mobility

Mobility &Body Mechanism

Mobility: the ability to move freely, easily,

rhythmically, and purposefully in the environment, is ane ssential part of living.

Normal movement:

Normal movement and stability are the result of an intactm usculoskeletal system, an intact nervous system, andi ntact inner ear structures which responsible for

equilibrium.

Normal body movement involves four basic elements:

body alignment and( Posture), joint mobility, balance, and coordinatedm ovement.

1- Alignment and posture: proper body alignment andp osture bring body parts in to position in a manner thatp romotes optimal balance and function whether the clienti s standing, sitting, or lying down.

Line of gravity: an imaginary vertical line drawn throught he body s center gravity pass through the point at which

all of the body mass is centered.

2- Balance: mechanisms of equilibrium (sense of balance)

3- Coordination: balance, smooth, purposeful movement,

it's the result of the proper functioning of the nervess systems

4- Range of motion (ROM): is the maximum movementt hat is possible for that joint. It varies from one person too ther by genetic makeup, developmental patterns,

presence and absence of disease and the amount ofp hysical activities in which the person normally engageW hen a person is inactive, the joints are pulled into a

flexed position, if the tendency is not counteracted withe xercise and position changes, the muscle permanently

shorten, and the joint becomes fixed.

Types of joint movement are:

Flexion: decreasing the angle of the joint.

Extension: increasing the angle of the joint.

Hyper extension: further extension of the joint.

Abduction: movement of the bone away from the midline of the body.

Adduction: movement of the bone toward the midline oft he body.

Rotation: movement of the bone around its center axis

Circumduction : movement of the distal part of the bone

in a circle while the proximal end remain fixed .

Eversion : turning the sole of the foot outward bym oving the ankle joint .

Inversion: turning the sole of the foot inward by movingt he ankle joint.

Pronation : moving of the bones of the forearm so thatt he palm of the hand face the body .

Supination : moving of the bones of the forearm so that

the palm of the hand faces upward when held in front of

the body .

Activity & Exercis

Daily Living Activity (DLAs): activities which carried out during a routine day independently including the following (DLAsDLAs)

*Eating

*Dressing/

grooming

*Bathing

*Toileting

*Ambulating

*Transferring

*Cooking

*Housholding

*Shopping

Isotonic exer cise (dynamic): are those in which them uscle shortens to produce muscle contraction and activem ovement, such as, running, walking, cycling, ADLs,

and active exercise.

Active Exercise: Is isotonic exercise in which the clientm oves each joint in the body through its complete range of movement.

Passive Exercise: another person move each of thec lient joint through its complete range of movement, its hould be performed only when the client is unable to accomplish the movement actively. The movements hould be systematic, and the same sequence should bef ollowed during each exercise

Effects of Immobility on Body Systems

The most obvious signs of prolonged immobility are often manifested in the musculoskeletal system. Clients

experience a significant decrease in muscular strength and agility whenever they do not maintain a moderate

amount of physical activity. In addition immobility also affects the cardiovascular, respiratory, and urinary and psychoneurologic system .Nurses needs to understand these effects and encourage client movement as much as possible.

1. Musculoskeletal system:

Disuse osteoporosis: demineralization process take place in the bones calcium, the bones became spongy and may gradually deform and fracture easily

Disuse Atrophy: unused muscles atrophy (decrease in size), losing most of their strength and normal function
Contracture: it's permanent shortening of the muscles which limiting joint mobility, its effect the tendons, ligaments and joint capsules such as (foot drop, external hip rotation) Stiffness & pain: as the bone demineralization excess calcium may deposit in the joints contributing to stiffness and pain

2. Cardiovascular System:

Diminished cardiac reserve : decrease mobility create an imbalance in the autonomic nerves system ,increase heart rate , rapid heart rate reduce diastolic pressure ,coronary blood flow and capacity of heart respond to any dbecause, because of that the person may experience tachycardia with minimal exertion

Increased use of Valsalva maneuver : (Valsalvamaneuver)refer to holding the breath and straining against a closed glottis , client hold their breath when move up in bed ,sit on bedpan ,which buildup pressure on the large veins of thorax to interfere with the return blood flow to the heart and coronary arteries ,when exhales sudden blood flow reach the heart causing tachycardia and cardiac arrhythmia

Interstitial edema: when the venous pressure is great,

some serous of the blood is found out of the blood into the interstitial spaces surrounding the blood vessel,causing edema is most likely occur around the sacrum or heels of client who sits up in bed or in feet and and lower legs of a client who sits in a chair. Poor blood flow to the

heart case more pooling and more susceptible to injury than normal tissue.

