Mobility

1. Define the concept of mobility and its scope

 Mobility: refers to purposeful physical movement, including gross simple
movements, fine complex movements, and coordination
o Dependent on: The synchronized efforts of the musculoskeletal and
nervous systems as well as adequate oxygenation, perfusion, and
cognition
 Immobility: inability to move
o Paralyzed pt, in a coma, terminally ill
 Impaired physical mobility: a state in which a person has a limitation in physical
movement, but is not immobile
 Deconditioned: loss of physical fitness
 Disuse syndrome: Describes the predictable adverse effect on body tissues and
functions associated with sedentary lifestyle and inactivity
o Identifying characteristics of the disuse syndrome include
cardiovascular vulnerability, obesity, musculoskeletal fragility,
depression, and premature aging
o “Don’t use it, lose it”
 Mobility and immobility may refer to a particular part of the body or the entire
body
 Scope: Full mobility to partial mobility (also referred to as impaired mobility) to
complete immobility

2. Discuss the physiological processes that effect mobility

 Neurologic system:
o Motor cortex in the frontal lobe is responsible for voluntary motor
activity – nerve impulses sent from the brain, through the spinal cord and
peripheral nerves, to the target muscle
o Cerebellum: coordinates movement, equilibrium, muscle tone and
proprioception

 Musculoskeletal system: (composed of bones, joints, and muscle)

o The skeleton has 3 roles:
1. structural foundation leverage to move body
2. supports and protects tissues and organs
3. provides attachment sites for muscles and ligaments
o Bones: serve as a storage center for calcium and produce RBC within the
bone marrow
 Living organs
 Humans have 206. Classified into two:
  Axial skeleton: skull, thorax, spinal column
 Appendicular skeleton: upper and lower extremities
 Remodeling: Describes an ongoing maintenance of bone tissue
through a process in which new bone tissue replaces existing bone
tissue in bone-remodeling units
Provides the mechanism to repair injured bones (fracture)
Requires adequate nutrition, hormonal regulation,

o Joints: connection between bones

 Provides stability to bones and allows skeletal movement
 Mobility is impacted by the degree of joint freedom
 3 classifications:
 synarthrosis (nonmoveable)
 amphiarthosis (slightly moveable)
 diarthrosis (freely moveable)

o Skeletal muscle: under voluntary control

 depends on nerve impulses, muscle fibers, proprioception,
mechanical load, and joint mobility
o impact of any of these negatively impacts movement
 nerve impulses reach skeletal muscle by motor neurons
 muscle fibers: functional unit of muscle contraction
 Movement occurs in a reciprocal manner among muscle groups. If
one group contracts, another group must relax.
 Proprioception: provides a sense of position and movement

3. Identity populations at risk/individual risk factors for impaired mobility

o Populations at risk: all individuals are potentially at risk regardless of age,
ethnicity, race, or socioeconomic status
 Older adults are at greater risk for immobility due to effects of
aging
 Bone degeneration = osteoporosis
 Muscle atrophy
 Decrease lung capacity
 Decreased balance
 Hearing/vision
 Arthritis
o Individual risk factors: attributed to acute and chronic conditions,
chronic pain, and injury/trauma
 Orthopedic injury, congenital deformities, strokes, head injury,
spinal injury, nutritional deficiencies, end-stage cancer,
neurological conditions
 Side effects of many medications also effect mobility
4. Explain the consequences of mobility:
o Attaining mobility is paramount to health. The degree of consequence is
largely dependent on the degree of mobility and length of time. Greater
the length, the more consequences
o Cardiovascular complications: a lack of physical activity results in
reduced cardiac capacity
 A 15% reduction in muscle mass after 12 weeks of immobility
 Problems also occur within the vascular system
 Slowed blood flow provides the opportunity for blood clots
o Deep vein thrombosis is common with immobility
o Respiratory complications:
 Reduced lung expansion and can lead to atelectasis (an airless
state of the alveoli)
 Pooling of respiratory secretions coupled with a reduced cough
effort places the patient at risk for pneumonia
o Musculoskeletal complications:
 Muscle effects:
o Loss of muscle mass, endurance, and joint instability
increases risks for falls
o Muscle atrophy and joint contractions are concerns
 Skeletal effects:
 Impaired calcium metabolism and joint abnormalities
 Osteoporosis
 Joint contracture: abnormal and possibly permanent
condition characterized by fixation of a joint
o Integument system complications:
 Sustained pressure on the skin reduces perfusion to the tissues,
reduced risk of oxygen causes hypoxemia of the issues and
increases risk of skin breakdown
 Immobilization if a major risk for pressure ulcers
o Pressure ulcer: impairment of the skin as a result of
ischemia (decreased blood supply)
 Characterized by inflammation and forms usually
over bony prominence
 Most common in long-term care facilities, and in
adult intensive care units in the hospital
o Gastrointestinal complications
 Constipation
 Not being able to assume an optimal upright position for a
bowel movement
 o Urinary complications:
 Renal calculi: calcium stones that lodge in the renal pelvis.
Immobilized patients are at risk because they frequently have
hypercalcemia
 Urinary tract infection: urinary stasis provides an optimal
environment for the growth of bacteria
 Urinary catheters also raise risk
o Psychological effects:
 Boredom, depression, decreased communication
 Especially concerning among children
 Can interfere with intellectual and psychomotor function
 In some cases, hallucinations occur

