Immobility ppt

1. Course : B.Sc. Nursing
Subject : Nursing Foundations
Unit Number : XII
Title : Meeting needs of the patient
Topic : Immobility
Prepared by
SELVIS
Nursing Tutor,SRMCON

2. OBJECTIVES:
At the end of session the students will be able to
- define immobility
- list out the causes of immobility
- discuss about the different positions and its comfort
- guidelines for moving and lifting patients
-care of patients with restraints
-using mechanical aids for walking canes
- hazards of immobility
-nursing management for immobility patients.

3. DEFINITION
• Immobility : The inability to move about freely

4. COMMON CAUSES OF IMMOBILITY
• Musculoskeletal disorders:
• Arthritis
• Osteoporosis & Fractures (especially hip and femur)
• Other (e.g., Paget’s disease)
• Neurological disorders:
• Stroke
• Parkinson’s disease
• Other (cerebellar dysfunction, neuropathies)
• Cardiovascular disease
• Congestive heart failure (severe)
• Coronary artery disease
• Peripheral vascular disease (frequent claudication)

5. COMMON CAUSES OF IMMOBILITY
• Pulmonary disease
• Chronic obstructive lung disease (severe)
• Sensory factors
• Impairment of vision
• Fear (from instability and fear of falling)
• Environmental causes
• Forced immobility (in hospitals and nursing homes)
• Inadequate aids for mobility
• Acute and chronic pain
• Others
• Deconditioning (after prolonged bed rest from acute illness)
• Malnutrition
• Severe systemic illness (e.g., widespread malignancy)
• Depression
• Drug side effects (e.g., antipsychotic-induced rigidity)

6. POSITIONING THE PATIENT
Positioning
Positioning as planning the person in a proper body alignment of
preventive
Promotive , curative and rehabilitative aspects of health or placing
the patient in good body alignment as needed therapeutically.
Purposes
To provide comfort to the patient.
To relive pressure on the various body parts.
To improve circulation
To prevent formation of deformities.
 To carry out certain nursing, therapeutic and operative procedure.

7. POSITION USED FOR COMFORT
Supine position
Dorsal elevated position/ semi recumbent position
Prone position
Lateral position / side-lying position
Fowler’s position
Cardiac position

8. POSITION USED FOR COMFORT
Supine position
• To promote comfort after
spinal anaesthesia.
• To prevent contracture
• To prevent bed sore
Dorsal elevated position/
semi recumbent position
• This position used in
Convalescence & minor
respiratory disease.

9. POSITION USED FOR COMFORT
Prone position
• Used for burns patients.
• Relive pressure from bed
score.
• To prevent aspiration of saliva
and mucus.
Lateral position /
side-lying position
• Facilitates good lung expansion.
• A pillow for the head prevents
lateral flexion of the head.
• helps relieve pressure on the
coccyx.

10. POSITION USED FOR COMFORT
Fowler’s position
• To relieve dyspnoea.
• To relieve tension on the
abdominal sutures
• To relax the large muscles of
the back and thighs .
• To easy for self care.
Cardiac position
• Comfortable to cardiac and
asthma.
• To relieve fatigue prevent
embolism

11. POSITION USED FOR PHYSICAL EXAMINATIONS
Dorsal or horizontal recumbent
Dorsal recumbent position
Sim’s lateral / Left lateral position
Lithotomy Position
Knee chest position
Trendelenburg position

12. POSITION USED FOR PHYSICAL EXAMINATIONS
Dorsal or horizontal
recumbent Position:
Vaginal and rectal
examinations
Operative procedures on the
vulval area
Catheterization of the
bladder.
Sim’s lateral / Left lateral
position
• This position used for vaginal
and rectal examination.

13. POSITION USED FOR PHYSICAL EXAMINATIONS
Lithotomy Position
This position is used for the
gynecological examination
and treatment.
Child birth and surgery.
Knee Chest Position
• This position for rectum and
vaginal examination.
• As an exercise for post partum
patients.
• genital tract operations, vaginal
hysterectomy, and the diagnosis
and treatment of diseases of the
urethra and bladder.

