1 Orthopedic Nursing Lesson 2

Lesson 2

Immobility

Immobility: the inability to move or be moved, motionless, the state of not moving.

According to North American Nursing Diagnosis Association defines impaired physical mobility or
immobility as a state in which the individual experience or is at risk for experiencing limitation of
physical movement.

Immobility is a restriction imposed on all part of the body. people become immobilized for various
reasons including chronic illness, pain and age related changes.

Therapeutic reasons for immobility include:

 To obtain relief from pain and prevent further injury of a part, as in a fractured bone.
 to reduce the workload of the heart in a cardiac or renal condition
 to promote healing and repair
 to reverse the effects of gravity, as in abdominal hernias and prolapsed organs

Causes of immobility:

1. Musculature, joint and skeletal problem

 Arthritis
 osteoporosis
 fracture(specially hip & femur)
 pediatric complication

2. Heart, Lung and circulation problems

 chronic coronary heart disease
 chronic obstructive lung disease
 severe heart failure
 peripheral vascular disease

3. environmental causes
 forced immobilization (restraint use)
 inadequate aids for mobility

4. Neurological problems
 stroke
 Parkinson’s disease
 cerebellar dysfunction
 neuropathies

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5. Cognitive, psychological and sensory problems

 dementia
 depression
 fear and anxiety( e.g. fear from instability and falling)
 pain
 impaired vision

6. Others general weakness after prolonged bed rest

 malnutrition
 drug side effects
 severe illness of any type

Risks and risk assessment

Risks

 Age.
 Level of immobilization.
 Level of conscious.
 Degree of impaired neurovascular function or underlying disease.

Risk Assessment

 Health History
 Sign and Symptoms
 Physical Examination.
 Laboratory.
 Screening tools such as pressure ulcer risk assessment tools.

Complication

Physical Complication

 Muscle wasting.
 Contractures.
 Muscle pain.
 Osteoporosis.
 Pressure sores.
 Hypothermia.
 Aspiration pneumonia.
 Constipation.
 Incontinence.
 Deep vein thrombosis and Anorexia

Psychological and Social

 Isolation.
 Loss of independence.
 Sensory deprivation.
 Depression delirium and dementia

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Averse effect/consequences of Immobility

S.No Body System Adverse Effect/Consequences

 Thickening of joint capsule
 Loss of smoothness of cartilage surface
 Decreased flexibility of connective tissues
 Charges similar to osteoarthritis joint contractures
 Demineralization of bone
1. Musculoskeletal
 Bone loss
 Atrophy and shortening of muscle
 Decreased in muscle strength
 Decreased muscle oxidative capacity
 Decline in aerobic capacity
 Arterial oxygen desaturation
2. Pulmonary  Increased hypostatic pooling
 Increased risk of atelectasis and infection
 Decreased cardiac output and stroke volume
3. Cardiovascular  Increased peripheral resistance
 Net loss of total body water and total blood volume
4. Integumentary  Pressure ulcers
 General weakening of muscles
5. Gastrointestinal  altered colonic motility
 Constipation
 Increased nitrogen, Phosphorus, total sulfur, sodium, potassium,
and calcium excretion
 Renal insufficiency
6. Urinary
 Decreased glomerular filtration rate
 Loss of ability to concentrate urine
 Lower creatinine tolerance
 Decreased basal metabolic rate
 Increased storage of fat or carbohydrate
 Negative nitrogen and calcium metabolic balance due to
7. Metabolic
decreased absorption of protein and calcium intake.
 Decreased glucose tolerance
 Metabolic alkalosis
 Decreased sensory stimulation (kinesthetic, visual, auditory,
tactile)
8. Sensory
 Decreased social interaction
 Changes in affect, cognition, and perception
9. Sexual pattern  Altered sexual function

Management of Adverse effects

 Consider conditions that might affect mobility. For example, does the person you care for suffer
from arthritis or a similar condition, or from a disease that affects circulation? Perhaps they have
bunions, corns, callouses or an ingrown toenail that causes pain when they walk. Certain
medications can cause drowsiness and chest conditions (i.e., asthma, lung cancer, or bronchitis)
and likely cause the person you care for to be too breathless. All of these situations can affect
mobility, and are therefore, important to consider.

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 Immobility or restricted mobility can lead to social isolation. Find ways to involve the person you
care for when you are in a social setting. If they cannot stand or move to the place where
everyone is gathered, provide a chair so that they can sit comfortably amongst all the people,
and be involved. Look into programs at local health clubs, senior centers or recreational centers
which can provide exercise as well as social contact. Exercise can improve mobility and also
decrease isolation.

 If the person you care for is at risk for pressure sores due to immobility, it is important to
reposition them every two hours. Very frail individuals should be repositioned every hour.

 When foot conditions such as bunions, corns, callouses, verrucae and ingrown toenails are
hindering the mobility of the person you care for, get a referral to a chiropodist.

 When constipation due to immobility is a concern, it may help to increase the fiber and water
intake of the person you care for. If this does not help, talk to your doctor about the possibility
of laxatives.

 Consider installing split bed rails on the bed of the person you care for. These are useful because
they provide assistance with mobility but do not act as restraints.

 Install railings in parts of the house which are potentially dangerous for the person you care for.
They are useful along stairwells, in the bathtub and beside the toilet. This can increase their
sense of security and independence, by allowing them to change position without assistance.

 If mobile, try and have the person you care for involved in some form of exercise, especially low
impact exercise. Some low impact sports that improve mobility are water aerobics, walking or
dancing. These can strengthen muscles and joints which all help to improve mobility and range
of motion. When starting an exercise program, it is important to consult the family doctor for a
physical exam.

 Consider getting a walking aid or wheelchair for the person you care for if they have problems
getting around on their own. This will allow them to become mobile, and will avoid the pressure
sores and constipation that result from immobility. A walking aid also will provide security and
comfort to those who are hesitant to walk on their own. If these items would be helpful to the
person you care for, but you cannot afford them, there often are programs in your area which
can provide assistance to you.

 If the person you care for needs your assistance to get around, they will likely respond better if
they feel safe in their environment. Floors that slope, the change from carpet to hardwood,
cluttered areas, and areas of varied lighting can cause the person you care for to feel that they
are losing balance or that they might slip or trip over something, which in turn may result in
decreased mobility.

Similarly, most people, even those with dementia, respond to non-verbal cues. If you are in a hurry
or if you sigh when you are trying to help the person you care for to get up, they might get the
impression that they are a burden to you or that their attempts are useless. By making the attempt
to smile, nod, have frequent eye contact or offer reassuring gestures, you might make the difference
between someone giving on a task and completing it.

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Prevention of adverse effects

1. Continue with daily activities that you are able to perform as tolerated but avoiding
overexertion.) Do not let others do for you what you can do for yourself.

2. Perform exercises to keep your limbs flexible and promote circulation. Do not stay in bed with
little movement. Do stretching and range of motion exercises to each of the joints on a daily
basis.

3. Maintain a sufficient fluid intake. Ensure 1.5-2 liters’ fluid intake per day as possible.

4. Focus on abilities and not disabilities. Find possible ways to enhance mobility through the use of
assistive devices (e.g. walking aids, wheelchairs) and making the home accessible. You may ask
therapists for further advice.

5. Maintain regular contact with people. Engage in pleasurable activities with family, friends or
caregivers.

6. For bed-bound cases, maintain proper body alignment and change positions every few hours.
Pressure padding and heel protectors may be used to provide comfort and prevent pressure

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