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Uploaded byAPARNA C LAKSHMI
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Mobility and immobility

This document discusses body mechanics and mobility. It defines body mechanics as using correct muscles to safely and efficiently complete tasks without strain. Maintaining proper body alignment and mobility is important to avoid health issues. The document outlines principles of body mechanics for various activities like lifting, pushing, pulling and carrying. It also discusses range of motion exercises and factors that can affect body alignment and mobility such as age, injury and disease.

Health & Medicine◦
MOBILITY AND IMMOBILITYPRESENTED BY MISS.APARNA C LAKSHMY CLINICAL INSTRUCTOR SNEHODAYA COLLEGE OF NURSING
BODY MECHANICS  BODY MECHANICS is the utilization of correct muscles to complete a task safely and efficiently, without undue strain on any muscle or joint.  It is the efficient use of body as a machine and as a means for locomotion
Purposes of body mechanics:  To avoid stress and strain on the musculoskeletal system  It promotes proper physiological function of the body  It minimizes the expenditure of the energy  It helps in maintaining balance of the body without strain  To prevent kyphosis,lordosis,scoliosis and other deformities.
 It contributes to one’s beauty.
Principles of body mechanics  Maintain good posture in all activity by avoiding twisting the body,turn your whole body,face the area in which you are working.  It is easier to slide,pull,or roll an object than to lift it.it helps to reduce the energy needed to raise the weight .  Movements should be smooth and co-ordinated rather than jerky to prevent injury.
 Use strongest and longest muscles to perform tasks which require physical effort.  Keep the object as close as possible to your body when lifting,moving or carrying them.  Keep the work at a comfortable height to avoid excessive bending at the waist.  Keep your body in good physical condition to reduce the chance of injury.
 Place the feet apart to provide a wide base of support and better balance.  Get help if the object feels too heavy to lift.  Flex the joints(knees and hips) to come close to the object instead of bending back.  Keep work close to the body  Use the weight of the body to pull or push an object by keeping the body above the object.
General instructions in moving and lifting patients  Plan the movement of the patient ahead of time and be sure the path is clear.  Face the direction in which the movement will be made, to avoid twisting of the vertebral column.  Place the feet comfortably apart to provide a wide base of support.  Flex the knees and hip joints but keep the trunk as vertical as possible.
 Keep the patient as close to the body as possible.  Avoiding jerking and twisting during the lift.  Heavy patients should be moved in bed by sliding 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.
 When moving a patient by more than one person,each worker assumes the responsibility for supporting one of the patient’s body sections.the areas to be supported are,  1.head,shoulders and chest  2.hips  3.thighs and ankles
 In order to co-ordinate the movements of the workers and to maintain the patient’s body in correct alignment throughout,the leader gives the signal by counting 1,2,3.etc.during each count a particular procedure is carried out by the workers  Unless contraindicated,encourage the patient to use his abilities as much as possible.
 Observe the patient for symptoms of orthostatic hypotension such as fainting,dizziness,sweating etc  Do not support the patient under his armpits,since injury to major nerves and blood vessels may occur.  Always lock the wheels of bed and stretcher prior to transferring a patient to increase marimum static friction between the wheels and the floor.
Positions used for comfort  Supine position or horizontal recumbent or dorsal or back lying.  Dorsal elevated or semirecumbent position  Prone position  Lateral or side-lying position  Fowler’s position  Cardiac position
Position used for physical examinations  Dorsal or horizontal recumbent  Dorsal recumbent position  Erect position  Sim’s lateral or left lateral prone position.  Lithotomy position  Knee chest or genupectoral position  Trendelenburg position
Dorsal or horizontal recumbent  used mostly for the head to foot examination.
Dorsal recumbent position  used for the vulval,vaginal and rectal examinations and for the operative procedures on the vulval area and for such procedures as catheterisation of the bladder.
Erect position  This is the normal standing position with both feet on the floor.  Used for orthopaedic and neurological disorders.
Sim’s lateral or left lateral prone position  The patient lies on his left side.  One pillow placed under the head with the left cheek resting on it.the left arm is drawn behind the back and right arm may be in any position comfortable for the patient.the right thigh is flexed against the abdomen.  Used mainly for the vaginal and rectal examinations
Lithotomy position  The patient lies on his back with one pillow under the head  The legs are well separated and the thighs are well flexed on the abdomen and the legs on the thighs.  The patient’s buttocks are brought to the extreme edge of the table and legs are supported on the stirrups.  Used for the gynaecological examinations and treatments and during the surgical procedures involving the genitourinary system.
Knee chest or genupectoral position  Mainly used for the examination of the rectum and vagina.  Also as an exercise for the post partum patients.
Trendelenburg position  The patient lies on his back .the foot of the bed is elevated at a 45 degree angle.  The body is on an inclined place and legs hang downward over the end of the table.  This position is used during the examinations or operations on the pelvic cavity into the upper abdomen.  Also used to treat shock and decreased blood pressure.
