chapter 39 immobility body mechanics describe the coordinated efforts of the musculoskeletal and the nervous systems the body mechanics applied in lifting and positioning techniques are used in nursing practice and if not done correctly can cause debilitating injuries to nurses or assistant staff we need to ensure that we change the normal coordination so we do not place patients at risk for numerous health related problems as a nurse we need to use correct body alignment so we reduce strain on musculoskeletal structures which will help promote comfort and coordinate our balance as well as conserve energy weight is considered as the force exerted by gravity the force of weight is always directed downward which is why an object that's unbalanced falls friction is a force that occurs in a direction to opposit oppose movement the greater the surface area of the object that is moved the greater the friction a large object therefore produces a greater resistance to movement force exerted against the skin while the skin remains stationary and the bony structure's move is called a skin shear skeletal system provides attachment for muscles ligaments as well as leverage needed for mobility bones are vital for mobilization because they're firm rigid and elastic we know as nurses that elasticity and skeletal flexibility do change with age the aging process nutrition and disease processes has the potential to change the components of bone which will impact an individual's mobility the nervous system regulates movement and posture congenital or acquired postural abnormalities will affect the efficacy of the musculoskeletal system and body alignment the balance and the appearance postural abnormalities may cause pain impair alignment or mobility knowledge about the characteristics causes and treatment of common postural abnormalities is necessary for nurses to provide safe lifting transfer and positioning when damage occurs to any component of the central nervous system that regulates voluntary movement this will result in impaired body alignment balance and mobility direct trauma to the musculoskelet skeletal system will cause bruises contusions tears sprains and fractures one of the most common pathological influence on mobility is in the form of joint disease bed rest is an intervention that restricts patients to bed for therapeutic reasons and is sometimes prescribed for certain patients the therapeutic reasons for bed rest will include decreasing the oxygen needs of the body reducing cardiac workload and pain and allowing a debilitated patient to rest bed rest has many different interpretations among health care individuals the duration of the bed rest will depend on the illness or the injury as well as the patient's prior state of health the effects of muscular deconditioning associated with lack of physical activity can be apparent in a matter of days the individual of average weight and height without a chronic illness on bed rest will lose muscle muscle strength from baseline levels at a rate of 3 percent a day in the supine position there can be pooling of secretions in the dependent areas or regions of the lungs with an alteration in mobility each body system is at risk for impairment the severity of the impairment will depend on the patient's overall health the degree as well as the length of the immobility and the individual's age immobility does disrupt normal metabolic processes decreasing the metabolic rate it alters the metabolism of carbohydrates fats and proteins causes fluid and fluid electrolyte and calcium imbalances and causes gi disturbances like decreased appetite and slowing of peristalsis the lack of movement and exercise places patients at risk for respiratory complications patients who are immobile at are at high risk for developing pulmonary atelectasis which is a collapse of the alveoli and hypostatic pneumonia which is an inflation of the lung tissue from stasis or pooling of secretions both of these conditions add to the patient's discomfort prolong recovery and decrease the patient's oxygenation immobility can cause thrombus formation in a vessel it will also affect the cardiovascular system often resulting in orthostatic hypotension increased cardiac workload as well as the thrombus formation immobility may cause permanent or temporary impairment of the musculoskeletal structures because of the protein breakdown the patient will lose lean body mass during immobility the reduced muscle mass will make it difficult for the patient to sustain activity without increased fatigue immobility will also alter the patient's urinary elimination in an upright position urine flows out of the renal pelvis and into the ureters and bladder due to gravitational forces when the patient is recumbent or flat the kidneys and ureters move toward a more level plane urine formation by the kidney needs to enter the bladder unaided by gravity because the peristaltic contractions of the ureters are insufficient to overcome gravity the renal pelvis can fill with urine before the urine enters the ureters this condition can cause urinary stasis and can increase the risk of a urinary tract infect infection and renal calculi the changes in the metabolism that accompany immobility add to the harmful effect of pressure on the skin in the immobilized patient this makes immobility a major risk for pressure injuries any break in the skin integrity is difficult to heal immobilization can lead to emotional and