Care for Individuals with Mobility Needs

Introduction:

having trouble walking

It is important for direct care staff persons to follow infection control procedures to prevent illness. Of equal importance is taking steps to assist a resident to be as mobile as possible. Mobility gives people the opportunity to socialize, be active and independent. If mobility becomes limited, a person’s opportunities shrink and choices are reduced. Serious complications can result from long periods of limited mobility.

While the thought of being less active may sound very soothing, it can lead to many complications that can cause problems in almost every major body system. Immobility can have the following effects:

  • Difficulty breathing and in the ability to expand one’s lungs. This can result in fluid buildup in the lungs, which increases the risk of pneumonia and lung infections.
  • The heart works harder to pump blood through a body laying flat. Possible problems with blood circulation are swelling, blood pooling in the legs, decreases in blood pressure and increased risk of blood clots.
  • Pressure sores develop quickly because the oxygen supply is reduced and pressure is increased.
  • Muscles weaken and deteriorate from lack of use.
  • Osteoporosis, fractures, slowed healing and other complications result because calcium is reduced in unexercised bones.
  • If a person is in a flat position for a long time, urine does not fully drain out of the bladder and leftover urine in the bladder can become infected.
  • There is a higher risk of choking and for developing indigestion or heartburn.
  • A person’s appetite may decrease because they are less active or bored.
  • Dehydration may become a problem as well.
  • Mental health problems like depression become more common.

To help residents with mobility needs avoid these health risks, you can encourage them to be as active as possible, letting them do tasks, no matter how small, that they are able to do safely.

 

Pressure sores:

Pressure sores, more commonly called “bed sores,” develop when there is constant pressure on an area of the skin for a long time. This pressure squeezes tiny blood vessels that supply the skin with nutrients and oxygen. If starved for too long, the tissue dies and a pressure sore forms. Anyone confined to a bed, a chair or a wheelchair, is at risk of getting pressure sores. Pressure sores often occur on the lower back and buttocks and on bony protruding areas such as shoulders, hips, knees, heels and ankles.

In the first stage of a pressure sore it will look like a red or dark patch. If it gets worse, the skin blisters. Dead skin will ultimately infect underlying tissues, bones and joints. It takes as little as two hours of constant pressure to trigger skin damage. Damage can get worse by rubbing or having excess moisture on the skin. The surface damage you see is just the beginning; the real damage is under the skin.

Always report any skin changes to your supervisor for assessment.

Several risk factors increase a person’s chances for developing pressure sores.

  • Age – The majority of pressure sores occur in people over the age of 70 because skin is thinner, making them more susceptible to damage from minor pressure.
  • Malnutrition and Dehydration – A healthy diet helps prevent skin breakdown and helps wounds heal. People who are underweight have less cushioning over their bones to protect from pressure sores.
  • Immobility – When confined to a bed or chair, there is more pressure on the skin that makes contact with the bed or chair. This can lead to pressure sores.
  • Incontinence – When skin stays wet (for example, from urine), this can lead to pressure sores because wet skin is more likely to break down.
  • Poor mental condition – A person with certain types of mental impairments may be less likely to know or be able to communicate that a pressure sore is forming, and take actions to prevent or care for the sore.

Pressure sores are easier to prevent than to treat. Although wounds can develop in spite of the most careful care, it’s possible to prevent them in many cases. The first step is to develop a plan that can be followed. The basis of the plan is to assist the resident to change position frequently, do daily skin inspections and have a nutritious diet. Experts advise shifting position every 15 to 30 minutes that the person is in a wheelchair and at least every two hours, even during the night, if they spend most of their time in bed.

A few guidelines to help prevent pressure sores include:

  • Avoid lying directly on the hipbones.
  • Support the legs. When lying on the back, place a foam pad or pillow under the legs, from mid-calf to the ankle, not directly behind the knees which could restrict blood flow. This will also keep pressure off the heels, another area prone to pressure sores.
  • Keep knees and ankles from touching by using small pillows or pads.
  • Avoid raising the head more than 30 degrees so the person doesn’t slide down and risk friction injuries.
  • Use a pressure-reducing mattress or bed.
  • Pressure-release wheelchairs, which tilt to redistribute pressure, make sitting for a long time easier and more comfortable. All wheelchairs need cushions that reduce pressure and provide maximum support and comfort. While cushions may help relieve pressure, they don't prevent pressure sores from forming or replace the need to change a person’s position.
  • Daily skin inspections are an essential part of prevention, paying particular attention to bony areas.
  • Cleanse the skin immediately when soiled and at routine intervals; avoid hot water and use a mild cleansing agent. Dry skin thoroughly. Do not use powder as it holds in moisture and can help cause skin breakdown.
  • Minimize skin exposure to secretions and excretions such as incontinence and perspiration.
  • Provide adequate intake of fluid, protein and calories to aid against sores.
  • Assist the resident to be as active as possible.

 

Incontinence (loss of bowel and bladder control):

There are two types of incontinence – fecal and urinary.

Fecal incontinence is an involuntary bowel movement. Fecal impaction, diarrhea and some endocrine disorders such as hyperthyroidism may underlie incontinence. Depression, stroke, dementia and other neurological problems may interfere with messages about the urge to defecate or the ability to wait until a toilet can be used. In general, you can help a resident who experiences this problem by establishing toileting schedules, providing adaptive equipment and promoting privacy.

Urinary incontinence is the involuntary leakage of urine, regardless of the amount.

Incontinence is a time-consuming and expensive problem. You can help lessen the problem in the following ways:

  • Affirm the resident’s sense of dignity. When an “accident” occurs, offer your assistance by saying, for example, “Let me help you freshen up.” Use the term “adult briefs,” NOT “diapers,” which is demeaning.
  • Protect the resident from skin breakdown and poor hygiene. Help keep the resident’s skin clean and dry. When a resident who has had an “accident” requires your assistance, wear disposable gloves. Use soap and warm water, rinse and pat the skin dry. Place clean padding under the buttocks if the person uses incontinence pads. Follow the home’s procedures for disposal of soiled articles. Wash your hands before and after assisting.

 

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