Activity And Immobility

Question 1

Body alignment

Answer 1

• Standing: head erect and midline, shoulders, and hips straight toes pointed forward etc.
• Sitting: head erect, weight evenly distributed, feet supported on floor
• Walking: posture, gait and mobility should be fluid & coordinated
• Greatest no. of falls occur from not picking up feet high enough
• Positioning patients: Maintain correct alignment
• Use supportive devices as needed: footboard, overhead trapeze, trochanter rolls, splints

Question 2

Body Mechanics

Answer 2

• Lifting Mechanics
• Use center of gravity
• keep weight close to lifter as possible
• Synchronize manner
• Avoid lifting person or object > 35% of your body weight. Ask for assistance when needed
• Avoid twisting & bending
• Slightly flex knees & hips; use thighs & lower torso, wide - base of support

Question 3

Body Mechanics

Answer 3

• Moving, repositioning &transferring
• Assess pt’s musculoskeletal alignment
• Mobility of joints
• Neuromuscular system
• Ask patient to assist when possible
• use center of gravity and correct body alignment
• Raise bed to a comfortable height
• Use assistive devices properly

Question 4

Positioning in Bed

Answer 4

• Prone: lying face
  Down, palms
• Supine: Flat
• Semi Fowler’s (30-45 degrees)
• Fowler’s Position >45 degrees
• Lateral (side-lying)
• Trendelenburg
• Sim’s (enema)
• Lithotomy
• Knee- Chest

Question 5

Assessing Muscle strength

Answer 5

• Test strength of prime mover muscle groups for each joint; repeat motions for active ROM
• Ask person to flex and hold as you apply opposing force
• Muscle strength should be equal bilaterally and should fully resist opposing force
• Graded on 0-5 scale

Question 6

Range of motion

Answer 6

Assess extremities for comprised circulation, physical impairment/ limitations and contraindications before performing exercises

• Encourage active and functional ROM exercises
• Perform passive ROM for any limitations to prevent contracture
• Discontinue excercises with c/o of pain
• Do not exercise painful or swollen joints
• Do not force joints pass point of resist
• Exercise one extremity at a time

Question 7

Range of Motion

Answer 7

• Pull all joints through ROM slowly and gently
• Provide support above and below the joint
• Follow sequence of exercises for upper and lower body
• Exercises with at least 5 full ROM to each joint at least twice daily

Question 8

Ambulation

Answer 8

• Assess activity tolerance, strength , coordination and balance
• Determine type of assistance needed
• Maintain safety precautions

Question 9

Factors affecting mobility

Answer 9

• Older adults
• Increased convexity in the thoracic spine(kyphosis) from disk shrinkage and decreased height
• Loss of muscle tone
• Subcutaneous fat loss
• Arthritic joint changes may be present
• Inflammation, regent, and trauma can all interfere with joint mobility
• Osteoporosis

Question 10

Effects of immobility

Answer 10

Muscle atrophy

• Contractures
• Ankylosis
• Atelectasis/ hypostatic pneumonia
• Pressure Ulcers
• Sleep disturbances
• Osteoporosis
• Venous STasis leading to potential DVT
• Orthostatic intolerance
• Constipation
• Urinary Stasis
• UTI & kidney stones
• depression, anxiety

Question 11

Implementation

Answer 11

• Health promotion- recommend exercise 150- 300 min/ wk
• Encourage attempts at behavior that promote self- care activities despite limitations
• Encourage functional ROM, AROM, PROM as needed
• Get patients out of bed as indicated

Question 12

Implementation

Answer 12

Types of exercises

• isometric (contraction without motion)
• Isotonic ( weight training)
• Isokinetic ( resistance at constant, pre-set speed
• Aerobic
• Anerobic ( rapid, intense exercise)

Question 13

Assistive devices and safety precautions

Answer 13

• Canes
• Place cane on stronger side advance cane then weaker leg, then stronger leg pass cane
• Two points of support are present at all times
• Walkers : Advance walker, the client to walk into walker
• Wheelchair Safety anc Etiquette
• Hoyer Lift/ Mechanical Lifts
• Casts, splints, braces, crutches

Question 14

Transferring Patients Safety

Answer 14

• Transfer patients from bed to chair
• Assess patients for dizziness, orthostatic hypotension
• Allow patients to dangle at bedside before standing
• Transferring patient from chair to bed
• Transferring patient from bed to stretcher
• Using Hoyer or mechanical lifters
• Preventing injury during a fall - lowering patient to be on the floor

Question 15

Summary

Answer 15

• Nurses must adhere to safe body mechanics to avoid injury to self and patients
• Back injury is a leading cause of disability and loss hours of work for nurses, precautions must be taken to prevent injury
• Assessing of the patient’s functional ability is paramount in maintaining safety
• Promoting safe mobility and transfer will help preserve patient’s functional ability and prevent the many complications of immobility