14. • Trendelenburg Position
• Examination or surgery on pelvic organs in
order to displace the intestines from the
pelvic cavity into the upper abdomen.
• It is used in the wards to treat shock and
decrease blood pressure.
POSITION USED FOR PHYSICAL EXAMINATIONS

15. MOVING AND LIFTING
• Moving or lifting means shift or transfer the patient one place to
another place with the use of different type of devices.
PURPOSES
To perform the task efficiently
To avoid the patient from unnecessary effort
To prevent nurses from strain and back injuries

16. MOVING AND LIFTING DEVICES
1. Wheel chair or arm chair
2. Wheel bed
3. Stretcher

17. Guidelines for moving and lifting patients
1. proper body alignment and posture helps -
• Prevent fatigue and deformities eg:Kyposis, lordosis, scoliosis, etc.
• promote physical functions, e.g Circulation and digestion.
• Maintain body balance without undue strain on body parts.
• Contribute to reduce energy and maintain beauty .
2. When performing any body movement or task observe the
principles..,
Face the direction in which the movement
or task will be made .
This allows to work freely and easily.

18. Cont..,
• Align and balance or posture your body as under to prevent strain
and injury
Place your feet parallel , 6 to 8 inches apart---
This provides good base o f support
Put one foot ahead of other–
This provides anterior posterior stability.
Distribute your body weight evenly on both feet –
This allows weight bearing joints and their support structures to
divide & share the load.
Flex the knees slightly--- To avoid jointing movements of entire
body & prevents hyperextension of knees. Tuck in your buttocks
and tilt pelvis forward.

19. Cont..,
Keep back straight and head erect. Straight back decreases
muscles strain on back decreases muscle strain on back and
allows complete expansion of lungs.
• Maintain a more comfortable working height usually at the waist
level for many people --- allows to easy flexion of knees and hips &
application of force the task.
• Keep the task close to your body.– This bring center of the gravity of
task& easy to do the task.
• Ready your muscles for action --- Take a deep breath , tense your
muscles & Breathe out slowly as you perform the movement or task
e.g: moving the object or body.

20. Cont..,
3. To increase efficiency and reduce unnecessary stress on your body
while moving and lifting the heavy objects and patients.
 Use your strongest and largest muscles
 Push , pull or roll an object or body rather than lift it.
• Avoiding jerking and twisting during the lift.
• Heavy patients should be moved in bed by siding them rather than
lifting them.
• Assistance should be requested when lifting or moving heavy
patients.
• The height of the bed should be adjusted to a height that permits the
nurse to keep her back as erect as possible when moving the patient
in bed.
• The patient is moved to the edge of the bed before he is lifted from the
bed. This helps the nurse to keep her trunk more erect

21. Cont..,
• 4. the basic movements to perform:
a. Reach:
b. Stooping :Lower the body to the stooped position
by flexing hip & knee joints.
C. Lift and carry
D. Push or pull
• D. Pivot :Set your trunk and leg muscles ,
shift your weight to the ball of each foot.
5. Encourage the patient to use his / her abilities as much as possible unless
contraindicated .
6.Observe the patient for symptoms of orthostatic hypotension , e.g: Fainting,
dizziness, sweating , etc.
7. Lock the wheels of stretcher or wheelchair when using it.

22. NURSING RESPONSIBILITY – SHIFTING THE PATIENTS
• PRELIMINARY ASSESSMENT
1. Check the diagnosis of the patient.
2. Check the level of the consciousness and ability to follow
instructions.
3. Check the ability of the self care.
4. Check the abilities and limitations such as paralysis, fractures and
splints.
5. Check the presence of the muscle, skin and bone lesions and
attachment e.g. catheters and I.V. connections.
6. Check numbers of personnel required.

23. PREPARATION OF THE PATIENT AND UNIT
• Provide the privacy.
• Explain the procedure.
• Adjust the bed at working height.
• Fanfold the top linen.
• Change the wet linen.
• Offer the bedpan.
• Remove all comfort devices.
• Clamp the catheter. Attach the I.V pole to the device.
• Position foot stool if needed.
• Follow the body mechanics while shifting the patients

24. CARE OF PATIENTS HAVING RESTRAINTS
Restraint is defined as the intentional restriction of a person’s
voluntary movement or behaviors.
Principles: It should be selected to reduce client’s movement only as
much as necessary Nurses should carefully explain type of restraint
and reason for its use. It should not interfere with treatment. Bony
prominences should be padded before applying it.

