nursing interventions to prevent complications of immobility nursing interventions to prevent complications of immobility

Determine the patients progress towards their specific SMART outcomes. Assess for potential signs of atelectasis and pneumonia. Mobility can be assessed by using direct observation of the client's movements and mobility and using some standardized tests such as the Timed Get Up and Go Test with which the nurse assesses the client's ability to rise from a chair, walk, and then return to the chair and sit, the Assessment Tool for Safe Patient Handling and Movement, the Egress test which the nurse uses to assess the client's ability to sit and then stand, march in place and advance forward with each foot and return to the same position. This process is referred to as autolysis. Shearing is a combination of both pressure and friction that can cause some distortion of the client's skin and its underlying tissues. For example, infants move their limbs, hold their head up, roll, sit, crawl, stand, and then eventually walk. Compression stockings require a physicians order and should be applied in the morning and taken off at night. For example, a patient undergoing a cardiac catheterization may be mobilized within a few hours following the procedure, whereas a patient undergoing total knee arthroplasty may begin mobilizing 24 hours following the surgery. Encouraging activity as tolerated means involving the resident in movement while also adhering to mobility restrictions noted in the care plan and observing for respiratory changes that indicate the resident may be lacking endurance to maintain the activity. The pressure from compression stockings helps return fluid into the cardiovascular system and may reduce the risk for DVT. Like automatic sequential compression, compression stockings are fitted for the specific client after measuring the client's legs and checking the doctor's order for the amount of pressure that these stockings should exert on the client's leg. Some of these intrinsic factors include the client's urinary and/or fecal incontinence, poor nutritional and fluid intake, diabetes, hyperthermia, hypothermia, hypotension, a decreased cardiac output, obesity, an altered sensory perception, some medications, an alteration in terms of the client's perfusion and peripheral circulation, some of the normal changes of the aging process, cachexia and emaciation, an alteration in terms of the client's metabolic status, and the client's body build as well as the size of their boney prominences. Several terms are used to refer to certain body movements during range of motion exercises, such as abduction, adduction, flexion, and extension. The signs and symptoms of compartment syndrome include intense pain that cannot be relieved with raising the affected limb and/or the client's ordered analgesic medications. Mobility abilities and impairments can be also assessed by observing the client while they: Simply defined, gait is the way the person walks, or ambulates. If neither of these devices is available, a washcloth can be rolled and placed underneath the fingers. Some of these complications of immobility can be prevented with respiratory hygiene measures such as deep breathing, coughing, postural drainage, Some of these complications can be prevented with leg exercises, the use of sequential compression devices or antiembolism stockings, and the initiation of falls risk prevention measures when an immobilized client is adversely affected with orthostatic hypotension. RegisteredNursing.org does not guarantee the accuracy or results of any of this information. Pressure occludes the vessels that oxygenate the area and it also causes cellular damage because harmful substances, such as toxins, accumulate in the area where the pressure is exerted. The skin is described in terms of its color which can be yellow, ecchymosed, purple, green, blanched and reddened, for example. Patients in a coma, for example, should be given complete passive range of motion to all joints several times a day. Enzymatic chemical debridement can be used on wounds with at least moderate amounts of necrosis and eschar, including pressure ulcers and burns. WebTo prevent the further complications of immobility, nurses would usually perform the following interventions:. Older adults are at increased risk for immobility. This type of fracture occurs with depressed skull fractures. Some of the nursing diagnoses related to skin and skin integrity can include: All skin areas that are not within normal limits and indicate any signs of skin breakdown are assessed and described according to its color, size, location, odor, drainage, margins, texture, distribution and underlying bed tissue. The first type of hand device is a cone that slides into the palm of the hand and is kept in place with a soft elastic band. They should never touch the floor or any other surface such as a part of the bed because this will interfere with the traction's ordered weight. An example of segmenting ADLs would be assisting a person to bathe in bed as independently as possible, letting them rest after bathing, and then returning later to assist them with dressing and grooming to get them ready for the day. WebNursing interventions promote a patients mobility and prevent effects of immobility. These techniques will be discussed below immediately after this section. A staff member may provide verbal cues to complete the action, but the movement is done independently by the client. When mobilization and ambulation are impaired as the result of muscular weakness and/or impairments of their gait, balance and coordination, the client should be provided with rehabilitation and restorative care to facilitate this mobilization and ambulation. Do not send them to the laundry or put them on a heater to dry because this can cause shrinking and ruin the hose. There are three types of ROM exercises: passive, active, and active assist. In addition to traction and splints, many fractures are also casted. External fixation