Chapter 25

Mobility
Introduction to Mobility
 Mobility: The ability to move freely within the
environment.
 Fundamental to normal daily functioning, as it affects
ability to perform ADLs as well as job- and role-related
activities.
 Movement is significant in stress-release, protection, and
self-concept.
 The musculoskeletal system is the supporting framework
for the body and vital to mobility.

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Musculoskeletal System Components
 Bones: The framework on which muscles, tendons, and
ligaments are attached.

 Muscles: Skeletal muscles are composed of striated, long

muscle fibers that are connected to bones at or across
joints.

 Joints: Joints are the areas where bones meet. Ligaments

and tendons connect and support the joints.

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Physiologic Functioning in Mobility #1
Alignment and posture: Alignment is achieved when
the joints and muscles are not experiencing extremes in
extension or flexion or unusual stress; upright posture
and movement require a balanced center of gravity.
Balance: Maintaining balance is a complex function of
counteracting gravity and coordinating reflexes to
maintain posture.
Coordinated movement: The cerebellum, cerebral
cortex, and basal ganglia are responsible for the control of
motor functions.

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Physiologic Functioning in Mobility #2

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Physiologic Functioning in Mobility #3
Body mechanics: Using alignment, posture, and balance
in a coordinated effort to perform activities such as lifting,
bending, and moving.
o Principles of body mechanics.
o General rules of body mechanics:
 Assess the situation carefully before acting.
 Use the large muscle groups of the legs.
 Work at the appropriate height for body position.
 Use mechanical lifts or assistance when possible.

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Physiologic Functioning in Mobility #4
Exercise: Exercise that actively requires alignment,
posture, balance, and coordinated movement offers
physiologic and psychological benefits.
o Types of exercise: Aerobic, anaerobic, isotonic, and
isometric
o Benefits of exercise
Characteristics of normal movement
o Full range of motion
o Normal gait

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Factors Affecting Mobility
 Lifestyle and habits
 Intact musculoskeletal system
 Nervous system control
 Circulation and oxygenation
 Energy
 Congenital problems
 Affective disorders
 Therapeutic modalities

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Manifestations of Altered Mobility
Decreased muscle strength and tone
Lack of coordination
Falls
Decreased joint flexibility
Pain on movement
Activity intolerance

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Impact of Immobility on Function #1
Muscle atrophy and weakness
Contractures and joint pain
Increased cardiac workload
Orthostatic hypotension
Thrombus formation and embolism
Decreased lung expansion

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Impact of Immobility on Function #2
Disuse osteoporosis
Pressure ulcers
Urinary tract infection
Renal calculi
Constipation
Sleep and rest disturbance

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Impact of Immobility on Function

 Cognition and pain

 Self-perception and self-concept

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Assessment: Normal Pattern
Identification
 Patient's normal activity pattern and any recent changes
should be determined; exercise, and type of
employment, and leisure activities should be included.

 Satisfaction with current activity level pattern and

motivation to change should be noted.

 Rating scales may be useful for documenting level of

independence for tasks requiring mobility.

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Assessment: Risk Identification
 Assess for weakness, fatigue or distressing symptoms
after routine exercise or activities.

 Assess for fall risk.

 Assess for presence of current or chronic health problems

that may limit mobility or decrease activity tolerance.

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Assessment: Dysfunction Identification
 Upon first contact, document any inability to move
normally and easily and reassess for changes.
 If change occurs, determine the extent of the problem,
when it first occurred, and if the cause is known by the
patient.
 Determine whether assistive devices for ambulation are
used.
 A comprehensive functional health assessment should be
performed to determine the impact of decreased mobility.

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Assessment: Physical Assessment
Alignment
Balance
Coordination
Gait
Joint structure and function
Muscle mass, tone, and strength
Postural blood pressure
Activity tolerance

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Assessment: Diagnostic Tests and
Procedures
Radiographic studies: X-rays, arthrograms,
myelograms, bone mineral density testing.

Arthroscopy: Examination of a joint with a fiber-optic

instrument.

Hematologic studies: Hemoglobin and hematocrit

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Nursing Diagnoses Related to Mobility
 Impaired physical mobility
 Impaired walking
 Impaired wheelchair mobility
 Impaired transfer ability
 Impaired bed mobility
 Activity intolerance
 Risk for falls
 Risk for disuse syndrome

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Implementation: Health Promotion and
Injury Prevention Education

Physical fitness promotion

Osteoporosis prevention

Injury prevention

Fall prevention

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Implementation: Patient Positioning
 Therapeutic positioning:
o Supine, Fowler's, semi-Fowler's, prone, side-lying,
and Sims’

o Turning schedules

o Logrolling
 Care of patients after hip surgery

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Implementation: Maintenance of Joint
Mobility

 Types of range of motion exercises.

 General principles of range of motion exercises.

 Automatic range of motion equipment.

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Implementation: Ambulation
 Pre-ambulation interventions:
o Muscle strengthening
o Dangling the legs
 Ambulation assistance
o Transfer belts
 Ambulation aids
o Walkers
o Canes and Quad canes
o Crutches

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Transferring and Lifting Patients Safely

 Lift teams

 Hydraulic lifts

 Ceiling lifts

 Stand-up assist lifts

 Two- or three-person lifts

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Community-Based Interventions
 Patient teaching: Use of safe transfer techniques,
ambulation techniques, and special equipment (both
patient and family/caregiver)

 Environmental assessment and modification

 Community resources

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Mobility elderly
 How much physical activity do older adults need?
| Physical Activity | CDC

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