Immobility & Body Mechanics


Oct 24, 2013 (4 years and 8 months ago)


Immobility & Body Mechanics

Refers to the ability to engage in activity and
free movement, which includes walking,
running, sitting, standing, lifting, pushing,
pulling and performing ADLs (Activities of
Daily Living)

Is a therapeutic intervention that achieves:

Rest for client’s who are exhausted

Decreases body’s O2 consumption

Reduces pain and discomfort

To reverse effects of gravity
abdominal hernia

After 48 hr of bed rest
structural changes in joints
and shorten muscles occur

7 days are needed to restore function lost after 1
day of bed rest (Eliopoulos, 1999)

Metabolic: decrease in BMR r/t decreased
energy requirements, which is directly r/t
cellular 02 demands

Results in > % body fat & loss of lean body

Altered carbohydrates ,proteins, fats

Fluid and electrolyte imbalances

Orthostatic hypotension due to prolonged bed rest.
Drop of 15 mm Hg or more in systolic BP with
position change

Decrease circulating volume, pooling of blood in
lower extremities(edema), decreased autonomic
response results in decrease in venous return,
central venous pressure, stroke volume, increase in
HR=>>>cardiac workload,02 demand

Due to stasis >>> risk thrombus formation

Increase activity slowly but progressively

Avoid crossing legs, pressure behind knee

Encourage antiembolic leg exercises q 2
hours, other isometric exercises

Ant embolic hose

Gradually raise client noting BP, HR, assess

Decrease in lung expansion, generalized
respiratory muscle weakness, and stasis of

Decreased hemoglobin levels

collapse of alveoli resulting in
decrease of 02 / C02 exchange

Hypostatic pneumonia

inflammation of the
lung from stasis or pooling of secretions

Change of position q 1

2 hr which
allows elastic recoil property of lungs
and clears dependent lung secretions

Cough and deep breath q 2 hr, incentive
spirometry, chest physiotherapy

Fluids to 3000 ml / 24 h to thin

Decrease in appetite, peristalsis, constipation

NI: high fiber foods, fluids to 3000 ml/24hr

Small frequent foods of choice

Monitor bowel sounds q shift

Monitor bowel patterns 24 hours

Stool softeners daily as ordered

Muscle atrophy

Loss of strength and decreased endurance

Joint contractures

Decreased stability or balance

Disuse osteoporosis, a disorder characterized
by bone reabsorption
results from impaired
calcium metabolism

Frequent ROM: active, passive, active assist q
4 hours

Develop an individualized progressive
exercise program

Isometric and isotonic exercises q 4 hours

Urine formed by the kidney must enter the
bladder against gravity due to recumbent

Ureters insufficient to overcome gravity, renal
pelvis may fill with urine
urinary stasis which
increases risk for UTI & renal calculi

Renal calculi
calcium stones lodged in in
renal pelvis and pass through ureters

Position change q 1
2 hours

Position 30 degrees of higher to enhance
gravitational forces required for normal urine
flow through kidney, ureters, bladder

I & O q 8 hours

Fluids to 3000 ml 24 hours

RD for diet plan r/t calcium intake

Increase isolation, passive behavior, changes
in sleep/wake cycles, stressors, sensory

Decrease in self
identity, self
esteem, coping

Anticipate changes
provide routine and
informal socialization

interact with staff q
2 hours

Place in room with others

Encourage family and friends to visit

Activity and recreational consult

Schedule nursing cares from 10pm
7am to
minimize interruptions

Increase in dependence

Regression in development

NI: care should stimulate client mentally,
focus on activities that promote cognitive
awareness, allow client to make care
decisions, allow to be as independent as
condition permits

Previously called: a decubitus ulcer

A pressure sore

A pressure ulcer

A bedsore

is a wound caused by unrelieved pressure
that damages underlying tissue

Jury still out: caused by external pressure
transmitted inward or from the bone and proceeds

Pressure ulcers is a wound caused by unrelieved
pressure that damages underlying tissue.

The pressure interferes with the tissue blood
supply, leading to vascular compromise, tissue
anoxia, and cell death

Tend to be located over bony prominences:
*elbows, posterior calf, *sacrum/coccyx ischial
tuberosities, trochanter, lateral malleous, *heel,
lateral edge of foot also: ears, occiput, great toe

AHCPR: Agency for Health Care Policy and
Research establish guidelines to identify at
risk individuals needing prevention and the
specific factors placing them at risk

Risk assessment tool: Braden Scale or Norton
Scale are most commonly used.

Assesses sensory perception: ability to
respond meaningfully to pressure

Moisture: degree to which skin is exposed to

Activity: degree of physical activity

Mobility: ability to change and control body

Nutrition: usual intake pattern

Friction and Shear:

Each category measured from 1
4 with low
score having most limitation

Overall score: Maximum of 23, little or no risk
A score of 16 or < indicates ‘at risk”
A score of 9 or < indicates ‘high risk”

Implement preventive measures for ‘at risk’
and ‘high risk’ clients

Tissue ischemia is localized absence of blood
or major reduction of resulting in mechanical
obstruction. The reduction of blood floe
caused blanching (to become pale

When obstruction of blood flow is removed
normally there will be reactive hyperemia, the
blood vessels dilate and skin is red

Will last for less than 1 hr and is effective

only if there is no necrosis of tissue

Abnormal reactive hyperemia is an excessive
vasodilatation and induration in response to

Skin appears bright pink and there is
localized edema under the skin

may last up
to 2 weeks after pressure is removed

Shearing force: sliding down in bed

Friction: linens on the bed

Moisture: diaphoresis urine, wounds, feces

Poor nutrition: neg nitrogen balance

Anemia: < 02 carrying capacity

Obesity: poor vascular supply, weight

Age: epidermis thins with age, < blood flow

LOC: drowsy, sedated, comatose=1position

Non blanchable erythema of intact skin.