devices, halo traction, skeletal traction, and Crutchfield or Vinke cervical tongs are immobilization techniques that are used for fractures and other serious disorders. The three basic traction techniques can also be classified as manual traction, skeletal traction and skin traction. See Figure 9.9[10] for images of both types of applications of the toe opening of the stocking. The nurse should monitor these clients to insure that they are performing these active range of motion exercises in the correct manner and to the greatest possible extent of movement for all of the joints of the body. Accessibility StatementFor more information contact us atinfo@libretexts.org. Demonstrate placement of patient in various positions, such as Fowler's, supine (dorsal), Assess the respiratory system, including respiratory rate, oxygen saturation, lung sounds, chest wall movement and symmetry, and depth and effort of respirations. Passive range of motion is done by the nurse when the client is not able to even assist with range of motion exercise. Corn starch is NOT used. Note if urinary incontinence is occurring due to the inability of the patient to reach the restroom in time.[1]. Segmenting ADLs refers to breaking up tasks to accommodate the clients activity intolerance. Mobilization efforts, ranging from dangling on the edge of the bed, sitting up in a chair, and assisting with early ambulation, depend on the patients unique circumstances, such as their medical condition and surgery performed. 7. Skin traction is the most commonly used type of traction. Encourage rest between activities. The wound edges are approximated and closed with a closure technique such as suturing, Steri Strips, and surgical glues. Coordination can be adversely affected with a neurological disorder of the cerebellum, cerebral cortex and basal ganglia; muscular strength can be impaired with things like muscular atrophy, spasticity, nutritional deficits, paresis, flaccidity and other causes; and joint mobility can be impaired disuse, arthritis and other disorders of the bone. One of its disadvantages, when compared to some other method of debridement, is the need to anesthetize the client which, in itself, has some risks. See Figure 9.5[6] for an image comparing both lengths. Postural drainage is done by the nurse or the certified respiratory therapist. Manual traction, which is applied with the hands, is done to properly align a bone after a fracture so that a cast can be applied to the bone while it is in correct anatomical alignment. For example, clients who undergo knee replacement surgery may be prescribed a passive range of motion machine that continuously flexes and extends the patients knee while they are lying in bed. Routine exercising and mobilization also enhance the client's circulatory function in addition to preventing complications of immobility such as muscular weakness and venous stasis. See Figure 9.7[8] for a demonstration of these techniques. Butcher, H., Bulechek, G., Dochterman, J., & Wagner, C. (2018). Some of these compression stockings are knee high and others are thigh high. Patients able to perform full joint movement on their own and without the assistance of another should be encouraged to do so several times a day to promote circulatory functioning and also to maintain full joint mobility. The metabolic system alterations associated with immobility are a decreased rate of metabolism which can lead to unintended weight gain, a negative calcium balance secondary to the loss of calcium from the bones during immobilization, a negative nitrogen balance secondary to an increase in terms of catabolic protein breakdown, and anorexia. When working with school-age children, nurses provide education to prevent injury that can occur with activity, such as using helmets and knee pads to prevent injury while bicycling and skateboarding. (OpenRN) via source content that was edited to the style and standards of the LibreTexts platform; a detailed edit history is available upon request. Compression fractures occur when the fractured bone collapses as occurs with vertebral spinal fractures. See Table 9.4 for potential complications of immobility by body system and additional preventative measures that will keep clients as healthy as possible. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of mobility and immobility in order to: The hazards or complications of immobility, such as skin breakdown, pressure ulcers, contractures, muscular weakness, muscular atrophy, disuse osteoporosis, renal calculi, urinary stasis, urinary retention, urinary incontinence, urinary tract infections, atelectasis, pneumonia, decreased respiratory vital capacity, venous stasis, venous insufficiency, orthostatic hypotension, decreased cardiac reserve, edema, emboli, thrombophlebitis, constipation and the loss of calcium from the bones, are highly costly in terms of health care dollars and in terms of client suffering. The bones lose calcium as a result of the lack of weight bearing activity and this can lead to disuse osteoporosis, hypercalcemia, and fractures. Review a nursing care planning source for current NANDA-I approved nursing diagnoses and interventions. Members of the nursing care team and other health care professionals like physical therapists must, therefore, promote client mobility and prevent immobility whenever possible. Braces are applied to various parts of the body to provide support and alignment of the part. WebActive and passive range of motion (ROM) exercises prevent complications of immobility in the musculoskeletal system. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. For example, use the Banner Mobility Assessment Tool to determine the patients current mobility status and needs for safe patient handling. Assess for the presence of urinary tract abnormalities related to immobility, such as suprapubic distention or tenderness that can result from urinary retention. Percussion is also performed by the nurse or the certified respiratory therapist. Check that there are no wrinkles in the hose and that the client has no discomfort. The cone should not be forced into the fingers but placed gently. Identifying the Complications of Immobility, Assessing the Client for Mobility, Gait, Strength and Motor Skills, Performing a Skin Assessment and Implementing Measures to Maintain Skin Integrity and Prevent Skin Breakdown, Implementing Measures to Maintain Skin Integrity and Prevent Skin Breakdown, Applying a Knowledge of Nursing Procedures and Psychomotor Skills When Providing Care to Clients with Immobility, Coughing, Deep Breathing, Incentive Spirometry, Postural Drainage, Percussion, Vibration and Inspiratory Respiratory Exercises, Applying, Maintaining and Removing Orthopedic Devices, Applying and Maintaining Devices That are Used to Promote Venous Return, Educating the Client Regarding the Proper Methods Used When Repositioning an Immobilized Client, Maintaining the Client's Correct Body Alignment, Maintaining and Correcting the Adjustment of the Client's Traction Device, Implementing Measures to Promote Circulation, Evaluating the Client's Responses to Interventions to Prevent the Complications From Immobility, Adult Gerontology Nurse Practitioner Programs (AGNP), Womens Health Nurse Practitioner Programs, Advanced Practice Registered Nurse (APRN), Non Pharmacological Comfort Interventions, Basic Care & Comfort Practice Test Questions, Identify complications of immobility (e.g., skin breakdown, contractures), Assess the client for mobility, gait, strength and motor skills, Perform skin assessment and implement measures to maintain skin integrity and prevent skin breakdown (e.g., turning, repositioning, pressure-relieving support surfaces), Apply knowledge of nursing procedures and psychomotor skills when providing care to clients with immobility, Apply, maintain or remove orthopedic devices (e.g., traction, splints, braces, casts), Apply and maintain devices used to promote venous return (e.g., anti-embolic stockings, sequential compression devices), Educate the client regarding proper methods used when repositioning an immobilized client, Maintain the client's correct body alignment, Maintain/correct the adjustment of client's traction device (e.g., external fixation device, halo traction, skeletal traction), Implement measures to promote circulation (e.g., active or passive range of motion, positioning and mobilization), Evaluate the client's response to interventions to prevent complications from immobility, At risk for pressure ulcers related to immobility, Muscular weakness and muscular atrophy related to immobility, At risk for venous stasis and emboli related to immobility, At risk for altered and impaired respiratory functioning related to immobility, At risk for falls related to orthostatic hypotension secondary to immobility, At risk for osteoporosis and fractures related to the loss of calcium from the bones secondary to the lack of weight bearing activity, Plantar flexion contracture related to immobility, Loss of complete range of motion related to immobility, Are sitting to determine whether or not they need support while sitting, Change from a sitting position to standing, transferring from the bed to the chair, and sitting down on a chair or bed, At risk for impaired skin integrity related to immobility, At risk for impaired skin integrity related to poor skin turgor, Impaired skin integrity related to impaired tissue perfusion, At risk for impaired skin integrity related to boney prominences, Impaired skin integrity related to pressure, shearing and friction, Impaired skin integrity related to poor nutritional status, The screening of all clients for their potential for skin breakdown and then initiating special preventive measures, Performing skin assessments and reassessments on a regular basis, Keeping the client clean and dry at all times to prevent moisture and skin maceration as well as debris, Turning and positioning clients at least every two hours when the client is unable to move about in bed to turn and position on their own, Maintaining the client's nutritional and fluid needs, The utilization of supportive and assistive devices such as a wedge, pillow, and a pressure relieving mattress, The elimination of pressure, friction, shearing and moisture on the client's body and bodily parts, The client will perform active range of motion to all joints two times a day, The client will safely transfer from the bed to the chair with assistance, The client will demonstrate proper deep breathing and coughing, The client will ambulate 30 feet three times a day with a walker and the assistance of another, The client will increase their level of exercise and physical activity, The client will demonstrate the proper use of their assistive device, The client will maintain adequate respiratory functioning, Splint any painful or tender abdominal areas with a pillow or the client's hand, Take the deepest possible diaphragmatic breath through the nose, Repeat this coughing and deep breathing as often as necessary to clear the airways. Pressure, particularly over boney prominences, areas of poor tissue perfusion, and areas affected with poor circulation, is a physical force associated with the development of pressure ulcers and skin breakdown. Some of these complications of immobility can be prevented with respiratory hygiene measures such as deep breathing, coughing, postural drainage, percussion and vibration. Encourage or perform active or passive range of motion exercises as prescribed by the physical therapist. All trademarks are the property of their respective trademark holders. Accessibility StatementFor more information contact us atinfo@libretexts.org. See Figure 9.3[3] for an image of a passive motion machine. Hospitalization poses a risk for altered functional status of older adults due to acute illness, decreased mobility, and the negative effects of bedrest. The eschar is gently crosshatched with a scalpel so that the introduced enzymes can penetrate all layers of it. To prevent a decrease in lung function, reduce