Janet:

List three systems responsible for coordinating body movements:

a.) Nervous system

b.) Musculoskeletal System

c.) Skeletal system

Briefly describe how the following pathological conditions affect mobility.

a.) Postural abnormalities:

- Postural abnormalities indicate muscular, bone or joint deformity, pain

or fatigue. This can affect the client’s musculoskeletal system as well as
the body alignment, balance, appearance.

b.) Impaired muscle development:

- Can lead to numerous alterations in musculoskeletal function. An

example of a impaired muscle disorder is dystrophies (break down of
skeletal muscle fibers.

c.) Damage to the central nervous system:

- When damage is done to the central nervous system than any voluntary
movement can be impaired (action potential is not sent). An example of
damage to the central nervous system could be a head trauma that
affects the cerebral cortex.

d.) Direct trauma to the musculoskeletal system:

- This trauma can lead to bruising, contusions, sprains and fractures.

Fractures usually occur from direct external trauma.

The nurse plans therapies according to severity of risks to the client, and the plan is
individualized according to the client’s:

- Developmental stage
 - Level of health

- Lifestyle

Give a brief description and list four trouble areas of the Fowler’s position:

Fowler’s position is a standard patient position used to relax abdominal muscles and
improve breathing.

Four troubled areas of the Fowler’s position:

1. Paralyzed muscles do not automatically resist pull of gravity as they do normally.

As a result, shoulder subluxation, pain and edema may occur.

2. If pillows are adjusted wrong, or there are too many than a worsen neck flexion
contracture may be caused.

3. Angle of the bed must be adjusted to patient’s condition, for example a patient
with an increase chance for pressure ulcers should be at a 30 degree angle.

4. If heels contact bed than a long period of the pressure of mattress on heels will
occur (floating heels).

Instrumental activities of daily living (IADLs) are:

The ability to use a telephone, prepare a meal, travel, do housework, take medications
and shop.

Indicate the correct use for each positioning device listed:

-pillow – provides support, elevate body, and splint incisional areas which can reduce
pain when moving and breathing.

-abductor pillow – is used for after hip replacements, placed between the legs.
Immobolizes the lower extremities’

-bed board – a stiff board that lies under the mattress to add support for the body

-footboard – a narrow platform to stand or brace the feet

-footboot – this maintains feet in dorsiflexion, They keep the foot flexed at the proper
angle.

Trina:
The ability to balance can be compromised by what
7 things?
Disease, injury, pain, physical development (e.g. Age), life changes (e.g.
Pregnancy), medications, and prolonged immobility.

Define leverage: The action of using a lever. Positional advantage;

power to act effectively.

Briefly describe the physiological hazards of

immobility in relation to the following systems.
a.) Metabolic: Endocrine metabolism is effected as well as calcium
reabsorption, and gastrointestinal system.

b.) Respiratory:Immobile clients are at higher risk of respiratory

and pulmonary complications. Most common complications are
atelectasis and hypostatic pneumonia.

c.) Cardiovascular: Three major changes – orthostatic

hypotension, increased cardiac workload, and thrombus formation.

d.) Musculoskeletal: Loss of endurance, strength, and muscle

mass, as well as decreased stability and balance. Impaired calcium
metabolism and impaired joint mobility.

e.) Integumentary: Compounded by metabolism. Breaks in skin

is difficult to heal. Ulcers are a major risk.

f.)Elimination: Urinary stasis. Increases risk of UTI and renal calculi.

Increase risk for dehydration.

Identify two nursing interventions for the

immobilized child:
Plan activities that provide both physical and psychosocial stimuli.
List four areas the nurse needs to consider in
determining if assistance is required when moving
a client in bed.
1- Weight
2-Mobility
3-If the client comprehends what is expected
4- Physical ability

All of the following measures are used to assess for

deep vein thrombosis except:
a.) Measuring the circumference of each leg
daily, placing the tape measure at the mid-
point of the knee
b.) Observing the dorsal aspect of lower
extremities for redness, warmth, and
tenderness
c.) Asking the client about the presence of calf
pain
d.) Checking for a positives Homans’ sign, if not
contraindicated
Answer: A
Rationale: The measurement is supposed to be taken on the calf, ten
centimetres from the mid-patella

Chapter 46 Mobility and Immobility

Define the following

Body Mechanics: Coordinated efforts of the musculoskeletal and nervous system to maintain balance,
posture and body alignment during lifting bending moving and performing ADLs Potter and perry p1186

Body Alignment: (Analogous with posture) Positioning of joints tendons ligaments and muscles while
standing sitting and lying… individual center of gravity is stable and body strain is minimized.” Potter
and Perry p 1186

Briefly describe how skeletal muscle causes movement: Body movement is coordinated between skeletal
system, skeletal muscle, and nervous system. Skeletal muscle is the working element of movement using
its contracting and relaxing ability and its attachment to bones and joints to move, stabilize body parts.

