Mobility and Immobility chapter 47 11/15/2018 NRS 320 S2010

The Nature of Movement Coordination between the musculoskeletal system and the nervous system. Alignment and Balance The positioning of the joints, tendons, ligaments and muscles. Gravity and Friction Gravity is the force of weight downward Friction opposes movement 11/15/2018 NRS 105.320 S2009

Physiology and Regulation of Movement Please review Anatomy and Physiology text Musculoskeletal system Nervous system 11/15/2018 NRS 105.320 S2009

Pathological Influences on Mobility Postural abnormalities Impaired Muscle development and strength Damage to the Central Nervous System Trauma to the Musculoskeletal System Examples: 11/15/2018 NRS 105.320 S2009

Safe Patient Handling Protecting the Patient and Health Care worker No lift policies Plan ahead based on patient assessment how much help do you need? Equipment? 11/15/2018 NRS 105.320 S2009

Mobility and Immobility The effects of Immobility Metabolic changes Respiratory changes Cardiovascular changes Musculoskeletal changes Changes in urinary elimination Integumentary [skin] changes 11/15/2018 NRS 105.320 S2009

Gait Belt

Wearing a Gait Belt

Using a Gait Belt

Ambulating with a walker

What does it feel like? Effort Fear Do people treat you differently? Time involved Obstacles Students to perform task[s] using wheelchair, walker, cane, etc. with impaired mobility and/or perception MUST have aide for safety!

Positioning

Semi Fowler’s Position

Sim’s or left lateral position

Range of Motion

Assistive Devices for Patient Movement Canes Walkers Wheel chairs All Devices must be appropriate for patient Weight limit Reason for Device Measured to patient 11/15/2018 NRS 105.320 S2009

Hoyer lift 11/15/2018 NRS 105.320 S2009

Bariatric lift 11/15/2018 NRS 105.320 S2009

Even bigger lift 11/15/2018 NRS 105.320 S2009

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11/15/2018 NRS 105.320 S2009

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11/15/2018 NRS 105.320 S2009

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Risks of ↓ Mobility Immobility Unable to move independently Impaired Perception [numbness, paralysis] Unable to sense pain/pressure Altered LOC Confused – perceive pressure/pain but can’t communicate/ relieve pressure Coma: no perception + immobility →↑ risk for pressure ulcers

Risks of ↓ Mobility Weakness, muscle loss Orthostatic hypotension Risk for Falls Circulation impairment [DVT] Boredom, isolation Pain ……etc.

Shearing Skeleton, muscle slide one way, skin stays or moves the other way Raising HOB, transferring pt by sliding stretching of skin, tears capillaries, necrosis leads to undermining of tissues

Friction Top layers of skin Sliding across coarse linens, seats Position changes w/o lifts

Nursing Process for Impaired Mobility Assessment Nursing Diagnosis Planning Implementation Evaluation 11/15/2018 NRS 105.320 S2009

Pressure Ulcer Impaired skin integrity (damage to the skin) related to unrelieved, prolonged pressure. AKA: Pressure sore, decubitus ulcer, bedsore 11/15/2018 NRS 105.320 S2009

Nursing Diagnosis Impaired Skin Integrity r/t immobility as evidenced by stage III decubitus ulcer on coccyx 11/15/2018 NRS 105.320 S2009

Plan (stage I ulcer) On-going skin assessment Nutritional assessment Pressure relief for affected areas Preventative care for intact skin 11/15/2018 NRS 105.320 S2009

Goals Pressure ulcer will not increase in size during hospitalization Infection will not develop in pressure during hospitalization Pt will eat a balanced, high protein diet while in facility Patient and family will develop a plan (with assistance of nursing) for preventing further skin breakdown. 11/15/2018 NRS 105.320 S2009

Interventions RN to assess skin q shift Dietician to complete nutritional assessment and recommend a diet within 24 hours Offer health shake/ protein cup between meals Assistive personnel to reposition patient q 2 hours using the following schedule 8am supine 10 am left side [6o degrees with pillows] 12 noon prone 2pm right side [6o degrees with pillows]… 11/15/2018 NRS 105.320 S2009

Rationales (with Citations) Decreasing the duration of pressure on skin will prevent further skin breakdown. (Perry and Potter, p. 1281) Wound healing requires proper nutrition. (Perry and Potter, p. 1290) Family caregivers require education and counseling to be effective. (MSU by Joan 2009) 11/15/2018 NRS 105.320 S2009

Outcome Evaluation Goal not met: By discharge date, patient had developed stage I ulcer on Rt hip, Coccyx still stage 3 Revise/ update plan for ulcer prevention Goal met: Patient has gained 3lbs this month and serum proteins have increased. - Continue w/ plan – it’s working! Goal met: Family has decided on transfer to LTC for further patient care. - Plan: provide skin history and assessment to LTC facility 11/15/2018 NRS 105.320 S2009

Additional Nursing DX: Weakness, muscle loss Orthostatic hypotension Risk for Falls Circulation impairment [DVT] Boredom, isolation Pain Create a Nursing Care Plan for Pt with impaired mobility