Level of mobility has a significant impact on?
an individual’s physiological, psychosocial, and developmental wellbeing.
Body systems at risk of impairment when mobility is altered:
- Altered cardiovascular functioning
- Disruption of normal metabolic functioning
- Increased risk for pulmonary complications
- Development of pressure ulcers (bed sores)
- Urinary elimination alterations
Severity of mobile impairment depends on:
- Age
- Overall health
- Nutritional status
- Degree of mobility experienced
Any age can be affected by immobility. Immobilization may lead to:
emotional, intellectual, sensory and sociocultural alterations.
Nursing measures:
: attempt to maintain and/or restore optimal mobility, as well as to decrease the hazards associated with immobility. Examples: Frequent repositioning, deep breathing and couching exercises, muscle and joint exercises, increased fluid intake, and dietary intake of foods containing fiber
Orthostatic hypotension:
drop in blood pressure that occurs when a patient changes position from a horizontal to a vertical position. Traditionally defined as a drop in systolic or diastolic blood pressure of greater than 20mm Hg or greater than 10mm Hg. At risk: immobilized clients, those undergoing prolonged bed rest, older adult clients, clients receiving antihypertensive medications, and clients with chronic illness. Signs and Symptoms: dizziness, light-headedness, nausea, tachycardia, pallor, and fainting.
Recommended to raise the head of the bed, and allow a few minutes before dangling – allows for gradual adjustment. Also recommended to use movement of the legs and feet in the dangling position, and asking patient to take several deep breaths while dangling. Dangling allows you to assess the individual before changing positions to maintain safety and prevent injury.
Skill Performance Guidelines:
- Check DR orders to determine client’s activity level and type of exercise or assistive device.
- Know client’s past medical history. Why client needs assistance with ambulation and any contraindication or limits to exercise.
- Know client’s normal range for vitals.
- Assess baseline muscle strength. Client may need muscle-strengthening before ambulation.
- Assess baseline joint function. Determines if ROM exercises are needed and provides baseline for comparison when ROM is finished.
- Obtain and become familiar with the type of assistive device used. Knowledge of proper preparation and use of devices is needed to be able to teach clients how to use them safely, and correctly.
- Prepare the client. Ensure they are rested and not fatigued. Obtain extra personnel to assist, safety devices, and flat, non-skid shoes for the client.
- Address client’s fear of falling, if present.
- Determine type and frequency of intervention. May change day to day.
- Know client’s home care plan.
Procedural Guideline: Performing ROM Exercises
ROM can be passive, active, or active-assisted.
Considerations:
•preform slowly
•support joint
•do not exercise beyond point of resistance, pain or fatigue
•discuss individual’s limitations or pre-existing conditions
Procedural Steps:
- Review chart.
- Obtain data on client’s baseline joint function. Observe for limitations in joint mobility, redness or warmth over joints, joint tenderness, deformities, or decrepitus produced by joint motion.
- Determine client’s or caregiver’s readiness to learn and explain and demonstrate ROM exercises.
- Assess client’s level of comfort (Scale of 1-10) before exercises. Determine if client would benefit from pain meds before ROM.
- Wear clean gloves if wound drainage or skin lesions are present.
- Assist client to a comfortable position, sitting or lying down.
- When performing active-assisted or passive ROM exercises, support joint by holding distal portion of extremity or using cupped hand to support the joint.
- Complete exercises head to toe sequence. Each movement should be repeated five times.
- Observe client performing ROM activities.
- Measure joint motion as needed
- Monitor pain throughout ROM
Performing Isometric Exercises
- Done in addition to ROM exercises, if needed
- Isotonic muscle contractions: cause a change in muscle length
- These activities positively effect lung and heart function, muscle tone
- Isometric or static exercises: involve tightening or tensing of the muscle without moving body parts. They increase muscle tension but do not change the length of muscle fibers. Involve the contraction of a muscle while pushing against a stationary object or resisting the movement of an object. Promotes muscular strength and provide necessary stress for bone maintenance and growth.
Applying Elastic Stockings
Deep Vein Thrombosis (DVT): blood clot in a deep vein. Three factors (Virchow’s triad) contribute to DVT: hypercoagulability of the blood, venous wall damage, and stasis of blood flow. Elastic stockings help reduce two of the factors: blood stasis and venous wall injury. They promote venous return by maintaining pressure on superficial veins to prevent venous pooling, thereby reducing the risk for clot formation. They prevent massive dilation of the veins, thereby decreasing the risk for endothelial tears.
Assisting with Ambulation and Use of Canes, Crutches, and Walker
When assisting a client ambulate, stay on their strong side so you can pull the client toward you on the strong side if they begin to fall.
CANES:
Lightweight, easily movable devices that extend about waist high and are made of wood or metal. Canes help to maintain balance by widening the base of support. Used with clients with unilateral, partial or complete leg paralysis, and are used to ease the strain on weight bearing joints. Three types of commonly used canes: standard crook cane (provides the least support, client needs minimal assistance), tripod cane and quad cane (provide a wide base of support with the extra legs). Cane is to extend from the greater trochanter to the floor.
CRUTCH:
a wooden or metal staff that reaches from the ground almost to the axilla. They are used to remove weight from one or both legs. Three types of crutches: axillary, Lofstrand (hand grip and metal band that goes around forearm), and platform (has horizontal trough which clients can rest their forearms and wrists on, and a vertical handle to grip). Two to three fingers must fit between crutch and axilla. Using appropriate crutch gait, ex: four-point, three-point and two-point gait.
WALKER:
extremely light, moveable device about waist high, consisting of a metal frame with handgrips, for widely placed, sturdy legs, and one open side. Many types of walkers – foldable, some with wheels. Upper bar of walker should be slightly below client’s waist.
Moving and Positioning Patients in Bed
Correct positioning of patients maintains body alignment and comfort. It prevents injury to the musculoskeletal and integumentary systems, and provides sensory, motor, and cognitive stimulation.
Body alignment:
refers to the condition of the joints, tendons, ligaments, and muscles in various body positions. When the body is aligned no excessive strain is placed on these structures. The body is in line with the pull of gravity and contributes to body balance.
Risk Factors that Contribute to Complications of Immobility:
- Paralysis
- Impaired mobility
- Impaired circulation
- Age
Anthropometric Measurements:
measures of height, weight, and skinfold thickness. Used to evaluate muscle atrophy.
Atelectasis:
collapse of alveoli
Bariatric:
deals with cause, prevention, and treatment of obesity
Body Alignment/Posture:
refers to the positioning of joints, tendons, ligaments and muscles while standing, sitting and lying. Body alignment means that the individual’s sense of gravity is stable and body strain is minimized.
Body Mechanics:
the coordinated efforts of the musculoskeletal and nervous system to maintain balance, posture, and body alignment through lifting, bending, moving, and performing activities of daily living (ADLs).
Chest Physiotherapy (CPT):
effective method for preventing pulmonary secretion stasis. Help drain secretions from specific segments of the bronchi and lung to the trachea so they excretions can be coughed or expelled.
