Chapter 37 & 47
Mobility and Immobility
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Advantages of Mobility and
Exercise
• See p. 794, Box 37-6 In addition:
– Decreases risk of sensory deficits
– Decreases social isolation
– Decreases risk of personal injury
– Improves VS and labs
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Types of Exercise
• Isotonic—involves active movement
• Isometric—muscle contraction only
• Isokinetic—muscle contraction with
resistance applied
• Aerobic—systematic movements which
improve CV system—need 30” day
• Stretching—should be done before
exercise
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Regulation of Movement
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Bones
Joints
Ligaments—bone to bone
Tendons—muscle to bone
Cartilage—joint cushion (unossified)
Skeletal muscle—attached to skeleton;
contract and relax
• Nervous system—neurotransmitters; inner
ear
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Risks of No Exercise
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Muscle strain and sprain
Pain
Fractures
Changes in VS—can be dangerous for
people with HD and pulmonary probs if
wrong kind of exercise is done
• Falls
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Factors Important for Movement,
Balance, and Posture
• Strong skeletal system, muscles, and
joints
• Intact nervous system
• Stable center of gravity
• Wide base of support
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Conditions That Affect
Movement, Balance, Posture,
and Mobility
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Musculoskeletal conditions
Nervous system disorders
CV disorders
Respiratory disorders
Cancer
Mental illness
Sedentary lifestyle, restricted activity
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Systemic Effects of Immobility
(1225)
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Metabolic
Respiratory
Cardiovascular
Musculoskeletal
GI
Urinary and bowel elimination
Integumentary
Psychological well-being
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Patient Assessment
• History:
– Activity tolerance
– Daily activities and exercise
– Lifestyle
– Physical or mental conditions that impair
mobility
– Risk for falls, pressure ulcers
– Hx of hospitalizations, surgery, injury,
falls
– Medications
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Physiological Assessment
• Metabolic: anthropometric
measurements, wound healing
• Respiratory system: ventilatory
status, breath sounds
• Cardiovascular system: BP, pulse,
peripheral circulation, signs of DVT
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Physical Assessment (cont'd)
• Musculoskeletal: ROM; muscle
strength, tone, and mass, gait, use of
assistive devices, skeletal/postural
abnormalities
• Integumentary: color, integrity, turgor,
breakdown, drainage, rashes
• Elimination: I&O, bowel sounds,
inspect bowel and bladder output
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Ongoing Physical Assessment
• Each shift should continue to assess:
– Activity tolerance (subjective and objective)
– Gait and mobility and use of devices
– Lung and heart sounds
– Skin observation and wound healing, if applicable
(pp. 1279-1283)
– Labs
– Use of pain meds
– Watch for depression—note verbal and nonverbal
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Nursing Diagnoses (Patient
Problems)
Activity intolerance
Impaired physical mobility
Self-care deficit
Altered skin integrity
Risk for infection
Risk for injury
Risk for disuse syndrome
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Planning
• Outcome criteria should be to decrease
risk of injury and complications of
immobility, and increase knowledge level.
• Make goals simple and related to :
– Increasing mobility, i.e “Pt will ambulate 100
feet today without shortness of breath.”
– Teaching about complications, i.e “Pt will
verbalize 2 complications of bedrest”
– Use of assistive devices, i.e “Pt will use walker
using correct technique.”
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Evaluation of Goals
• For evaluation of cognitive goals, have
patient repeat information back to you.
• For evaluation of psychomotor skills,
have patient demonstrate the skill after
you have taught it.
• Successful evaluation of long term
goals usually requires pt to also modify
behavior or attitude
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Interventions
• Metabolic
– Meet nutritional needs for protein, calories,
vitamins (B and C)
– Promotion of physical fitness and exercise
• Respiratory system
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TCDB
FF
ambulation
Removal of secretions
Maintenance of patent airway
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Interventions (cont'd)
• Cardiovascular system
– Dangling before OOB to prevent orthostatic
hypotension
– Discourage Valsalva maneuver to
decrease cardiac workload
– Preventing thrombus formation by
medications, exercise, fluids, TED
stockings (1249), pneumatic compression
(1248), positioning
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Interventions (cont'd)
• Musculoskeletal system
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ROM (1232)
Isometric exercise
Progressive ambulation
Good body alignment
Teaching on prevention of osteoporosis and injury
Promoting fitness and exercise
Using assistive devices correctly (802)
Pain meds
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Interventions (cont'd)
• Integumentary system
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Turning every 1 to 2 hours
Ambulation
Hygienic care
Protection: preventive aids
• Elimination
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Hydration
I&O
Nutritional intake: fiber
Ambulation
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Interventions (cont'd)
• Psychosocial
– Orientation
– Good listening and communication skills
– Client participation in own care
– Encourage diversional activities and
visitors
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Interventions (cont'd)
• Positioning
– Supports: footboards, trochanter rolls,
hand rolls, and splints
– Trapeze bar
– Bed positions: Fowler’s, supine, prone,
side-lying, Sims’ (1252)
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Interventions (cont’d)
• Transfer techniques(1260)
– In bed—moving up in bed, side to side
– Bed to chair (1 and 2 man)
– Bed to stretcher (3 man)
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Interventions (cont’d)
• Restorative Care
– Occupational therapy
• ADLs
– Physical therapy
• Exercises—ROM, isometrics, upper body
strengthening
• Ambulation: canes, walkers, crutches
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Principles of Body Mechanics
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More force to lift an object than to push or pull it
Objects closer to center of gravity are easier to lift
Wide base of support provides stability
Twisting motions cause back strain
If load is > force then no movement will occur
Thigh muscles are stronger than back muscles
Healthy active muscles are stronger
See p. 790, Box 37-2
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Preventing Personal Injury
(801)
• Keep object close to maintain balance
• Keep back straight and bend @ knees to
maintain center of gravity and protect back
• Use leg muscles to lift, not back
• Tighten abs and tuck pelvis for balance and
back protection
• See handout on how to practice good body
mechanics
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