 Moving up in a bed  Turning a patient to lateral and prone position  Logrolling-(technique used to turn a patient whose body must at all times be kept in straight alignment.)
 Assisting patient to sitting position.  Transfering a patient from bed to chair.  Transfering a patient between a bed and stretcher.
Factors affecting body alignment and mobility.  Growth and development. In adolescence ,growth spurts may result in awkwardness that can be manifested in posture.As age advances,muscle tone and bone density decrease,joints loose flexibility,reaction time slows and bone mass decreases..
 Congenital problems; Eg:hip dysplasia,spina bifida,cerebral palsy .  Neuromuscular deficits Eg: muscular dystrophy,Parkinson’s disease,multiple sclerosis are progressive that impairs the ability of nervous system to control muscular movements and coordination.
 Musculoskeletal deficits:eg:osteoporosis,rheumatoid arthritis.  Chronic health problems: These conditions often decrease mobility because such disorders limit the oxygen and nutrients delivered to the muscle contraction and movements.  Trauma: Injury to joints,tendons,ligaments,muscles or bones affects body alignment and mobility.
.  Affective disorders. Eg:depression and catatonic states result in limited mobility,not because of physical impairment but due to lack of desire to move.  Therapeutic modalities : Eg :restrictive devices such as cast, splint may be used to immobilize certain areas of body to promote healing.  Nutrition: Both under and over nutrition can influence body alignment and mobility.poorly nourished people may have weakness and fatigue.vitamin D deficiency causes bone deformity during growth.inadequate calcium intake increases the risk of osteoporosis
 Personal values and attitudes: Choice of physical activity or type of exercises may influence by values.
Range of motion exercises:  Range of motion exercises refers to activity aimed at improving movement of a specific joint.  Types  Active range of motion exercise(performed by the patient without help)  Passive range of motion exercise(not performed by the patient and the health care worker moves each joint through its range of motion)  Active assistive range of motion(the patient does the exercises with some assistance from another person or equipment.
General rules for ROM  Use good body mechanics  Expose only the body part being exercised,  Explain to the patient what you are going to do and teach the patient how to do .  Support the extremity being exercised.  Move each joint slowly,smoothly and gently  Return the joint to a neutral position after the movement.  Repeat each exercise 3-5times
 Ideally these exercises should be done once per day.  Expect the patient’s heart rate and respiratory rate to increase during exercise.  Joints are exercised sequentially,starting with the neck and moving down.  Don’t continue the exercise to the point that the patient develops fatigue.  Some exercises may need to be delayed until the patient condition improves.
`  Trunk –gliding joint:  Flexion:bend the trunk towards the toes  Extension: straighten the trunk from the flexed position  Hyperextension:bend the trunk backward  Lateral flexion:bend the trunk to the right and left  Rotation:turn the upper part of the body from side to side.
Hazards associated with immobility  Types of immobility  Social:withdrawal from normal patterns of social interaction.  Emotional :it can occur when stressors exceed the coping ability of an individual.  Intellectual : It can occur in persons who lack the ability to acquire needed knowledge.  Physical :can be caused by physical problems or by necessary therapeutic measures.
 1.cardiovascular system:  Venous stasis:caused by prolonged inactivity that restricts or slows venous circulation  Increased cardiac workload:due to increased viscosity from dehydration and decreased venous return.  Thrombus and embolus :formation caused by slow flowing blood,which may begin clotting within hours.  Orthostatic hypotension:
2.Respiratory system:  Hypostatic pneumonia :the depth and rate of respiration and the movement of secretions in the respiratory tract is decreased when a person is immobile.the pooling secretions and congestions predispose to respiratory tract infections.  Atelectasis :when areas of lung tissues are not used over a period of time,collapse of lung tissue may occur
Musculoskeletal system:  Muscle atrophy :disuse leads to decreased muscle size,tone,and strength.  Contracture:decreased joint movement leads to permanent shortening of muscle tissue,resistant to stretching.  Ankylosis:consolidation and immobility of a joint in a particular position due to contracture.
3.Nervous system  Altered sensation caused by prolonged pressure.usually pain is felt at first and the sensation is altered,and the patient no longer senses the pain.  Peripheral nerve palsy.
Gastrointestinal system:  Disturbance in appetite caused by the slowing of gastrointestinal tract  Constipation  Altered protein metabolism  6.INTEGUMENTARY SYSTEM:  Risk of skin breakdown which leads to necrosis and ulceration of tissues,especially on bony areas
Urinary system:  renal calculi caused by stagnation of urine in the renal pelvis.  Urinary tract infections caused by urinary stasis that favours the growth of bacteria  Decreased bladder muscle tone resulting in urinary retention
metabolism  Decreased metabolic rate.  Altered exchange of nutrients and gases.  Increased risk of electrolyte imbalance.
Psychosocial functioning:  Decrease in self concept and increase in sense of powerlessness.  Body image distortions  Increased risk of depression  Decreased social interaction.