25. PRINCIPLES OF RESTRAINTS
• It should be changed when they become soiled or damp.
• It should be secured away from a client’s reach
• It should be attached to bed frame not to side rails.
• It should be removed a minimum of every 2 hours
• Frequent circulation checks should be performed when
extremity are used.

26. RESTRAINT GUIDELINES
• Doctor’s order
• Informed consent
• Follow proper technique
• Least restrictive
• Pad bony prominence
• Maintain body alignment.

27. USING MECHANICAL AIDS FOR WALKING CANES
Canes are light weight, easily movable devices that are made of
wood or metal.
• Types of canes
1. Single ended canes with half circle handle.
2. Single ended canes with straight handles
3. Canes with 3 or 4 prongs (quad canes)

28. PROCEDURE
• Instruct patient to stand with weight, evenly distributed between
the feet and the cane.
• The cane is held on the patient’s stronger side.
• instruct patient to position cane 6 inches(15 cm) anterior of the
foot.
• Move the affected leg forward to the cane while the weight is
borne by the cane and stronger leg.
• Next move the unaffected leg forward ahead of the cane and
weak leg while the weight is borne by the cane and weak leg.
• Repeat the steps.

29. WALKERS
A walker is a light weight metal frame with four legs.
• Patient’s requirements to use walker:
• Partial strength in both hands and wrist
• Strong elbow extensors such as triceps brachi
• Strong shoulder depressors such as the pectoralis
minor
• Ability to bear at least partial weight on both legs

30. EXPLAIN THE METHOD OF USING WALKER
• Instruct patient to wear non-skid shoe or slipper
• Have patient stand in center of walker and grasp handgrips on upper
bars.
• Lift walker and move it 6-8 inches forward, making sure all 4 feet of
the walker stays on the floor.
• Take a step forward with one foot. then follow through with other leg.
If one leg is weaker than the other:
Move the walker and weak leg ahead together about 15 cm while your
weight is borne by the affected leg and both

31. ASSISTING WITH CRUTCH WALKING
• Assisting patient to walk using crutches while providing support
and balance and as a convenient method of getting from one
place to another.
Types of crutches:
1. Axillary crutch
2. Lofstrand crutch(it has a handgrip and
metal band that fits around the patient’s
forearm.
3. Platform crutch :it is used by the patients
who are unable to bear weight on their

32. ASSIST PATIENT IN CRUTCH WALKING
1.Four point gait:
This is the most stable of crutch gaits because
it provides at least 3 points of support at all times
2. Tripod position: crutches are placed 6 inches in front
and 6 inches to side of each foot.
Move right crutch forward 10-15 cm.(4-6 in)
Move the left front foot forward, preferably to the level of left
crutch. Move the left crutch forward.
Move the right foot forward

33. THREE POINT GAIT
The client must be able to bear the entire body weight on affected leg. The
nurse asks the client to,
1.move both crutches and the weaker leg forward.
2.Move the stronger leg forward.
• TWO POINT GAIT
• It requires at least partial weight bearing on each foot.it requires more
balance.
• Begin in tripod position
• Move left crutch and right foot forward.
• Move right crutch and left foot forward
• Repeat sequences

34. SWING -THROUGH GAIT
• Requires that patient have the ability to sustain partial weight
bearing on both feet. Move both crutches forward Lift and swing
legs through and beyond crutches.

