

• You tell me!!!

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Implementation

• Health Promotion
• Acute Care
• Metabolic system
• Respiratory system
• Cardiovascular system
• Musculoskeletal system
• Elimination system

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Metabolic System

• Evaluate muscle atrophy
• IO
• Monitor lab data (BUN, albumin, protein,
  electrolytes)
• Assess wound healing
• Assess edema
• Assess for dehydration (Skin turgor, mucous
  membranes)
• Assess nutritional status (protein and vitamin
  supplements, enteral feedings, TPN)

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Respiratory System

• Frequent respiratory assessment
• Ascultate lung sounds
• Inspect chest wall movement
• Promote lung expansion and stasis of pulmonary
  secrections
• Deep breathing and coughing exercises
• Incentive spirometer
• Chest physiotherapy
• Suctioning
• Hydration
• Positioning every 2 hours

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Cardiovascular System

• Vital sign monitoring
• Assess for orthostatic changes (Baseline BP)
• Reduce workload of heart
• Peripheral pulse assessment
• Assessment of edema (hearts inability to handle
  increased work load)
• Prevent thrombus formation
• Assessment of VTE/DVT (Calf circumference)

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Prevent Thrombus Formation

• Anticoagulants (Lovenox, Heparin)
• TED Stockings
• Calf pumping exercises
• Sequential compression stockings

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Musculoskeletal System

• Assessment of muscle tone, strength, loss of
  muscle mass, contractures
• Assess for risk of disuse osteoporosis
• Assessment of ROM
• Passive ROM for all immobilized joints
• Physical therapy consult
• Prevent foot drop and contractures

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Elimination System

• IO each shift
• Assess for fluid electrolyte imbalances
• Bowel assessment
• Adequate hydration
• Incontinent considerations
• Assess bladder distention

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Positioning techniques

• Footboard
• Trocanter roll
• Trapeze bar
• Pillows
• Splints
• Abductor pillow
• ROM exercises

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Practice Scenario

• A 72 year old client is recovering following
  abdominal surgery for colon cancer. Which
  hazards of immobility is this client at risk for
  and why?
• How would you as the nurse prevent post-operative
  complications associated with this clients
  condition?

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Clicker Question

• Which nursing assessment of the immobilized
  client would prompt the nurse to take further
  action?
• A. Client complaining of fatique
• B. Urinary output of 50 ml/hr
• C. White blood cell count of 9.5
• D. Absence of bowel sounds

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Clicker Question

• During an exercise session, the nurse assists the
  client to dorsiflex and plantarflex the foot,
  explaining the client needs to exercise the foot
  to maintain function. The nurse recognizes this
  type of exercise activity as
• A. Active range of motion
• B. Passive range of motion
• C. Isometric exercise
• D. Isotonic exercise

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Clicker Question

• Which of the following patients is most at risk
  for thrombus formation?
• A. Patient with renal failure
• B. Patient with severe abdominal pain
• C. Patient with a total hip replacement
• D. Patient with right sided heart failure

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Clicker Question

• Which of the following is true concerning the
  physiologic effects of immobility?
• A. Serum calcium levels decrease.
• B. Hypertension develops because of increased
  cardiac workload.
• C. Caloric intake often increases.
• D. Secretions may block bronchioles.