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September 8, 2021 Lecture 1430

Mobility

 Mobility: factors that facilitate or impair movement of the body

 Factors affecting mobility
o Developmental considerations: age, BMI, posture
o Physical health: illness or trauma interferes with movement, ADL
o Musculoskeletal, nervous system problems: congenital or acquired
(accident/trauma)
o Problems involving other body systems: COPD impacts posture (barrel chest)
 Any illness interfering w/ O2 decreases amount of O2 available for
muscles to work & decreases activity tolerance (anemia, angina)
o Mental health: body processes slowdown in depression, posture affected
o Lifestyle: sedentary vs. active
o Attitude/values: does patient value regular exercise?
o Fatigue/stress: depletes body energy, makes exercise overwhelming, excess
exercise can stress body and lead to injury
o External factors: weather, finances for gym memberships, safe outdoor
parks, lack of free time, lack of support
 Types of exercise
o Isotonic: active movement independently (walking, jogging)
o Isometric: muscle contraction (quads/glute contraction); builds muscle
o Isokinetic: muscle contraction w/ resistance (rehab exercises)
o Range of motion: max degree of movement of joint (move to level of
resistance, not pain)
o Abduction (away from midline of body) vs. adduction (toward midline of
body)
 Attributes
o Gross simple movements: involve large muscles (running, jumping)
o Fine complex movements: smaller movements that occur in wrists, hands,
fingers, toes (writing)
o Coordination
o Synchronized efforts of musculoskeletal and nervous systems: work
together during mobility
 Antecedents
o Adequate energy: allows for regular exercise, sitting, standing, ADL
o Muscle strength: regular exercise increases strength, flexibility,
coordination; decreases bone loss
 Immobile patients become weak, immobility  atrophy  decreased
joint mobility & endurance
o Underlying skeletal stability: if not sufficient, contractures develop
o Joint function
o Neuromuscular coordination: problems w/ brain/spinal cord involved w/
skeletal muscle control can affect mobility
 Cerebral motor cortex of brain controls precise, discrete movements
 CVA or head trauma can damage motor cortex & produce temporary
or permanent motor impairment
o Age: affects muscle mass and strength, bone density, joint flexibility
 Consequences
o Positive
 Independence: move freely w/ ADL = sense of self-worth
 Physical activity: ability to exercise
 Weight control: physical activity allows for weight management
o Negative

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  Swelling of lower extremities: immobility = edema in lower
extremities, increased work on heart
 Blood normally pushed from legs to heart; w/ immobility this
does not occur adequately, leading to blood clots d/t venous
stasis (blood sitting in lower extremities)
 Dyspnea on exertion: shortness of breath w/ activity
 Immobility = decreased rate/depth of respirations = atelectasis
(lung collapse)
 Movement of secretions decreased = secretions pool in lungs =
respiratory congestion & infection
 Contractures: stiffness of joint; results from muscle atrophy &
decreased muscle strength; inability of function
 Skin breakdown: impaired circulation = skin breakdown; prolonged
pressure on bony prominences = pressure injury (change position q2-3
hours)
 Loss of self-worth: can be caused by dependence on others for ADL
 Skeletal deformities impact body image
 Inability to meet role expectations
 Prolonged bedrest = feelings of diminished self-worth, social
isolation
 Incontinence: immobile patient = kidneys & ureters are level = urine
remains in renal pelvis for longer periods = urinary stasis = UTI
 Constipation: GI muscular activity slows down = poor defecation
reflexes (straining w/ BM), inability to expel feces/gas adequately
(painful); stool softeners needed
 Sub-concepts
o Musculoskeletal responses to injury, stress, and aging
o Alterations in neuromuscular function
 CVA – one or both sides may be affected
 Parkinson’s – affects walking/coordination; tremor
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  Multiple sclerosis – causes lack of coordination, tremors, weaknesses
 Exemplars
o Hip fractures
 90% due to fall, 30% will die within 1 year of injury
 Intracapsular fracture: fractures that occur within the hip joint capsule
(femoral neck)
 Often associated w/ osteoporosis & minor trauma
 Extracapsular fracture: occurs outside joint capsule, usually caused by
severe, direct trauma or fall
 Risk factors: chronic health problems, >65y/o, environmental hazards,
women due to osteoporosis, post-menopausal women, trauma,
multiple medication usage
 Assessment:
 History of trauma, bone disease, immobility
 Medications: use of corticosteroids (osteoporotic fracture),
analgesics (disorientation)
 Previous musculoskeletal surgeries
 Collaborative care:
 Open reduction: surgical repair (pins, screws, rods, requires
incision)
 Closed reduction: Buck’s traction (immobilize/manage spasm; no
incision)
 After procedure:
o Know weight bearing status before ambulating – full,
partial, non-weightbearing
o Pain management
o Safety protocols (abductor wedge, hip precautions)
o Pt education: pillow between legs when turning; avoid hip
flexion >90 degrees, avoid turning on affected side
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 o Adequate nutrition
o Exercises w/ PT
o Calcium supplements/estrogen replacement
 Post-op hip precautions
o Foster proper healing & prevent hip dislocation
 Avoid bending at hip past 90 degrees
 Avoid crossing legs
 Avoid twisting leg in or out
o Osteoarthritis
 Single cause has not been identified – cartilage breaks down (bone on
bone), progressive noninflammatory disorder of joints
 Number of factors have been linked: estrogen reduction at
menopause, genetic factors, obesity
 Regular moderate exercise decreases risk
 Clinical manifestations:
 Joint pain: worsens w/ activity
o Early stages: rest relieves pain
o Late stage: pain w/ decreased movement (rest/sleep)
 Joint stiffness occurs after periods of rest or static position
 Early morning stiffness usually resolves within 30 minutes
 Overactivity can cause mild joint effusion, temporary increase in
stiffness
 Deformity: Heberden’s & Bouchard’s nodes
o Red, swollen & tender, visible disfigurement
 Collaborative care
 Focuses on: managing pain/inflammation, preventing disability,
maintaining & improving joint function

