MOBILITY & IMMOBILITY

IMMOBILITY
Refers to a reduction in the

amount and control of movement a

person has. It is the inability to move the whole body or its part.

Factors affecting mobility 1.Age It generally affects the activity level and general mobility. As people get older, activity level get slow down. 2.Lifestyle People learn early in life often from families, the value of activity in relation to health. some people participate in physical activities regularly in an effort to maintain or improve health.

3.Energy level It influences an individuals mobility. people demonstrate different energy level at different times. 4.Fear & pain These can limit mobility.

5.Disability
A disability is a persistent mental or

physical weakness that prevent a person

from caring out the normal activities of

Body mechanics is defined

as using alignment, posture and

balance in a coordinated in a coordinated and moving. effort to perform

activities such as lifting, bending

POSTURE

It is defined as the position in which

the various parts of the body are held when sitting, standing, and

lying down.

POSTURAL ABNORMALITIES KYPHOSIS It is an abnormal condition of the vertebral column characterized by increased convexity in the thoracic spine. LORDOSIS It is an abnormal condition of the vertebral column characterized by an exaggerated curvature of the lumbar spine.

SCOLIOSIS

It is an abnormal condition of the

vertebral column characterized by a lateral deviation.

PRINCIPLES OF BODY MECHANICS

1. Proper balancing of all body parts helps to conserve energy. 2. Stability of the body part is maintained by having a greater base of support. 3. Injury and strain on the lower back can be avoided by performing pelvic tilt before the activity. 4. Facing the direction of work will helps to avoid the chances of injury.

5. Initiating movement requires more energy than maintaining the movement of an object. 6. Moving an object on a level surface requires less effort. 7. Reducing friction between the object moved and the surface on which it is moved requires less energy. 8. Holding an object close to the body requires less energy than holding it farther away.

9. Muscle strain can be avoided by using the strong leg muscle when lifting, pushing and pulling. 10.Smooth continuous movements are

easier and safer than sudden sharp

or uncontrolled movements.

11.Using

rhythmic

movements

at

normal speed requires less energy.

Maintenance of Normal Body Alignment

Assess the situation carefully before acting. Careful planning is very important. Maintain good body posture in all activities. Stand with a wide base of support. The greater the base of support the more stable the body is.

Use the stronger, longer and larger

muscles of the body which include the

shoulders, upper arms, thighs and hips. This helps to reduce muscle strain.

While lifting, moving or carrying an

object, keep it close to the body to

prevent unnecessary strain on the muscle. This brings centre of gravity of

the object close to the centre of gravity

of the body.

Avoid unnecessary reaching for an object. Flex the knees to come close to

the object. Adjust the bed/table to the

proper height. Keep work close to the body. E.g: Sit

close to the desk when performing a

task at a desk.

Slide, roll, push or pull the object rather

than lifting it in order to reduce the

energy needed to lift the weight against the pull of gravity.

Use the weight of the body to pull or

push an object.

Face the area of direction of motion, using the muscles of the lower

extremities and shifting body weight for

lifting, pushing and pulling activities. This will reduce the chances of injury.

For lifting, moving or carrying heavy

objects use both hands and arms.

While

changing

the

direction

of

movement turn the whole body. Avoid sudden jerky movements. To lift heavy objects, try to get help from a co-worker.

Squat to lift heavy objects from the floor. Push against the strong hip and thigh muscles to raise oneself to standing position. Pelvic tilt before activity will help to protect the lower back from injury. Energy requirement will be less to keep an object moving than to initiate a movement.

Less effort and energy is required to move an object on a level surface.

Energy expenditure can be minimized by

reducing the friction between the object moved and the surface on which it is

moved.

Use of rhythmic movements at a normal speed to reduce energy.

Always assume a starting position, which will allow freedom of movement in range, direction and position.

Bend hips and knees to alter position of

the body. Use elbows, hip and knees as

levers when lifting. Use mechanical devices when

appropriate.

General Instructions in Moving and Lifting clients Plan the movement of the client ahead of time and be sure the path is clear.

