Mobility

Definition and Components

Mobility refers to the anatomical structures (bones, joints, muscles) and body functions (neurologic, cognitive, perfusion) that enable purposeful, simple, complex, and coordinated movement. Changes in any component of the musculoskeletal system can affect mobility.

• Bones: Provide structural support and protection.

• Muscles: Facilitate movement by contracting and relaxing.

• Joints: Allow for flexibility and range of motion.

• Tendons and Ligaments: Connect muscles to bones and stabilize joints.

• Cartilage: Cushions joints and supports movement.

Exemplars associated with mobility include complications of immobility (e.g., pulmonary embolism), rheumatoid and osteoarthritis, fractures, Parkinson’s disease, and spinal cord injury.

Normal vs. Altered Mobility

Physical and Functional Comparison

Mobility can be assessed by comparing normal and altered states:

• Normal Mobility:

  • Free movement of extremities

  • No muscle spasms or weakness

  • Pain-free

  • Correct body alignment

  • No respiratory problems

  • Intact skin and skeletal system

  • Balance and continence

  • No sensory or cognitive deficits

  • Flexible joints, no tremors

  • Clear speech, intact coordination

• Altered Mobility:

  • Impaired movement, muscle spasms/weakness

  • Pain, tingling, numbness

  • Incorrect alignment, leaning

  • Dyspnea, skin integrity issues, fractures

  • Dizziness, imbalance, incontinence

  • Sensory/cognitive deficits, joint pain/swelling

  • Muscle tremors, rigidity, bradykinesia

  • Impaired balance, slurred speech, spasticity

Curricular Concepts Related to Mobility

Impact of Impaired Mobility

• Gas Exchange: Reduced movement can impair lung function.

• Tissue Perfusion: Immobility may decrease blood flow.

• Tissue Integrity: Risk of skin breakdown, open fractures.

• Pain: Fractures and decreased activity increase pain.

• Nutrition: Impaired mobility affects intake and metabolism.

• Digestion/Elimination: Constipation and urinary retention may occur.

Mobility Assessment

Observation and Interview

• Gait and Ambulation: Assess balance, steadiness, use of assistive devices, weight-bearing ability.

• Pain: Evaluate pain during movement, location, triggers, and relief measures.

• Lifestyle: Physical activity, ADLs, sports participation, sedentary habits, nutrition.

• Past Injuries: History of bone/joint injuries.

• Current Problem: Patient’s description of mobility issues.

Physical Examination

• Inspect and palpate bones, muscles, joints for deformities, tenderness, pain.

• Perform range of motion (ROM) assessment to identify limitations.

Neurovascular Checks (CMS/CSM)

Assessment After Orthopedic Procedures

• C (Color/Circulation): Assess skin color and pulse distal to operative site.

• S (Sensation): Lightly tap skin distal to operative site; ask if sensation is intact.

• M (Movement): Ask patient to move body part distal to operative site.

If any component is compromised, conditions such as compartment syndrome may be present.

Fall Risk Assessment Scales

Morse Fall Scale

Six indicators are used to assess fall risk:

• History of falls

• Secondary diagnosis

• Use of ambulatory aid

• IV/Saline lock

• Gait/transferring

• Mental status

Hester-Davis Scale

Nine indicators are used:

• Age

• Date of last fall

• Mobility

• Medications

• Mental status and awareness

• Toileting needs

• Nutritional needs

• Communication/sensory deficits

• Behavioral issues

Patients are categorized as high, medium, or low risk based on score.

Preventing Patient Falls

Clinical Application

• Assess individual risk factors: history of falls, cognitive/sensory impairment, mobility issues.

• Assess environmental causes: lighting, cords, railings, slippery floors, rugs, hazards.

Measures to Prevent Falls

• Home: Vision/hearing exams, clean aids, supervised exercise, uncluttered environment, non-skid footwear, grab bars, medication review.

• Healthcare: Identify risk, orient patient, keep items within reach, bed in lowest position, uncluttered environment, non-skid footwear, assistance/aids, alarms, seizure precautions, restraints (last resort).

