Download hazzards of immobility

FUNDAMENTALS OF NURSING
LESSON 5
PROMOTING
ACTIVITY AND
MOBILITY
HAZZARDS OF IMMOBILITY
DR. DIETRICK EXPERIMENT 1948
NURSES ARE LEGALLY AND MORALLY
ACCOUNTABLE FOR DECREASING THE
EFFECTS OF IMMOBILITY
HAZZARDS OF IMMOBILITY
MUSCULOSKELETAL SYSTEM
HYPERTROPHY—INCREASES IN SIZE
WHEN USED
ATROPHY—DECREASES
IN SIZE WITH NON-USE
HAZZARDS OF IMMOBILITY
MUSCULOSKELETAL SYSTEM
HAZZARDS OF IMMOBILITY
MUSCULOSKELETAL SYSTEM
HAZZARDS OF IMMOBILITY
MUSCULOSKELETAL SYSTEM
Osteoporosis=loss of bone mass
Pt’s need an increase in Ca and
adequate activity to maintain bone
strength
HAZZARDS OF IMMOBILITY
MUSCULOSKELETAL SYSTEM
Contractures: stiffness in JOINT caused
by shortened muscle
HAZZARDS OF IMMOBILITY
MUSCULOSKELETAL SYSTEM
end stage renal disease patient
HAZZARDS OF IMMOBILITY
MUSCULOSKELETAL SYSTEM
HAZZARDS OF IMMOBILITY
GASTROINTESTINAL SYSTEM
NEGATIVE NITROGEN BALANCE
ANOREXIA
DECREASED PERISTALSIS
HAZZARDS OF IMMOBILITY
CARDOVASCULAR SYSTEM

ORTHOSTATIC HYPOTENSION

HEART WORKS 30% HARDER

THROMBUS FORMATION
HAZZARDS OF IMMOBILITY
RESPIRATORY SYSTEM


DECREASED RESPIRATORY MOVEMENT
THICK AND STICKY LUNG SECRETIONS
HAZZARDS OF IMMOBILITY
URINARY SYSTEM

KIDNEY STONES
–


INCREASED BLOOD CALCIUM
INCREASED URINE pH
UTI—KIDNEY INFECTION
–
D/T STASIS OF URINE
HAZZARDS OF IMMOBILITY
SKIN
DECUBITUS ULCERS
LATIN WORD FOR LYING DOWN, RECLINING
HAZZARDS OF IMMOBILITY
SKIN
HAZZARDS OF IMMOBILITY
SKIN
HAZZARDS OF IMMOBILITY
SKIN
HAZZARDS OF IMMOBILITY
SKIN
HAZZARDS OF IMMOBILITY
SKIN
HAZZARDS OF IMMOBILITY
NERVOUS SYSTEM
• NERVE IMPAIRMENT—
PRESSURE ON NERVE OR
BLOOD SUPPLY
• DECREASED INTELLECTUAL AND
SOCIAL ABILITIES
• DECREASED SPEED OF
PERCEPTIONS AND REACTIONS
• INCREASED PAIN PERCEPTION
HAZZARDS OF IMMOBILITY
PSYCHOSOCIAL




DECREASED SELF CONCEPT
DECREASED MOTIVATION
DECREASED DRIVES
INCREASED EMOTIONAL DISTURBANCES
BODY MECHANICS
BODY MECHANICS = USING THE BODY
EFFICIENTLY AS A MACHINE
A KEY FACTOR IN PROPER BODY MECHANICS
IS MAINTAINING PROPER BODY ALIGNMENT
PRINCIPLES OF BODY
MECHANICS
ESTABLISH
A WIDE
BASE OF
SUPPORT
FOR BETTER
STABILITY
AND
BALANCE
PRINCIPLES OF BODY
MECHANICS





MAINTAIN EQUILIBRIUM
BEND OR FLEX THE
KNEES
USE LARGE MUSCLE
GROUPS (FACE
DIRECTION OF
MOVEMENT)
ADJUST THE WORK
LEVEL. (LEVEL
SURFACE=LESS WORK)
CARRY OBJECTS CLOSE
TO MIDLINE
WHY USE PROPER
BODY MECHANICS?

PREVENT STRAIN & INJURY TO PATIENT

PREVENT STRAIN & INJURY TO YOU

PATIENT SAFETY
5 MOST COMMON INJURIES





LIFTING PATIENT (50%)
HELPING PATIENT OUT OF BED (30%)
MOVING A BED (8%)
LIFTING PATIENT TO STRETCHER (7%)
CARRYING EQUIPMENT (5%)
PURPOSES FOR PROPERLY
POSITIONING THE PATIENT





PRIMARY REASON: TO REDUCE
PRESSURE ULCERS
TO MAINTAIN BODY ALIGNMENT
TO PROVIDE MOVEMENT FOR PATIENT—
PROMOTE SKIN INTEGRITY
TO PREVENT CONTRACTURES
TO PREPARE PATIENT FOR PROCEDURE
ACTIVITY AND MOBILITY
***THE NURSE SHOULD TURN AN
INACTIVE PT EVERY 2 HOURS TO
AVOID PRESSURE SORES
(a great nurse will turn more often if
time permits!!)
BODY POSITIONS AS APPLIES TO
NURSING INTERVENTIONS
 DORSAL
(SUPINE)
– FLAT ON BACK
 DORSAL
RECUMBENT
BODY POSITIONS AS APPLIES TO
NURSING INTERVENTIONS
SEMI FOWLERS
– HOB AT 30°
 FOWLERS
– HOB AT 45-60°
 HIGH FOWLERS
– HOB AT 90°
 TRENDELENBERG

