Immobility

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Immobility

  1. 1. .Identify factors affect or alter mobility Describe the impact of immobility on physiologic and .psychological functioningDiscuss appropriate subjective and objective data to collect .to assess mobility statusDemonstrate nursing interventions, such as positioning, ambulating, providing range of motion, and using assistive.devicesPlan strategies to avoid musculoskeletal injury to the .nurse and client during client care 
  2. 2. The musculoskeletal system is the .supposing framework for the bodyThe bones and muscles are involved in movement and are responsible for. the bodys form and shapeCentral and peripheral nerves coordinate the complex activity ofmovement posture and balanceagainst the force of gravity requiressmooth, joints, and nerves and a.stable center of gravity
  3. 3. Carrying out coordinatedmovement is a complex.processEven with a framework of bonesheld together by ligaments andcovered with soft tissue andskin, normal function cannotoccur without coordinatedmuscle activity and.neurological integration
  4. 4. Nervous Systems ControlNormal mobility requires thesmooth control of movement provided by the nervous system. Any disorder that impairs theability of the nervous systems tocontrol muscular movement andcoordination hinders functionalmobility
  5. 5. :Circulation and Oxygenation The skeletal muscles need adequate amounts of oxygen to function . optimallyThe lungs must provide oxygen to the hemoglobin while removing carbondioxide, the byproduct of aerobic . metabolism in the muscles
  6. 6. The heart must adequately pump bloodto the muscles and supply other bodyorgans with enough blood to meetthe increased demands imposed by. exerciseMany chronic disorders limit the supplyof oxygen and nutrients needed formuscle contraction and movementsuch as congestive heart failure or.peripheral vascular disease
  7. 7. :Energy Energy for muscle function is derived from using oxygen and thebreakdown products of food to.produce muscle contractionAny conditions that strain nutritional stores deplete energy necessary for. movement
  8. 8. :Congenital problemsSome conditions such as bifida orcerebral palsy, are present at birth. cannot be curedTreatment goals are maximal functional.mobility and minimal complications
  9. 9. :Affective Disorders Severe affective disorders can hinder. mobilityDepression and catatonic states result inlimited mobility, not because of physicalimpairments but because the person. lacks the desire to moveFear, especially of pain on movement,may cause some people to restrict their.movements as well
  10. 10. :Therapeutic Modalities Sometimes, limited movement is the  .treatment of medical problemsRestrictive devices, such as casts, braces, and splints can immobilizecertain areas of the body to promote . healingBed rest is another treatment whereby motility is restricted for .therapeutic benefits
  11. 11. To promote healing and tissues repair by.decreasing metabolic needs.To relive edema.To reduce the body oxygen requirements.To decrease painTo support a weak ,exhausted, or febrile.client 
  12. 12. Decreased muscle strength andtoneDisused may be accompanied bymuscles atrophy, which is a.decrease in muscles sizeDecrease in muscle strength maybe so sever that the client can.not support his body weight
  13. 13. Lack of Coordination Lack of coordination occurs when neurological control andregulation of movement are.impaired
  14. 14. Ataxia: is a general term used to .describe defective muscle coordinationTremor : is a rhythmic repetitive movement that can occur at rest orwhen movement is initiated. A tremorusually interferes with fine motorcontrol, but in Parkinsons disease italso can interfere with coordinated. ambulation
  15. 15. Chorea: is spontaneous brief, involuntarymuscle twitching of the limbs or facialmuscles; severe chorea hinders.mobilityAthetosis: is movement characterized by.slow, irregular, twisting motionsDystonia: is similar to athetosis but usually involves larger areas of the.body
  16. 16. Altered Gait Abnormal gait can affect the rhythm. steadiness, or speed of walking An ataxic gait is characterized by .staggering and unsteadiness
  17. 17. Decreased Joint Flexibility Decreased joint flexibility typically occurs with altered mobility because decreased movement. causes joints to stiffenssNormal ROM decreases, because fibrosis and . fixation affect the joint structuresMuscles atrophy when they do not regularly shorten and lengthen during normal musclecontraction. Initially, decreased flexibility andaltered ROM occur in affected joints, but if thejoints remain immobilized, contractures can. occurA contracture: is the progressive shortening of a muscle and loss of joint mobility resultingfrom fibrotic changes in the tissues
