12 Chapter 21 Immobility _____________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 21.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the consequences of immobility
outlined in Table 21-1 (p. 326). Note that
these effects have implications on multiple
body systems that must be addressed in
order to ensure patient health.
• Discuss the Nursing Care Plan (p. 326),
outlining methods of preventing the hazards
of immobility. Compare the patient’s current
• Divide the class into several groups. Have
each group identify what problems
immobility causes on each of the following
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
2
DISCUSS
• Discuss the reasons why exercise, whether
active or passive, is the best medicine for
immobility.
• Discuss the purpose of positioning in
supporting the health of the immobile
patient.
• Invite a physical therapist to speak to the
class about active and passive exercises
and how they prevent complications. Ask the
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe
positive effects exercise has on the overall
health of a patient with limited mobility.
• Post the following discussion topic online
and have students comment. Create a table
of complications that can occur with the
immobile patient and how to prevent those
complications.
____________________________________________________________________ Chapter 21 Immobility 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 21.1
3
DISCUSS
• Discuss pressure ulcers and their
development process, including factors that
contribute to the development of these open
wounds.
• Discuss the locations at which pressure
ulcers are likely to develop, as shown in
Figure 21-1 (p. 329).
• As a class, discuss the risk factors for
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Create a table
of risk factors for developing a pressure
ulcer. How would you decrease these risk
factors?
4
DISCUSS
• Discuss the four stages of pressure ulcer
development illustrated in Figure 21-5
(p. 331).
• Discuss the timeline for progression from
stage I to stage IV. Note the importance of
early treatment in preventing serious
complications that may arise if a pressure
ulcer is not properly treated.
• In small groups, have students identify the
stage of the pressure ulcer in each of the
following scenarios. Have each group share
its answers with the class and describe its
reasoning for assigning a particular stage.
• A patient has damage to the dermis and
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
difference in each type of pressure ulcer.
14 Chapter 21 Immobility _____________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 21.1
5
DISCUSS
• Discuss treatment of a pressure ulcer at
each stage of development.
• In small groups, have students identify
treatment options for the following scenarios
(including prevention).
• A woman with a multifetal pregnancy is
confined to bedrest. Damage to the
dermis and subcutaneous tissue has
developed on her greater trochanter.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss the
steps that should be followed in caring for an
immobile patient in order to avoid the
development of pressure ulcers.
Critical Thinking Question
A nurse is repositioning a patient and the patient says: “Will you put a pillow under my
knees when you put me on my back? I am so comfortable in this position, and I always sleep
at home like this.” What should the nurse say?
Instructor Notes/Student Feedback
____________________________________________________________________ Chapter 21 Immobility 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 21.2
Instructor Preparation
Textbook Objectives Covered
6. Discuss the effects of immobility on respiratory status, nutrition, and elimination.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• active exercise (p. 327)
• range-of-motion exercise
Student Preparation
Assignments 2 hours
6
READ – Textbook (pp. 332-334)
REVIEW
• Table 21-1: Consequences of Immobility of Body Systems (p. 326)
• Box 21-1: Case Study: Immobility (p. 326)
• Nursing Care Plan 21–1: Preventing Hazards of Immobility (p. 326)
ANSWER – Text
• Review Questions for the NCLEX Examination: 5, 6, 7 (p. 335)
ANSWER – Study Guide
16 Chapter 21 Immobility _____________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 21.2
50-Minute Lesson Plan
Lecture Outline 20 minutes
6
Slide 22
Respiratory Status
• When a person is immobile or does not take deep breaths, thick secretions can
accumulate and pool in the lower respiratory structures
TALKING POINTS:
• How does sighing help the respiratory status?
Slide 23
Respiratory Status (cont.)
• Individuals who are at risk for impaired gas exchange related to immobility
• Patients prescribed medications that depress respirations
• Patients wearing tight binders or bandages that limit chest expansion
• Patients with abdominal distention from gas, fluid, or feces
• Individuals who lie in one position for extended periods
Slide 24
Respiratory Status (cont.)
• Nursing interventions
• Frequent turning and position changes and coughing and deep-breathing exercises
• Must be done every 2 hours to be effective
TALKING POINTS:
• Effective coughing may be difficult for patients, especially those who are in pain from a
surgical incision or those who have chronic coughs and are worried that the coughing may
Slide 25
Food and Fluid Intake
• Anorexia
• Most common problem of immobility
• Factors: anxiety about dependence on others and decreased metabolic needs
resulting from inactivity
• Inadequate fluid intake
TALKING POINTS:
• Older adults are particularly prone to becoming dehydrated from an inadequate fluid
intake, resulting in complications such as confusion, constipation, or urinary tract infection.
• What dietary guidelines should be followed?
____________________________________________________________________ Chapter 21 Immobility 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 21.2
Food and Fluid Intake (cont.)
• Accurate records of dietary and fluid intake
• Small, frequent meals better than three large meals for patients with anorexia
• Encourage visiting family members to offer fluids
Slide 27
Elimination: Constipation
• Changes in the usual routine and environment, inability to defecate on a bedpan because
of embarrassment or discomfort, and weakened muscle tone
• From many medications: slow intestinal motility
TALKING POINTS:
• If the impulse to defecate is ignored for a considerable time, the natural urge to defecate
can diminish and eventually disappear.