Thrombus formation:

Thrombophlebitis: a clot take is loosely attached to an inflamed vein wall caused by:

1- Impaired venous return to the heart.

2- Hyper coagulation of the blood.

3- Injury to vessel wall.

*Thrombus: clot, which breaks loose form the vein wall to enter the general circulation.

*Embolus: an object that moved from its place to another

causing obstruction of circulation such s (pulmonary.

Cerebral, Renal embolism

3. Respiratory System:

Decreased respiratory movement:

In a recumbent, immobile client the ventilation of the lungs limited because the abdominal organs push against the diaphragm, restricting the lay movement and making

it difficult to expand, and over all muscle atrophy also affects the respiratory muscles.

These changes produce shallow respiration & reduce vital capacity (the maximum amount of air that can be exhaled after a maximum inhalation).

Pooling of respiratory secretion:

Inactivity allows secretions to pool by gravity interfering with normal gas exchange, the ability to cough up secretion may also be hindered by loss of respiratory muscle tone, dehydration which thickens secretion & sedation that depress the cough reflex. All that lead of poor oxygen fun retention of carbon d oxide in the blood causing respiratory acidosis which is left at disorder.

Atelectasis: when ventilation is decreased pooled secretions Accumulate in a dependent area of a bronchiole and effecting block it and the combination of decreased surfactant (ability of the alveoli to remain open) and blockage of a bronchiole with mucus can causes collapse of the lung lobe.

Hypostatic pneumonia : pooled secretions provide excellent media for bacterial growth, upper respiratory infection can evolved rapidly to sever infection of the lower respiratory trait penumbra caused by static secretion which severely impair oxygen-carbon d oxide exchange in the alveoli.

4. Metabolic system:

Decrease metabolic rate :

Basal metabolic rate : is the minimal energy expended for the maintenance of these produce from the physical andc hemical process of the body.

In immobile person the basal metabolic rate andg astrointestinal motility as the energy requirement of the

body decrease.

Negative nitr ogen balance:

In active person a balance exists between protein synthesis (anabolism) & protein breakdown (catabolism).

Immobility increase catabolism (muscle mass release snitrogen) so more nitrogen is excreted than is ingested leading to negative nitrogen balance which effecting thee ssential building of muscle & tissue& for wound healing.

Anorexia : loss of appetite occurs because of the decrease metabolic rate. Negative calcium balance: Greater amount of calcium loss from bones .The absence of weight-bearing & stress on the

musculoskeletal structure is the direct cause of the calcium loss from bones.

5. Urinary system:

Urinary stasis : immobilization cause overall decrease in muscle tone so the bladder empting is not as complete

Renal Calculi: In mobile person calcium remain dissolved because calcium & citric acid are balanced in acid urine. In immobile person the balance not longer maintain the urine become more alkaline so the calcium salts precipitate out as crystals to from renal calculi. The stone usually develop in the renal pelvis & pass through the ureters into the bladder causing pain bleeding

& sometime obstruction of the urinary tract

Urinary retention: accumulation of urine in the bladder.

Urinary infection: static urine provides an excellent medium for bacterial growth.

6. Gastrointestinal system:

Constipation : decreased peristalsis overall muscle weakness affects the abdominal & perineal muscle usedin defecation. When the stool becomes very hard more strength is required to expel it. Excessive used of the valsalva maneuver by straining at stool, this effort increase intra-abdominal & intrathoracic pressure which cause stress on the heart & circulatory system.

7. Integumentar y system:

Reduce skin turgor : the health of the dermis & subcutaneous tissue can affect by shifting in body fluids between the fluid compartments & skin atrophy.

Pressure ulcers (skin breakdown): caused by poor blood flow &diminishes supplement of nutrients to specific

area.

8. Psychoneurologic system:

The participation of the immobile client in the life event comes narrow so, time perception & problem-solving,

decision making abilities may deteriorate as a result of lack of intellectual stimulation, in addition to that loss of control & stress of illness increase client's anxiety.in defecation. When the stool becomes very hard more strength is required to expel it. Excessive used of the valsalva maneuver by straining at stool, this effort increase intra-abdominal & intrathoracic pressure which cause stress on the heart & circulatory system.