behavioral responses sensory alterations and changes in coping illness that results in limited or impaired mobility may cause social isolation as well as loneliness you notice a respiratory change in your immobilized postoperative patient the change you note is most consistent with atelectasis hypertension orthostatic hypotension coagulation of blood the answer is a atelectasis is the collapse of alveoli in the case study what hazard hazards could mrs thomas face from being immobilized in bed at her age think about bone loss osteoporosis increase of risk of fractures chronic illness that develops because of immobility effects of decreased circulating fluid volume pooling of blood in lower extremities risk of contractures risk of ischemia nutritional needs cardiac issues because most of the older individuals don't tolerate increased cardiac workload that often comes with the recumbent position let alone the impact that immobility will have on an older adult's independence and their functional status immobility can lead to developmental changes in the very young and in older adults as the baby grows their musculoskeletal development permits the support of weight for their standing and walking posture is often awkward because their head and upper trunk are carried forward because the body weight is not evenly distributed along the line of gravity posture is routinely off balance and falls occur often in the adolescent stage it will begin with routinely a increase in their growth when their activity level is reduced because of trauma illness the adolescent is often behind in their peers in gaining independence and accomplishing skills social isolation is a concern for this age group if immobilization occurs an adult that uh already maintains correct posture and body alignment will feel good look good and generally appears self-confident healthy adult also has necessary musculoskeletal development and coordination to carry out activities of daily living when prolonged periods of immobility occurred all physiological systems are at risk with the older adult there is a progressive loss of total bone mass from decreased physical activity hormonal changes and bone reabsorption the effect of bone loss is weaker bones older adults often walk more slowly take smaller steps and appear less coordinated this is the critical thinking model for assessing impaired mobility during the assessment phase the nurse will consider the patient's normal mobility status the effects of the disease or conditions on the patient's mobility and the patient's risk for mobility alterations as resulting from a treatment then the nurse will critically analyze the findings to ensure that they have made patient-centered clinical decisions that are required for safe nursing care range of motion is the maximum amount of movement available at any joint in any one of the three planes of the body the body planes are sagittal transverse or frontal some of the range of motion alterations may occur in the neck there could be flexion contracture where a patient's neck is permanently flexed with the chin close to or actually touching the chest there could be elbow contract or elbow issues where it is flexed in full position the wrist may become fixed and slightly flexed the hip contractures often fix the hip in positions of deformity the ankle and foot the joint may become unstable when the person relaxes as in sleep the foot will relax and assume a position of plantar flexion as a result it can become fixed in a plantar flexion or foot drop a patient that is experiencing an alteration in mobility has more than one nursing diagnosis the two diagnoses that are most likely direct related to mobility problems are impaired mobility and risk for disuse syndrome during the planning phase the nurse will synthesize information from scientific knowledge the nurse's knowledge of the roles of the resources and their clinical standards from agency for healthcare research equality and wound ostomy and continence impaired mobility can affect all physiologic symptoms and affect a patient's independence and psychosocial status the nurse will develop an individualized care plan for each nursing diagnoses they will set realistic expectations for care and include the patient and family whenever possible the goals that are set need to be individualized realistic and measuring measurable the goals focus on preventing problems or risk to impaired body alignment and mobility the nurse will develop goals and expected outcomes to help patients achieve their highest level of mobility and reduce the hat the reduce the hazards of immobility the effect that problems have on patients mental and physical health determines the the immediacy of any problem priorities when planning care are set to ensure that immediate needs are met first this is vital in patients that have multiple diagnoses health promotion activities include a variety of interventions it can be education prevention and early detection back injuries are often the direct result of improper lifting or bending the most common back injury is strain on the lumbar muscle group that includes the muscles around the lumbar vertebrae injury to these areas will affect the ability to bend forward backward and from side to side and also limit the ability to rotate the hips as well as the lower back although many diseases and physical problems cause or contribute to immobility it is important to remember that exercise