35. HAZARDS OF IMMOBILITY
 Respiratory system
 Cardiovascular system
 Musculoskeletal system
 Metabolic system
 Gastro intestinal system
Urinary system
 Skin
 Psychosocial outlook

36. RESPIRATORY CHANGES
 Atelectasis (collapse of alveoli)
 Hypostatic pneumonia
 Decreased ventilatory effort
 Increased respiratory secretions
 Acid base imbalance
Respiratory congestion

37. CARDIOVASCULAR CHANGES
Increased cardiac work load
 Orthostatic hypotension
 Venous stasis
 Venous thrombosis

38. MUSCULOSKELETAL CHANGES
 Atrophy
 Decreased joint mobility and flexibility
 Bone de mineralization
 Osteoporosis
 Contractures and ankylosis

39. METABOLIC CHANGES
 Decreased metabolic rate
 Increased catabolism
 Negative nitrogen balance
 Anorexia
 Fluid and electrolyte
imbalances

40. GASTROINTESTINAL CHANGES
 Decreased food intake
 Altered protein metabolism
 Poor digestion and utilization
 Weight gain
 Constipation

41. URINARY CHANGES
Urinary stasis
 UTI
 Poor perineal hygiene
 Incontinence
 Decreased fluid intake
 Indwelling urinary catheterization
 Renal calculi
 Alkaline urine

42. SKIN CHANGES
Impaired circulation
Pressure ulcer

43. PSYCHOSOCIAL CHANGES
Decreased self concept
 Feeling of worthlessness
 Diminished self esteem
 Apathetic
 Altered thought process
 Coping difficulties
 Disturbed sleep pattern

45. NURSING MANAGEMENT
• ASSESSMENT
• History
 Daily activity level
 Exercise
 Fitness goals
 Mobility problems
 Physical and mental alternations
• Physical examination :
 Movement and gait and Alignment
 Joint structure and function
 Muscle mass and power

46. • ASSESSMENT
• Physical examination
• Ability to stand, walk, and
sit
• Physical and mental
alternations
• NURSING DIAGNOSIS
• Activity intolerance
• Impaired physical mobility
• Impaired bed mobility
• Impaired comfort
• Impaired skin integrity
• Impaired wheel chair mobility
• Impaired sitting
• Impaired standing
• Impaired transfer ability

47. NURSING DIAGNOSIS
• Impaired walking
• Fatigue
• Risk for activity intolerance
• Risk for falls
• Risk for injury
• Risk for physical trauma
• Risk for pressure ulcer
• Risk for disuse syndrome
• Risk for impaired skin integrity

48. INTERVENTIONS
• Goal
Long term :
Patient will maintain or regain normal body alignment, activity or
mobility level.
Short term:
Demonstrate correct body alignment
whenever observed Demonstrate full ROM
Perform ADL with assistance
Be free from skin breakdown

49. PLANNING/IMPLEMENTATION
• Interventions are directed towards
• Prevention of complication
• Depends on system effected
• To restore musculoskeletal function
• Position the patient to maintain normal body alignment
• Change position every 2 hourly
• Teach to use overhead trapeze
• Provide exercise
-Isometric
-Isotonic
-Passive ROM (Offer analgesics 30 mts prior to exercise)

50. PLANNING/IMPLEMENTATION
• Airway clearance problem
Deep breathing and coughing exercises
Chest physiotherapy
Suctioning
• Monitor vital signs
before and after activity
• Instruct to stop if he is unable to tolerate
Renal problems ▫ Increase fluid intake
Frequent position changes

51. PLANNING/IMPLEMENTATION
Risk for injury
 Keep side rails
 Do not leave the patient un attended
 Take all safety measures
• Nutrition
 Provide balance diet
 Sufficient proteins, CHO, vitamins and minerals.
 Increase fluid intake
• Encourages for ADL ▫
Assist for brushing, combing etc
• Ambulate the patient at the earliest

52. PLANNING/IMPLEMENTATION
• Elimination
High fiber diet
Add more fruits, vegetables and fluids
Changing position and exercises
• Keep the patient clean and tidy
Prevent soiling linens
Provide/assist sponge bath
Observe skin integrity
Take precautions to prevent the developments of bed sores

53. REFERENCE
• Kozier and Erb’s , Fundamentals of Nursing, 10th edition,
published by Frenchs forest , N.S.W. Pearson
• Potter- Perry, “Fundamentals of Nursing”, 2009, Elsevier’s
publication.
• Sakunthala J Rajan, - “A text book of Nursing Fundamentals of
Nursing”, TNNMC 2014, VitMed publishing Pvt Ltd.
• Shakuntla Sharma ‘Bripurit’, Principles & Practice of Nursing,
2012,Jaypee Publication.
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