Welcome! We’re going to talk about mobility
and immobility. My name is Diana Shenefield,
and this is going to be a big part of NCLEX as
well, and it falls under basic caring comfort.
So, what’s this topic about? We’re going
to talk about a little bit of an overview.
When we’re looking at comfort and we’re looking
at taking care of our patients, mobility
and immobility are a big part of that. And so we’re
going to look at what's the complications
and what’s the importance of making sure
that our patients are moving.
Our learning outcomes, as we know, our mobility
and immobility has to do with promoting circulation
and maintaining correct body alignment. So
you want to make sure that you go back and
you look in your fundamentals book on positioning
and different positions on whether it’s
Fowler or semi-Fowler’s, again, Sims’
position, supine, prone. Make sure you go
back and you review that, because as we talk
about mobility or immobility, positioning
is a big part of that. You need to identify
the complications of immobility. What happens
if our patients don’t move? And why is that
that they’re not moving and what can we do as
nurses to promote that? And then assessing
the patient’s mobility, their gait, strength
and motor skills. That sounds like neurological
assessment. And so we want to make sure that we’re
watching that and that we notice any
changes in our patient.
So here’s a sample question that you might see
on NCLEX. An elderly patient has a noncemented
total hip joint replaced. So picture that
in your mind. I know if you’ve been on the
med/surg floor, you’ve probably had some
hip replacements. Postoperative activity for
this patient should include. So again, think
back to that patient and think back to what
has happened to that patient, and that there're
an elderly patient. What are you going to
do? How about number A? Bed rest for six weeks
with continuous passive motion. Remember,
continuous passive motion as the CPM machines.
What about B? Touch-down weight-bearing starting
first postoperative day, or C, head of the
bed flat for 48 hours, or D, hip immobilization
for three to four weeks with no weight-bearing.
So think about what is going to be best for
your elderly patient, not just because of
the hip, but also because of all the other
body systems that are affected by this illness.
Again, hopefully, you picked B. We want them
to be up moving around, but we don’t want
them putting a lot of weight on that hip.
So, what’s our responsibility as far as
immobility and mobility? Well, we need to
assess our patient. Who can get up and walk?
And what is their gait? We want to make sure
we’re keeping our patients safe, and that
means knowing which patients are at risk for
falls. And we can only know that by getting
our patients up or getting a history on how
well they can walk. Do they need a walker?
Do they need a cane? Are they unsteady?
Are they on medications in the hospital that make
them unsteady but they’re normally steady?
And how do we adjust that to keep our
And then what are the causes of immobility?
I know you’re thinking in your mind.
Well, I could think of a bunch of them. But let’s
look at some of the causes so that you can
be prepared as a nurse on how to take care of
these patients and prevent some complications.
So, what are our main causes of immobility?
We could see the first one listed there is
a pain. And pain is one of those things that
should not keep a patient from moving.
If my patient says to me, “I’m not getting
up because I hurt too bad,” then that’s
a problem that I have. I need to make sure
that I’m medicating my patient so they can
get up and about. And if the medication I’m
giving them isn’t working, it’s my responsibility
to call the physician and try to work something
else out or look for other ways so that my
patient isn’t in as much pain. Pain shouldn’t
be a big excuse for not getting
up and walking around. We have trauma, injury.
Again, just like we had the man in the question
that had the noncemented hip. Things happen
that keep us from moving around, but again,
is that an excuse or is there something as
a nurse that I can do to help my patient still
get up and move around? You could have motor
or nervous system impairment. Maybe you have
a patient that has had a stroke, and maybe
one side of their body is paralyzed.
Again, immobility doesn’t mean, “Well, I’d
just leave you lay there.” We know as nurses,
that we can still move people around, but
I need to be aware of that so that I’m watching
for those signs and symptoms. What
about somebody who’s in traction?
That’s a whole different bugging. They’re in traction,
I can’t just say, “Well, today, we’re
going to get up and walk.” So, what can I do to
help my patient not have all the complications
of immobility because they’re stuck in traction?