5. Assess factors that impact mobility page 418 – potter&perry

o History:
 General health information (past health history, medications, family
history, surgery/treatments) and social history (lifestyle, employment,
ADLs)
 Investigation of specific symptoms:
 Presence of pain with movement
 Recent changes in mobility or problems with balance
 Presence of fatigue
 Recent falls
 Recent changes in ability to complete ADL
o Examination:
 Assessment of musculoskeletal system
o Gait, body posture, joints, size, symmetry, strength of muscles
o Pediatric includes observation of motor activities
o Expected findings:
 Gait should be smooth, coordinated, and balanced
 Spine should be straight with expected curvatures
 Muscles and joints assessed for size, strength, ROM
 0 = no detection of muscular contraction
 5 = full muscle strength
o abnormal findings:
 observed deformity of bone or joint
 edema
 ecchymosis: subcutaneous bleeding not caused by trauma
 numbness
 loss of function
 localized warmth and redness
 o Diagnostic tests: used to evaluate musculoskeletal disorders

Radiographic Diagnostics
• The x-ray evaluates the integrity of bones and joints and is the most common
radiographic test used to diagnose fractures.
• Computed tomography scan identifies soft tissue and bony abnormalities and
evaluates musculoskeletal trauma.
• Magnetic resonance imaging uses radio waves and magnetic fields to provide
an image of soft tissue. This is used most efficiently to evaluate soft tissues, such
as a vertebral disk, tumor, ligaments, and cartilage.11
• Myelogram is a radiographic study of the spinal cord and nerve root using a
contrast dye. This is particularly useful in the evaluation of individuals with back
pain.
• Arthrography (arthrogram) is a visualization of a joint by injection of a
radiopaque substance into the joint cavity, allowing for the evaluation of bones,
cartilage, and ligaments. This is most commonly performed on the knee and
shoulder joints, but it also can be done on hips, ankles, and wrists.11
• Bone mineral density is a diagnostic test used to determine the core mineral
content and the density of bone. This test is used for the diagnosis of
osteoporosis and osteopenia.
• Bone scan evaluates the bone uptake of a radionuclide material; the uptake is
related to the metabolism of the bone. The primary indication of this test is to
detect metastatic cancer in the bone,11 but it is also used to evaluate avascular
necrosis or unexplained bone pain.

Other Diagnostic Tests

• Arthroscopy is a procedure that allows direct visualization of the interior of a
joint through an endoscope. This procedure is most 256commonly performed on
the knee, but it can be done on other joints as well.
• Electromyography is an evaluation of electrical activity generated within the
muscle. This is used to determine the quality of neuromuscular innervation.
• Laboratory tests can be used to provide various types of information about the
functional state of muscles, bones, or joints. Types of tests include blood tests
(e.g., alkaline phosphatase, calcium, phosphorus, uric acid, creatine kinase, blood
urea nitrogen, creatinine, and myoglobinuria), analysis of joint fluids, and
pathologic analysis of biopsied tissue (e.g., a muscle biopsy or bone biopsy)