Does not resolve in 30 minutes but remains
for longer than 2 hours after pressure is

This occurs as an acute inflammatory
response involving the epidermis

There is partial thickness loss

Pressure area appears as an abrasion, blister,
or shallow crater surrounded by erythema
and induration

Ulcer involves full
thickness tissue
destruction involving subcutaneous tissue, as
well as epidermis and dermis

The muscle layer is in tact

Requires Wound Nurse consult, may require
surgical intervention

Includes all of above changes, plus, extensive
damage involving muscle, bone, or
supporting structures such as tendons or
joint capsule

Requires Wound Nurse consult and surgical

Emphasis is on prevention !!!

Autolysis: uses body’s own enzymes and
moisture to re
hydrate, soften and liquefy
necrotic tissue

Use occlusive or semi
occlusive dressings:
hydrocolloids, hydrogels, transparent films

Used with wounds with little drainage and

Very selective, with no damage to
surrounding skin

Safe, using the body’s own defense
mechanisms to clean the wound of necrotic

Effective, versatile and easy to perform

Little or no pain for the client

Not as rapid as surgical debridement

Wound must be monitored closely for signs
of infection

May promote anaerobic growth if an occlusive
hydrocolloidal is used

Chemical enzymes are fast acting products
that produce slough of necrotic tissue. Some
enzymatic debriders are selective, while some
are not.

Best uses: on any wound with a large amount
of necrotic tissue

Escar formation

Fast acting

Minimal or no damage to healthy tissue with
proper application


Requires a prescription

Application must be performed carefully only
to necrotic tissue

May require secondary dressing

Inflammation or discomfort may occur

Uses force to remove necrotic tissue, for
example wet
dry, whirlpool treatment, or
wound irrigation devices

Cost of the actual material is low

May traumatize healthy or healing tissue

Time consuming

Can be painful

Hydrotherapy can cause tissue maceration
and water borne pathogens may cause
contamination or infection

Disinfecting additives may harm health

Cutting dead tissue away from the wound

Considered the fastest and most effective
type of debridement

Can be done at bedside, surgical suite, or in
an outpatient setting

Should be considered when infection such as
cellulitis or sepsis suspected

Wounds with a large amount of necrotic

Used in conjunction with infected tissue

Fast and selective

Cant be extremely effective


Costly, esp if operating room is required

Requires transport of client to OR

Maggot larvae placed in wound and ingests
the microorganisms

Used extensively in Europe and is gaining
popularity in the US

Develop and post a turning schedule

Use a pressure
reducing devices

Assess pressure points daily

After urinating or stooling cleanse, rinse, dry

Establish a bowel/bladder program


Monitor intake and output q 8 hr

Use trapeze and foot boards

Protect friction
prone areas

Proper diet: good protein intake, Vitamin C,
supplements between meals if necessary

Use lift sheets, hoyer lift, smooth roller

Personal hygiene measures

keep clean dry and
linens wrinkle free.

Avoid use of alkaline and deodorant soaps due to
dryness. Use emollients to preserve natural state
of skin moisture

Coordinated effort
of the
system to maintain
posture, balance,
and body alignment
during lifting,
bending, etc.

Refers to the relationship of
body parts to one another.

Reduces muscle strain

Maintains muscle tone

Contributes to balance

Contributes to “system”

Directly related to alignment
and achieved when:

COG is low

Stable (wide) base of support

Vertical line from COG thru
base of support

Imaginary vertical line which goes thru center
of body

Point at which all of
the mass of an
object is centered;
in the adult, who is
in a standing
position it is in the

Foundation of an object

To stabilize: lower your
center of gravity and
broaden your base of

Force exerted by gravity on the

Force that occurs in a direction to oppose

Reduce surface area

Passive object
produces more

Lift rather than pull

Use wide base of support

Keep COG low

Keep line of gravity passing through base of

Face direction of movement when possible

Roll, pull, push objects rather than

Use largest & strongest muscles

Keep object close to COG

Reduce area of contact

Move object on flat level, smooth

Bed: Deep breath, neck rolls, knees to chest, pelvic
tilts, head raising, leg lifts, foot dorsi and planter
flex, ankle rotations, rolling, arms over head, side
to side, palms up and rotate

Chair: deep breathing, head rolls, knee to chest,
head to knees, shoulder rolls, hands on head, leg
lifts, ankle rotation, push down of legs, lean
forward, lift up.

Use Thera bands handball

Refers to the presence of a blood clot in one
of the veins

Risks: prescribed bedrest

General anesthesia for client’s > 40 years of age

Leg trauma resulting in immobilization

Previous venous insufficiency


Oral contraceptives


Anti embolic hose: TED are effective in
providing support to vasculature while client
is in bed

Compression Hose: JOBST are effective in
providing support to vasculature while client
is ambulatory

ALWAYS apply BEFORE client
gets out of bed in the AM. Often removed at