Mobility
Let’s Get Going!
E. Heim
RANC Objectives
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Describe the functions of the musculoskeletal and
nervous systems in the regulation of movement.
Discuss physiological and pathological influences
on body alignment and joint mobility.
Assess for correct and impaired body alignment
and mobility.
Discuss the importance of “no-lift” policies for the
client and health care provider.
Describe equipment needed for safe client
handling and movement.
Compare and contrast active and passive range-ofmotion exercises.
Evaluate the nursing plan for maintaining body
alignment and mobility.
Scientific Knowledge Base:
Nature of Movement
Body mechanics
Alignment and
balance
Coordinated efforts of
the musculoskeletal and Also refers to posture
nervous systems
Gravity
Friction
Weight force exerted on
the body
Force that occurs in a
direction opposite to
movement
Physiology and Regulation
of Movements
• Skeletal system
– Provides attachments for muscles and ligaments
– Provides leverage for movement
• Skeletal muscles
– Help movement of bones and joints
• Nervous system
– Regulates movement and posture
Muscle Contraction
• Mobility requires an interaction of the
musculoskeletal & nervous systems
• Bones, muscles, & nerves must be healthy
• Nerve pathways and spinal nerves must be
intact to transmit impulses to the muscle
• Chemical reactions occur
– Acetylcholine
• Electrolytes
– Calcium
– Sodium
– Potassium
http://faculty.etsu.edu/forsman/Histologyofmuscleforweb.htm
Types of Muscle Contractions
• Isotonic
– Building bulk or “tone”
– Shortening of muscle but no  flexion
• Isometric
– Building strength
– Length remains same but force is 
Pathological Influences
on Mobility
Postural abnormalities
Impaired muscle
development
Damage to CNS
Musculoskeletal
trauma
Mobility and Immobility
• Mobility
– The ability to move about freely
• Immobility
– Inability to move about freely
• Bed rest
– An intervention that restricts clients for therapeutic
reasons
•  pain
•  oxygen demand of body
• Allows rest periods
Systemic Effects
Metabolic
Respiratory
Endocrine, calcium absorption, Atelectasis (“collapsed lung”) and
and GI function
hypostatic pneumonia
Cardiovascular
Musculoskeletal Δs
Orthostatic hypotension
Thrombus (blood clots)
Loss of endurance and muscle mass
and decreased stability and balance
Muscle effects
Skeletal effects
Loss of muscle mass
Muscle atrophy (wasting)
Impaired calcium absorption
Joint abnormalities
Urinary elimination
Integumentary
Urinary stasis
Renal calculi (kidney stones)
Pressure ulcer Ischemia (bedsores)
Psychosocial Effects
• Emotional and behavioral responses
– Hostility, giddiness, fear, anxiety
• Sensory alterations
– Sleep-wake alterations
• Changes in coping
– Depression, sadness, dejection
Developmental Changes
Infants, Toddlers,
Preschoolers
Prolonged immobility delays gross
motor skills, intellectual
development or musculoskeletal development
Adults
Physiological systems are
at risk for changes in family and
social structures
Adolescents
Delayed in gaining
independence and in
accomplishing skills
Social isolation can occur
Older Adults
Decreased physical activity
Hormonal changes
Bone reabsorption
Assessment
• Mobility
– ROM
– Gait
– Exercise & Activity Tolerance
– Body alignment
• Standing
• Sitting
• Lying
http://moveintohealth.com/learn_about_restore
Assessment
• Immobility
– Metabolic
– Respiratory
– Cardiovascular
– Musculoskeletal
– Integumentary
– Elimination
– Psychosocial
– Developmental
Nursing Diagnosis & Planning
• Select the applicable NANDA nursing
diagnosis:
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Impaired physical mobility
Risk for disuse syndrome
Risk for injury
Impaired skin integrity
Social isolation
…etc.
• The planning phase will establish client goals
and outcomes:
– Realistic, time-framed, and measurable
Implementation
Acute Care
• Metabolic
– Provide high-protein, high-caloric diet with vitamin
B and C supplements
• Respiratory
– Cough & deep breathe every 1 to 2 hours (q1-2h)
– Chest physiotherapy (CPT)
– Incentive spirometer (IS)
• Cardiovascular
– Progress from bed to chair to ambulation
– SCDs, TED hose, and leg exercises
Implementation
• Musculoskeletal
– Passive ROM
• Con’t passive motion (CPM) equipment
– Active ROM
• Integumentary system
http://www.coastalortho.com/articles/acl.htm
– Reposition every 1 to 2 hours
– Skin care
• Elimination system
– Adequate hydration
– Diet rich in fluids, fruits, vegetables, and fiber
Implementation
• Positioning techniques
– Fowler’s
– Supine
– Prone
– Side lying
– Sims
• Transfer
Evaluation
• Gauges the effectiveness of specific
interventions designed to promote body
alignment, improve mobility, and protect
the client from hazards of immobility
THE END
• Moving on….!