MOBILITY AND ACTIVITY

 Mobility - The ability to move freely, easily, rhythmically

and purposefully
 Range of Motion - The ROM of the joint is the maximum
movement that is possible for that joint.
 Exercise - A type of physical activity defined as a planned,
structure and repetitive bodily movement done to improve
or maintain one or more components of physical fitness .
 Types of Exercise
 ISOTONIC - Dynamic exercise in which the muscle
shortens to produce contraction and movement
Ex. Running, walking, swimming, cycling

ISOMETRIC - Are those in which there is a change in

muscle tension but NO CHANGE in muscle length Tensing,
extending and pressing exercises
ISOKINETIC - Involves muscle contraction or tension
against a resistance
Aerobic exercise activity during which the amount of
oxygen taken into the body is greater than that used to
perform the activity.
 Benefits of Exercise
 Increases joint flexibility, tone and ROM
 Bone density is maintained
 Increases cardiac output and perfusion
 Prevents pooling of secretions in the lungs
 Improves appetite and facilitate peristalsis
 Elevates the metabolic rate
 Prevents stasis of urine
 Produces a sense of well-being
 IMPAIRED PHYSICAL MOBILITY
Complications of IMMOBILITY
1. Contractures, atrophy and stiffness
2. Foot drop
3. DVT
4. Hypostatic pneumonia
5. Pressure ulcers, skin breakdown, reduced skin turgor
6. Muscle atrophy
7. osteoporosis
8. dependent edema
9. urine stasis
10. constipation
ASSESSMENT
1. Assess patient’s ability to move
2. Assess muscle tone, strength
3. Assess joint movement and positioning
Nursing Interventions
1. Position properly to prevent contractures

 Place trochanter roll from the iliac crest to the mid-

thigh to prevent EXTERNAL rotation
 Place patient on wheelchair 90 degrees with the foot
resting flat on the floor/foot rest
 Place foot board or high-heeled shoes to prevent foot
drop
Nursing Interventions
2. Maintain muscle strength and joint
mobility
 Perform passive ROME
 Perform assistive ROME
 Perform active ROME
 Move the joints three times TID
Nursing Interventions
3. Promote independent mobility
 Warn patient of the orthostatic hypotension
when suddenly standing upright.
4. Assist patient with transfer
 Assess patient’s ability to participate
 Position yourself in front of the patient
 Lock the wheelchair or the bed wheel
 Use devices such as transfer boards, sliding
boards, trapeze and sheets
 Assist patient with transfer
 In general, the equipments are placed on the
side of the STRONGER , UNAFFECTED
body part .
 Nurses assist the patient to move
TOWARDS the stronger side
 In moving the patient, move to the direction
FACING the nurse
Nursing Interventions
5. Assist patient to prepare for ambulation
 Exercise such as quadriceps setting, gluteal
setting and arm push ups
 Use rubber ball for hand exercise
6. Assist patient in crutch ambulation
 Measure correct crutch length
LYING DOWN
 Measure from the Anterior Axillary Fold to the
HEEL of the foot then
Nursing Interventions
 Add 1 inch (Kozier)
 Add 2 inches (Brunner and Suddarth)
STANDING
 (Kozier) - Mark a distance of 2 inches to the side from
the tip of the toe (first mark), 6 inches is marked
(second mark) ahead from the first Measure 2 inches
below the axilla to the second mark
 Measure correct crutch length
 STANDING (Kozier) Make sure that the shoulder-rest
of the crutch is at least 1- 2 inches below the axilla
Assist patient in crutch ambulation
 Measure correct crutch length - Utilizing
the patient’s HEIGHT
 Height MINUS 40 cm or 16 inches
 Hand piece should allow 20-30 degrees
elbow flexion
Nursing Interventions
Assist patient in crutch GAIT
A. 4 point gait
B. three-point gait
C. two point gait
D. swing to gait
E. swing through gait
 GAIT
 4-point gait - Safest gait
 Requires weight bearing on both legs
 Move RIGHT crutch ahead (6 inches) Move LEFT foot
forward at the level of the RIGHT crutch Move the
LEFT crutch forward Move the RIGHT foot forward
 GAIT
3-point gait - Requires weight bearing on the
UNAFECTED leg
 Move BOTH crutches and the WEAKER LEG forward
 Move the STRONGER leg forward

2-point gait - Faster than 4-point

 Requires more balance
 Partial bearing on BOTH legs
 Move the LEFT crutch and RIGHT foot FORWARD
together
 Move the RIGHT crutch and LEFT foot forward together
Swing-to gait
Swing-to gait - Usually used by client with
paralysis of both legs
 Prolonged use results in atrophy of unused
muscle Move BOTH crutches together
 Lift body weight by the arms and swing to
the crutches (at the level)
Swing-through gait
 Swing-through gait - Move BOTH crutches
together Lift body weight by the arms and
swing forward, ahead of the crutches
(beyond the level)
Assist patient in ambulation with
a walker
 Correct height of the walker must allow a
20-30 degrees of elbow flexion.
Assist patient in ambulation with
a cane
 Assist patient in ambulation with a cane
Correct cane measurement:
 With elbow flexion of 30 degrees, measure
the length from the HAND to 6 inches
lateral to the tip of the 5 th toe.
 Nursing Interventions
IMPROVE MOBILITY
 Active and passive exercises
 Assistive exercise
Nursing Interventions
IMPROVE TISSUE PERFUSION
 Exercise and repositioning are the most important
activities : AVOID MASSAGE ON THE REDDENED
AREAS
Nursing Interventions IMPROVE
NUTRITIONAL STATUS

 HIGH protein , HIGH vitamin C diet Measure body

weight Assess hemoglobin and albumin

Nursing Interventions REDUCE FRICTION AND

SHEAR
 Lift and not drag patient Prevent the presence of
wrinkles and creases on bed sheets.
Nursing Interventions to REDUCE IRRITATING
MOISTURE
 Adhere to a meticulous skin care
 Promptly clean and dry the soiled areas
 Use mild soap and water
 Lotion may be applied
 AVOID powders (cause dryness)
 Positions
 Fowler’s Position - The Sitting position
 Fowler’s Position (Low Fowler’s, Semi-fowler’s, High
Fowler’s
 Orthopneic position The client sits in chair or bed,
with an over-bed table.
 Dorsal Recumbent . Back-lying position, with head
and shoulders SLIGHTLY elevated
 Prone The client lies on the abdomen with the head
usually turned to one side.
 Positions
 Lateral . Side-lying position
 Sims – (Semi-prone position )
 Support Devices
 Pillows.
 Mattresses
 Suspension or heel guard boot.
 Hand roll.
 Abduction pillow.
 Support Devices
Pillows The Slipp® Patient Mover
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 Support Devices
Suspension boot Heel guard
 Support Devices
FootBoard Chair Bed
 Support Devices
TROCHANTER
ROLLTROCHANTER
TTROLL Trochanter Rol
TRANSFER TRANSFER BELTBELT
.
 OVER BED TABLE
.
 STRETCHER
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STRETCHER
 Wheelchair
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