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IMMOBILITY.pptx

This document discusses immobility in patients and nursing management. It defines immobility and lists common causes such as musculoskeletal and neurological disorders. It describes different positions used for comfort and examinations. Guidelines are provided for moving and lifting patients safely as well as using mechanical mobility aids. Hazards of immobility are outlined affecting various body systems. Finally, the nursing management of immobility is discussed including assessment, nursing diagnoses, and interventions to prevent complications and restore function.

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Course : B.Sc. Nursing Subject : Nursing Foundations Unit Number : XII Title : Meeting needs of the patient Topic : Immobility Prepared by SELVIS Nursing Tutor,SRMCON
OBJECTIVES: At the end of session the students will be able to - define immobility - list out the causes of immobility - discuss about the different positions and its comfort - guidelines for moving and lifting patients -care of patients with restraints -using mechanical aids for walking canes - hazards of immobility -nursing management for immobility patients.
DEFINITION • Immobility : The inability to move about freely
COMMON CAUSES OF IMMOBILITY • Musculoskeletal disorders: • Arthritis • Osteoporosis & Fractures (especially hip and femur) • Other (e.g., Paget’s disease) • Neurological disorders: • Stroke • Parkinson’s disease • Other (cerebellar dysfunction, neuropathies) • Cardiovascular disease • Congestive heart failure (severe) • Coronary artery disease • Peripheral vascular disease (frequent claudication)
COMMON CAUSES OF IMMOBILITY • Pulmonary disease • Chronic obstructive lung disease (severe) • Sensory factors • Impairment of vision • Fear (from instability and fear of falling) • Environmental causes • Forced immobility (in hospitals and nursing homes) • Inadequate aids for mobility • Acute and chronic pain • Others • Deconditioning (after prolonged bed rest from acute illness) • Malnutrition • Severe systemic illness (e.g., widespread malignancy) • Depression • Drug side effects (e.g., antipsychotic-induced rigidity)
POSITIONING THE PATIENT Positioning Positioning as planning the person in a proper body alignment of preventive Promotive , curative and rehabilitative aspects of health or placing the patient in good body alignment as needed therapeutically. Purposes To provide comfort to the patient. To relive pressure on the various body parts. To improve circulation To prevent formation of deformities.  To carry out certain nursing, therapeutic and operative procedure.
POSITION USED FOR COMFORT Supine position Dorsal elevated position/ semi recumbent position Prone position Lateral position / side-lying position Fowler’s position Cardiac position
POSITION USED FOR COMFORT Supine position • To promote comfort after spinal anaesthesia. • To prevent contracture • To prevent bed sore Dorsal elevated position/ semi recumbent position • This position used in Convalescence & minor respiratory disease.
POSITION USED FOR COMFORT Prone position • Used for burns patients. • Relive pressure from bed score. • To prevent aspiration of saliva and mucus. Lateral position / side-lying position • Facilitates good lung expansion. • A pillow for the head prevents lateral flexion of the head. • helps relieve pressure on the coccyx.
POSITION USED FOR COMFORT Fowler’s position • To relieve dyspnoea. • To relieve tension on the abdominal sutures • To relax the large muscles of the back and thighs . • To easy for self care. Cardiac position • Comfortable to cardiac and asthma. • To relieve fatigue prevent embolism
POSITION USED FOR PHYSICAL EXAMINATIONS Dorsal or horizontal recumbent Dorsal recumbent position Sim’s lateral / Left lateral position Lithotomy Position Knee chest position Trendelenburg position
POSITION USED FOR PHYSICAL EXAMINATIONS Dorsal or horizontal recumbent Position: Vaginal and rectal examinations Operative procedures on the vulval area Catheterization of the bladder. Sim’s lateral / Left lateral position • This position used for vaginal and rectal examination.
POSITION USED FOR PHYSICAL EXAMINATIONS Lithotomy Position This position is used for the gynecological examination and treatment. Child birth and surgery. Knee Chest Position • This position for rectum and vaginal examination. • As an exercise for post partum patients. • genital tract operations, vaginal hysterectomy, and the diagnosis and treatment of diseases of the urethra and bladder.
• Trendelenburg Position • Examination or surgery on pelvic organs in order to displace the intestines from the pelvic cavity into the upper abdomen. • It is used in the wards to treat shock and decrease blood pressure. POSITION USED FOR PHYSICAL EXAMINATIONS
MOVING AND LIFTING • Moving or lifting means shift or transfer the patient one place to another place with the use of different type of devices. PURPOSES To perform the task efficiently To avoid the patient from unnecessary effort To prevent nurses from strain and back injuries
MOVING AND LIFTING DEVICES 1. Wheel chair or arm chair 2. Wheel bed 3. Stretcher
Guidelines for moving and lifting patients 1. proper body alignment and posture helps - • Prevent fatigue and deformities eg:Kyposis, lordosis, scoliosis, etc. • promote physical functions, e.g Circulation and digestion. • Maintain body balance without undue strain on body parts. • Contribute to reduce energy and maintain beauty . 2. When performing any body movement or task observe the principles.., Face the direction in which the movement or task will be made . This allows to work freely and easily.
