Mobility and Immobility

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Mobility and Immobility

• Lecture in Basic Nursing,
• Thursday October 11. 2007,
• Margrethe Truelsen

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Introduction

• Name Margrethe Truelsen Age 32
• Come from Denmark (small country in northern
  Europe)?
• Educated nurse, graduated in 2006
• Worked 6 months in a medical ward,
  gastro-intestinal unit
• Came to Taizhou, China, 10 months ago
• Husband works at pharmaceutical company in
  Taizhou
• Have a son 1½ year old

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Introduction

• There are 2 purposes of this lecture1) To teach
  you Basic Nursing.2) To train your English
  skills.
• Therefore please let me know if I speak too fast
  or if there are specific words that you do not
  understand.I will try my best to speak slowly
  and explain the words.

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Mobility/immobility Content of lecture

• Introduction
• 4 nursing principles
• Physical environment in the hospital
• The hospital bed making the bed
• Bodymechanics
• Different positions in the bed
• Moving the patient
• Immobility introduction

• Consequences of immobility- pneumonia- urinary
  tract infection- constipation- thrombosis-
  sleeplessness and depression- footdrop and
  contractures- pressure ulcer
• Activity
• Influence of the environment on activity
• Questions and case

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The 4 nursing principles

• Health Promotion
• Disease Prevention
• Health Restoration
• Suffering ReliefOne important task for the
  nurse is to create and ensure the optimal
  environment for these principles to take place.

See textbook page 1
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The physical environment in the hospital

• The patient's unit The hospital bed and its
  surroundings.The hospital bed is an important
  work tool for the nurse, but it is also a private
  resting place for the patient. The hospital bed
  has several functions to ease the work of the
  nurse and to increase the comfort for the
  patient. It is important for the nurse to create
  a clean, tidy and inviting environment for the
  patient.

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The physical environment in the hospital

• The hospital bed making the bed1) Bring all
  required linen and accessories.2) Raise the bed
  to a comfortable height and lower the
  siderails.3) Remove the dirty linen and avoid
  shaking it to prevent the spread of
  microorganisms.4) Do not place dirty linen on
  the floor.5) Do not hold dirty linen against
  your uniform.6) Put on the clean sheet.
  Place and fold the sheet as shown on the
  picture. Remember to fix the sheet very
  tight to avoid wrinkles.7) Put on blanket-cover
  and pillow-case.

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Body Mechanics

• The basic components used in movement of the
  human body is Bones MusclesJointsTendons and
  ligamentsMuscles are attached to the bones
  through tendons and ligaments. Muscles can either
  be contracted or relaxed. When a patient is
  resting in the bed it is important that the
  muscles can relax and that the joints are placed
  in natural positions without any strain.

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Positions

• A Supine position
• B Lateral position
• C Lateral position
• D Prone position
• E Sim's position
• F Fowler's position

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Positions

• Fowlers position is good for patients that have
  trouble breathing, such as Lung patients. The
  arms can be supported by pillows, this will ease
  the respiration further.
• Trendelenberg positions is used for patients with
  anaphylactic shock or in other cases where the
  venous blood-flow need to be quickly increased.

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Body Mechanics

• Gravity influences all work and movement of the
  body.
• When standing up, the center of gravity is in the
  middle of the body near the sacral-region.
• To keep a good balance, onecan either place the
  center ofgravity low or widen the baseof
  support (spread the legs).
• This is important knowledge for the nurse because
  this is a way to use the correct muscles to
  complete a task safely and efficiently, without
  undue strain on any muscle or joint.

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Moving the patient

• Moving the patient from supine to lateral or
  prone position.
• Helping the patient to sit up.
• Moving the patient upwards in the bed.

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Moving the patient

• Helping a weak patient from the bed to a
  wheelchair.
• Moving a passive patient from the bed to a
  wheelchair.

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Immobility

• Many hospitalised patients are immobile to some
  extent.
• Some patients suffer from total immobility, which
  means that they are unable to leave the hospital
  bed and need help and support for every activity.
• Immobility can lead to many bad conditions for
  the human body.
• Immobility has big impact on for instance the
  blood-circulation and the muscles.

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Consequences of immobility

• Pneumonia The chest movement is impaired in the
  lying position and the muscles are weakened.
  This leads to low respiration-frequency and bad
  coughing-reflex. This causes secretion to
  stagnate in the lung and thereby a high risk for
  infection.
• Urinary Tract Infection (UTI) The flow from the
  kidneys is diminished, because of the changed
  influence of gravity. This also affects the
  bladder, that can not be properly emptied. The
  urine-retention can then cause an infection.

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Consequences of immobility

• Constipation The abdominal muscles are weakened
  and the intestinal movement are slowed. This
  means that the stool will be in the colon for a
  long period and the fluid will be absorbed. This
  leads to constipation, because the stool becomes
  very hard and is moving very slow.
• Thrombosis The muscles controlling the
  venouspumps in the legs are weakened and this
  leads to blood pooling in the veins. This can
  cause blood clotting and a Deep Vein Thrombosis
  (DVT) can form.The DVT block the vein and
  prohibits blood to flow back to the heart.