Identify the descriptive characteristics of body alignment and mobility related to the following
developmental stages:

Infants: Spine is flexed and lacks the curves that are present in a healthy adult’s spine. As growth occurs
musculoskeletal development permits support of weight for standing and walking.

Toddlers: While leaning to walk the head and upper body are carried forward. Body balance is off and
falls happen often.

Adolescents: Rapid growth takes place at this stage. Often infrequent resulting in growth spirts.

Older Adult: Loss of total bone mass. Muscle strength and aerobic capacity decrease. Older adults may
walk slowly with shorted steps appearing less coordinated. Balance is impaired and this leaves them
vulnerable to falls and injuries.
Identify two nursing interventions to meet each of the following goals for the immobilized client

Maintain optimal nutritional metabolic state

A) Providing the client with a high protein and high calorie diet with adequate vitamin B and C in
order to replace depleted protein, provide adequate nutrition for healing tissue, supplement
muscle break down.
B) Providing Nutrients through various tubes is an option when the client is unable to eat. Providing
diets that are purred or liquefied is also an option.

Promote expansion of chest and lungs

A) Change position of patient every two hours

B) Encourage deep breaths and coughing every two hours.

Prevents stasis of pulmonary secretions

A) Moving the client every two hours. This will change the position (rotate) of the lung creating
secretions

C) Allowing the client to take in 2000Ml of fluid a day. This helps to keep mucociliary clearance
normal. Promotes a clear liquid sputum, easier to cough up.

Maintain Patient airway

A) Coughing every two hours promotes clear airway.

B) If coughing every two hours is no longer effective for maintaining patient air way.
Nasotracheal or orotracheal suction techniques may be used to remove secretions in upper airway.

Reduce orthostatic hypotension (a large decrease in blood pressure when arising to a sitting or standing
potion)

A) Encourage movement as soon as condition permits

B) While helping a patient to get up help them to do so very slowly. Raise the head of the bed
and allow the client to sit in position for ten minuets. Next help the client to dangle sitting on
the side of the bed for ten minuets before fully standing up. Be close for support if the client
falls and ask if they are feeling dizzy.

Reducing Cardiac workload

 A) Discouraging client from holding breath while bearing down also called the Valaslva
Maneuver

Give a brief description and list four trouble areas for the sim’s position:

Weight is placed on the anterior ilium, humerus, and clavicle

Some trouble with the sims position are Lateral flexion of the neck. Internal rotation, adduction, or lack of
supports to the shoulders and hips. Lack of support for the feet. Lack of protection for pressure points at
the ilium, humaerus, clacicle, knees and ankles.

Which of the following is a potential hazard that a nurse should assess when the client is in the prone
position?

Answer: Plantar flexion

Rationale: The client in laying on their stomach with a small pillow under their head. If there is no pillow
under their ankles plantar flexion may take place. supporting the feet with a small pillow will aid in
dorsiflexion of the ankles and knees providing relaxation If the appropriate sized pillow is not available
she feet should dangle over the mattress.

Simren:
Mobility refers to: the ability to move easily and
independently.
Ligaments are: A short band of tough, flexible,
fibrous connective tissue that connects two bones
or cartilages or holds together a joint
Tendons are: tough band of fibrous connective
tissue that connects muscle to bone
Cartilage is: type of connective tissue which is
quite flexible and provides structure and support.
When there is an alteration in mobility, each body
system is at risk. Identify at least two hazards of
immobility for each area.
a.) Musculoskeletal changes:
i. Temporary or permanent immobility-
loss of muscle mass and strength-
Atrophy
ii. Increase rate of bone reabsorption
which causes calcium to be released
into blood and causes hypercalcemia

b.) Urinary elimination changes:

i. Urinary stasis- increase the risk of
urinary tract infection
ii. renal calculi (calcium stones)

c.) Integumentary changes:

i. Skin breakdown and infection
ii. Pain and pressure ulcers
Briefly explain the benefits of exercise: conditions
the body, improves health. Can be used to correct
a deformity or to restore overall body to a maximal
state of health.