BODY POSITIONS AS APPLIES TO
NURSING INTERVENTIONS
ORTHOPNEIC:
LITERALLY SITTING
UP
BODY POSITIONS AS APPLIES TO
NURSING INTERVENTIONS

SIMS
– POSITION OF CHOICE FOR ENEMA OR
RECTAL EXAM
BODY POSITIONS AS APPLIES TO
NURSING INTERVENTIONS
 LATERAL
LYING
SIDE-
BODY POSITIONS AS APPLIES TO
NURSING INTERVENTIONS
P
R
O
N
E
RARELY USED EXCEPT LOWER EXTREMITY
AMPUTATIONS
BODY POSITIONS AS APPLIES TO
NURSING INTERVENTIONS
GENUPECTORAL
LITHOTOMY
RANGE OF MOTION
DEFINED: THE MAXIMUM
MOVEMENT THAT IS POSSIBLE FOR
A JOINT
 INFLUENCED BY
– GENETIC INHERITANCE
– DISEASE
– NORMAL AMOUNT OF ACTIVITY
– INJURY
– DEVELOPMENTAL PATTERNS

TYPES OF RANGE OF MOTION






ACTIVE—PATIENT PERFORMS
INDEPENDENTLY
PASSIVE—PERFORMED FOR PT BY
NURSE OR PHYSICAL THERAPIST
ACTIVE ASSISTED
ISOMETRIC
ISOTONIC
CONTINUOUS PASSIVE MOTION—CPM
MACHINE
PURPOSES FOR RANGE OF
MOTION



TO PREVENT CONTRACTURES
TO RESTORE, INCREASE, OR MAINTAIN
THE STRENGTH OF MUSCLES
TO MAINTAIN OR INCREASE FLEXIBILITY
OF JOINTS
PURPOSES FOR RANGE OF
MOTION



TO MAINTAIN OR PROMOTE THE
GROWTH OF BONES THROUGH STRESS
IF NOT STRESSED THEY BEGIN TO
DECALCIFY
TO IMPROVE FUNCTION OF OTHER
BODY SYSTEMS (GI OR CV)
–
–
HOSPITALIZATION DECREASES MOBILITY
EVERY SYSTEM IS AT RISK OF IMPAIRMENT
NURSE’S RESPONSIBILITY




ASSESS PATIENT’S LEVEL OF FUNCTION
IF PARTIALLY IMMOBILE, ASSIST WITH
ROM EXERCISES
ASSESS NEED AND IMPLEMENT
INTERVENTIONS TO PREVENT
COMPLICATIONS
ROM NEEDS TO BE STARTED EARLY TO
PREVENT COMPLICATIONS
ANGLES OF RANGE OF MOTION








FLEXION
EXTENSION
HYPEREXTENSION
LATERAL FLEXION
ROTATION
ABDUCTION
ADDUCTION
EXTERNAL ROTATION







INTERNAL
ROTATION
CIRCUMDUCTION
SUPINATION
PRONATION
OPPOSITION
INVERSION
EXERSION
PRINCIPLES OF PERFORMING
ROM
MOVE FROM HEAD TO TOE
 SUPPORT THE JOINT
 CPM
 DOCUMENTATION
 DEFINITIONS

TECHNIQUES FOR MOVING PATIENTS


PROPRIOCEPTION
CHECK EQUIPMENT
–
–


ORTHOSTATIC
HYPOTENSION
–
–
–
PROTECT SKIN
–

IV’S, FOLEYS, FEEDING
TUBES, RESTRAINTS
DON’T ATTEMPT >35%
OF YOUR OWN BODY
WEIGHT

PRESSURE, FRICTION,
SHEARING
PROTECT YOURSELF
DANGLE PATIENT
–
BEDREST
HYPOVOLEMIA—
DECREASED
CIRCULATING BLOOD
HYPOKALEMIA—LOW
SERUM POTASSIUM
MEDICATIONS
TECHNIQUES FOR MOVING PATIENTS

LOSS OF SENSATION
–
–
–
–
–
–
–
HEMIPLEGIA—ONE SIDED WEAKNESS OR
PARALYSIS
PARAPLEGIA—PARALYSIS OF LOWER LIMBS
SPASTIC—SPASMS
PARESIS—PARTIAL PARALYSIS
PARALYSIS—LOSS OF MUSCLE FUNCTION OR
LOSS OF SENSATION
FLACCID—WEAK, SOFT, FLABBY, LOSS OF TONE
QUADRIPLEGIA—LOSS IN ALL 4 LIMBS
TECHNIQUES FOR MOVING PATIENTS




AMBULATING
– NORMAL WALKING POSITION
– IF FALLS:
 CALL FOR HELP
 ARMS AROUND WAIST,
 LOWER PT TO FLOOR SLOWLY
 STAY WITH PT UNTIL HELP ARRIVES
HOYER LIFT
LOG ROLL
BED TO STETCHER
INDICATIONS FOR PERFORMING ROM





PHYSICIAN ORDER
IMMOBILITY
MUSCLE ATROPHY OR WEAKNESS
INJURY TO JOINT
DISEASE PROCESSES
DATA TO KNOW R/T ROM AND CPM

ASSESS THE PATIENT
–
–
–

PAIN
INCISION INFLAMMATION, DRAINAGE
OTHER
CHECK CPM MACHINE
–
–
–
CORRECT FLEXION AND EXTENSION
ALL PARTS OPERABLE
SPEED CONTROL
THE END