the build-up of fluids in the airways, and prevent pneumonia, clients are often prescribed incentive spirometry to keep their bronchioles open. Some commonly used braces are neck braces, back braces, and elbow braces. They should be applied upon awakening because edema is usually at its lowest point after lying in bed overnight. The externally placed skin traction must be applied firmly but without any potentially damaging pressure and in a smooth manner without any creases. The treatment plan includes the removal of the cast and, at times, a fasciotomy or epimysiotomy are indicated. Casts can be made with plaster or fiberglass. The later signs of compartment syndrome include burning pain secondary to ischemia, paresthesia secondary to neurological impairment, hypoesthesia secondary to sensory nerve damage, pulselessness, and cool and pale skin. Some of the orthopedic devices that nurses apply, maintain and remove include traction devices, splints, braces and casts: Traction, simply defined, is a physical pulling force that exerts pulling on the bodily part. Planning Interventions. An oblique fracture is one that occurs at an angle across the fractured bone. Educate the patient about appropriately using assistive devices and other fall precautions. Some nursing diagnoses related to immobility can include: Mobility is defined as the "ability to move freely, easily, rhythmically, and purposefully in the environment. WebPreventing Complications From Immobility: Haematological - Medstrom Part 3: Haematological Part 3: How Can I Prevent Complications From Immobility? The wound remains vulnerable to injury until full healing is completed with good tensile strength. Monitor and document the patients response to activity, such as heart rate, blood pressure, dyspnea, and skin color.[13],[14]. Immobility can also lead to shallow, ineffective respirations, decreased respiratory movement, and a decrease in terms of the client's vital capacity. The three types of wound healing are primary intention healing, secondary intention healing and tertiary intention healing. A greenstick fracture occurs when only one side of the bone is fractured. Splints are also used the immobilization of the spine, to support a weakened area of articulation such as a knee from damage and to support it after a knee replacement, for example. Gait is a function of a number of different things including balance, coordination, muscular strength, and joint mobility. Legal. WebOverview Complications of Immobility Psychologic Cardiovascular Pulmonary Gastrointestinal and renal Musculoskeletal and skin Nursing Points General Psychologic To avoid or minimize complications of immobility, mobilize the patient as soon as possible and to the fullest extent possible. Preventive measures and the treatments of these skin integrity disorders will be discussed below in the section entitled "Performing a Skin Assessment and Implementing Measures to Maintain Skin Integrity and Prevent Skin Breakdown". The client is placed in the same positions that are used for postural drainage, as discussed immediately above. These bowel alterations are further confounded when the client is not getting adequate fluid intake. Monitor oxygenation levels and provide supplemental oxygen as prescribed to maintain adequate oxygenation, especially during ambulation. When blood is not moving much due to client inactivity, it can coagulate (i.e, form a clot). Wound discharge, which is also referred to as wound exudate, is assessed and described as the lack of any drainage or the presence of some drainage which be described in terms of color, amount and characteristics. For example, serous drainage is clear or a slight yellowish color because it consists of serum which is the clear portion of the blood; sanguineous drainage is bloody and red because it consists of red blood cells; serosanguinous drainage is pinkish in color because it is a combination of serum and red blood cells; and purulent drainage can be yellow, green, rust color or brown and this drainage indicates the presence of infection and thick pus. Underlying bed tissue reflects the extent to which the wound is healing, regenerating and renewing. Coughing, deep breathing and the use of an incentive spirometer are described as hyperinflation exercises because, when done properly, these respiratory techniques hyper inflate the lung to facilitate the loosening and mobilization of respiratory secretions. 9: Promote Independence Through Rehabilitation/Restorative Care, { "9.01:_Introduction_to_Promote_Independence_Through_Rehabilitation_Restorative_Care" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "9.02:_The_Rehabilitation_Process" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "9.03:_Members_of_the_Therapy_Team" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "9.04:_Complications_of_Immobility" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "9.05:_Rehabilitation_Versus_Restorative_Care" : 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Care, Application of Compression Stockings (TED Hose), source@https://wtcs.pressbooks.pub/nurseassist, Assisting with active or passive range of motion (ROM) exercises, Applying splints or positioning devices as prescribed, Encouraging fluids (if not contraindicated), Providing bowel and bladder retraining if needed, Encouraging incentive spirometry or coughing and deep breathing, Applying compression stockings or other compression devices as ordered, Encouraging low sodium intake (as prescribed), Offering pleasurable individual activities if not interested in group activities, Encouraging visits by family, friends, or volunteers for 1:1 interaction, Cone to Prevent Hand Contracture (left) and a Palm Protector (right) by Myra Reuter for, Cone and Palm Protectors on Client" by Myra Reuter for, TED Hose Lengths.jpg" by Myra Reuter for, TED Hose Heel Marker.jpg" by Myra Reuter for, TED Hose Application Methods.jpg" by Myra Reuter for, Heel Marker on TED Hose.jpg by Myra Reuter for, Toes of TED Hose.jpg by Myra Reuter for.