Cont.., • Align and balance or posture your body as under to prevent strain and injury Place your feet parallel , 6 to 8 inches apart--- This provides good base o f support Put one foot ahead of other– This provides anterior posterior stability. Distribute your body weight evenly on both feet – This allows weight bearing joints and their support structures to divide & share the load. Flex the knees slightly--- To avoid jointing movements of entire body & prevents hyperextension of knees. Tuck in your buttocks and tilt pelvis forward.
Cont.., Keep back straight and head erect. Straight back decreases muscles strain on back decreases muscle strain on back and allows complete expansion of lungs. • Maintain a more comfortable working height usually at the waist level for many people --- allows to easy flexion of knees and hips & application of force the task. • Keep the task close to your body.– This bring center of the gravity of task& easy to do the task. • Ready your muscles for action --- Take a deep breath , tense your muscles & Breathe out slowly as you perform the movement or task e.g: moving the object or body.
Cont.., 3. To increase efficiency and reduce unnecessary stress on your body while moving and lifting the heavy objects and patients.  Use your strongest and largest muscles  Push , pull or roll an object or body rather than lift it. • Avoiding jerking and twisting during the lift. • Heavy patients should be moved in bed by siding them rather than lifting them. • Assistance should be requested when lifting or moving heavy patients. • The height of the bed should be adjusted to a height that permits the nurse to keep her back as erect as possible when moving the patient in bed. • The patient is moved to the edge of the bed before he is lifted from the bed. This helps the nurse to keep her trunk more erect
Cont.., • 4. the basic movements to perform: a. Reach: b. Stooping :Lower the body to the stooped position by flexing hip & knee joints. C. Lift and carry D. Push or pull • D. Pivot :Set your trunk and leg muscles , shift your weight to the ball of each foot. 5. Encourage the patient to use his / her abilities as much as possible unless contraindicated . 6.Observe the patient for symptoms of orthostatic hypotension , e.g: Fainting, dizziness, sweating , etc. 7. Lock the wheels of stretcher or wheelchair when using it.
NURSING RESPONSIBILITY – SHIFTING THE PATIENTS • PRELIMINARY ASSESSMENT 1. Check the diagnosis of the patient. 2. Check the level of the consciousness and ability to follow instructions. 3. Check the ability of the self care. 4. Check the abilities and limitations such as paralysis, fractures and splints. 5. Check the presence of the muscle, skin and bone lesions and attachment e.g. catheters and I.V. connections. 6. Check numbers of personnel required.
PREPARATION OF THE PATIENT AND UNIT • Provide the privacy. • Explain the procedure. • Adjust the bed at working height. • Fanfold the top linen. • Change the wet linen. • Offer the bedpan. • Remove all comfort devices. • Clamp the catheter. Attach the I.V pole to the device. • Position foot stool if needed. • Follow the body mechanics while shifting the patients
CARE OF PATIENTS HAVING RESTRAINTS Restraint is defined as the intentional restriction of a person’s voluntary movement or behaviors. Principles: It should be selected to reduce client’s movement only as much as necessary Nurses should carefully explain type of restraint and reason for its use. It should not interfere with treatment. Bony prominences should be padded before applying it.
PRINCIPLES OF RESTRAINTS • It should be changed when they become soiled or damp. • It should be secured away from a client’s reach • It should be attached to bed frame not to side rails. • It should be removed a minimum of every 2 hours • Frequent circulation checks should be performed when extremity are used.
RESTRAINT GUIDELINES • Doctor’s order • Informed consent • Follow proper technique • Least restrictive • Pad bony prominence • Maintain body alignment.
USING MECHANICAL AIDS FOR WALKING CANES Canes are light weight, easily movable devices that are made of wood or metal. • Types of canes 1. Single ended canes with half circle handle. 2. Single ended canes with straight handles 3. Canes with 3 or 4 prongs (quad canes)
PROCEDURE • Instruct patient to stand with weight, evenly distributed between the feet and the cane. • The cane is held on the patient’s stronger side. • instruct patient to position cane 6 inches(15 cm) anterior of the foot. • Move the affected leg forward to the cane while the weight is borne by the cane and stronger leg. • Next move the unaffected leg forward ahead of the cane and weak leg while the weight is borne by the cane and weak leg. • Repeat the steps.
