MobilityLet’s Get Going!

E. Heim

RANC Objectives• Describe the functions of the musculoskeletal and

nervous systems in the regulation of movement.• Discuss physiological and pathological influences

on body alignment and joint mobility.• Assess for correct and impaired body alignment

and mobility.• Discuss the importance of “no-lift” policies for the

client and health care provider.• Describe equipment needed for safe client

handling and movement.• Compare and contrast active and passive range-of-

motion exercises.• Evaluate the nursing plan for maintaining body

alignment and mobility.

Scientific Knowledge Base:Nature of Movement

Body mechanicsCoordinated efforts of the musculoskeletal and nervous systems

Alignment and balanceAlso refers to posture

Gravity Weight force exerted on the body

FrictionForce that occurs in a direction opposite to movement

Physiology and Regulation of Movements

• Skeletal system– Provides attachments for muscles and ligaments – Provides leverage for movement

• Skeletal muscles– Help movement of bones and joints

• Nervous system– Regulates movement and posture

Muscle Contraction • Mobility requires an interaction of the

musculoskeletal & nervous systems• Bones, muscles, & nerves must be healthy• Nerve pathways and spinal nerves must be intact to

transmit impulses to the muscle• Chemical reactions occur

– Acetylcholine• Electrolytes

– Calcium– Sodium– Potassium

http://faculty.etsu.edu/forsman/Histologyofmuscleforweb.htm

Types of Muscle Contractions

• Isotonic– Building bulk or “tone”– Shortening of muscle but no flexion

• Isometric– Building strength– Length remains same but force is

Pathological Influences on Mobility

Postural abnormalities Impaired muscle development

Damage to CNS Musculoskeletal trauma

Mobility and Immobility• Mobility

– The ability to move about freely• Immobility

– Inability to move about freely• Bed rest

– An intervention that restricts clients for therapeutic reasons pain oxygen demand of body• Allows rest periods

Systemic EffectsMetabolic Endocrine, calcium absorption, and GI function

RespiratoryAtelectasis (“collapsed lung”) and hypostatic pneumonia

CardiovascularOrthostatic hypotension Thrombus (blood clots)

Musculoskeletal ΔsLoss of endurance and muscle mass and decreased stability and balance

Muscle effectsLoss of muscle massMuscle atrophy (wasting)

Skeletal effectsImpaired calcium absorptionJoint abnormalities

Urinary eliminationUrinary stasisRenal calculi (kidney stones)

IntegumentaryPressure ulcer Ischemia (bedsores)

Psychosocial Effects• Emotional and behavioral responses

– Hostility, giddiness, fear, anxiety• Sensory alterations

– Sleep-wake alterations• Changes in coping

– Depression, sadness, dejection

Developmental ChangesInfants, Toddlers, PreschoolersProlonged immobility delays gross motor skills, intellectual development or musculo-skeletal development

AdolescentsDelayed in gaining independence and in accomplishing skills Social isolation can occur

AdultsPhysiological systems are at risk for changes in family and social structures

Older Adults Decreased physical activityHormonal changesBone reabsorption

Assessment• Mobility

– ROM– Gait– Exercise & Activity Tolerance– Body alignment

• Standing• Sitting• Lying

http://moveintohealth.com/learn_about_restore

Assessment• Immobility

– Metabolic– Respiratory– Cardiovascular– Musculoskeletal– Integumentary– Elimination– Psychosocial– Developmental

Nursing Diagnosis & Planning• Select the applicable NANDA nursing

diagnosis:– Impaired physical mobility– Risk for disuse syndrome– Risk for injury– Impaired skin integrity– Social isolation …etc.

• The planning phase will establish client goals and outcomes:– Realistic, time-framed, and measurable

ImplementationAcute Care

• Metabolic– Provide high-protein, high-caloric diet with vitamin

B and C supplements• Respiratory

– Cough & deep breathe every 1 to 2 hours (q1-2h)– Chest physiotherapy (CPT)– Incentive spirometer (IS)

• Cardiovascular– Progress from bed to chair to ambulation– SCDs, TED hose, and leg exercises

Implementation• Musculoskeletal

– Passive ROM• Con’t passive motion (CPM) equipment

– Active ROM• Integumentary system

– Reposition every 1 to 2 hours– Skin care

• Elimination system– Adequate hydration– Diet rich in fluids, fruits, vegetables, and fiber

http://www.coastalortho.com/articles/acl.htm

Implementation• Positioning techniques

– Fowler’s– Supine– Prone– Side lying– Sims

• Transfer

Evaluation• Gauges the effectiveness of specific

interventions designed to promote body alignment, improve mobility, and protect the client from hazards of immobility

THE END

• Moving on….!