Mobility

• Musculoskeletal Disorders (MDS)


  Back injuries prominent from lifting, transferring, and repositioning patients
• Assistive patient equipment


  • Decreases injuries
• Ergonomics


  The science of designing/arranging things so that the people and things interact most efficiently and safely
• Evidence-based practice


  Safe-lift program
• Safe-lift program


  Decreased injuries
• Application to nursing practice

  • Appropriate body mechanics
• Older adults


  • Skin fragile
  • Support joints when moving in bed
  • Lose flexibility and joint mobility
  • Weakness
  • Orthostatic hypotension
• Orthostatic hypotension


  • Dehydration, blood loss, and anemia are the most common reasons
  • Beta blockers, other high blood pressure medications, and Sildenafil (Viagra) may all cause orthostatic hypotension

  
• Principles of body mechanics

  1. Maintain appropriate body alignment

  2. Maintain wide base of support

  3. Bend knees and hips

  4. Do not bend from waist
• Body mechanics


  • Efficient use of body to move objects
  • Ensure safe and efficient use of muscle group
  • Maintain balance, reduce fatigue and energy
• Body balance


  • Use wide base of support
  • Lower center of gravity
• Use of appropriate body mechanics

  1. Proper balance

  2. Use of arms and legs

  3. Use of body weight

  4. Base of support

  5. Don't twist

  6. Hold objects close

  7. Avoid reaching too far

  8. Avoid lifting when possible

  9. Slide, roll, push or pull
• Patient positions


  • Dorsal (supine)
  • Dorsal recumbent
  • Semi- Flower's
  • Orthopneic
  • Sims'
  • Prone
  • Knee-chest
  • Lithotomy
  • Trendelenburg
  • Reverse Trendelenburg
• Complications of immobility


  • Loss of appetite (anorexia)
  • Constipation
  • Embarrassment or discomfort using bedpan
  • Contractures
  • Disorientation
  • Disuse Osteoporosis
  • Hypostatic pneumonia
  • Insomnia
  • Muscle Atrophy asthenia
  • Orthostatic hypotension
  • Pressure ulcers
  • Thrombus
  • Urinary tract infection
  • Urinary retention
  • Renal calculi
  • Joint pain/stiffness
  • Venous stasis
  • Loss of self-esteem

  
• Pooling of secretions in the lungs of an immobile person
• Pooling of urine in the urinary bladder: A. The client is in an upright position. B. The client is in a back-lying position

  
• Leg veins: A. in a mobile person; B. in an immobile person
• Assistive devices


  • Pillows
  • Foot boots
  • Trochanter rolls
  • Sandbags
• Foot Drop


  Describes the inability to raise the front part of the foot due to weakness or paralysis of the muscles that lift the foot
• Neurovascular function


  • Circulation
  • Sensation
  • Movement
• Capillary Refill


  Used to monitor dehydration and the amount of blood flow to tissue. If there is good blood flow to the nail bed, a pink color should return in less than 3 seconds after pressure is removed

  
• Acute Compartment syndrome


  • Excess pressure can occur from a cast or bulky dressing, tissue swells nowhere to go, inadequate circulation, death of tissue w/in 4-8 hrs
  • Symptoms: severe pain, decreased pulse, pallor, paresthesia, paralysis (5 P's)
  • Treatment: fasciotomy- incision in skin to relieve pressure

  
• Range-of-Motion Exercises [ROM]


  • Movement of the body that involves the muscles and joints in natural directional movements
  • Prevents muscle atrophy and joint contracture
  • Moved to the point of resistance
  • Active – performed by patient
  • Passive – performed by caregivers