Give a brief description and four trouble areas of

the side-lying position:

The nurse would expect all of the following

physiological effects of exercise on the body
systems except:
a.) Decreased cardiac output
b.) Increased respiratory rate and depth
c.) Increased muscle tone, size, and strength
d.) Change in metabolic rate
Answer: A
Rationale: Cardiac output is increased during
exercise because stroke volume and heart rate are
increasing. The heart is pumping out more blood
than normal to supply your skeletal muscle with a
sufficient amount of blood.
Simren:
Mobility refers to: the ability to move easily and
independently.
Ligaments are: A short band of tough, flexible,
fibrous connective tissue that connects two bones
or cartilages or holds together a joint
Tendons are: tough band of fibrous connective
tissue that connects muscle to bone
Cartilage is: type of connective tissue which is
quite flexible and provides structure and support.
When there is an alteration in mobility, each body
system is at risk. Identify at least two hazards of
immobility for each area.
d.) Musculoskeletal changes:
i. Temporary or permanent immobility-
loss of muscle mass and strength-
Atrophy
ii. Increase rate of bone reabsorption
which causes calcium to be released
into blood and causes hypercalcemia

e.) Urinary elimination changes:

 i. Urinary stasis- increase the risk of
urinary tract infection
ii. renal calculi (calcium stones)

f.) Integumentary changes:

i. Skin breakdown and infection
ii. Pain and pressure ulcers

Briefly explain the benefits of exercise: conditions

the body, improves health. Can be used to correct
a deformity or to restore overall body to a maximal
state of health.
The nurse would expect all of the following
physiological effects of exercise on the body
systems except:
e.) Decreased cardiac output
f.) Increased respiratory rate and depth
g.) Increased muscle tone, size, and strength
h.) Change in metabolic rate
Answer: A
Rationale: Cardiac output is increased during
exercise because stroke volume and heart rate are
increasing. The heart is pumping out more blood
than normal to supply your skeletal muscle with a
sufficient amount of blood.
Kayla:
Describe the following types of joints and give an
example of each.
a.) Synarthrotic joint: bone jointed to bone, no
movement (ex. sacrum)
b.) Cartilaginous joint: cartilage linking body
surfaces, little movement but are elastic
(ex. connecting ribs to costal cartilage)
c.) Fibrous joint: two bony surfaces connected
by a ligament or membrane, limited
movement (ex. tibia and fibula)
d.) Synovial joint: bony surfaces covered by
auricular cartilage and connected by
ligaments lined with a synovial membrane.
Freely moveable (ex. ball-and-socket joints
– hip joint and hinge joints – elbow)
When there is an alteration in mobility, each body
system is at risk. Identify at least two hazards of
immobility for each area.
 a.) Metabolic changes:
i. Calcium loss from bones
ii. Decreased gastric motility
b.) Respiratory changes:
i. High risk for respiratory complication
ii. Increased work of breathing
c.) Cardiovascular changes:
i. Increased cardiac workload
ii. Decreased venous return
List alternatives to manual lifting:
a.) Mechanical lift
b.) Friction reducing device (ex. placing client on
slider board)
c.) Have the client aid in the lifting process as
much as possible (ex. to reduce friction have them
cross their arms over their chest)
Give a brief description and list four trouble areas
of the prone position: The prone position is laying
chest down, face often turned to one side. A pillow
may be placed beneath the head or feet.
1. Neck hyperextension
2. Hyperextension of the lumbar spine
3. Plantar flexion of the ankles
4. Unprotected pressure points at chin, elbows,
hips, knees and toes.

Identify the steps the nurse should take to prepare

to assist a client to walk.

1. Assess the client’s activity tolerance, tolerance

to upright positioning, strength, level of pain,
coordination and balance to determine amount of
assistance needed.
2. Explain to client: the distance, when the walk is,
why walking is important, and who is helping them.

3. Check walking area for obstacles, make sure

there is enough room and establish rest points
(placing a chair or other support at the rest points)
4. Provide support at waist (clients center of
gravity) by placing both hands on clients waist or
using a gait belt.
5. Client should not lean to side, walk t the side
and slightly behind client.
Note 1: if client is unsteady at any point they
should return to nearby chair or bed.
Note 2: if client begins to fall, assume a wide base
of support with one foot in front of the other,
extend one leg and let client slide down that leg
and gently lower client to floor protecting the head.

Describe how the nurse assists clients with

hemiplegia (one sided paralysis) or hemiparesis
(one sided weakness) in walking.

