Summarize the following text to main points and sub-points and make detailed explain for them:

 Patient Mobility and Immobility 
 
ILO's  
 
1-Explain factors that contribute to the amount of 
disability  
2- List the predisposing factors and causes  of 
immobilization 
3-Explain the Pathophysiology of immobilization and 
discus the effect of immobilization on body system. 
4-Discuss  the nursing care for immobilized patient 
according   to ABC, Hs. 
5-Apply the general nursing care for immobilized patient 
on the clinical area. 
MOBILITY AND IMMOBILITY 
 
Introduction 
 A mobile person generally turns approximately 
once every 10-12 minutes while sleeping. This 
action provides for healthy blood circulation, 
stimulation of body organs and movement of 
body 
fluids. 
When 
a 
person 
becomes 
temporarily or permanently immobilized, major 
problems will occur.  
 
Key Terms:  
 
Mobility  
        It is a person ability to move freely in his or her environment. 
 
Immobility :                  
       Immobility occurs when a person is unable to independently 
move or change position, or movement is restricted for medical 
reasons . 
   Mobility _________________________ Immobility 
                          Immobility continuum  
Bed rest : 
Is an intervention in which the patient is restricted to bed 
for therapeutic reasons such as; 
 reducing physical activity and the oxygen needs of the 
body. 
 allowing ill or debilitating patients to rest & regain 
strength. 
 preventing further injury to traumatizes structure (e.g. 
spinal & vertebral injury).  
Most Common Causes and risk 
factors of immobility 
 
Musculature, joint &skeleton 
problems 
 arthritis 
 Osteoporosis 
 fractures (especially hip & femur) 
Neurological problems 
 cerebro-vascular stroke 
 parkison’s disease 
 cerebellar dysfunction 
 neuropathies 
Heart, lung & circulation 
problems 
 chronic coronary heart disease 
 chronic obstructive lung disease 
 sever heart failure 
 peripheral vascular disease 
Cognitive, psychological & 
sensory problems 
 dementia 
 depression 
 Fear & anxiety (e.g. Fear from 
instability & falling 
 pain       
 impaired vision 
Environmental causes 
 forced immobilization (restrain    
   use) 
 restricted space (bed, ICU) 
 devices applied to body (cast, splint,  
   traction ) 
Others 
 general weakness after prolonged  
   bed rest 
 malnutrition  
 drug side effects 
 Severe illness of any type 
Purpose of Mobility: 
1- Expressing emotion 
2- Self defence. 
3- Attaining basic needs. 
4- Performing recreational activities. 
5- Completing activities of daily living (ADLs). 
6- Maintaining the body's normal physiological activities. 
7- Maintain normal physical motility, the nervous muscular and 
skeletal systems of the body must be intact, functioning and 
used regularly. 
 
Factors that contribute to the amount of disability: 
1- The degree of immobility 
 2- Length of immobilization 
 3- Severity of illness 
 4- Emotional state of the client  
 5- The client’s premorbid physical condition 
 6- The client age 
 
Predisposing factors and causes of immobility : 
1-  Physical : 
              e.g. sever pain, sensory changes 
reducing the physical stimulus to move, 
paralysis 
2- Social: 
             e.g. Insecurity 
3- Emotional: 
             e.g. Sadness, depression, isolation 
4- Mental : 
             e.g. phobia  
5- Environmental: 
            e.g. Bed, chair, cast, splint 
 
• N.B.  
            Immobility  =  Stagnation = Stasis  
1- Respiratory System 
• Effects 
 Decreased lung expansion 
 Decreased surface area for exchange of CO2 
and O2 (secondary to lung expansion) 
 Decreased haemoglobin level 
 Respiratory muscle weakness 
 Stasis of secretions 
 Hypostatic pneumonia 
 Atelelctasis 
Effect of recumbence and gravity on 
distribution of respiratory tract and 
diameter of bronchiolar lumen 
Pooling of secretions 
in the supine position  
Respiratory System 
Respiratory assessment 
          (performed every 2hours) 
◦Assess respirations every 2 hrs 
◦Observe chest movements 
◦Auscultate for pulmonary secretions 
◦Check O2 saturations 
◦Observe for respiratory difficulties 
Respiratory interventions 
◦Maintain patent airway 
◦Changing the patient’s position every 11 to 12 min. (the minimum 
timing for turning is every 2 hours) 
◦ increase fluid intake (2000 ml/day) if not contraindicated 
◦ coughing and breathing exercises 
◦Chest physiotherapy (CPT) 
◦Encourge incentive spirometer if ordered 
2- Cardiovascular System 
• Effects 
 Orthostatic hypotension 
 Increased cardiac workload 
 Thrombus formation 
• May become emboli 
• Most dangerous complication of bed rest 
 Valsalva maneuver 
Thrombus formation in a vessel 
Cardiovascular System 
•  Assessment 
 BP measurements with postural changes 
 Monitor pulse 
 Check temperature of extremities  
 Monitor for edema 
 Watch for s/s of Deep Venous 
Thrombosis(DVT) (Homan’s sign) 
– Passively dorsiflex the foot and check if the 
client complaining of pain in the posterior calf 
– Also note if there is any erythema, warmth, 
and/or tenderness to palpation 
 