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  Foundation for OA management is nonpharmacologic
interventions (PT, ice) – drug therapy serves as adjunct
 Balance rest/activity
 Avoid prolonged standing
 Heat/cold therapy: decreases pain/stiffness; ice for swelling,
heat for stiffness
 Nutrition/exercise: weight reduction; obesity breaks down
cartilage quickly
 Last resort is total joint replacement
 Drug therapy:
o Mild to moderate: Tylenol, topical (capsaicin cream,
salicylates (Aspercrème))
o Joint replacement
o Osteoporosis
 Chronic progressive metabolic bone disease characterized by:
 Porous bone
 Low bone mass
 Structural deterioration of bone tissue
 Increased bone fragility
 Loss of height
 Bone formation slows & breakdown increases = loss of bone, calcium,
phosphorus, & bone matrix
 Bone becomes spongy or brittle = fractures
 Silent disease: no symptoms
 Risk factors:
 Female, increasing age, low body weight, white or Asian
ethnicity, family history, early menopause, excess alcohol intake,
smoking, sedentary lifestyle, insufficient calcium intake, long-

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 term use of corticosteroids, thyroid replacement, antiseizure
drugs
 Preventive care:
 Proper nutrition: encourage foods w/ calcium
 Calcium supplements
 Exercise
 Prevention of fractures
 Drug therapy:
o Calcium
o Vit D
o Biophosphonates – Fosamax (prevents calcium from being
taken from bones)
o Selective estrogen receptor modulators – Evista
o Teriparatide – Forteo (stimulates new bone formation)
o Disuse syndrome
 General term for conditions that result from a period of immobility
 Deconditioning: changes that occur after periods of inactivity or
bedrest
 Involves muscle atrophy or wasting
 Can lead to multisystem problems
 May affect one muscle group or multiple muscle groups
 May result in contractures
 Interventions: joint movement (ROM, isometric exercise, CPM),
encourage clients to do as much as they can for themselves to
improve strength
 Interrelated concepts
o Tissue integrity: risk for skin breakdown & pressure ulcers w/ immobility

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 o Elimination: risk for incontinence, UTI, kidney stones (lose calcium in urine),
constipation
o Nutrition: immobility = loss of appetite, decreased food intake, poor
digestion of food
 Poor nutrition can increase metabolic demands – increased
breakdown of protein stores that provide energy – muscle
wasting/weakness
o Perfusion: risk for blood clots (blood sits in legs, not re-perfused to heart)
o Functional ability: inability to perform ADL
o Comfort: pain associated w/ bone disorders
o Intracranial regulation: if perfusion to brain impacted (CVA), mobility
affected
o Gas exchange: immobility – poor exchange of O2/CO2 – leads to acid-base
imbalance & lung infections
 Nursing Care
o Primary prevention: maintaining highest level of physical activity, optimal
nutrition (ideal body weight), getting adequate rest, education to prevent
injuries or trauma
o Secondary: screening for osteoporosis, mobility screening, fall risk screening
o Tertiary: physical assessment, medication assessment, fall risk assessment,
skin integrity assessment, provide adequate diet and teach health nutrition
habits, teach safety concepts, provide safe environment, provide assistive
devices as needed, collaborate
 Nursing interventions
o Prevent back injuries when caring for immobile clients
 Ask for assistance
 Use assistive devices
 Proper body mechanics
o Prevent skin breakdown: turn patients every 2-3 hours

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 o Use log-rolling technique: move patients w/o flexing spinal column; requires
2-3 people to assist
o Prevent falls:
 Ask about history of falls
 Education: remove scatter rugs, comfortable shoes, good lighting
o Prevent DVTs: avoid sitting for prolonged periods