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Mobility & Immobility Objectives: Define mobility, immobility, bed rest and disuse atrophy. State...

Date post:28-Mar-2015
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Slide 2 Mobility & Immobility Slide 3 Objectives: Define mobility, immobility, bed rest and disuse atrophy. State the causes of impaired physical mobility. List the factors affecting the severity of physical impairment due to immobility. Discuss the effect immobility on physiological and psychological condition of clients. Mobility & Immobility Slide 4 Continue: List the items of ass. for mobility and immobility Give examples of NANDA nursing diagnosis related to impaired mobility. Mobility & Immobility Slide 5 Outlines: Definitions mobility, immobility, bed rest and disuse atrophy. Causes of impaired physical mobility. Factors affecting the severity of physical impairment due to immobility. Effect immobility on physiological and psychological condition of clients. Mobility & Immobility Slide 6 The items of ass. for mobility and immobility Examples of NANDA nursing diagnosis related to impaired mobility. Mobility & Immobility Slide 7 Mobility refers to: a person's ability to move about freely. Immobility refers to: the inability to move about freely. NANDA definition of immobility: is a state in which the individual experiences or is at risk of experiencing limitation of physical movement. Bed rest: is an intervention in which the client is restricted to bed for therapeutic reasons. Slide 8 Mobility & Immobility Slide 9 Slide 10 Slide 11 Disuse atrophy: has been used to describe the pathological reduction in normal size of muscle fibers after prolonged inactivity from bed rest, trauma, casting, or local nerve damage. *Causes of impaired physical mobility: prescribed restriction of movement in the form of bed rest. Mobility & Immobility Slide 12 Physical restriction of movement through the use of external devices (e.g. cast, or traction). Voluntary restriction of movement, or impairment or loss of motor function. Mobility & Immobility Slide 13 *Factors affecting the severity of physical impairment due to immobility: o Clients age. o Clients overall health. o Degree of immobility experienced. Mobility & Immobility Slide 14 Effect of immobility on physiological condition of clients including changes in the following systems: 1.Metabolic. 2.Respiratory. 3.Cardiovascular. 4.Musculoskeletal. 5.Integumentary. 6.Urinary elimination. Mobility & Immobility Slide 15 Metabolic changes: Immobility disrupts normal metabolic functioning including: Metabolic rate. Metabolism of carbohydrates,fats, and protein. Fluid and electrolyte imbalances. Calcium imbalance. GIT disturbances (anorexia, diarrhea, fecal impaction, and constipation). Mobility & Immobility Slide 16 A deficiency of calories and protein causing: Anorexia. Negative nitrogen balance. Weight loss. Decreased muscle mass. Weakness result from tissue catabolism. Protein loss leads to decreased muscle mass, especially in the liver, heart, lungs, GIT, and immune system. Mobility & Immobility Slide 17 Increase of calcium release to circulation causing hypercalcemia if the kidney are unable to respond appropriately. Mobility & Immobility Slide 18 Respiratory changes: Hypostatic pulmonary complications: pneumonia Leads to O 2, prolong recovery, and add to the clients discomfort. Decline in the clients ability to cough productively. Increase of mucus distribution in the bronchi especially in supine, prone, or lateral position. Mucus accumulation in the airways. Because the mucus is an excellent media for bacterial growth hypostatic pneumonia result. Mobility & Immobility Slide 19 Cardiovascular changes: The three major changes are: Orthostatic hypotension. Increased cardiac workload. Thrombus formation. Slide 20 Mobility & Immobility Orthostatic hypotension: is a drop of 25 mm Hg systolic and of 10 mm Hg diastolic in blood pressure when the client rises from a lying or sitting position to a standing position. Causes of Orthostatic hypotension in immobilization o Decreased circulating fluid volume. o Pooling of blood in the lower extremities. These factors result in decreased venous return followed by a decrease in cardiac output which is reflected by a decreased in blood pressure increasing heart workload. Slide 21 Mobility & Immobility Thrombus formation: A thrombus: is an accumulation of platelets, fibrin, clotting factors, and the cellular elements of the blood attached to the anterior wall of a vein or artery, sometimes occluding the lumen of the vessels. Slide 22 Factors that can cause thrombus formation: 1. Loss of integrity of the vessel wall (e.g., atherosclerosis). 2. Abnormalities of blood flow (e.g., slow blood flow in veins associated with bed rest and immobility). 3. Alterations in blood constituents (e.g., a change in clotting factors or increased platelet activity). Mobility & Immobility Slide 23 Musculoskeletal changes: Immobility lead to permanent impairment of mobility which causing: Loss of endurance (staying power) of the muscles. Decreased muscle mass. Atrophy. Decreased stability. Impaired calcium metabolism. Impaired joint mobility. Mobility & Immobility Slide 24 Integumentary changes: A pressure ulcer, or decubitus ulcer, is the consequence of ischemia and anoxia to tissue. Tissues are compressed, blood diverted, and blood vessels powerfully constricted by continual pressure on the skin and underlying structures; thus cellular respiration is impaired, and cells die. Mobility & Immobility Slide 25 Pressure Areas Slide 26 Slide 27 Urinary elimination changes: In the upright position, urine flows out of the renal pelvis and into the ureter and bladder because of gravitational forces. In recumbent or flat position, the kidneys and the ureters move toward a more flat surface. Urine format by the kidney must enter the bladder against gravity. Because the peristaltic contractions of the ureters are insufficient to overcome gravity, the renal pelvis may fill before urine enters the ureters (Urinary stasis). Mobility & Immobility Slide 28 Urinary stasis increases the risk of: Urinary tract infection. Renal calculi. Renal calculi: Are calcium stones that lodge in the renal pelvis and pass through the ureters. Causes of renal calculi in immobilized client: Altered calcium metabolism. The resulting hypercalcemia. Mobility & Immobility Slide 29 Predisposing factors with renal calculi formarion: Fluid intake diminish. Other causes, such as fever. Increase the risk for dehydration. As a result of previous factors, urinary output declines on or about the fifth or sixth day. Urine become highly concentrated. Mobility & Immobility Slide 30 Causes of urinary tract infection: Concentrated urine. Poor perineal care after bowel elimination, particularly in women. Use of an indwelling urinary catheter. Mobility & Immobility Slide 31 Psychosocial effects of immobility: Depression. Behavioral changes. Changes in the sleep-wake cycle. Impaired coping. Mobility & Immobility Slide 32 Assessment clients for mobility: Range of motion. Gait. Exercise and activity tolerance. Body alignment: Standing. Sitting. Lying. Mobility & Immobility Slide 33 Assessment clients for immobility: *Physiological effect on different body systems as mentioned before. *Psychosocial factors. Mobility & Immobility Slide 34 Examples of NANDA nursing diagnosis related to impaired mobility: See the following slide. Mobility & Immobility Slide 35 Impaired physical mobility r/t reduced range of motion, bed rest, decreased strength. Ineffective breathing pattern r/t decreased lung expansion, accumulation of pulmonary secretions, improper body positioning. Impaired skin integrity r/t restricted mobility, pressure on skins surface, shearing force. Risk for fluid volume deficit r/t decreased fluid intake Ineffective individual coping r/t reduced activity level, social isolation Mobility & Immobility Slide 36 Thanks

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