Mobility Diagnostic Tests

Blood Work

Imaging Tests

• Bone density scans (especially for menopausal women)

• CT scans

• MRI

• X-ray

If contrast dye is used, assess for iodine or shellfish allergy.

Mobility Across the Lifespan

Children and Adolescents

• Infant skull not fused at birth; fuses by 19 months.

• Spine changes from C-shape to S-shape as child develops.

• Bones are more porous; calcium intake is critical.

Pregnant Women

• Decreased range of motion and back pain are common.

Older Adults

• Bone density decreases, increasing fracture risk.

• Arthritis and back pain are common.

• Vertebral discs thin, leading to compression and posture changes.

• Muscle strength, reaction time, and balance decrease.

• Tendons and ligaments lose elasticity, reducing flexibility.

Assistive Devices Across the Lifespan

• Toddlers/preschoolers: crawling, scooting, carried by parents.

• School-age/adolescents/young adults: walking cast, crutches.

• Middle-aged adults: crutches, cane.

• Older adults: walker, cane, wheelchair.

Nursing Process: Mobility

Analysis/Nursing Diagnosis

• Alteration in mobility r/t disease process

• Potential for injury r/t decreased mobility

• Self-care deficit r/t disease process

• Alteration in comfort r/t pain

• Knowledge deficit r/t crutch walking

• Social isolation r/t immobility

Goals

• Patient will be mobile using crutches in 1 day.

• Patient will be free from injury during shift.

• Patient will wash upper body with minimal assistance in 1 week.

• Patient’s pain level will be ≤ 4 during shift.

• Patient will ambulate 30 feet in 1 week.

• Patient will attend senior center in 1 month.

Interventions

• Altered Mobility: Assess status, encourage assistive devices, ROM exercises, ambulate with client, use gait belt.

• Injury Prevention: Assess status, keep bed low, call bell within reach, assess fall risk, place on fall risk if needed.

• Self-care Deficits: Assess ability, provide rest, encourage ADLs, assist as needed, space activities.

• Alteration in Comfort: Assess pain, administer medications, use diversional activities, evaluate effectiveness.

• Knowledge Deficit: Assess knowledge, instruct on crutch use, observe technique, provide pamphlet, answer questions.

• Social Isolation: Assess ability to socialize, involve family/support, assess community resources, discuss living arrangements.

Restraints

Types and Complications

• Physical Restraints: Manual or mechanical devices restricting movement.

• Chemical Restraints: Medications (anxiolytics, sedatives) not standard for patient’s condition.

Complications include pressure ulcers, pneumonia, incontinence, constipation, loss of self-esteem, agitation, and death. Alternatives: frequent observation, room near nurse station, family involvement, reorientation, diversionary activities, relaxation, normal sleep patterns.

Complications of Immobility: Deep Vein Thrombosis (DVT)

Definition and Clinical Features

• DVT is a blood clot in a deep vein, usually in the leg.

• Causes: immobility, surgery, accident, prolonged bedrest, clotting disorders.

• Symptoms: redness, warmth, leg pain/cramping, swelling.

• Immediate notification of care provider is required if DVT is suspected.

Case Study: Mrs. P

Fall Risk Factors

• Extrinsic (Environment/Equipment): Bed/chair, side rails, restraints, lighting, clutter.

• Intrinsic (Medical Conditions): Alzheimer’s, diabetes, hypertension, osteoarthritis, depression, history of falls.

• Unsafe Behaviors: Restlessness, agitation, attempts to get up unassisted.

Further Evaluation

• Chronic conditions: worsening agitation, insomnia.

• Medications: sedatives, Ativan.

• Acute illness: recent falls, sleep deprivation.

• Environment/equipment: restraints, side rails, soiled undergarments.

Goals and Interventions

• Goal: Prevent further falls, ensure safety, improve comfort and sleep.

• Environmental/equipment: Remove hazards, ensure accessibility, minimize restraints.

• Gait/mobility: Assist with transfers, use aids as needed.

• Medications: Review and adjust as appropriate.

• Anxiety/agitation: Provide support, involve family, use diversionary activities.

• Pain management: Assess and treat pain.

Evaluation

Evaluation is the process of determining if interventions have achieved the desired outcomes and goals for the patient.