programs enhance feelings of well-being improve endurance strength and health exercise also reduces the risk of many health problems like cardiovascular disease diabetes and will help osteoporosis from worsening patients who are at risk for or diagnosed with osteoporosis actually have special promotion needs these patients need to be encouraged to be screened for osteoporosis and their diets need to be assessed for calcium and vitamin d intake people that have lactose intolerance need dietary teaching about alternatives for sources of calcium patients in an acute care setting who experience altered physical mobility are usually at a higher risk for hazards of immobility such as in poor impaired respiratory status orthostatic hypotension impaired and skin integrity during nursing interventions to reduce the impact of immobility on body systems and prepare the patient for the restorative phase of care the nursing interventions need to be designed appropriately because the patient's body needs protein to repair injured tissue and rebuild depleted protein stores the immobilized patient needs a high protein high calorie diet the high calorie intake provides sufficient fuel to meet the metabolic demands and replace any sub-q tissue ensure that the patient is taking enough vitamin b and c supplements supplementation with vitamin c is needed for skin integrity and wound healing vitamin b assists with energy metabolism individuals that are immobilized and have reduced ventilation can benefit from a variety of nursing interventions that promote lung expansion as well as the removal of pulmonary secretions individuals need to frequently and fully expand their lungs to maintain elastic recoil secretions and accumulate in the dependent areas of the lungs deep breathing exercises incentive spirality and controlled coughing are among the nursing interventions that can be used to expand the lungs dislodge and mobilize stagnant secretions as well as clear the lungs what three nursing interventions might you initiate to prevent respiratory complications related to her immobility think about deep breathing and coughing every two hours while awake turning every one to two hours while awake the use of an incentive spirometer five times every 30 minutes while awake during the first 24 to 48 hours post-operatively the effects of bed rest or immobilization on the cardiovascular system could include orthostatic hypotension an increased cardiac workload as well as thrombus formation nursing therapy should be designed to minimize or prevent any alterations or complications exercise should be instilled to prevent excessive muscle atrophy and joint contractures as well as maintaining muscular function active range of motion should be encouraged for a patient who's at risk for reduced musculoskeletal strength or functionality by improving joint mobility when the patient has a muscle weakness fatigue or pain assisted assisted range of motion exercises are more appropriate the sims position differs from the sideline position in the distribution of the patient's weight in the sims position the patient places all their weight on the anterior ilium humerus and clavicle difficult points that are common in the sims position would include lateral flex flexion of the neck internal rotation ab sorry adduction or lack of support to the shoulders and hips lack of foot support or lack of protection for pressure points on the ilium humerus clavicle knees and or ankles when moving a patient during repositioning a safe transfer is the first priority patients require various levels of assistance to move up in bed move to a sideline position or sit up on the side of the bed as nurses we should always ask the patients to help to their fullest extent during positioning the major risk to the skin from restricted mobility is the formation of pressure injuries early identification of high-risk patients will help prevent pressure injuries interventions are aimed at the prevention interventions aimed at prevention will include turning and repositioning use of therapeutic support surfaces and devices to help relieve the pressure the goal of restorative care for patients that are immobile is to maximize their functional mobility and independence while reducing their residual function deficits like an impaired gait or a decreased endurance the focus in restorative care is not only on activities of daily livings that relate to physical self-care but also on instrumental activities of daily living and these include being independent in society shopping preparing their own meals doing their banking taking medications just as it is important to include the patient during the assessment and planning phase of the care plan it is also essential to have the patient's feedback or evaluation of the care plan you can ask the patient things like were the goals met ask them to describe their perception of their recovery from their immobility and then from your perspective as a nurse you can evaluate the expected outcomes and a patient's responses to the nursing care and compare the patient's actual outcomes with the outcomes that were selected during the planning phase think safety first always in nursing so if we're trying to move in a patient we need to determine how much help is going to be necessary we need to already have assessed the patient's mobility so that we can gather all the equipment that we need and the individuals that we need to assist the patient