1. Chapter 35 Immobility

2. 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

3. 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

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

6. 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.

8. 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

9. 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

13. 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

14. Planning
Goals and outcomes
Setting priorities
Collaborative care

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

16. 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

17. 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

18. Restorative Care Maximize independence Increase endurance
Prevent injury

19. Evaluation
Patient care
Patient expectations

20. 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

21. 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.

22. 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.”