MOBILITY & IMMOBILITY

MOBILITY DEFINITION

The ability to move freely,

easily, rhythmically and purposefully

in the environment.

The ability to move also

influences persons self-esteem. It

depends on a sense of independence

and a feeling of usefulness.

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 mobility1.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 individual’s

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 life.

BODY MECHANICSBody mechanics is

defined as using alignment,

posture and balance in a

coordinated in a coordinated

effort to perform activities

such as lifting, bending and

moving.

POSTURE

It is defined as the position in

which the various parts of the

body are held when sitting,

standing, and lying down.

POSTURAL ABNORMALITIESKYPHOSIS

It is an abnormal condition of the vertebral column characterized by increased convexity in the thoracic spine.

LORDOSISIt 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 MECHANICS1. 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 chestHipsThighs 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 IMMOBILITYMusculoskeletal system Effects

AtrophyIt 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 contractureIt 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 DropIt 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 EffectsPressure 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 EffectsOrthostatic 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 EmbolismIt 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 EffectsHypostatic 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 exchangeAtlectasis

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

Gastro Intestinal System EffectsAnorexia

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 EffectsUrinary 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 client’s ability to

perform normal daily activities either

temporarily or permanently.

Effects on Psycho neurologic system

Lower the person’s Self Esteem

Increased risk of Depression

Decreased social interaction

Nursing managementAssessingNursing HistoryPhysical examination

Body AlignmentAppearance and movement of jointsCapabilities and limitation for movementMuscle mass and strengthActivity toleranceProblems 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 client’s

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

one’s usual social, vocational, educational,

and family roles.

There are often changes in the client’s 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

PlanningImplementing 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 MOBILITYSOFT 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

RICERestIceIst 24-48hrs : cold 20-30min/application with

10-15 min break between 2 applicationsThen apply heat 20-30 min/applicationCompressionElevation of the affected part

TRACTIONTraction 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 .