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What is immobility? (2)

1. Immobile: prevent or lack movement
2. Regular movement supports the healthy functioning of every body system therefore immobility adversely effects every system.
Ex. pressure ulcers, digestion, circulation, respiratory

What are the 6 P's?

Pain
Place
Personal Needs
Possessions
Positioning
Pulmonary Hygiene

What are three CARDIOVASCULAR effects of immobility?

- ↑ cardiac workload
- ↑ risk for venous thrombosis
- ↑ orthostatic hypotension (give fluid & then reassess)
- shut down of neuromuscular system

What are three RESPIRATORY effects of immobility?

- ↓ depth & rate (reduced need for O2 by body cells)
- ↑ atelectasis
- ↑ risk of pneumonia

What are four MUSCULOSKELETAL effects of immobility?

- ↓ muscle size (atrophy****), tone & strength
- ↓ joint mobility & flexibility →contractures*** get stiff
- ↑ bone demineralization → osteoporosis
- ↓ endurance & stability

What are four METABOLIC & GASTROINTESTINAL effects of immobility?

- ↑ or ↓ metabolic rate
- fluid & electrolyte imbalances → confusion, look at Na, K, CO2.
- constipation
- alter/poor food utilization

What are three URINARY & INTEGUMENT effects of immobility?

- ↑ risk of UTI's = dehydration, not enough fluid
- ↑ risk of calculi (kidney stones)
- skin breakdown = incontinent

What are the psychosocial effects of immobility?

- ↓ self esteem
- ↑ risk of depression

What are three psychological benefits of regular exercise?

1. Improved self-concept
2. Improved sleep
3. Improved energy

What is the patient's history in regards to mobility? (6)

1. Daily activity level = what do you do?
2. Endurance = how have you been doing?
3. Fitness goals = what are your goals?
4. Mobility problems = arthritis, fx
5. Physical or mental health alterations
a. Chronic diseases = COPD, diabetes
b. Neuromuscular problems = parkinsons
c. Pain - get under control
6. External factors = Environment (churches) & financial

What to assess in physical exam for mobility? (5)

1. Gait
2. Walk = shuffling
3. Speed
4. Stance & swing
5. Assistive devices = cane, walker

What are three consideration of Alignment (3)

1. Ear, shoulder & hip in a straight line
2. Base of support on soles & heels of feet
3. Erect posture

What 3 things do you look for in the appearance of a joint?

1. Size
2. Shape
3. Color = variation in color

ABDUCTION

moving extremity away from body

ADDUCTION

moving extremity towards body

DORSIFLEXION

pull toes toward body

What is PLANTAR FLEXION

point toes

ankylosis

consolidation and immobilization of a joint

osteoporosis

bone demineralization

muscle atrophy

muscle MASS that is decreased through disuse or neurologic impairment
- wasting

hypertrophy

increased muscle MASS resulting from exersize or training

Flaccid

no muscle TONE
Ex. CVA

Spastic

- increased TONE that interferes with movement
- spasms

What are three nursing diagnoses?

1. Impaired Physical Mobility
2. Activity Intolerance
3. Risk for Injury

What is the equipment used to maintain body alignment (impaired physical mobility?

- pillows, wedges
- splints
- c-collers
- braces
- side rails
- trapeze bar
- foot board, mediboot (prevent foot drop)

What are two advantages of Fowlers position

↑ ease of breathing
↓ risk of aspiration

What is a disadvantages of Fowlers position

↑ risk of pressure ulcers

What are two advantages of Supine position

easy to move patient
decrease pressure points

What are three disadvantages of Supine position

- aspiration
- foot drop
- breathing problems

What are two advantages of the lateral position?

1. ↓ ulcer (if turning)
2. Comfort
- float heels and watch elbows

What are two disadvantages of the lateral position?

1. spinal misalignment
2. pressure ulcer (ilium)

What is the Sims position?

patient is lying on left side with the right knee and thigh drawn up
- sometimes used for enemas

What is an advantages of Sim's position

Redistributes pressure points

What are three disadvantages of Sim's position?

- New pressure points (humerus, clavicle and ilium)
- foot drop
- internal rotation & adduction (shoulder & hip)
Ex. right ilium ulcer, don't put into right Sims position

Advantages of prone position

- Good alignment and prevents hip and knee problems
- some believe good for respiratory problems

Disadvantages of prone position

Inhibits adequate respirations and ↑ foot drop

What position is used for patients on ventilators?

prone position

minimum frequency for ROM exercises

2-3 times a day

what is active exercise?

patient independantly moves joints

what is active assist exercise?

nurse provides some support

what is passive exercise?

- nurse moves each joint through ROM
- 2 times per day, 2-5 times each exercise

What are eight ROM exercise guidelines?

- should not cause pain or fatigue
- older adults should not hyperextend neck
- all movement should be smouth and rhythmic
- stop when resistance is met without pain
- support distal joint
- perform each movement 2-5 times
- avoid friction/injury to skin
- return joint to normal position when done

This type of ROM improves muscle tone strength and mass

active

How often should you turn a patient

every 2 hours

How does turning prevent immobility complications? (3)

1. Pressure ulcers
2. Atelectasis & pneumonia?
3. Urinary stasis and infection?

If BMI is greater than ____ use bariatric equipment

50

What are ten general guidelines for moving patients?

1. Use appropriate assistive devices
2. Encourage patient to help as much as possible
3. Ensure enough help is available
4. Remove obstacles
5. Plan and communicate plan to patient & your help
6. Position and lock bed, w/c, stretcher, etc.
7. Use good body mechanics
8. Patient pain should be controlled
9. Avoid injury/friction to skin
10. If BMI >50% then use bariatric equipment

What are the Immobility Quality Measurements for ECF?

Must show evidence that mobility was maintained or improved

What are the Immobility Quality Measurements for a Hospital?

Integrated into specific best practice guidelines

Ex: hip & knee surgery: post-op physical therapy
Heart Attack: cardiac rehab
COPD: pulmonary rehab

What approach should the nurse take when handling a patient with dementia?

Incorporate established behavior patterns

what does foot drop look like?

plantar flexion

What are two examples of endurance?

1. ability to perform ADLs
2. ability to tolerate increased activity

What are eight variables leading to injury

1. Uncoordinated lifts
2. size, height differences among lifters
3. Moving patients without assistance
4. Lifting when fatigued
5. Lifting after a recent recovery
6. Repetitive movement & repositioning
7. Moving uncooperative or confused patients
8. Standing for long periods

What are six activity intolerance interventions?

1. Monitor response
a. Baseline VS with pulse ox
b. Slow down if
c. Stop if
2. Increase gradually
3. Plan a purpose
4. Provide physical support
5. Provide emotional support
6. Rest periods

What are four additional strategies for the older adult?

1. Avoid sudden position changes
2. Avoid extreme temperatures during exercise
3. Stop if chest pain occurs
4. Use proper footwear

if the patient has respiratory issues when performing ADLS, what is the diagnosis?

Activity intolerance

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