  18. 18. Pain on movement Impaired mobility is often caused or  . accompanied by pain on movementPain can result from physical injury, as in sprains, strains, or torn ligaments, orit may result from degenerative and . inflammatory processesOsteoarthritis (degeneration of the articular surface of weight-bearingjoints) and rheumatoid arthritis (aninflammatory disorder that affectsjoints) are two common disorders thatlimit mobility secondary to discomfort/
  19. 19. Activity Intolerance Decreased ability to tolerate activity . often accompanies impaired mobilityActivity intolerance :is the state in which the person has inadequatephysiologic or psychological energy to. endure or to complete an activityA balance must occur between the . activity and the clients energySymptoms associated with activity intolerance are dyspnea, tachycardia,.discomfort, weakness, and fatigue
  20. 20. . Disuse Osteoporosis Immobility results in an imbalance between osteoblastic and osteoclasticactivity, because normal stress and strainimposed on bone through movement are an. important part of osteoblastic processesIn the immobilized client, osteoblasts continue to lay down bony matrix, butosteoclasts, break down bone faster thanosteoblasts can build it. The result is a loss. of bony matrixDisuse osteoporosis results in bones that are more porous, brittle, and susceptible to.fractures
  21. 21. Increased Cardiac Workload Cardiac workload is increased in the immobilized client because the heartmust work harder when the body is. supine than when it is erect
  22. 22. Orthostatic Hypotension Orthostatic hypotension is the deceased ability to maintain systemic bloodpressure when changing from a supine to. an upright positionImmobility decreases the effectiveness . of neurovascular reflexDuring inactivity, regulatory adjustments . are not used and become inactive
  23. 23. Sympathetic stimulation may still occur in response to standing up right, butperipheral vessels do not respond tothis stimulation. Therefore,vasoconstriction does not occur, and a.drop in blood pressure resultsAnother factor that may contribute to orthostatic hypotension is theineffectiveness of the muscle pump inpromoting venous return. This isespecially true of muscles atrophied by. immobility
  24. 24. : Thrombus Formation and Embolism A thrombus is a blood clot composed of platelets, fibrin, and cellular elements that . attaches to the wall of an artery or veinA thrombus most commonly originates in the large veins of the legs because of the .relatively low velocity of blood flow thereThis condition is called deep vein  (. thrombosis (DVTWhen the clot breaks away from the vessel wall and enters circulating blood, it .is called an embolus
  25. 25. The clot lodges in the circulatory system as the diameter of the vesselsdecreases. This most commonlyoccurs when the thrombus enters thepulmonary vasculature, where itinterferes with blood flow to the lung (. (a pulmonary embolusLarge pulmonary emboli can cause immediate death, but small thrombi .may produce no clinical symptoms
  26. 26. Immobility promotes venous stasis, contributing to the development of .DVTWhen leg muscles are inactive, venous return to the heart decreases withtime the gravitational effect of thesupine position results in theredistribution of body fluids, with a net . decrease in venous return
  27. 27. Decreased Lung Expansion The immobilized client experiences greater -than-normal resistance tobreathing, resulting in under inflation ofthe lungs and increased work of.breathingThe immobile client, breathes less deeply and with greater effort. The supine clientmust overcome two resistances that do. not ordinarily work against breathing
  28. 28. First, the diaphragm ,second, the pressure of the bed against the chestwall limits the clients chestmovement. Together, these factorsresult in diminished depth of . breathingBecause the immobilized clients activity level is less than normal, lesscarbon dioxide is produced. Thisresults in a lower level of stimulationfor breathing, causing further
  29. 29. Decreased depth of breathing can result in the collapse of alveoli, which in turn,hinders the exchange of oxygen andcarbon dioxide. This condition causesalveolar collapse is known as . atelectasisIn addition to limiting the lungsability to exchange gases, atelectasis . predisposes the client to pneumoniaThe client ability to cough deeply is often limited; thus, mucus may becometrapped in the lung, providing a rich .medium for microbial growth
