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The effects of Immobility Factors Influencing obility/Immobility Mobility Ability to move about freely Immobility Inability to move about freely Bed rest An intervention that restricts patients for therapeutic reasons Systemic Effects Metabolic Endocrine, calcium absorption, and GI function Respiratory Atelectasis and hypostatic pneumonia Cardiovascular Orthostatic hypotension Thrombus Musculoskeletal changes Loss of endurance and muscle mass and decreased stability and balance Muscle effects Loss of muscle mass Muscle atrophy Skeletal effects Impaired calcium absorption Joint abnormalities Urinary elimination Urinary stasis Renal calculi Integumentary Pressure ulcer Ischemia Metabolic Changes Respiratory Changes Cardiovascular Changes Orthostatic hypotension Increased cardiac workload Thrombus formation Musculoskeletal Changes Muscle effects Patient loses lean body mass. Muscle weakness/ atrophy Skeletal effects Disuse osteoporosis Joint contracture Urinary Elimination Changes Urinary stasis Renal calculi Infection Integumentary Changes Pressure ulcers Inflammation Ischemia Older adults at greater risk Psychosocial Effects Emotional and behavioral responses Hostility, giddiness, fear, anxiety Sensory alterations Altered sleep patterns Changes in coping Depression, sadness, dejection Developmental Changes Infants, Toddlers, Adolescents Preschoolers Delayed in gaining Prolonged immobility delays independence and in gross motor skills, accomplishing skills intellectual development, or Social isolation can occur musculoskeletal development Adults Older Adults Physiological systems are at Decreased physical activity risk Hormonal changes Changes in family and social Bone reabsorption structures Nursing Process: Assessment (cont’d) Mobility Gait (a particular manner or style of walking) Exercise (physical activity for conditioning the body, improving health, and maintaining fitness) Activity tolerance Physiological Emotional Developmental Nursing Process: Assessment (cont’d) Mobility Body alignment is used for: Determining normal physical changes Identifying deviations in body alignment Patient awareness of posture Identifying postural learning needs of patients Identifying trauma, muscle damage, or nerve dysfunction Obtaining information on incorrect alignment (i.e., fatigue, malnutrition, psychological problems) Nursing Process: Assessment (cont’d) Body alignment Lying Nursing Process: Assessment (cont’d) Immobility Metabolic Respiratory Cardiovascular Musculoskeletal Integumentary Elimination Psychosocial Developmental Nursing Diagnosis and Planning Impaired physical mobility Risk for disuse syndrome Ineffective airway clearance Ineffective coping Risk for injury Risk for impaired skin integrity Insomnia Social isolation Nursing Diagnosis and Planning (cont’d) Planning Goals and outcomes Setting priorities Teamwork and collaboration Implementation: Acute Care Metabolic Provide high-protein, high-calorie diet with vitamin B and C supplements. Respiratory Cough and deep breathe every 1 to 2 hours. Provide chest physiotherapy. Implementation Cardiovascular Progress from bed to chair to ambulation. SCDs, TED hose, and leg exercises Musculoskeletal Passive ROM CPM Active ROM CPM, Continuous passive motion; ROM, range of motion; SCD, sequential compression device; TED, thromboembolic deterrent. Implementation Integumentary system Reposition every 1 to 2 hours. Provide skin care. Elimination system Provide adequate hydration. Serve a diet rich in fluids, fruits, vegetables, and fiber. Psychosocial changes Developmental changes Implementation (cont’d) Positioning techniques Supported Fowler’s Supine Prone Side-lying Sims’ Implementation Restorative and continuing care IADLs ROM exercise Walking IADLs, Instrumental activities of daily living; ROM, range of motion. Evaluation Have the patient’s goals been met? Have outcomes been met? If not, ask questions: Are there ways we can assist you to increase your activity? Which activities are you having trouble completing right now? How do you feel about not being able to dress yourself and make your own meals? Which exercises do you find most helpful? What goals for your activity would you like to set now? Safety Guidelines Communicate clearly. Mentally review transfer steps. Assess patient mobility and strength. Determine assistance needed. Raise side rail on opposite side of bed. Arrange equipment. Evaluate body alignment. Understand use of equipment. Educate patient.
