Chapter 39: Immobility and Patient Mobility Care

Immobility and Patient Mobility Care defines mobility as a continuum ranging from full movement to complete immobility, often necessitating therapeutic bed rest which can paradoxically lead to severe deconditioning. The content extensively details the systemic hazards of immobility, beginning with metabolic changes such as negative nitrogen balance, tissue catabolism, calcium resorption leading to hypercalcemia, and gastrointestinal disturbances like constipation and fecal impaction. Respiratory complications are highlighted as major risks, specifically atelectasis (alveolar collapse) and hypostatic pneumonia caused by pooling secretions and decreased cough reflex. The cardiovascular section explains the development of orthostatic hypotension, increased cardiac workload, and the formation of thrombi based on the Virchow triad (vessel wall damage, blood flow stasis, and hypercoagulability), potentially resulting in deep vein thrombosis and pulmonary embolisms. Musculoskeletal effects include disuse atrophy, loss of lean body mass, disuse osteoporosis increasing the risk of pathological fractures, and joint contractures such as foot drop. Further physiological impacts cover urinary stasis contributing to renal calculi and infection, as well as integumentary breakdown resulting in pressure injuries due to ischemia, shear, and friction. Psychosocial and developmental dimensions are also explored, noting risks for depression, sensory deprivation, social isolation, and functional decline, particularly in older adults. The chapter outlines the nursing process for immobile patients, detailing assessment techniques for range of motion (active, active-assisted, and passive), gait, activity tolerance, and body alignment in standing, sitting, and lying positions. It provides evidence-based interventions for prevention and restorative care, including safe patient handling algorithms to prevent work-related injuries, proper positioning techniques like the supported Fowler, supine, prone, logrolling, and thirty-degree lateral positions, and the use of mechanical aids like trapeze bars and lifts. Finally, it covers essential protocols for preventing venous thromboembolism using graduated compression stockings and sequential compression devices, maintaining respiratory function through incentive spirometry and coughing exercises, and implementing nutritional support to counteract metabolic deficits.