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Consequences of immobility

• Sleeplessness and depression When a person is
  immobile for a longer period, the mind can be
  affected as well as the body. In the hospital
  environment there is not much to stimulate the
  senses and this lack of stimulation can cause
  sleeplessness or even depression.
• Footdrop and contractures The muscles are
  greatly affected by immobility. When a muscle is
  not used it will loose mass and strength called
  muscle-atrophy. The joints are also affected by
  immobility. The connective tissue becomes
  in-elastic and fiber-like and the movement of the
  joint is diminished. This is called a
  contracture, and often happens in the knee, the
  hip or the foot. When the foot is affected it is
  called footdrop.

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Consequences of immobility

• Pressure Ulcer This is a very common but also
  very serious consequence of immobility. It is a
  very painful condition for the patient and since
  it can be prevented, it is important for the
  health staff, especially the nurses to be aware
  of the development of pressure ulcers. When the
  tissue underlying the skin does not get enough
  oxygen, ischeamia occurs. If the ischeamia last
  more than 2-3 hours there will be damage to the
  tissue and the cells (necrosis).When a patient
  is immobile in the bed or in a wheelchair, there
  are certain points where the pressure on the
  skin is high. And there are risk of developing
  pressure ulcers on these sites.

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Pressure Ulcer

• There are different stages in the development of
  a pressure ulcer.1) Local redness, warmth and
  edema of the skin.2) Skin is destroyed
  superficially. Appears like an abrasion or a
  blister.3) Skin severely damaged with necrosis
  of the subcutaneous tissue.4) Severe necrosis
  and also damage to the sorrounding tissues,
  such as muscle or bone. In this stage there is
  also a high risk of infection.

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Pressure Ulcer

• Healing of For the ulcer to heal, it requires a
  lot of energy from the body. New tissue has to be
  rebuild and it requires oxygen and nutrients.
  Therefore the blood-flow to the ulcer needs to be
  good. It is very important that the patient gets
  a good diet with lots of protein and vitamins.
• Prevention of The most important is to prevent
  the ulcers from developing. The best way to do
  this is by relieving the pressure on the high
  risk areas. The nurse must encourage the patient
  to move and change position often. Or if the
  patient is incapable of moving, the nurse must
  move him and relieve the pressure fx by using
  pillows.

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Activity

• Different people have very different needs for
  activity in their lives. Some people are very
  physically active and other people have other
  interests and ways to fill their life.
• When a patient comes into the hospital and
  experience a loss of mobility/activity, it is
  important that the nurse cooperates with the
  patient in setting reasonable goals for the
  future. The nurse must find out what is important
  for the patient and which activities he enjoys
  doing. That way it is easier for the nurse to
  motivate the patient and the patient will enjoy
  the rehabilitation.

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Activity

• Activities can be all kind of things depending on
  the condition of the patient. For the very weak
  patient very simple things such as brushing his
  teeth or putting on clothes can be an exhausting
  activity.
• In the hospital most activities revolve around
  the activities of daily living, which is the
  skills a person needs to do to take care of
  himself.
• Although activities can also be other things such
  as sports, reading, watching TV or creative
  doings such as drawing, painting, dancing and so
  on.

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Influence of the environment on activity

• The idea of activities as an important part of
  rehabilitation is not new. In the 1850's Florence
  Nightingale thought that the environment
  surrounding the patient is very important for
  well-being and activity. Nightingale arranged
  that the patients could do sports, read and play
  theatre as a part of their rehabilitation.She
  also made sure that the environment was colourful
  with flowers, paintings and nice furniture. This
  stimulated the senses of the patients and made
  them feel better and more active.
• The environment and the atmosphere has big
  influence on patients. In a nice environment they
  are more likely to feel safe and have confidence.

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Case

• Ms Ping is 78 years old. She has been admitted in
  your ward for approximately 1 week. She has
  suffered a stroke and is very weak. She is lying
  in bed all day and has lost a lot of strength.
  She is conscious and she can communicate fine.
  She is not in severe pain and is capable of
  moving a little, but she needs help to sit up.
  Today it is your job to take care of Ms Ping.
  When you enter the room you can hear secretion in
  her lungs, when she breathes. How are you today
  ? you ask. Not well, I haven't slept all night
  ! she answers.

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Questions

• How will you answer Ms Ping ? What questions will
  you ask ?
• What will you pay special attention to when you
  care for Ms Ping ?
• How will you prevent that she suffers from any
  consequences of immobility ?
• Which activities will you suggest for Ms Ping and
  how will you motivate her ?

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Questions about the lecture

• Did You understand anything ?
• How was the language too complicated, many
  foreign words ?
• How was the subject ? Too complicated, too simple
  ?
• How was the slides ? Too much text or too simple ?