2. Immobility: impaired physical mobility or limitation of physical movement may be accompanied by a number of complications that can involve any or all of the major systems of the body. Regardless of the cause of immobilization, there are a number of conditions that arise primarily as a complication of immobility.
1. Types of immobility:
   1. Physical - physical restriction due to limitation in movement or physiological processes (e.g., breathing).
   2. Intellectual - lack of action due to lack of knowledge (e.g., mental retardation, brain damage).
   3. Emotional - immobilized when highly stressed (e.g., after loss of loved person or diagnosis of terminal illness).
   4. Social - decreased social interaction due to separation from family when hospitalized or when alone, as in old age.
2. Risk factors:
   1. Pain, trauma, injury.
   2. Loss of body function or body part.
   3. Chronic disease.
   4. Emotional, mental illness; neglect.
   5. Malnutrition. Bed rest, traction, surgery, medications.

3. Assessment:                    .         .
   1. Subjective data: psychological/social effects of immobility:
      1. Decreased motivation to learn; decreased retention.
      2. Decreased problem-solving abilities.
      3. Diminished drives; decreased hunger.
      4. Changes in body image, self-concept.
      5. Exaggerated emotional reactions, inappropriate to situation or person; aggression, apathy, withdrawal.
      6. Deterioration of time perception.
      7. Fear, anxiety, feelings of worthlessness related to change in role activities, e.g., when no longer employed.
   2. Objective data: physical effects of immobility:
      1. Cardiovascular.
         1. Orthostatic hypotension.
         2. Increased cardiac load.
         3. Thrombus formation.
      2. Gastrointestinal.
         1. Anorexia.
         2. Diarrhea.
         3. Constipation.
      3. Metabolism.
         1. Tissue atrophy and protein catabolism.
         2. BMR reduced.
         3. Fluid/electrolyte imbalances.
      4. Musculoskeletal.
         1. Demineralization (osteoporosis).
         2. Contractures and atrophy.
         3. Skin breakdown.
      5. Respiratory.
         1. Decreased respiratory movement.
         2. Accumulation of secretions in respiratory tract.
         3. O₂/CO₂ level imbalance.
      6. Urinary.
         1. Calculi.
         2. Bladder distention, stasis.
         3. Infection.
         4. Frequency.
4. Analysis/nursing diagnosis:
   1. Impaired physical mobility related to specific patient condition.
   2. Impaired skin integrity related to physical immobilization.
   3. Urinary retention related to incomplete emptying of bladder.
   4. Constipation related to inactivity.
   5. Risk for disuse syndrome related to lack of range of motion.
   6. Bathing/hygiene self-care deficit related to musculoskeletal impairment.
   7. Sensory/perceptual alteration related to complications of immobility.
   8. Body image disturbance related to physical limitations.
5. Nursing care plan/implementation:
   1. Goal: prevent physical, psychological hazards.
      1. Apply nursing measures to promote venous flow, muscle strength, endurance, joint mobility, skin integrity.
      2. Assess and counteract psychological impact of immobility (e.g., feelings of helplessness, hopelessness, powerlessness).
      3. Help maintain accurate sensory processing to prevent and lessen sensory disturbances.
      4. Help adapt to altered body image due to increased dependency, sensory deprivation, and changes in status and power that accompany immobility.
      5. Offer counseling when sexual expression is impaired.
   2. Goal: health teaching: how to prevent physical problems related to immobility (e.g., anti-constipation diet, range of motion, skin care); teach activities while immobile that encourage independence and provide sensory stimulation.
6. Evaluation/outcome criteria:
   1. Minimal contractures, skin breakdown, muscle atrophy or loss of strength.
   2. Interest in self and environment; positive self-image.
   3. Returns to optimal level of physical activity.