1. Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. MOBILITY

2. 2Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Goals for This Concept Presentation  Explain the concept of mobility (including definition, antecedents, and attributes).  Analyze conditions which place a patient at risk for altered mobility.  Identify when altered mobility (negative consequence) is developing or has developed.  Discuss exemplars of common mobility disorders.  Apply the nursing process (including collaborative interventions) for individuals experiencing altered mobility and to promote full mobility

3. 3Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. DEFINE AND DESCRIBE THE CONCEPT OF MOBILITY

4. 4Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Definition Factors that facilitate or impair movement of the body

5. 5Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Scope of Concept

6. 6Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. ANTECEDENTS 1. Adequate energy 2. Muscle strength 3. Underlying skeletal stability 4. Joint function 5. Neuromuscular coordination 6. Age

7. 7Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. CONSEQUENCES OF MOBILITY  Positive  Independence  Physical activity  Weight control  Negative  Swelling of lower extremities  Dyspnea on exertion  Contractures  Skin breakdown  Constipation  Incontinence  Loss of self worth

8. 8Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Categories of Mobility Collaborative Learning #1 In your learning group, discuss the three mobility categories.  How they are different  How they are similar  In what ways they are dependent on one another Musculoskeletal Neurologic Neuromuscular

9. 9Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Review of Musculoskeletal System  Muscles  Bones  Joints

10. 10Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Consequences of Immobility Collaborative Learning # 2 In your learning group, analyze one or more of the consequences of immobility. Why does each consequence occur? How does it link to other consequences? ConsequenceWhy It OccursLink to Other Consequences

11. 11Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. NOTICE RISK FACTORS FOR IMPAIRED MOBILITY

12. 12Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Risk Factors: Population at Greatest Risk Collaborative Learning #3 In your learning group, discuss the following: As a population group, older adults are at greatest risk for immobility. What physiologic factors contribute to this risk?

13. 13Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Individual Risk Factors  Traumatic injury  Brain  Spinal cord  Bones, joints, muscles  Neurologic conditions  Chronic conditions (and/or treatment interventions)

14. 14Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. RECOGNIZE WHEN AN INDIVIDUAL HAS COMPROMISED MOBILITY

15. 15Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Elements of Musculoskeletal Assessment History  Past medical history  Family history  Current medications  Lifestyle behaviors  Occupation  Social environment  Problem-based history Common Symptoms Associated with Altered Mobility  Pain  Reduced joint movement  Reduced sensation or loss of sensation  Falls  Fatigue  Altered gait or imbalance  Reduced functional ability

16. 16Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Examination Techniques Collaborative Learning #4 In your learning group, discuss how to do the listed examination techniques, and list the expected and abnormal findings. How do the examination process and expected findings vary across the age span (infants, children, older adults)? Examination Technique Expected FindingAbnormal Finding Observe balance, gait, posture Inspect joints and muscles Assess muscle strength

17. 17Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Common Diagnostic Tests Radiographic Tests  X-ray  MRI  CT scans  Bone scan  Bone mineral density  Myelogram  Arthrography Other Diagnostic Tests  Arthroscopy  Electromyography  General laboratory tests  Multiple

18. 18Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. CLINICAL MANAGEMENT

19. 19Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Clinical Management: Primary Prevention  Regular physical activity  Protection against injury  Optimal nutrition  Fall prevention measures

20. 20Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Clinical Management: Screening  Osteoporosis screening  What are the national guidelines for screening?  Fall assessment screening  What are common screening tools?  When should these be used?

21. 21Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Clinical Management: Collaborative Interventions  General care guidelines for immobilized patient  Frequent turning, positioning, alignment  Skin assessment and skin care  Range of motion  Deep breathing  Weight bearing (if possible)  Measures to optimize elimination  Nutrition

22. 22Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Clinical Management: Collaborative Interventions (cont’d)  Exercise therapy  Ambulation  Joint mobility  Stretching  Balance  Pharmacologic agents  Antiinflammatory agents  Analgesics  Nutrition supplementation

23. 23Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Clinical Management: Collaborative Interventions (cont’d)  Surgical interventions  Curative versus palliative  Immobilization  Casts and splints, braces, traction, slings, shoulder immobilizers, pillows, etc.  Assistive devices  Crutches, canes, walkers, wheelchairs, prostheses

24. 24Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Exemplars  Hip Fracture  Disuse Syndrome  Joint Replacement  Osteoarthritis  Osteoporosis,  Cerebral Palsy,  Spinal cord Injury

25. 25Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Interrelated Concepts Collaborative Learning #5 In your learning group, list the four most important concepts interrelated with mobility. Defend your answers. Compare the list with those of other learning groups. Interrelated ConceptRationale

26. 26Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. Activity Think about common examples of impaired mobility. How do these differ by age?  Infants  Young children  Adolescents  Adults  Older adults