 
Cardiovascular System 
• Interventions 
– “Dangling” feet before standing 
– Discourage valsalva 
– Prevent venous stasis 
• ROM exercises (isometric exercises) 
• Prevent pressure on the posterior knee 
and deep vein in the lower extremities 
avoiding crossing the legs and not wearing 
tight cloths 
– Anti-embolic stockings  
• Never massage extremities 
• Observe for s/s DVTs (warmth, redness, 
+Homans’ sign) 
3- Gastrointestinal System 
• Effects 
Decrease in appetite  
 Decrease in peristalsis. 
 Nausea/ vomiting 
 Gas 
 Indigestion 
 Constipation 
 Fecal impaction 
Gastrointestinal System 
Assessment 
Check bowel sound every shift 
Check bowel movement frequency with patient 
Check intake and output every 8 hrs 
Check percentage of meals taken—assess appetite 
Assess protein and albumin levels in the labs 
Observe for passage of liquid stool 
Interventions 
Record appetite at each meal percentage of eaten 
Be sure to include patient’s likes and dislikes 
A diet rich in fruits and vegetables  
Encourage fluids 
Administer stool softener & enemas as ordered 
Digital removal of fecal impactions 
4- Genitourinary System 
• Effects 
Urinary Stasis 
 Renal Calculi 
 Decreased urinary output 
Urinary tract infection 
 Decrease Bladder muscle tone 
Stasis of 
urine  
Renal calculi 
Genitourinary System 
Assessment 
◦Assess the frequency, color, odor, clarity and 
amount of urinary output 
◦Monitor vital signs every 4 hrs 
◦Intake and Output (I & O) measurement 
◦Signs and symptoms of UTI 
Interventions 
◦Keeping the patient well hydrated without causing 
bladder distention 
◦Proper perineal care 
◦Record I & O 
◦Bladder training in case of urinary incontinence 
5- Metabolic System 
• Immobility causes 
 Decrease in BMR.  
 Altered metabolism of carbohydrates, 
fats, and proteins.  
 Fluid and electrolyte imbalances. 
 Increase bone resorption (bone loss). 
gastrointestinal disturbances 
 
Metabolic System 
Metabolic System 
• Metabolic assessment 
– Anthropometric measurements (height, weight, mid arm 
circumference & triceps skin fold). 
– Fluid Intake and Output measurements 
– Lab tests for electrolyte imbalances/ nutritional status 
– Assess ability to heal and fight infection 
• Metabolic interventions 
– High protein, high calorie diet 
– Supplemental vitamin C  
– Vitamin B complex 
6- Musculoskeletal System 
• Effects 
– Decreased muscle mass 
– Muscular atrophy 
– Reduced muscle endurance 
– Decreased stability 
– Joint contractures 
– Disuse osteoporosis 
– Decreased skeletal mass 
Contracture 
of the elbow 
Footdrop 
Musculskeletal System 
Assessment 
◦Anthropometric measurements 
◦ROM measurements 
◦Check urine and serum for CALCIUM levels 
◦Check for contractures 
 
Interventions 
◦Active and passive ROM 
◦Put joints in functional position 
◦Early ambulation or turning 
◦Warm moist packs over inflamed joints 
Pressure on the skin + poor circulation Ischemia                 
skin breakdown (Pressure ulcer) 
N.B.  
    The pressure sores an develop over bony prominence 
pressing against any surface (e.g. bed or chair ) 
So 
    The longer the pressure is applied, the longer the 
period of ischemia and therefore the greater the risk 
of skin breakdown  
7- Integument changes : 
Integumentary System 
Assessment 
Check skin for breakdown and or erythema every 
2 hrs 
Observe for sensory loss at every skin check 
Check labs for anemia, protein and albumin 
levels, WBC levels 
Monitor for signs of infection 
 Observe for skin breakdown 
Stage 1 
Stage 2 
Stage 3 
Stage 4 
 
Integumentary System 
Interventions 
– Prevention 
• Identify at risk clients 
• Daily skin exam 
• Change positions every 2 hours 
• Massage 
• Skin care products (lubricate and protect) 
• Stimulate circulation 
– Pressure support devices Use such as 
therapeutic mattresses 
 
Integumentary System 
• Treat skin breakdowns 
– Keep area dry and clean 

Summary :