What about just a generalized weakness?
Maybe there are patient that’s suffering from multiple
sclerosis and their disease is getting worse,
and they don’t have the energy. Again, does
that mean I just let them lay there? Or does
that mean that I look for creative ways to
help them be as mobile as possible?
Then we have psychological problems. There’s
a whole range of diseases where people feel
like they can’t get up and move. Again,
I don’t just leave them there because they
think they can’t get up and move. But what
can I do to prevent complications? And then
side effects of medications, if I just gave
my patient a big dose of a narcotic, they
may be asleep, they may be uneasy on their
feet. Or maybe I’ve given them a medicine
that may help them sleep and they’ve very,
very sleep? Again, that’s a temporary thing,
but I can’t let my patient just lay there and
give the excuse that they’re on a medication.
So, what are the types of immobility? Well,
the main one that we think of is physical.
There’s something wrong, either they’re
older and their joints don’t work, or they’ve
been in an accident, or they have a broken
leg. There's lots of physical things that
can keep people from getting up and moving
around. What about intellectual, lack of knowledge?
Maybe your patient just doesn’t understand
how important it is to get up and move.
You know, we all know it’s sometimes easier just
to lie in bed or just to sit in the recliner.
But does your patient understand the importance?
And then emotional. Again, sometimes people
that are highly stressed, it’s easy to just
kind of close in, maybe cover your head with
the blanket. You don’t want to deal with things.
And before you know it, time has moved on.
So again, understanding that and being
sensitive to your highly stressed patients,
but also helping them still move around and
deal with their stress. And then social, sometimes
socially, it’s nice to get people to take
care of you if they think you can’t move
around or maybe you’re not able. Maybe you
don’t live somewhere where you have a nice
recliner to sit in or a nice place to walk.
Again, just saying, “Well, that’s okay.
You don’t need to move around.” As a nurse,
I need to work on that and I need to find
ways to keep my patients as mobile as possible
so that they don’t develop the complications
we’re going to talk about. So, what
complications? There are things I
see and there are objective things. And the
first thing is they’re going to have a decreased
motivation. The longer you’re immobile,
the less motivated you’re going to be to
get up and move around. You can kind of look
at people and exercise. The longer a person
goes without going to the gym, the easier
it is to not go to the gym, and it’s the
same with our patients. The easier it is to
just sit in the chair, the harder it is to
get up and move around. So we’re looking
at motivation. We’re looking at problem-solving
abilities. Maybe they can’t get
around because there's
rugs all over. That’s a pretty easy
one for us but maybe not for them to realize
that we can move those rugs. How can we make
a place for the patient to move? If they’re
in traction, what can we do? We can’t just
start getting them up and moving around, but
what can we do? What kind of problem solving
can we do to help that patient move around?
What about diminished drive? Again, is it
a depression problem? Is it that they don’t
care or lack of self-esteem? Again, identifying
that and then being able to address interventions
to go with that. Changes in body image can have
a big effect depending on what has happened
with your patient. Emotional reactions.
If I have an exacerbated
mode or emotions, you know, all of the sudden, everything
is a crisis. And we’ve had patients where
they have no coping skills. And whatever has
happened to them has put them into a crisis
that they can’t function. Again, we don’t
want that to lead to problems of mobility.
Deterioration of time perception. People that
are in the ICUs lose all track of time.
And so, you know, maybe it seems like I’ve only been in
bed for a day, and all of the sudden, it’s
been a week. So, helping our patients,
keeping them oriented.
Fear and anxiety. Is it going to hurt when
I get up and move around? It’s easier to
just stay still. What about sensory deprivation,
sensory overload, or “I don’t have enough
sense for sensory deprivation”? So again, what
am I doing with my patient? Am I teaching
them or am I just leaving them lay there?
And then as we talked about before, depression.
Depression is huge with our patients. They’re
dealing with illnesses. They’re dealing
with financial problems, with family loss,
with job loss. Our patients don’t just come
to us with a COPD. They come to us with their
whole lives. And so, understanding that and what
motivates them is really important as nurses.
