You receive change-of-shift report about a recently admitted client. The outgoing nurse reports that the client is immobile and has required two nurses for repositioning. Consider the following questions, and respond to each in your initial discussion post:
What complications are associated with immobility?
What nursing interventions can help prevent these complications?
How will you ensure your own safety when assisting this client?
How will you ensure the client’s safety?
Responses to Peers
This discussion requires two replies to classmates. In your replies, compare and contrast your classmates’ initial posts with your own. Critique your classmates’ posts by suggesting an area for improvement or something new to add to the discussion.
Full Answer Section
- Integumentary: Pressure ulcers, skin breakdown, poor wound healing.
- Psychological: Anxiety, depression, isolation, decreased self-esteem.
Nursing Interventions to Prevent Complications:
- Mobility and Positioning: Assist the patient with range-of-motion exercises, frequent repositioning, and ambulation as tolerated. Utilize assistive devices like walkers or canes as needed.
- Skin Care: Assess skin integrity regularly, especially over bony prominences. Use pressure-relieving devices like specialized mattresses or pillows. Maintain good hygiene practices.
- Respiratory Care: Encourage deep breathing exercises and coughing, provide incentive spirometry, and monitor respiratory status.
- Circulation: Apply compression stockings, use sequential compression devices (SCDs), and encourage leg exercises to prevent DVT.
- Hydration and Nutrition: Ensure adequate fluid intake and provide a balanced diet to support overall health and promote bowel function.
- Pain Management: Address pain effectively to facilitate movement and comfort.
- Psychosocial Support: Provide opportunities for social interaction, encourage communication, and address any psychological concerns related to immobility.
Ensuring My Safety:
- Proper Body Mechanics: Use correct lifting techniques, utilizing assistive devices like gait belts and mechanical lifts when necessary. Seek assistance from another nurse when repositioning heavy patients.
- Environmental Safety: Ensure a safe and clear environment, removing obstacles and tripping hazards, to prevent falls.
- Appropriate Equipment: Use available equipment, such as gait belts, transfer boards, and mechanical lifts, to facilitate safe patient handling.
Ensuring the Client's Safety:
- Assessment: Conduct a thorough assessment to identify the patient's specific needs and risks associated with immobility. Evaluate pain levels, vital signs, and any potential contraindications to movement.
- Clear Communication: Communicate with the patient regarding the importance of movement and their role in preventing complications. Explain procedures clearly and address any concerns.
- Patient Education: Teach the patient and family about safe mobility practices and how to prevent complications.
- Fall Prevention: Implement fall prevention measures, including bed alarms, non-slip footwear, and frequent checks on the patient.
- Medication Administration: Monitor medication administration closely, especially for drugs that can affect mobility or increase the risk of falls.
Responding to Peers:
In my replies to classmates, I will focus on:
- Comparing and Contrasting: Highlighting similarities and differences in the interventions proposed by my classmates.
- Adding New Information: Expanding on the discussion by introducing additional interventions, risks, or resources.
- Critique: Offering constructive feedback on areas for improvement, such as adding specific techniques or addressing potential barriers.
Conclusion:
Immobility poses significant risks to patients, making it essential for nurses to implement proactive interventions to prevent complications.
By prioritizing patient safety and utilizing effective communication and collaboration, nurses can provide high-quality care and ensure the best possible outcomes for patients who are immobile
Sample Answer
Immobility: A Case Study in Nursing Interventions and Safety
The change-of-shift report highlights a patient at risk for complications associated with immobility. Here's an analysis of the situation and potential interventions:
Complications Associated with Immobility:
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Musculoskeletal: Muscle atrophy, contractures, decreased bone density, joint stiffness, pressure ulcers.
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Cardiovascular: Decreased cardiac output, orthostatic hypotension, venous thromboembolism (DVT), pulmonary embolism (PE).
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Respiratory: Decreased lung capacity, atelectasis, pneumonia, respiratory infections.
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Gastrointestinal: Constipation, fecal impaction, decreased appetite, bowel obstruction.
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Urinary: Urinary tract infections (UTIs), urinary retention, kidney stones.