6. Apply nursing process to provide general nursing care to prevent risks and
improve function
o Primary prevention:
 Regular physical activity, optimal nutrition, ideal body weight,
adequate rest
  Infancy, childhood & adolescence: calcium and protein intake
 Fall prevention
 Environmental safety: using hand rails, wearing sturdy shoes,
optimizing vision
o Secondary prevention (screening):
 Primary areas to highlight related to mobility and screening are
osteoporosis, mobility screening, and fall risk assessment
 For osteoporosis screening, the U.S. Preventive Services Task Force
(USPSTF) recommends screening of women age 65 years or older as
well as younger women who have increased fracture risk; dual-energy
x-ray absorptiometry of the hip and spine is the recommended
method to measure bone density. No recommendation for the
screening interval. USPSTF concludes that evidence is insufficient to
recommend screening for men
 One of the most common screening tests is the Timed Get Up and Go
test, which measures mobility in people who are able to walk on their
own (assistive devices allowed)
o Collaborative interventions:
 Numerous interventions for the care of individuals with
limitations in mobility exist and are usually presented based on
the underlying medical condition or diagnosis
o Care for immobilized patient:
 Important overarching principle to emphasize is the need for early
mobility
 Early mobility requires a cultural mindset among interdisciplinary
teams to overcome challenges and barriers associated with patient
mobility.
 Barriers to early mobility include:
- Patient factors (excessive sedation or delirium, morbid obesity, and
multiple invasive devices)
- Care delivery factors (fragmented care, availability of adequate
equipment, time constraints, adequate number of providers, and
concerns for patient safety)
o Exercise therapy:
 Cornerstone intervention in the management of individuals with
impairments in mobility
Several forms of exercise therapy exist, including the following:
- Exercise Therapy: Ambulation
- Exercise Therapy: Joint Mobility
- Exercise Therapy: Stretching
- Exercise Therapy: Balance
 Exercise therapy is performed by nurses or physical therapists in
acute care, community-based, and home care settings
 Goal of exercise therapy is rehabilitative or preventive, and it is often
done in multiple combinations
o Pharmacologic agents:
 Many of the drugs used to treat mobility problems are for the relief of
pain or inflammation or to treat underlying conditions
 Includes anti-inflammatory agents, analgesics and muscle
relaxants, and supplements
 Anti-inflammatory agents:
 Inflammation is a common primary or secondary finding
among conditions leading to changes in mobility, from an
underlying autoimmune condition to a traumatic injury
 Anti-inflammatory agents, such as corticosteroids and
nonsteroidal anti-inflammatory drugs (NSAIDs), are by far
the most commonly used
 Another group of agents used to reduce inflammation are
the immunomodulators
 These function to weaken or modulate the activity of the
immune system, thereby decreasing the inflammatory
response
 Analgesics and muscle relaxants:
o Analgesic agents are an important component of drug therapy
o Agents that are specific for analgesia include:
- Opioids (e.g., morphine)
- NSAIDs
- Aspirin
o Not considered analgesics, but muscle relaxants provide relief
from discomfort by eliminating muscle spasms
 Supplements:
o Nutritional supplementation with vitamin D and calcium is a
useful prevention and treatment measure for osteoporosis,
particularly for postmenopausal women
o Bisphosphonates are antiresorptive agents that slow or stop
the reabsorption of calcium from the bone, resulting in
maintained or increased bone density and strength
 These agents are used to treat osteoporosis

o Immobilization:
 Following an injury or surgery, immobilization of a joint or bone is often
necessary to provide stability and hold the appendage in place so that
healing can occur
 Immobilization is necessary to enhance the healing process, protect the bone
from further injury, and provide comfort to the patient
  Common examples of immobile devices include:
- Casts
- Splints
- Abductor pillows
- Shoulder restraints
- Braces

o Assistive devices and patient handling technology:

 Assistive devices are objects to provide assistance with a task
 Many types of assistive devices are commonly used in patient care, including
assistive devices for ambulation and assistive devices for activities of daily
living
 Common ambulation assistive devices include:
- Canes
- Crutches
- Walkers
- Wheelchairs
- Prostheses
 Patients must be taught to use these devices correctly to avoid injury
 Patient handling technology refers to a variety of equipment in the care
environment designed to assist with the handling and movement of patients
 Examples include:
- Transfer mats
- Slings
- Lifts
 Education and training on indications and use of these devises, including
assessment and decision algorithms for equipment selection, are essential to
ensure the safety of the patient and the health care providers

7. Identify interrelated concepts:

o Those with inadequate gas exchange may experience reduced mobility
because of excessive fatigue
 At risk of developing complications such as stasis pneumonia
o Intracranial regulation: problems with this may cause someone to
become immobile as a result of unsteadiness, imbalance
o Nutrition: unable to purchase, prepare, or consume
 Malnutrition leads to muscle wasting and bone loss
o Pain: those with chronic pain associated with cancer or back pain, fractures
o Perfusion: inadequate oxygen supply to blood leading to damage of tissue
integrity
o Elimination: constipation or urinary retention