And then objective. What kind of other complications
for immobility? Well, orthostatic hypertension.
Remember, that’s when you’re taking the
blood pressure when they’re lying, sitting,
standing. We know if somebody lies too
long, when they go to stand up, they get very
dizzy, risk for falls. So again, understanding
that. And it doesn’t mean that they’ve
been lying for days, maybe they’ve only
been lying for an hour. But that is a complication
of immobility. Thrombus formation, always
watching for those DVTs. We know that our
patients, even if they can’t get up, we
can do things to help them move their legs,
pump their ankles, so that we don’t get a
DVT. Anorexia, a lot of people,
older people will just not be hungry. Why?
Because they sit around all day long.
And so, just think about those patients, and that
is a complication because then they’re not
getting enough nutrients. So maybe if we got
them up and walked them a little bit that
they would have that drive to eat. Diarrhea
and constipation. Different people react different
ways, but definitely, constipation, if you’re
not getting up and moving around. Tissue and
muscle atrophy is a big problem. We know just
somebody that has had a cast on. I’m sure
you’ve seen somebody that has had their cast
taken off and how their tissue and muscle
has atrophied. If we’d leave it like that,
they’ll lose function of that limb.
So again, making sure that you’re moving people
as much as possible so that their tissues
and muscles don’t atrophy. Fluid and electrolyte
balances. Kindeys. Need to have you up and moving around.
They need gravity to help. So again, be watching
your lab results. Contractures is another
big problem which we don’t want to happen
because of tissue atrophy, but we don’t
want people to get stuck in a certain spot
to where they can’t move their arms.
They can’t take care of themselves or feed themselves.
And then skin breakdown should be number one
on your list. We know people that are immobile
are going to have skin breakdown, and we cannot
afford our patients having pressure ulcers
because we as nurses did not get them and
move them around, whether it’s rolling them
back and forth, whether it’s changing positions,
or whether it’s using special cushions or
bed, skin breakdown is a huge problem.
And then pneumonia. Think about your patient that’s
come back from surgery. What do we do right
away? We get them up and moving around. We
get them taking coughs and deep breaths to
get that anesthesia out. Why? Because they
will develop a pneumonia, which is another big
problem of immobility. Bladder distension.
How many people can go
to the bathroom lying down? And so, what they
do is they hold it and it ends up distending
their bladder till when they can’t go and
they become uncomfortable. So again, thinking
about all of these things. Your patient is not
going to be thinking about all these complications.
These all comes from patient teaching, but
it starts with your understanding as a nurse
on everything that you’re watching for,
so that you can prevent these things.
Infection and kidney stones are other big problems of
complications that happen when patients aren’t
moving around. So, what are we going
to do to prevent?
Why do we get people moving around? We want to
get that blood flowing. Blood has to move.
Gravity will help, but lying flat, it pulls.
So we need to make sure we’re getting people
moving around. We’re promoting good skin
integrity. We’re promoting muscle strength,
that we have an awareness of what’s going
on with immobility. Again, teaching the patient,
teaching the family how important it is and
why. Maintaining sensory stimuli, not letting
somebody just lay there without being interactive,
whether it’s talking to them, whether it’s
TV, giving them the motivation to move.
And then again, educating on certain devices.
If your patient needs a cane, they need to
be taught how to use a cane, whether it’s
a cane, a walker, crutches. Do they know how
to use them? Because a lot of times, we assume
that they do. They go home and the cane sits
in the corner and they sit in the chair because
nobody has taught them how to use it. So keep
that in mind as well as you’re answering
questions. Does the patient understand how
to use the devices?
So in closing, think about all the patients
that you could be taking care of that might
be immobile. What patients are at risk? And
then what are the complications that they’re
at risk for that as a nurse, I’m responsible
to prevent. And again, making sure I have
buy in with my patient and their family so
that they understand how important it is
to move. Good luck on NCLEX.