MEETING PATIENT NEEDS: MOBILITY AND IMMOBILITY: HAZARDS: NURSING MANAGEMENT

1. MOBILITY AND
IMMOBILITY

2. Mobility and immobility
• Mobility refers to a person’s ability to move
about freely
• Immobility refers to the inability to do so

3. Hazards of immobility
• Respiratory system
• Cardiovascular system
• Musculoskeletal system
• Metabolic system
• Gastro intestinal system
• Urinary system
• Skin
• Psychosocial outlook

4. Respiratory changes
• Atelectasis (collapse of alveoli)
• Hypostatic pneumonia
• Decreased ventilatory effort
• Increased respiratory secretions
• Acid base imbalance
• Respiratory congestion

5. Cardiovascular changes
• Increased cardiac work load
• Orthostatic hypotension
• Venous stasis
• Venous thrombosis

6. Musculoskeletal changes
• Atrophy
• Decreased joint mobility and
flexibility
• Bone de mineralization
• Osteoporosis
• Contractures and ankylosis

7. Metabolic changes
• Decreased metabolic rate
• Increased catabolism
• Negative nitrogen balance
• Anorexia
• Fluid and electrolyte
imbalances

8. Gastrointestinal changes
• Decreased food intake
• Altered protein metabolism
• Poor digestion and utilization
• Weight gain
• Constipation

9. Urinary changes
• Urinary stasis
• UTI
• Poor perineal hygiene
• Incontinence
• Decreased fluid intake
• Indwelling urinary catheterization
• Renal calculi
• Alkaline urine

10. Skin changes
• Impaired circulation
• Pressure ulcer

11. Psychosocial changes
• Decreased self concept
• Feeling of worthlessness
• Diminished self esteem
• Apathetic
• Altered thought process
• Coping difficulties
• Disturbed sleep pattern

12. factors influencing body alignment
and mobility
• Growth and development
• Physical health
• Mental health
• Nutritional status
• Life style practices
• Environment

14. Assessment
• History
▫ Daily activity level
▫ Exercise
▫ Fitness goals
▫ Mobility problems
▫ Physical and mental alternations
• Physical examination
▫ Movement and gait
▫ Alignment
▫ Joint structure and function
▫ Muscle mass and power
▫ ADL

15. Assessment
• Physical examination
▫ Ability to stand, walk, and sit
▫ Physical and mental alternations

16. Nursing diagnosis
• Activity intolerance
• Impaired physical mobility
• Impaired bed mobility
• Impaired comfort
• Impaired skin integrity
• Impaired wheel chair mobility
• Impaired sitting
• Impaired standing
• Impaired transfer ability

17. Nursing diagnosis
• Impaired walking
• Fatigue
• Risk for activity intolerance
• Risk for falls
• Risk for injury
• Risk for physical trauma
• Risk for pressure ulcer
• Risk for disuse syndrome
• Risk for impaired skin integrity

18. Interventions
• Goal
▫ Long term :
 Patient will maintain or regain normal body
alignment, activity or mobility level.
▫ Short term:
 Demonstrate correct body alignment
whenever observed
 Demonstrate full ROM
 Perform ADL with assistance
 Be free from skin breakdown

19. Planning/implementation
Interventions are directed towards,
Prevention of complication
Depends on system effected
To restore musculoskeletal function

20. Planning/implementation
Position the patient to maintain normal
body alignment
Change position every 2 hourly
Teach to use overhead trapeze
Provide exercise
Isometric
Isotonic
Passive ROM
(Offer analgesics 30 mts prior to exercise)

21. Planning/implementation
• Airway clearance problem
▫ Deep breathing and coughing exercises
▫ Chestphysiotherapy
▫ Suctioning
• Monitor vital signs
 before and after activity
• Instruct to stop if he is unable to tolerate
• Renal problems
▫ Increase fluid intake
▫ Frequent position changes

22. Planning/implementation
• Risk for injury
▫ Keep side rails
▫ Do not leave the patient un attended
▫ Take all safety measures
• Nutrition
▫ Provide balance diet
 Sufficient proteins, CHO, vitamins and minerals.
 Increase fluid intake
• Encourages for ADL
▫ Assist for brushing, combing etc
• Ambulate the patient at the earliest

23. Planning/implementation
• Elimination
▫ High fiber diet
▫ Add more fruits, vegetables and fluids
▫ Changing position and exercises
• Keep the patient clean and tidy
▫ Prevent soiling linens
▫ Provide/assist sponge bath
▫ Observe skin integrity
▫ Take precautions to prevent the
developments of bed sores