Face

the

direction

in

which

the

movement will be made, to avoid twisting of the vertebral column.

Place the feet comfortably apart to provide a wide base of support.

Flex the knees and hip joints but keep

the trunks as vertical as possible. Keep the client as close to the body as

possible.

Avoid jerking and twisting during the lift.

Heavy clients should be moved in bed

by sliding them rather than lifting them. Assistance should be requested when

lifting or moving heavy clients.

The height of the bed should be adjusted to a height that permits the

nurse to keep her back as erect as

possible when moving the client in bed. This reduces injury to the lower back.

The client is moved to the edge of the bed before he is lifted from the bed.This helps the nurse to keep her trunk more erect. When moving a client by more than one person, each worker should support the clients body sections. Head, shoulders and chest Hips Thighs and ankles.

In order to coordinate the movements of the workers the leader gives signal as

1, 2, 3.During each count the workers

should perform a particular procedure. Encourage the client to use his/ her

abilities if not contraindicated.

Observe for symptoms of orthostatic hypotension.

Do not support the client under his armpits because it may cause injury to major nerves and blood vessels.

Always lock the wheels of the bed and

stretcher prior to transferring the client

to increase the static friction between the wheels and the floor.

HAZARDS OF IMMOBILITY

Musculoskeletal system Effects Atrophy

It is the decrease in size of a normally developed tissue /organ as a result of inactivity or diminished function.

Disuse osteoporosis:
Demineralization of bones take place because of continues immobility.

Contracture
It is the abnormal shortening
of muscle fibers or their associated connective tissue, resulting in

resistance

to

stretching

and

eventually to flexion and finally to

permanent fixation.

Reversible contracture
It is the shortening of a muscle which can be corrected by exercise.

Non- Reversible contracture

It is one in which the muscle

or

tendon

becomes

permanently

fixed/frozen.

Foot Drop
It is the contracture deformity in
which the muscle of the anterior foot lengthens and the muscles of the

plantar

flexion

and

the

achilles

tendon shorten, resulting in plantar

flexion of the foot.

Wrist Drop
It is the contracture deformity of the wrist in the flexed position. In this, there is flexion of the wrist and fingers and opposition of the thumb.

Stiffness and pain in the joints

Without movement the connective tissue in the joints get immobile, in addition bone demineralization result in deposition of calcium to the joints.

Integumentary System Effects Pressure Ulcer

It is any lesion caused by unrelieved pressure that leads to damage of the underlying tissue.

Shear
A strain produced by pressure in the structure of a substance, when its layers are laterally shifted in relation to each other.

Excoriation
It is an injury to the epidermis caused by abrasion, scratching, a burn or chemicals, such as sweat, wound drainage, feces or urine coming in contact with skin.

Maceration
It is a softening of the epidermis caused by a prolonged contact with moisture such as from a wet sheet or diaper.

Cardiovascular System Effects Orthostatic intolerance

It is a drop in systolic B.P by 20mm Hg or more, and a drop in diastolic blood pressure by 10mm Hg or more for 1 to 2 min after a client stands up.

Deep Vein Thrombosis

It is the formation of thrombus or blood clot in the lumen of a deep leg vein such as tibial, popliteal, femoral or iliac vein.

Pulmonary Embolism
It is the blockage of pulmonary blood vessel by an embolus resulting in the blockage of blood flow and oxygen to the lung tissue supplied by the particular blood vessel.

Dependent edema
Increased venous pressure causes extravasations of blood to interstitial part resulting edema.(in lower limbs)

Venous vasodilatation and stasis.

Skeletal muscles(insufficient contraction
or atrophy) cannot assist in pumping blood back to heart result in pooling of blood in

lower

limbs

causing

vasodilatation,

engorgement and stasis of blood in lower

limbs .

Thrombus formation
Impaired venous return, hypercoagulability of blood and injury to
vessel wall causes thrombus formation and thrombo phlebitis(inflammation of vein)

Respiratory System Effects Hypostatic Pneumonia

It is an inflammation of the lungs caused by stasis of

secretions which become a medium for bacterial growth.

