1. Mobility and Immobility chapter 47
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NRS 320 S2010

2. 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
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3. Physiology and Regulation of Movement
Please review Anatomy and Physiology text
Musculoskeletal system
Nervous system
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4. Pathological Influences on Mobility
Postural abnormalities
Impaired Muscle development and strength
Damage to the Central Nervous System
Trauma to the Musculoskeletal System
Examples:
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5. 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?
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6. Mobility and Immobility
The effects of Immobility
Metabolic changes
Respiratory changes
Cardiovascular changes
Musculoskeletal changes
Changes in urinary elimination
Integumentary [skin] changes
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7. Gait Belt

8. Wearing a Gait Belt

9. Using a Gait Belt

10. Ambulating with a walker

11. 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!

12. Positioning

16. Semi Fowler’s Position

17. Sim’s or left lateral position

19. Range of Motion

24. Assistive Devices for Patient Movement
Canes
Walkers
Wheel chairs
All Devices must be appropriate for patient
Weight limit
Reason for Device
Measured to patient
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25. Hoyer lift
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26. Bariatric lift
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27. Even bigger lift
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33. 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

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

35. 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

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

37. Nursing Process for Impaired Mobility
Assessment
Nursing Diagnosis
Planning
Implementation
Evaluation
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38. Pressure Ulcer
Impaired skin integrity (damage to the skin) related to unrelieved, prolonged pressure.
AKA: Pressure sore, decubitus ulcer, bedsore
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39. Nursing Diagnosis
Impaired Skin Integrity r/t immobility as evidenced by stage III decubitus ulcer on coccyx
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40. Plan (stage I ulcer) On-going skin assessment Nutritional assessment
Pressure relief for affected areas
Preventative care for intact skin
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41. 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.
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42. 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]…
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43. 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)
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44. 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
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45. 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