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Course: Fundamentals of Nursing

Topic: Physical Activity and Mobility

The Nurses International Community

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Module Goals

Learners will be able to:

Describe the processes involved in regulation of movement.
Discuss normal changes in the regulation of movement across the lifespan.
Identify risk factors for impaired mobility and activity intolerance.
Discuss nursing care of clients with impaired mobility and activity intolerance in the primary, secondary, and tertiary care settings, including health promotion and safety.

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Process for Regulation of Movement

There are several regions of the brain, including the cerebral cortex, basal nuclei (basal ganglia), and cerebellum that work together to control and facilitate the desired movement.
This process can be broken down into three basic steps:

Planning,
Initiation, and
Execution

The first two steps are mainly controlled by different areas of the cerebral cortex and
The last step involves relaying the command from the CNS through the PNS to the muscles involved in the movement.

Brigham Young University, 2021

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Voluntary Control

Voluntary movements, such as walking upright, involve multiple areas within the central (CNS) and peripheral nervous systems (PNS).

Depend on upper motor neurons and lower motor neurons .

The cell bodies of upper motor neurons are found in the cerebral cortex, where planning, initiation, and coordination of movement occur.
The upper motor neurons initiate movement by sending impulses to lower motor neurons which then relay that information to the skeletal muscle.

Brigham Young University, 2021

Contact info: info@nursesinternational.org

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Normal Changes in the Regulation of Movement

Infants move their limbs, hold their head up, roll, sit, crawl, stand, and then eventually walk.
In school-age children injury can occur with activity of bicycling and skateboarding.
As teenagers become adults, the use of alcohol and other drugs may affect balance and safety while driving.
Older adults are at increased risk for immobility because of:

Osteoarthritis, orthostatic hypotension, inner ear dysfunction, osteoporosis resulting in hip fractures, stroke, and Parkinson’s disease are among the most common causes of immobility.

Ernstmeyer, & Christman, 2021

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Mobility and Immobility

Ernstmeyer & Christman, 2021

Mobility: the ability of a client to change and control their body position.
Physical mobility requires:

Sufficient muscle strength and energy
Adequate skeletal stability
Joint function, and
Neuromuscular synchronization

Anything that disrupts this integrated process can lead to impaired mobility or immobility.

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Mobility

Functional Mobility

The ability to move around in the environment, including walking, standing up from a chair, sitting down from standing, and moving around in bed.
The three main areas of functional mobility are:

Bed Mobility: ability to move around in bed, including moving from lying to sitting and sitting to lying.
Transferring: Moving from one surface to another, includes moving from a bed into a chair.
Ambulation: The ability to walk, includes assistance from another person or an assistive device, such as a cane, walker, or crutches.

Ernstmeyer, & Christman, 2021

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Critical Thinking Question

Which of the following is the most common cause of immobility in older client? (Select all that apply)

Kidney Disease
Stroke
Fall
Fracture

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Risk Factors for Impaired Mobility

Ernstmeyer, & Christman, 2021

Immobility can be caused by several physical and psychological factors, including acute and chronic diseases, traumatic injuries, and chronic pain.
Neurological and musculoskeletal disorders:

Osteoarthritis
Rheumatoid arthritis
Muscular dystrophy
Cerebral palsy
Multiple sclerosis
Parkinson’s disease

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Risk Factors for Impaired Mobility

Ernstmeyer, & Christman, 2021

Traumatic injuries

Skeletal fractures
Head injuries
Spinal injuries

Diseases that cause fatigue

Heart failure
Chronic obstructive pulmonary disease
Depression, or conditions that cause pain also affect the patient’s desire to move.

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Potential Complications Immobility on Body System

Psychological: Anxiety, Depression and Decreased quality of life.
Cardiovascular: Orthostatic hypotension. Thrombus formation
Respiratory: Atelectasis, Hypoxia, Pneumonia, Pulmonary edema.
Integumentary: Skin breakdown, Pressure injuries.
Musculoskeletal: Decreased stability and balance, Muscle atrophy, Joint contractures, Foot drop.
Gastrointestinal: Constipation, Fecal impaction, Ileus, Flatulence, Abdominal distention.
Genitourinary: Urinary tract infection.

Ernstmeyer, & Christman, 2021

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Nursing Care for Impaired Mobility

Ernstmeyer, & Christman, 2021

Assessment:

Assess the musculoskeletal system and its effect on the patient’s mobility status.
Assess muscle strength and coordination.
Assess mobility skills in the following order:

Mobility in bed, dangling on the bed with supported and unsupported sitting, weight-bearing while transferring from sitting to standing or to a chair, standing and walking with assistance, and walking independently.

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Nursing Care for Impaired Mobility

Ernstmeyer, & Christman, 2021

Assess the cardiovascular system:

Blood pressure, heart sounds, apical and peripheral pulses, and capillary refill time.
Lower extremity edema and for signs of a potential deep vein thrombosis (DVT).