WALKERS A walker is a light weight metal frame with four legs. • Patient’s requirements to use walker: • Partial strength in both hands and wrist • Strong elbow extensors such as triceps brachi • Strong shoulder depressors such as the pectoralis minor • Ability to bear at least partial weight on both legs
EXPLAIN THE METHOD OF USING WALKER • Instruct patient to wear non-skid shoe or slipper • Have patient stand in center of walker and grasp handgrips on upper bars. • Lift walker and move it 6-8 inches forward, making sure all 4 feet of the walker stays on the floor. • Take a step forward with one foot. then follow through with other leg. If one leg is weaker than the other: Move the walker and weak leg ahead together about 15 cm while your weight is borne by the affected leg and both
ASSISTING WITH CRUTCH WALKING • Assisting patient to walk using crutches while providing support and balance and as a convenient method of getting from one place to another. Types of crutches: 1. Axillary crutch 2. Lofstrand crutch(it has a handgrip and metal band that fits around the patient’s forearm. 3. Platform crutch :it is used by the patients who are unable to bear weight on their
ASSIST PATIENT IN CRUTCH WALKING 1.Four point gait: This is the most stable of crutch gaits because it provides at least 3 points of support at all times 2. Tripod position: crutches are placed 6 inches in front and 6 inches to side of each foot. Move right crutch forward 10-15 cm.(4-6 in) Move the left front foot forward, preferably to the level of left crutch. Move the left crutch forward. Move the right foot forward
THREE POINT GAIT The client must be able to bear the entire body weight on affected leg. The nurse asks the client to, 1.move both crutches and the weaker leg forward. 2.Move the stronger leg forward. • TWO POINT GAIT • It requires at least partial weight bearing on each foot.it requires more balance. • Begin in tripod position • Move left crutch and right foot forward. • Move right crutch and left foot forward • Repeat sequences
SWING -THROUGH GAIT • Requires that patient have the ability to sustain partial weight bearing on both feet. Move both crutches forward Lift and swing legs through and beyond crutches.
HAZARDS OF IMMOBILITY  Respiratory system  Cardiovascular system  Musculoskeletal system  Metabolic system  Gastro intestinal system Urinary system  Skin  Psychosocial outlook
RESPIRATORY CHANGES  Atelectasis (collapse of alveoli)  Hypostatic pneumonia  Decreased ventilatory effort  Increased respiratory secretions  Acid base imbalance Respiratory congestion
CARDIOVASCULAR CHANGES Increased cardiac work load  Orthostatic hypotension  Venous stasis  Venous thrombosis
MUSCULOSKELETAL CHANGES  Atrophy  Decreased joint mobility and flexibility  Bone de mineralization  Osteoporosis  Contractures and ankylosis
METABOLIC CHANGES  Decreased metabolic rate  Increased catabolism  Negative nitrogen balance  Anorexia  Fluid and electrolyte imbalances
GASTROINTESTINAL CHANGES  Decreased food intake  Altered protein metabolism  Poor digestion and utilization  Weight gain  Constipation
URINARY CHANGES Urinary stasis  UTI  Poor perineal hygiene  Incontinence  Decreased fluid intake  Indwelling urinary catheterization  Renal calculi  Alkaline urine
SKIN CHANGES Impaired circulation Pressure ulcer
PSYCHOSOCIAL CHANGES Decreased self concept  Feeling of worthlessness  Diminished self esteem  Apathetic  Altered thought process  Coping difficulties  Disturbed sleep pattern
NURSING MANAGEMENT • ASSESSMENT • History  Daily activity level  Exercise  Fitness goals  Mobility problems  Physical and mental alternations • Physical examination :  Movement and gait and Alignment  Joint structure and function  Muscle mass and power
• ASSESSMENT • Physical examination • Ability to stand, walk, and sit • Physical and mental alternations • 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
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
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
PLANNING/IMPLEMENTATION • Interventions are directed towards • Prevention of complication • Depends on system effected • To restore musculoskeletal function • 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)
PLANNING/IMPLEMENTATION • Airway clearance problem Deep breathing and coughing exercises Chest physiotherapy 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
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
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
REFERENCE • Kozier and Erb’s , Fundamentals of Nursing, 10th edition, published by Frenchs forest , N.S.W. Pearson • Potter- Perry, “Fundamentals of Nursing”, 2009, Elsevier’s publication. • Sakunthala J Rajan, - “A text book of Nursing Fundamentals of Nursing”, TNNMC 2014, VitMed publishing Pvt Ltd. • Shakuntla Sharma ‘Bripurit’, Principles & Practice of Nursing, 2012,Jaypee Publication. 6
IMMOBILITY.pptx