Chapter 35 Immobility

Mobility and Immobility Ability to move and perform ADLs Requires an intact nervous, muscle, and skeletal systems Maintains normal physiological activities Immobility Inability to move around freely Bed rest is an intervention No body system is spared from the effects of immobility

Physiological Effects Respiratory Atelectasis and pneumonia Metabolic  Energy and negative nitrogen balance Fluid and Electrolytes Diuresis and loss of sodium, potassium and calcium Gastrointestinal  Peristalsis causes constipation Cardiovascular  BP,  HR, risk for DVT Musculoskeletal  Strength, endurance, muscle mass, contractures, osteoporosis Integument Pressure on skin, weight on bony prominences, skin breakdown Urinary Urinary stasis, renal calculi

Psychosocial Effects Reduces independence Changes in self-concept Causes disruption of normal wake/sleep patterns Challenges normal coping strategies

Developmental Effects Infant, toddler, or preschooler Trauma or congenital defect related Young or middle-age adult Cope the best due to developmental age Older adult Related to degenerative disease, neurological trauma, or chronic illness.

Assessment Mobility Stiffness, muscle strength, pain, swelling, movement Respiratory Chest wall movement, auscultation Metabolic I&O, laboratory values, anthropometric measurements Cardiovascular BP, apical pulse, peripheral pulses, peripheral circulation

Assessment, cont Skin integrity Pressure ulcer formation, redness, blanching Elimination I&O, bowel sounds, frequency and consistency of BMs Psychosocial Emotional and behavioral changes, sleep and wake patterns Developmental Regression or changes in developmental stage

Nursing Diagnosis Ineffective airway clearance Risk for constipation Risk for disuse syndrome Risk for falls Impaired physical mobility Risk for impaired skin integrity Ineffective peripheral tissue perfusion Impaired urinary elimination

Planning Goals and outcomes Setting priorities Collaborative care

Implementation Health promotion Respiratory system Pulmonary secretions Preventing thrombus formation Skin integrity Elimination system

Acute Care Respiratory System Cough and deep breathe Pain management Early ambulation Cardiovascular System Orthostatic hypotension SCDs DVT prevention: drug therapy Musculoskeletal System ROJM, CPM Pillows Trapeze

Acute Care, con’t Psychosocial Problems Schedule activities to coincide with sleep/awake periods Assess coping strategies Developmental Changes Plan developmental appropriate strategies Provide explanations

Restorative Care Maximize independence Increase endurance Prevent injury

Evaluation Patient care Patient expectations

Practice Questions 1. You notice a respiratory change in your immobilized postoperative patient. The change you note is most consistent with which of the following? A. Atelectasis B. Hypertension C. Orthostatic hypotension D. Coagulation of blood

Practice Questions (continued) 2. When caring for a bedridden patient, the most appropriate nursing action is to: A. Turn the patient every 4 hours. B. Encourage the use of incentive spirometry every hour. C. Apply an abdominal binder to assist respirations. D. Maintain the patient’s maximum fluid intake at 1200 mL daily.

Practice Questions (continued) 3. After completing a preoperative teaching for a surgical patient, you can validate the patient’s understanding of the use of elastic stockings when the patient states: A. “I can remove them at night.” B. “I can roll them no lower than my calf muscle.” C. “I wear them no longer than 4 hours at a time.” D. “I can remove them for 30 minutes every 8 hours.”