  30. 30. :Decreased Metabolic Rate The basal metabolic rate decreases . during immobilitySeverely restricted activity affects the amount and pattern of production ofthyroid hormone, adrenocorticotropichormone, aldosterone, and insulin. It.also alters drug metabolism
  31. 31. Negative Nitrogen Balance: In an active person, a balance exists between protein . breakdown and protein synthesisHowever, immobility raises the rate of protein breakdown, probably because of muscleatrophy. A negative nitrogen balance resultswhen nitrogen excretion exceeds dietary . intakeAnorexia:(loss of appetite) is common in  . immobilized clientsDecreased metabolic rate is accompanied by decreased caloric need. Moreover, if the clientis confined to a healthcare facility, theinstitutional food, eating in a supine position,environmental factors, and psychological state
  32. 32. : Impaired Immunity The immune system is weakened  . during immobilityCatabolism of immunoglobulin G doubles, significantly decreasing thenormal concentration of circulating .antibodiesLeukocytes are less able to engulf and  . destroy microorganismsLymphatic transport may be decreased as well when skeletal muscles are .inactive
  33. 33. :Pressure Sores Pressure sores form when pressure exerted over an area of skin orsubcutaneous tissue exceeds thepressure required for adequate blood . to the areaCells die because they do not receive oxygen and nutrients and because . waste products accumulate
  34. 34. Pressure is usually concentrated on bony prominences but can occur . anywhere that pressure is greatIn the supine position, pressure is greatest over the back of the skull andat the elbows, sacrum, ischial . tuberosities, and heelsIn the sitting position, the greatest pressure is at the ischial tuberosities .and the sacrum
  35. 35. :Urinary Stasis The immobilized client may not heed the urge to void. Clients in institutionalsettings may not want to bother thenurse by asking for a bedpan. Someclients try to void when they feel the needbut have difficulty relaxing the perineal .muscles from the supine positionDelaying micturition causes urine to collect in the bladder. Chronic delay canlead to overstretching of the detrusormuscle in the bladder wall, permanentchanges in bladder tone, and long-termconsequences for normal voiding .patterns
  36. 36. In the upright position, gravity encourages the continual flow of urinefrom each renal pelvis into theureters, and from the ureters to the . bladderWhen a person is supine, the ureters are above the level of many renalcalyces, which means that urine mustflow upward against gravity to enter .the ureters
  37. 37. :Urinary retention poses significant problems for the immobilized client. One problem,urinary stasis, contributes to urinary . tract infections and renal calculiBladder distention, another problem, leads to overflow incontinence, which isembarrassing for the client and can .contribute to skin breakdown
  38. 38. : Urinary Tract Infection Stagnant urine makes a good medium  . for bacterial growthBladder distention can cause small tears in the delicate bladder mucosa, Whichcontributed to the incidence of urinary . tract infectionWhen the client experiences distention, catheterization may be necessary toempty the bladder. With an ofcatheterization comes the risk ofintroducing pathogen and infection into
  39. 39. : Renal Calculi Urinary stasis and an increased serum calcium level promote the formation of renal (. calculi (kidney stonesAs serum calcium levels rise (the result of calcium loss from the bones ), the kidneyexcretes more calcium. This raises urinarycalcium levels. Because calcium canprecipitate from solution to form crystals andbecause stagnant urine encourages theaggregation of crystals, renal calculi pose a . significant problemDehydration, common tit the immobilized client, also increases the incidence of calculi formationAdditionally, infection caused by some urea- splitting organisms makes the urine morealkaline, which also promotes calculi
  40. 40. :Constipation Even in a healthy person, dietary changes, activity variations, or emotional stress . affect normal bowel patternsThe immobilized client faces additional changes. Abdominal and perineal musclescan be weakened by muscle atrophy,making it more difficult for the client tobear down and exert pressure to evacuate . stoolAs stool descends against the rectum, the person feels the stimulus to defecate. In anupright posture, stool descends morequickly into the rectal area, eliciting a .strong stimulusIn the supine position, rectal filling is slow, 
