MOBILITY AND IMMOBILITY

Body Mechanics: Co-ordinated efforts of muscular / skeletal system to maintain, balance posture and body alignment during lifting, bending, moving and performing activities of daily living. Alignment -good alignment (or straight / proper anatomical positioning) is important when standing sitting or lying -helps to reduce injury for nurses and patients.

Balance Balance control means the centre of gravity is appropriate for the task at hand Balance is best with -a wide base of support -low centre of gravity kept in the base of support. Gravity and friction: - The weight of an object person is the force exerted from gravity. - Friction occurs when two surfaces rub against another.

Mobility refers to a person's ability to move about freely. Immobility refers to the inability to move about freely.

NANDA definition of immobility: is a state in which the individual experiences or is at risk of experiencing limitation of physical movement.

Effect of immobility on physiological condition: Metabolic changes Respiratory changes Cardiovascular changes Musculoskeletal changes Urinary elimination changes Integumentary changes.

Effect of immobility on physiological condition: 1. Metabolic changes: Immobility disrupts normal metabolic functioning including: Metabolic rate. Metabolism of carbohydrates, fats, and protein. Fluid and electrolyte imbalances. Calcium imbalance. Increase of calcium release to circulation causing hypercalcemia if the kidney are unable to respond appropriately. GIT disturbances (anorexia, diarrhea, fecal impaction, and constipation).

EFFECT OF IMMOBILITY ON PHYSIOLOGICAL CONDITION: 2. Respiratory changes: Hypostatic pulmonary complications: pneumonia . Leads to O2 , prolong recovery, and add to the clients discomfort. Decline in the clients ability to cough productively. Increase of mucus distribution in the bronchi especially in supine, prone, or lateral position. Mucus accumulation in the airways. Because the mucus is an excellent media for bacterial growth hypostatic pneumonia result.

EFFECT OF IMMOBILITY ON PHYSIOLOGICAL CONDITION:

3. Cardiovascular changes: The three major changes are: Orthostatic hypotension. Increased cardiac workload. Thrombus formation.

EFFECT OF IMMOBILITY ON PHYSIOLOGICAL CONDITION:

3 MAJOR CARDIOVASCULAR CHANGES

A.

Orthostatic hypotension: is a drop of 25 mm Hg systolic and of 10 mm Hg diastolic in blood pressure when the client rises from a lying or sitting position to a standing position. Causes of Orthostatic hypotension in immobilization - Decreased circulating fluid volume. - Pooling of blood in the lower extremities.

EFFECT OF IMMOBILITY ON PHYSIOLOGICAL CONDITION:

3 MAJOR CARDIOVASCULAR CHANGES

B. Increase cardiac workload.. - The factors result in decreased venous return followed by a decrease in cardiac output which is reflected by a decreased in blood pressure increasing heart workload. C. Thrombus formation: A thrombus is an accumulation of platelets, fibrin, clotting factors, and the cellular elements of the blood attached to the anterior wall of a vein or artery, sometimes occluding the lumen of the vessels.

EFFECT OF IMMOBILITY ON PHYSIOLOGICAL CONDITION: 3 MAJOR CARDIOVASCULAR CHANGES

Factors that can cause thrombus formation: 1. Loss of integrity of the vessel wall (e.g., atherosclerosis). 2. Abnormalities of blood flow (e.g., slow blood flow in veins associated with bed rest and immobility). 3. Alterations in blood constituents (e.g., a change in clotting factors or increased platelet activity).

EFFECT OF IMMOBILITY ON PHYSIOLOGICAL CONDITION:

4. Musculoskeletal changes:

Immobility lead to permanent impairment of mobility which causing:

Loss of endurance (staying power) of the muscles. Decreased muscle mass. Atrophy. Decreased stability. Impaired calcium metabolism. Impaired joint mobility.

EFFECT OF IMMOBILITY ON PHYSIOLOGICAL CONDITION: 5. Integumentary changes: A pressure ulcer, or decubitus ulcer, is the consequence of ischemia and anoxia to tissue. Tissues are compressed, blood diverted, and blood vessels powerfully constricted by continual pressure on the skin and underlying structures; thus cellular respiration is impaired, and cells die.

EFFECT OF IMMOBILITY ON PHYSIOLOGICAL CONDITION: 6. Urinary elimination changes: In the upright position, urine flows out of the renal pelvis and into the ureter and bladder because of gravitational forces. In recumbent or flat position, the kidneys and the ureters move toward a more flat surface. Urine format by the kidney must enter the bladder against gravity. Because the peristaltic contractions of the ureters are insufficient to overcome gravity, the renal pelvis may fill before urine enters the ureters (Urinary stasis).

EFFECT OF IMMOBILITY ON PHYSIOLOGICAL CONDITION:

Urinary stasis increases the risk of: Urinary tract infection. Renal calculi. Renal calculi: Are calcium stones that lodge in the renal pelvis and pass through the ureters. Causes of renal calculi in immobilized client: Altered calcium metabolism. The resulting hypercalcemia.