Decreased respiratory movement:

Restricted lung movement and atrophy of respiratory muscles result in reduced vital capacity.

Pooling of secretions
It interfere with gas exchange

Atlectasis
Partial or complete collapse of the lung. Occurs as a result of mucus block.

Gastro Intestinal System Effects Anorexia

It is the Loss of Appetite.

Hypo motility
It is the decreased peristalsis from lack of stimulation of the gastro colic reflex.

Constipation
Occurs as a result of decreased peristalsis and colon motility.

Genito Urinary System Effects Urinary tract infection

Urinary stasis favours the
growth of bacteria which can cause urinary tract infection.

Renal Calculi
These

are stones formed in the

kidney, when the excretion rates of calcium

or other minerals are high as when osteoclastic activity releases calcium from the bones during immobility.

Urinary stasis
It is stoppage or slowdown the urine
flow, as a result of decreased effect of gravity, decreased muscle tone.

Urinary retention
As result of decreased muscle tone

of bladder and inability to relax perineal

muscle.

Effects on Activities of Daily Living

Impaired mobility can
severely restrict the clients ability to perform normal daily activities either

temporarily or permanently.

Effects on Psycho neurologic system

Lower the persons Self Esteem Increased risk of Depression Decreased social interaction

Nursing management Assessing

Nursing History Physical examination Body Alignment Appearance and movement of joints Capabilities and limitation for movement Muscle mass and strength Activity tolerance Problems related to immobility

Nursing Diagnosis
Nursing diagnoses related to mobility focus
primarily on activity and mobility levels, and the psychosocial impact that alterations in

mobility can have on a client and the clients

family. Common NANDA nursing diagnoses

related to the risks resulting from altered

mobility include:

 Activity Intolerance related to bed rest and immobility, generalized weakness, sedentary lifestyle, and imbalance between oxygen supply and demand. Impaired Physical Mobility related to intolerance to activity or decreased strength, pain, perceptual or cognitive impairment, neuromuscular impairment, musculoskeletal impairment, and depression or severe anxiety.

 Self-Care Deficits related to inability to wash body or body parts, inability to obtain water source, activity intolerance, decreased strength and endurance, pain, and impaired transfer ability Ineffective Health Maintenance related to lack of or significant alteration in communication skills (written, nonverbal)

 Risk for Falls related to impaired mobility. Alterations in family and social processes

may also result from immobility and

inactivity. Disruption in activity and mobility

leads to impairment of the ability to perform

ones usual social, vocational, educational,

and family roles.

There are often changes in the clients perception of role. Disturbed Body Image and Situational Low Self-Esteem can result from: Changes in physical abilities Changes in family responsibilities Lack of knowledge regarding rehabilitation Fear (of falling) Ineffective coping Low self esteem Powerlessness

Planning Implementing Nursing strategies to maintain or promote body alignment and mobility involve positioning clients appropriately, moving and turning clients in bed, transferring clients, providing ROM exercises, ambulating clients with or without mechanical aids. Evaluation

ALTERATIONS IN MOBILITY
SOFT TISSUE INJURIES CONTUSIONS :Occurs when blood vessels are damaged and broken as a result of

a blow to the skin (ecchymosis).

STRAINS : Are injuries that affect muscles or tendons, thick bands that

attach muscles to bones. They occur in response to a quick tear, twist or

pull of the muscle. Pain, weakness and muscle spasms are common

symptoms of strain.

SPRAINS : Affect ligaments, thick bands of cartilage that attach bone to bone; they

occur in response to a stretch or tear of

a ligament; an outside force displaces the surrounding joint from its normal

alignment; bruising, swelling, instability

are common.

MANAGEMENT

RICE Rest Ice

Ist 24-48hrs : cold 20-30min/application with 10-15 min break between 2 applications Then apply heat 20-30 min/application

Compression Elevation of the affected part

TRACTION Traction is the application of a pulling force to a part of the body. Traction must be applied in the correct direction and magnitude to obtain its therapeutic effects.

Indications: Traction is used to

To minimize muscle spasm. To reduce align, and immobilize fractures To reduce deformity .