l Complete Bed Rest

l Bed Rest with BRP (bathroom privileges)

l Bed Rest with bedside commode

l Dangle on side of bed

l Up to Bedside Chair

l OOB ad lib

l OOB with assistance

l To decrease oxygen consumption

l Weakness

l Safety

l To rest a body part (e.g. pre op, post-op) and prevent damage

l Equipment

l Severity of condition

Causes "cellular sedation" 

Elevated levels of Calcium in the ECF

Calcium leaves the bone from lack of weight bearing and moves into the ECF causing? 

Hypercalcemia Causes “cellular sedation”- depressed nerve and muscle activity which can lead to:

•  Generalized muscle weakness

•  Altered myocardial function

•  Cardiac dysrhythmias

•  Decreased GI motility ( constipation, N/V)

•  Mental status changes ( lethargy, confusion)

A permanent shortening of the muscle 

This limits ROM of a joint. At some point tendons, ligaments and joint capsules are involved. Only surgery can reverse

l A positional drop of 20 points mm HG when client moves from a horizontal to a vertical position( lying to sitting or sitting to standing)

l Often heart rate goes up

l Could lead to dizziness, lightheadedness, fainting, pallor, nausea

l Common in elderly, those who are immobilized, blood volume depletion, certain medications

Orthostatic Hypotension

•  Client supine for 2-5 minutes or more. Take blood pressure and pulse

•  Repeat readings with patient sitting and standing

l Normally a balance exists between protein synthesis (anabolism) and protein breakdown (catabolism)

l Immobility creates a marked imbalance and the catabolic processes exceed the anabolic processes

l Catabolized muscle mass releases nitrogen. Over time more nitrogen is excreted that ingested producing a negative nitrogen balance

l The negative nitrogen balance represents a depletion of protein stores that are essential for building muscle and for wound healing

 The negative nitrogen balance represents a depletion of protein stores that are essential for

Collapse of alveoli in the lungs

Atelectasis

a blood clot that adheres to the wall of a blood vessel or organ

Thrombus

The blocking of a blood vessel by a clot ( or part of a clot) that has broken off from the place where it formed and traveled to another organ

Nursing Care of Client with Mobility Problem

• Recognizing Hazards of immobility

• Preventing complications (assessment, using techniques and equipment)

Limitation in independent, purposeful physical movement of the body/extremity

Impaired Physical Mobility

Assessment

l Limited range of motion

l Slowed movement – uncoordinated or jerky

l Gait changes

l Postural instability

l Movement induced shortness of breath

l Demonstrate techniques/behaviors that enable resumption of activities

l Maintain position of function and skin integrity (absence of contractures, footdrop, decubitus, etc

l Maintain or increase strength and function of affected or compensatory body part

Positioning interventions

•   Maintain body alignment

•   Prevent contractures

•   Promote comfort

•   Beds

•   Pillows / rolls

•   Trapeze

•   Footboard

•  Proper use of mobility aids

•  Canes, walkers, crutches

•  Use elastic stockings

•  Raise and lower head of the bed several times ( to stimulate baroreceptors)

•  Before getting out of bed, raise head of bed to Fowler’s position slowly

•  Have client dangle legs over the side of the bed

•  Observe for symptoms

•  Assist client to stand if no symptoms

Range of Motion exercises perform active/passive ROM how many times a day?

 Encourage client to incorporate ROM into daily ADL’s if able

At risk for deterioration of body systems as the result of prescribed or unavoidable musculoskeletal inactivity

Definition of what Nursing DX?

Risk for Disuse Syndrome

l Altered level of consciousness

l Severe pain

l Neuromuscular impairment

l Paralysis

l Prescribed immobilization

l Chronic physical or mental illness

l Pressure Ulcer

l Constipation

l Stasis of pulmonary secretions

l Urinary infection/retention

l Decreased strength and endurance

l Orthostatic hypotension

l Decreased range of joint motion

l Disorientation

l Body image disturbance

l Powerlessness

l Inspect skin at bony prominences and areas where devices such as splints, casts, traction and being utilized

l Turn and reposition q. 2 h.

l Maintain nutritional requirements (be specific)

l Keep skin clean and dry

l Decrease/eliminate shearing forces

Associated Nursing Diagnosis:

Risk for Impaired Skin Integrity

l Record frequency and consistency of BM’s

l Observe for leakage of liquid stool, if present check for impaction

l Increase fiber in diet

l Assess fluid intake and provide increased fluids

l Administer stool softeners/laxatives as ordered

Associated Nursing Diagnosis: Constipation

l Assess hydration by monitoring 24 hr. fluid intake and output and concentration of urine

l Provide intake of 2,000-3,000cc. per day

l Observe urine for signs of infection (cloudiness, odor)

l Assess frequency and amount of urinary output and signs and symptoms of urinary retention

l Assess for S & S of kidney stones(**hypercalcemia)

Associated Nursing Diagnosis:

Altered Urinary Elimination

l Assess dietary intake

l Provide increased protein, calories, vitamins

l Monitor weight q. _______.

l Monitor lab values.

Associated Nursing DX:

l Consult dietician, metabolic team ( with physician)

Altered Nutrition, less than body requirements

• Ineffective airway clearance
• Ineffective breating pattern
• Impaired gas exchange

Associated Nursing DX:

Associated Nursing Diagnosis: Respiratory

Interventions?

l Change position q. 2 hr.

l Suction oropharyngeal airway prn.

l Encourage deep breathing and coughing q. 1-2 hrs.

l Assess lung sounds q. ___ for diminished, absent, or adventitious breath sounds

l Assess for decreased ability to cough, accumulation of secretions, colored sputum, fever, SOB, changes in skin color, changes in pulse oximetry

Associated Nursing Diagnosis:

Altered Tissue Perfusion

Intervention?

l Impaired Social Interaction

l Grieving

l Body Image disturbance

l Self Esteem Disturbance

l Hopelessness

l Coping

l Note: Older adults are at risk for confusion, depression, and disorientation and are especially susceptible to the hazards of immobility