EFFECT OF IMMOBILITY ON PHYSIOLOGICAL CONDITION:

Predisposing factors with renal calculi formarion: Fluid intakediminish. Other causes, such as fever. Increase the risk for dehydration. As a result of previous factors, urinary output declines on or about the fifth or sixth day. Urine become highly concentrated.

EFFECT OF IMMOBILITY ON PHYSIOLOGICAL CONDITION:

Causes

of urinary tract infection: Concentrated urine. Poor perineal care after bowel elimination, particularly in women. Use of an indwelling urinary catheter.

Psychosocial effects of immobility: Depression. Behavioral changes. Changes in the sleep-wake cycle. Impaired coping.

Assessment clients for mobility: Range of motion. (flexion, extension, rotation, abduction, adduction). Gait. (Style of walking). Exercise and activity tolerance. Body alignment: Standing. Sitting. Lying.

TRACTION:
TRACTION: - The act of pulling and drawing associated with counter traction. TYPES OF TRACTION: A. Manual Traction B. Skeletal Traction C. Skin Traction.

TRACTION:
I. Manual Traction: - A pulling force applied by the hands of the operator. II. Skeletal Traction: - A pulling force applied directly to the bones using wires, pins, tongs. A. Kirschners Wire Holder it is thinner than the steinmanns pin. - For the affection of the radius and ulna.

TRACTION:
B. Stainmanns Pin Holder

it is for the affection of the humerous, femur, tibia and fibula. C. Crutchfield Tong for the affection of the upper dorsal cervical spine. - Inserted at the parietal area. D. Balanced Skeletal traction for the affection of the hips or femur.

TRACTION:
E. Overhead Traction

supracondylar fracture of the humerous. F. 90 90 Degrees traction subtrochanteric and proximal 3rd fracture of femur. G. Halo Pelvic Traction for C type scoliosis.

TRACTION:
H. Halo Femoral Traction for S type scoliosis. I. Bohler Braun Splint to support the lower leg. - For fracture of proximal 3rd and middle 3rd of tibia or fibula.

TRACTION:
III. Skin traction. - Pulling force is applied to the skin, transmitted to the muscle, then to the bones. A. Adhesive use adhesive tape, elastic bandage, wooden spreader and wadding sheet. B. Non Adhesive use for canvass, slings, leathers, straps with buckels, laces and ribbons and metal spreader.

TRACTION:
A. Adhesive. 1. Dunlop Traction affection of the supracondylar of the humerus. 2. Zero Degrees Traction affection of the surgical neck of the humerus and the shoulder joint. 3. Bucks Extension Traction affection of the hip and the femur.

TRACTION:
4. Bryant Traction Affection of the hip and femur for children below 3 yrs. Old. - Also for congenital hip dislocation. 5. Boot Cast Traction for post poliomyelitis with residual paralysis of the hip and knee. 6. Modified Bucks Extension Traction. - Use of foam instead of plaster (same indication).

TRACTION:
Non Adhesive 1. Head Halter Traction for cervical spine affection. 2. Pelvic Girdle Traction for lumbo sacral spine affection. - For herniated nucleus pulposus.

TRACTION:
4. Cotrel Traction A combination of head halter and pelvic girdle traction. for scoliosis. 5. Hammock Suspension Traction For affection of pelvis. For malgained fracture (double fracture of the pelvic ring).

QUESTIONS:
1. A client has been on prolonged bed rest, and the nurse is observing for signs associated with immobility. In assessment of the client, the nurse is alert to a(n): A. Increased blood pressure B. Decreased heart rate. C. Increased urinary output D. Decreased peristalsis

QUESTIONS:
2. A 61-year-old client recently suffered left-sided paralysis from a cerebrovascular accident (stroke). In planning care for this client, the nurse implements which one of the following as an appropriate intervention? A. Encourage an even gait when walking in place. B. Assess the extremities for unilateral swelling and muscle atrophy. C. Encourage holding the breath frequently to hyperinflate the client's lungs. D. Teach the use of a two-point crutch technique for ambulation.

QUESTIONS:
3. Two nurses are standing on opposite sides of the bed to move the client up in bed with a drawsheet. Where should the nurses be standing in relation to the client's body as they prepare for the move? A. Even with the thorax. B. Even with the shoulders. C. Even with the hips. D. Even with the knees

QUESTIONS:
4. A client is leaving for surgery and because of preoperative sedation needs complete assistance to transfer from the bed to the stretcher. Which of the following should the nurse do first? A. Elevate the head of the bed. B. Explain the procedure to the client. C. Place the client in the prone position. D. Assess the situation for any potentially unsafe complications.

QUESTIONS:
5. A client has sequential compression stockings in place. The nurse evaluates that they are implemented appropriately by the new staff nurse when the: A. Initial measurement is made around the client's calves. B. Intermittent pressure is set at 40 mm Hg. C. Stockings are wrapped directly over the leg from ankle to knee. D. Stockings are removed every hour during application.

ANSWERS:
1. D 2. B 3. B 4. D 5. B