Always stand on clients affected side and support

the client by holding one arm around clients waist
(or use a gait belt) and the other arm around the
inferior aspect of the clients upper arm so that your
hand is under the client’s axilla.
Jade:
List four functions of the skeletal system:
Support, Movement, Protection, Storage
Describe what pathological fractures are:
When a bone breaks in an area that is weakened
by another disease process. (ex: tumor)
Define bed rest:
Is an intervention that restricts clients to bed for
therapeutic reasons.
Impaired physical mobility is defined as:
A state in which the individual experiences, or is at
risk of experiencing, limitation of physical
movement.
Many health care agencies have a “no-lift” policy,
whereby manual lifting of the whole or a large part
of the weight of the client by a health care worker
is prohibited except for in exceptional or life-
threatening situations. Therefore, the nurse should
not attempt to lift a client without assistance
unless the client is a ___Infant?____ or ___In a
confined space?___ .

Give a brief description and list four trouble areas

of the supine position:
The position of the body on a horizontal line with
their frontal section facing upwards.
• Breathing difficulties

• Muscle Atrophy

• Integument changes

• Cardiovascular changes
Indicate the type of joint and range of motion
exercises for the body parts listed below:
BODY PART TYPE OF JOINT TYPE OF
MOVEMENT
Neck (Pivotal) Flexion, Extension, Hyperextension,
Lateral flexion, Rotation
Shoulder (Ball and Socket) Flexion, Extension,
Hyperextension, Internal/External Rotation,
Abduction, Adduction, Circumduction.
Elbow (Hinge) Flexion, Extension.
Forearm (Pivotal) Supination, Pronation.
Wrist (Condyloid) Flexion, Extension,
Hyperextension, Abduction, Adduction.
Fingers (Condyloid Hinge) Flexion, Extension,
Hyperextension, Abduction, Adduction.
Thumb (Saddle) Flexion, Extension,
Hyperextension, Abduction, Adduction, Opposition.
Hip (Ball and Socket) Flexion, Extension,
Hyperextension, Abduction, Adduction,
Internal/External Rotation, Circumduction.
Knee (Hinge) Flexion, Extension.
Ankle (Hinge) Dorsal/Plantar Flexion.
Foot (Gliding) Inversion, Eversion.
Toes (Condyloid) Flexion, Extension, Abduction,
Adduction.
Alyssa:
Define FRICTION: A force that occurs in a direction to
oppose movement.

List two techniques that minimize friction:

a.) minimize surface area; have the client cross
their arms in front of their chest
b.) lift upward instead of pushing or pulling
Briefly describe how posture and movement are
coordinated and regulated: some posture
abnormalities limit ROM. Nurses intervene to
maintain maximum ROM in unaffected joints and
can design interventions to improve affected joints
and muscles to improve posture and increase
mobility.
List 6 actual or potential nursing diagnoses related
to an immobilized or partially immobilized client.
a.) Activity intolerance
b.) Ineffective airway clearance
c.) Risk for fluid deficit
 d.) Impaired skin integrity
e.) Impaired urinary elimination
f.) Ineffective peripheral tissue perfusion

Indicate the correct use for each positioning device

listed:
-trochanter roll: prevents external rotation of the
hips when a client is in supine position. Fold a
cotton blanket lengthwise so that the width
extends from the greater trochanter of the femur
to the lower border of the popiteal space. Place
the blanket under the buttocks and roll both sides
counter-clockwise until the thigh is in a neutral or
slightly inward position.
-sandbag: sand-filled plastic tubes or bags that
immobilize and extremity or maintain body
alignment. They can be used in place of or along
with trochanter rolls.
-hand roll: prevents contractures by keeping the
hand of a paralyzed or unconscious in functional
position with the thumb slightly adducted and in
opposition to the fingers.
-hand-wrist splint: individually moulded for a client
and maintain slight adduction of the thumb and
slight extension of the wrist.
-trapeze bar: a triangular device that hangs from
an overhead bar attached to the bed frame; allows
the client to use their upper extremities to raise
their trunk and assist in movement from the bed.
It is also useful for arm exercises, upper body
strength and independence.
The goal of restorative care for the immobilized
client is to: maximize functional mobility and
independence and reduce residual functional
deficits such as impaired gait and decreased
endurance.

Which of the following is an appropriate

intervention to maintain the respiratory system of
the immobilized client?
a.) Turn the client every 4 hours
b.) Maintain a maximum fluid intake of 1500 mL
per day
c.) Apply an abdominal binder continuously
while in bed
 d.) Encourage the use of an incentive spirometer
Answer: encourage the use of an incentive
spirometer
Rationale: promotes voluntary deep breathing
which helps prevent atelectasis because it
promotes lung expansion and clears pulmonary
secretions.