Assess the respiratory system:

Respiratory rate
Oxygen saturation
Lung sounds,
Chest wall movement and symmetry
Depth and effort of respirations
Potential signs of atelectasis and pneumonia

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Nursing Care for Impaired Mobility

Ernstmeyer, & Christman, 2021

Assess the gastrointestinal system:

Inspecting for distension
Auscultating bowel sounds, and
Palpating the abdomen for tenderness

Assess for the urinary tract:

Abnormalities related to immobility,

Such as suprapubic distention/tenderness that can result from urinary retention

Monitor 24-hour trend of intake and output, as well as for symptoms of dysuria, urgency, or frequency

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Critical Thinking Question

An 82 year old woman was admitted to the hospital for fracture of the right hip after a fall at home.

What risks should the nurse identify related to the patient’s mobility?

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Assessing Mobility Status and Need for Assistance

Common types of assistance required:

Dependent:

The client is unable to help at all.

Maximum Assistance:

The client can perform 25% of the mobility task while the caregiver assists with 75%.

Moderate Assistance:

The client can perform 50% of the mobility task while the caregiver assists with 50%.

Minimal Assistance:

The client can perform 75% of the mobility task while the caregiver assists with 25%.

Ernstmeyer, & Christman, 2021

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Assessing Mobility Status and Need for Assistance

Contact Guard Assistance:

The caregiver places one or two hands on the patient’s body to help with balance but provides no other assistance.

Stand by Assist:

The caregiver does not provide assistance, but remains close to the client for safety in case they lose their balance or need help to maintain safety during the task being performed.

Independent:

The client can safely perform the functional task with no assistance.

Ernstmeyer, & Christman, 2021

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Nursing Interventions to Promote Mobility

Ernstmeyer, & Christman, 2021

Mobilize the client as soon as possible and to the fullest extent possible
Mobilization efforts:

Dangling on the edge of the bed
Sitting up in a chair, and assisting with early ambulation

Encourage the client to perform activities of daily living (ADLs) as independently as possible
Encourage active or passive range of motion exercises
Monitor the patient’s level of pain

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Nursing Interventions to Promote Mobility

Ernstmeyer, & Christman, 2021

Nonpharmacologic measures to reduce musculoskeletal discomfort such as:

Repositioning
Splinting
Heat/cold application

Minimize the potential for skin breakdown.

Turn or reposition.

Educate the patients:

About using assistive devices and other fall precautions.

Evaluate the appropriateness of medications and monitor the response of drug therapy.

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Nursing Interventions to Promote Mobility

Ernstmeyer, & Christman, 2021

Encourage rest between activities
IF risk of Respiratory complications:

Encourage adequate fluid intake to liquefy pulmonary secretions.
Deep breathing and coughing exercises to prevent atelectasis.
Monitor oxygenation levels.
Provide supplemental oxygen as prescribed to maintain adequate oxygenation.

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What would the nurse do?

What nursing interventions will promote mobility for the elderly client?

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Strategies to Reduce Functional Decline

Conduct comprehensive geriatric assessment of physical, psychosocial, and functional status at admission.
Encourage activity during hospitalization with structured exercise, progressive resistance strength training, and walking programs, in coordination with rehabilitation therapies.
Implement early mobilization for acute and critically ill clients based on established protocols.
Ensure assistive devices are in use (hearing aids, glasses, walker)
Ensure use of appropriate footwear to encourage mobility and prevent falls.

The Hartford Institute for Geriatric Nursing, 2020

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Strategies to Reduce Functional Decline

The Hartford Institute for Geriatric Nursing, 2020

Enhancements for age-friendly care

Handrails, uncluttered hallways, large clocks and calendars, elevated toilet seats.

Establish protocols for:

Reducing risk for geriatric syndromes
Improving self-care, continence, nutrition, mobility, sleep, skin care, cognition.

Promote safety while encouraging independence and dignity.

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Assistive Devices

An assistive device is an object or piece of equipment designed to help a client with activities of daily living.

Example:

A walker
Cane,
Gait belt
Mechanical lift

These assistive devices that a nurse may incorporate during safe client handling and mobility.

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Assistive Devices

Gait Belts:

Used to ensure stability when assisting clients to stand, ambulate, or transfer from bed to chair.

Slider Boards: (also called a transfer board).

Use to transfer an immobile client from one surface to another while the client is lying supine.

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Assistive Devices

Sit to Stand Lifts: (Also referred to as Sara Lifts, Lift Ups, Stand Assist, or Stand Up Lifts)

Mobility devices that assist weight-bearing clients who are unable to transition from a sitting position to a standing position using their own strength.
Used to safely transfer who have some muscular strength but not enough strength to safely change positions by themselves.

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What would the nurse do?

What interventions can the nurse implement to prevent functional decline in the elder clients?

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References:

Brigham Young University, (2021). Anatomy and Physiology: Control of Body Movement.https://content.byui.edu/file/a236934c-3c60-4fe9-90aa-d343b3e3a640/1/module9/readings/voluntary_control.html

Ernstmeyer, K., & Christman, E. (Eds.). (2021). Open RN Nursing Fundamentals by Chippewa Valley Technical College is licensed under CC BY 4.0

The Hartford Institute for Geriatric Nursing, (2020).Reducing Functional Decline in Older Adults During Hospitalization. https://hign.org/consultgeri/try-this-series/reducing-functional-decline-older-adults-during-hospitalization

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