  41. 41. The defecation reflex also can be affected if the person postpones defecation afterrecognizing the stimulus to defecate. Thishappens frequently in the immobilized client,who may feel embarrassed or may need . assist to use a bedpanWhen a person delays defecation, fecal material increases in size and the intestineabsorbs more water from the feces, making . stool passage even; more difficultDehydration, common in the immobile client, also can contribute to constipation. Theresult may be fecal impaction (hard stoolcontained in the rectum that cannot beremoved naturally by defecation). Often, iquid stool seeps around the obstruction
  42. 42. Immobility can interfere with normal sleep patterns. Normal activity,especially physical work, and aerobicexercise produce a sense of fatigue thathelps the person fall asleep and obtain . restful sleepThe immobilized client may doze frequently during the day, disrupting . normal night time sleep patternsThe immobilized client must be, awakened frequently to be turned ,monitored or given treatment and
  43. 43. Because immobility decreases freedom to interact normally with the environment, theclient receives less sensory information,preoccupation with somatic complaints,difficulty with time perception difficulty withun-derstanding and following directions,crying, and other emotional outbursts . frequently occurContusion is common but reversible it normal sensory input returns. In severe cases,sensory deprivation can occur, causing theclient to experience visual and auditory .hallucinationsPain may result from physiologic changes that occur with immobility. Joint stiffness,pneumonia, pressure sores, thrombosis, andemboli can contribute to discomfort. Theperception of pain also may intensify because
  44. 44. Changes in self-perception and self-concept come accompany functional motor impairment . or immobilityImmobility contributes to a feeling of powerlessness, especially when the clientmust depend on others. Motor impairment canalter body image, especially if the impairmentresults from loss of a body part. Self-conceptis altered when the client must depend ondevices such as crutches, wheelchairs, orwalkers. Problems with coordination cancause embarrassment (eg, the client mayworry about appearing awkward or even (. intoxicatedAltered body image can negatively impact self- esteem and lead to a feeling of lowered self- .worth
  45. 45. Loss of mobility is not something the client chooses or desires. With trauma,the loss occurs suddenly. In somecases, it is permanent, requiring theclient to adapt to different functional . abilitiesDespite supportive social interactions with family and friends, immobilizedclients may spend many hours alone . and are often bored or/ lonelyDepression, anger, and anxiety are  .common
  46. 46. Lack of privacy, depression, fatigue, and physical limitations cancontribute to decreased sexual . functionimmobility may impede grooming activities that are often important in . maintaining sexual identityFor some clients with long-term motor impairments, such asparaplegia, sexual function may bepermanently altered, requiring theclient to learn new methods of sexual
  47. 47. Impaired mobility can severely restrict the clients ability to perform normaldaily activities, either temporarily or .PermanentlyCoordination and muscle Strength are necessary for eating, dressing, andgrooming. Usually, the nurse can showthe client ways to function successfully . and despite physical limitations
  48. 48. Setting short-term, achievable goals and developing a long-range Plan incollaboration with the healthcareteam (eg, physician, physicaltherapist, occupational therapist,psychologist, social worker) usually . achieve the best resultsFor example, ambulatory physical therapy sessions may help the clientwith mobility problems regain .function and independence
  49. 49. Therapeutic positioning is used to prevent complications when mobility is limited. Theclient may be placed in specific positions tofacilitate diagnostic tests or surgical . interventionCommon positioning postures include prone (face on down), supine (lying on back), highFowlers (head of the bed elevated 80 to 90degrees), semi-Fowlers (head of the bedelevated 30 to 45 degrees), dorsal recumbent(supine with legs flexed in an elevatedposition), knee-chest position, Trendelenburg(supine with head lower than feet), lateral orside-lying position, and Sims (semiprone be a (. prone and side-lying positionPositions most commons used for the immobile client include supine, Fowlers,
