Immobility and Activity Study Guide
 Mobility
 A decline in a patient’s mobility status can result from illnesses, injuries, _______________
 Immobility occurs when a patient is unable to move independently or is restricted for therapeutic
reasons (e.g., casts, bedrest)
 The longer the immobility, the more pronounced the consequences on body systems
 Effects of Immobility
 Respiratory: decreased lung expansion, generalized respiratory muscle weakness, and stasis of
secretions
 Can lead to atelectasis and hypostatic pneumonia
 Changes in __________________: BMR decreases; decreases ability to produce insulin and metabolize
glucose so begins to break down protein stores (muscle). This leads to negative nitrogen balance which
predisposes to problems with wound healing
 Effects of Immobility
 Fluid and Electrolyte Changes: Diuresis occurs as result of increased blood flow to kidneys, which
causes loss of electrolytes (potassium and sodium). Also causes calcium resorption (loss) from bones
which causes elevated serum calcium levels (hypercalcemia).
 GI Changes: Risk of constipation from decreased peristalsis and hypercalcemia. Can become a partial or
complete bowel obstruction.
 Cardiovascular
 Orthostatic hypotension occurs after prolonged sitting or patients on bedrest due to blood pooling in
the extremities; is a SBP drop of 20mm Hg or more or a DBP drop of 10mm Hg or more when
patient stands
 Bedrest also increases HR 4-15 beats/min and increased rate is more pronounced on activity
 Risk for DVT/thrombus which puts them at risk for PE which can be life-threatening.
 Musculoskeletal changes
 Loss of strength and endurance, decreased muscle mass and decreased balance. Affects the leg
muscles the most.
 2 possible skeletal complications:
 Joint contractures: foot drop is common
 Disuse osteoporosis with risk of pathological fractures
 Integument Changes: risk for pressure ulcers due to pressure and changes in metabolism
 Urinary Elimination Changes:
 Urinary stasis from gravity not pulling urine into ureters and bladder.
 Increases risk for ________ and renal calculi (kidney stones). (Hypercalcemia further increases
risk.)
 Psychosocial Effects: reduces a patient’s independence and creates a sense of loss. Common emotional
changes are depression, sleep-wake disturbances, and impaired coping.
 Developmental Effects in children and older adult
 Assessing for Potential Effects of Immobility
 Respiratory: Assess at least every 2 hours for acutely ill patients
 Metabolic
 Monitor weight, BMI
 Monitor I &O and lab data: fluid electrolyte status
 Assess food intake/appetite
 Monitor wounds for healing if present
 Cardiovascular:
 monitor BP and check for orthostatic hypotension
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Monitor apical and peripheral pulses
Assess for Edema
Assess for DVT every _____________ (swelling, redness, warmth, tenderness, calf pain. Homans is
no longer considered accurate predictor of DVT). 50% are Asymptomatic!
Musculoskeletal: assess for decreased muscle strength, contractures
Skin Integrity: Assess for pressure ulcers
Elimination: Assess status every shift as well as total I/O over past 24 hrs. Also auscultate for bowel
sounds and assess the frequency and consistency of bowel movements
Psychosocial: observe for changes in mood, behavior and sleep
 Planning
 Encouraging/providing ROM and repositioning is first step in preventing complications
 Pain may need to be managed first
 Implementation
 Structured Exercise Programs
 Respiratory:
 Promote Expansion of Chest and Lungs by repositioning and encouraging incentive spirometry/deep
breathing. Post-op patients may need pain meds for incisional discomfort first
 Prevent stasis of secretions by repositioning and encouraging _____________ fluid intake daily if
not contraindicated
 If patient is too weak, you may need to suction
 Metabolic: work with dietician to promote good diet plan
 Cardiovascular
 Reduce orthostatic hypotension:
 Get patient moving ASAP, even if this means dangling on bed or sitting in chair
 Isometric exercises improve activity tolerance
 When transferring, do it gradually
 Prevent thrombi by:
 Being cautious with pressure on posterior knee
 ROM exercises like ankle pumps, foot circles, and knee flexion
 Encourage Elastic stockings and sequential compression devices (requires order)
 Prophylactic low-dose heparin therapy (requires order)
 Teach patient to avoid _______________________ response (it could be deadly)
 If you suspect a DVT, do not massage; Report immediately to the health care provider
 Musculoskeletal
 A total of 2 hours in 24 hour period scheduled throughout the day will prevent disuse syndromes.
Best method: ambulation
 Passive ROM for immobilized joints 3 or 4 times a day
 Devices like hand rolls, trapeze bars
 Individualize a Progressive Exercise Program with a physical therapist, if possible
 Skin Integrity
 Reposition patient every 1-2 hours or teach to shift weight every 15 minutes
 Use pressure-reducing devices; keep heels elevated off the bed
 Elimination
 Monitor urine output and bowel movements
 Initiate bowel training program if unable to maintain normal pattern
 Psychosocial
 Provide routine and informal socialization
 Place in room with other patients
 Provide stimuli to entertain
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Encourage patients to wear glasses and dentures, shave and apply makeup to enhance body image
Minimize sleep disruptions
Observe for failure to cope
 In Continuing Care
 Goal is to maximize independence, increase endurance and prevent injury
 Focus on IADLs as well as ADLs
 Ch. 25 Exercise and Activity
 Implementation: Positioning Techniques
 Fowler’s position
 Supine position
 Prone position
 Lateral position
 Sim’s position
 Review:
 Transfer techniques
 Assisting a patient in walking
 What to do if they feel dizzy or start to fall
 Don’t Forget: Prevent Back Injury While Repositioning Clients
 Always use proper body mechanics while transferring patients
 Do not be afraid to ask for assistance
 Do not try to reposition someone alone who requires the assistance of two
 Repeated injury to your back can cause a lifetime of back pain!