• What can happen if a fecal impaction is not relieved?
• When an impaction develops, the mass of feces must be broken up with a gloved finger (a
doctor’s order usually is needed).
Elimination: Constipation (cont.)
• Confused patients may ignore the normal urge to have a bowel movement
• Fecal impaction
Elimination: Constipation (cont.)
• Encourage foods with adequate roughage, fluids, and as much activity as possible
• If possible, patients should use a bedside commode or be taken to the bathroom rather
TALKING POINTS:
• Diet, exercise (including passive ROM) and fluid intake all effect GI motility.
18 Chapter 21 Immobility _____________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 21.2
Slide 30
Elimination: Urinary Incontinence
• When body in reclining position, kidney must force urine into the ureters against the pull of
gravity
• The peristaltic action of the ureters is not strong enough to maintain a constant flow of
urine
TALKING POINTS:
• The urinary system functions best when the body is upright.
• The pooling of urine puts the patient at risk for what complication?
Elimination: Urinary Incontinence (cont.)
• Prevention
• Toileting program
TALKING POINTS:
• Should fluids be restricted to prevent urinary incontinence?
____________________________________________________________________ Chapter 21 Immobility 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 21.2
Activities
Classroom Choose from below to make 30 minutes
Online
6
DISCUSS
• Discuss the Patient Teaching Plan (p. 333)
on coughing and deep-breathing.
• Discuss the development of anorexia and
hypoproteinemia in the immobilized patient.
• Divide the class into three groups. Assign
one of the following scenarios to each group.
Have the groups develop nursing
interventions and share their findings with
the class.
• An 80-year-old man with Parkinson
disease is in bed 90% of the day. He
does not feel hungry and is becoming
dehydrated.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Create a
patient teaching plan for the patient with
limited mobility. Make sure you include the
patient’s family in teaching.
20 Chapter 21 Immobility _____________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 21.2
Critical Thinking Question
A 69-year-old patient with diabetes mellitus living in a skilled nursing facility is hospitalized
for a right below-knee amputation (BKA). The patient spends most of the day in a
wheelchair, but she can shift her position and move herself from the wheelchair to the bed
with some assistance. She is incontinent of urine and wears incontinence underwear. The
patient often slides out of her wheelchair, and by the end of the day she does not have much
energy to move herself up, so the nursing assistants slide her up in the chair so she does
not fall out. Once in bed, she often moves the head of the bed up and sits up to read or do
crafts. During an assessment while the patient was in bed, the nurse notices an open area
on the patient’s coccyx. When the nurse informs the patient, she is surprised and states: “I
always move around, I hardly ever lie in bed during the day. I don’t see how I could have
developed a pressure ulcer.” How should the nurse respond?
Discussion Guidelines: This patient has numerous risks for pressure ulcers. The nurse should
explain that diabetes mellitus affects the patient’s general metabolism as well as protein
Instructor Notes/Student Feedback
____________________________________________________________________ Chapter 21 Immobility 21
Introduction to Medical-Surgical Nursing, 6th ed.
21
Assessments for
Immobility
CHAPTER OBJECTIVES
Lesson 21.1:
2. Discuss the impact of exercise and positioning on preventing complications related to immobility.
4. Describe the stages of pressure ulcers.
6. Discuss the effects of immobility on respiratory status, nutrition, and elimination.
Assessments by Lesson & Objective
Lesson 21.1
1
Study Guide
• Part IA: 1 (p. 121)
• Part IC: 1-10 (p. 122)
Evolve Instructor Resources
• Test Bank: 1, 15, 16, 23, 28, 29
Evolve Student Resources
• NCLEX Review: 1-6
2
Study Guide
• Part IA: 2-5, 7, 8 (p. 121)
• Part IIF: 5 (p. 124)
Evolve Instructor Resources
• Test Bank: 2, 8, 10, 22, 33
3
Study Guide
• Part ID: A-Z (p. 123)
• Part IE: 1, 2 (p. 124)
• Part IIF: 2 (p. 124)
Evolve Instructor Resources
• Test Bank: 11, 12, 32
4
Study Guide
Evolve Instructor Resources
• Test Bank: 7, 14, 17, 24, 26, 27
22 Chapter 21 Immobility _____________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
5
Study Guide
• Part IA: 6, 9 (p. 121)
Evolve Instructor Resources
• Test Bank: 3, 18, 19, 21, 30
Evolve Student Resources
• NCLEX Review: 9
• Prioritization: 3
Lesson 21.2
6
Study Guide
• Part IIF: 8, 9, 11, 13-15 (pp. 124-125)
• Part IIIG: 3-6 (pp. 125-126)
• Part IIIH: 2-4 (p. 126)
Evolve Instructor Resources
• Test Bank: 4-6, 9, 13, 20, 25, 31
Evolve Student Resources
Instructor’s Notes/Student Feedback