Maintenance of normal body alignment and mobility:  Body alignment refers to the arrangements of joints,tendons,ligaments and muscles while in a standing,sitting or lying positions.  in a correctly aligned body,a line passes through specific points while in a standing position.these points can be seen from the side and back view.  Side view,reference points are:top of ear,middle of shoulder,center of hip,front of kneecap,front of ankle bone.  Back view,reference points are: center of head,midpoint of spine,middle of buttocks, and the center point between heels.
Standing  Head extended  Shoulder slightly abducted  Wrist extended  Pull your abdomen in and up  Thighs extended and slightly abducted  Keep your back flat  Chest should be most forward apart  Elbows should be lightly flexed  Fingers flexed  Buttocks contracted  Knees slightly flexed  Feet parallel about 3 inches apart
Sitting:  Head straight  Chin tucked in  Shoulders abducted  Wrist extended  Abdomen flat and relaxed  Chest should most forward part  Elbows flexed can be supported.  Fingers flexed  Thighs flexed at right angles to the trunk.  Feet flexed at right angles to legs and supported on floor or foot rest  Get up,stretch and relax hourly when you have to sit for a long time.
Bending  place one foot in front of the other  Bend the knees as well as the hip  Squat while keeping the back straight to pick up an object from floor.  WHILE WORKING IN STANDING POSITIONS:  Always face towards the work  Keep your feet apart 3 inches  Keep your back straight.
During lifting weights  Stand with both feet placed firmly on the floor and wide apart.  Stand close to the weight.  Use the stronger leg muscles for lifting  Bend knees and hip slightly,keep back straight  Lift straight upward,in one smooth motion  Hold the weight close to the body while lifting  Avoid twisting the trunk.  Stand high enough to avoid lifting above waist.  Better to push rather than lifting.
carrying  Place both feet on the floor.  Hold the object close to the body near the center of gravity.  Hold head erect and spine straight.
pushing  stand close to the object  Place yourself in proper body alignment  Tense muscle and prepare for movement  Hold the object close to the body near the centre of gravity  Lean towards the object  Push away from utilizing body weight to add force.  PULLING:  Lean away from the object to pull it towards you
Reaching  To get an object above head level,  Stand directly in front of and close to the object  Avoid twisting or stretching  Use a stool or ladder for high objects  Maintain a good balance and a firm base of support.  Keep one foot forward  Keep the back straight  Reach with both hands  Before moving the object,be sure that it is not too large or too heavy
Exercises  Exercises is a type of physical activity defined as a planned ,structured and repetitive bodily movement performed to improve health and maintain fitness to achieve an optimal state of health.
Types  Classified according to  Types of muscle contraction  the source of energy.
 Isotonic exercise(Dynamic );  In this,muscle shortens to provide muscle contraction and active movement.  Eg:running,walking,swimming,cycling  They are active ROM exercises  It increases muscle tone,mass,strength,and maintain joint flexibility, and circulation  During isotonic exercise,both heart rate , cardiac output increase.
Isometric exercises(static)  There is muscle contraction without moving the joint.  Eg ;squeezing a towel or pillow bt knees  Cause mild increase in heart rate and cardiac output.but no appreciable increase in blood flow to other parts of the body.
Isokinetic (resistive exercise)  Involves muscle contraction or tension against resistance.  Special machines or devices provide resistance to the movements  These exercises are used in physical conditioning and are often done to build up certain muscle groups.  Increase in bp and blood flow to muscle occurs with resistance training.
Aerobic exercise  It is the activity during which the amount of oxygen taken into the body is greater than that used to perform activity.  This exercises use large muscle group that move repetitively.
Anerobic  It involves activity in which the muscles cannot drawnout enough oxygen from the bloodstream,and anaerobic pathways are used to provide additional energy for a short time
Nursing management. Assessment  Assessment relative to a client’s activity and exercise should be routinely addressed and includes a nursing history and a physical examination of body alignment,gait,appearance and movement of joints,capabilities,and limitations for movement,mass, and strength,activity tolerance, problems related immobility, and physical fitness.
Nursing history:  An activity and exercise history  Any change or difficulties with mobility.  Specific nature of the problem, its frequency, its cause, how the problem affects daily life, client's coping mechanisms, etc.
Physical examination:  Body alignment,gait,appearance,movement of joint,capabilities and limitations for movement,muscle mass and strength,activity tolerance,problems related to immobility.
Physical assessment of mobility status: component Normal findings Significant alterations General movements Voluntarily controlled,co- ordinated. Involuntary movements:tremors,chorea,dystonia, fasciculations,athetosis,oral facial dyskines. Gait and posture Head erect,vertebrae straight,knees and feet point forward,arms at side with elbows flexed.arms swing freely in alteration with leg swings. Spastic hemiparesis,scissors gait,steppage gait,sensory ataxia,cerebellar ataxia,Parkinson’s gait,use of assistive devices. Muscle mass,tone, and strength. Adequate muscle mass,tone,strength to accomplish movement and work Atrophy,hypertrophy,hypotonicity,sp astcity,paralysis