  50. 50. Regardless of the specific position, general principles of body mechanicsshould be used in any position change : toMaintain proper body alignment and  . support a body partsAvoid pressure, especially over body prominences, by adequately padding . these areasSuch positioning aids as pillows, splints, footboards, and foam rubber or .sheepskin protectors are helpful
  51. 51. Immobile clients should be turned and repositioned every 2 hours, More . frequent turning may be neededSignificant factors include the amount of adipose tissue, skeletal structure,underlying pathophysiology, comfortlevel, skin condition, and level of . mobilityAssessing for skin condition and signs of pressure is important indetermining the turning schedule.Decreased capillary refill andblanched or reddened areas indicate
  52. 52. Turning schedules should be incorporated in the plan of care andposted at the bedside whether theclient is receiving care in the home, along-term care facility, or a hospital.This helps ensure consistency of carebetween different shifts and different . caregiversIn extended-care facilities, where many clients require frequent positionchanges, a specific rotation pattern maybe developed to ensure that various .positions are used in an orderly fashion
  53. 53. Logrolling technique used for clients who have had surgery in injury  involving the back or spineInstruct the client to keep his or her body as stiff as possible and to avoidany sudden moves during theprocedure. A draw sheet can be helpfulin logrolling clients smoothly, especially . if they are obeseWhen turning a client, place pillow between the legs. Leave the pillows inplace if the client remains in the side-
  54. 54. .Assess the clients abilities and limitations  .Medicate client to provide optimal pain relief Organize environment, and request needed help to  .ensure safetyExplain what you are going to do and how you  .expect the client to helpPermit client to do as much as his or her  .capabilities allowConsider safety precautions (eg, lock wheels, use  (.transfer belt .Follow the principles of body mechanics  .Keep movements smooth and rhythmic Prevent trauma (eg, friction against skin, pulling  (.joints, grabbing musclesCheck client for proper body alignment and comfort, and provide client with call bell before .leaving
  55. 55. Increased cardiac workload related to  . prolonged bed restPotential for injury: deep vein thrombosis related to venous stasis,hypecoagulability, and decreased . muscle activityPotential for injury: falls related to  . orthostatic hypotension
  56. 56. Activity intolerance related to decreased muscle mass, tone, and .strengthImpaired physical mobility related to muscle atrophy (contractures) and (. limited joint mobility (ankylosisPotential injury: pathologic fracture related to excessive bonedmeineralizaiton (disuse (. osteoporosisSelf-care deficit related to decreased muscle strength and decreased
  57. 57. Altered nutrition: less than body requirements related to negative . nitrogen balance and anorexiaAltered nutrition: more than body requirements related to imbalancebetween calories ingested and . burned offFluid volume excess; dependent edema related to fluid shifts(intravascular to interstitialcompartments) secondary to . negative nitrogen balance
  58. 58. Altered bowel elimination: constipation related to decreased . gastric motility and muscle toneAltered nutrition: more than body requirements related to imbalancebetween food intake and activity (.(decreased energy expenditure
  59. 59. Alterations in comfort: acute pain related to inability to pass renal . calculiPotential for urinary tract infection related to urinary stasis and . increase urinary alkalinity
  60. 60. Impaired skin integrity (. (pressure ulcer
  61. 61. Disturbance in self concept (body image, self esteem, personal identity) related to. immobility and need to depend on othersPowerlessness related to increasing . dependency in basic self-care activitiesImpaired social interaction related to . immobilityAltered thought processes: disorientation related to decreased stimulation to maintain. orientationKnowledge deficit related to decreased . motivation to learnIneffective individual coping related to prolonged bed rest and increasing activity. intoleranceAltered sleep- wake pattern related to increased bed time/ napping and decreased

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