6 - Immobility Flashcards
What is the patient mortality attached to a diagnosis of “acopia”?
22%
When assessing someone’s immobility - what are the 2 questions that it is important to ask?
What is the timing of the decline in their mobility?
What is limiting their mobility?
What factors can cause immobility?
What can cause acute decline in mobility?
Infection (Sepsis)
Gout & Pseudo gout
Fractures
Soft tissue injury
Neurological - Stroke, spinal cord compression, cauda equina, vertigo
Medications
CV causes - HF, arrhythmias, acute hypoxia, anaemia
Hypoactive delirium
What can cause acute on chronic decline in mobility?
HF
COPD exacerbation
What blood tests should you do for immobility?
FBC, U&Es, LFTs, Bone Profile, TFTs, CRP
(Hypocalcaemia can cause lethargy)
How can you differentiate between gout and pseudo gout?
Gout = caused by MSU crystals deposited in joints. Crystals appeal needle shaped and are negatively birefringent. High levels of urea in blood commonly seen.
Psuedogout = caused by CPPD crystals. Crystals are rhomboid shaped and positively birefringent. High levels of urea are not really seen with this presentation.
Which WBC is commonly raised in septic arthritis?
Neutrophils
Which is the commonest joint affected by psudogout?
Knee
Then wrist
Which is the commonest joint affected by gout?
1st MTP
When considering a gout / psuedogout diagnosis - you need to rule out sceptic arthritis. How do you do this?
Aspirate the joint and send for MC&S
How are gout and psuedogout normally treated in the older population?
Use Colchicine or steroids
Dont use NSAIDs due to risk of AKI in this group
What neurological conditions can cause acute immobility in the older population?
Acute stroke
Spinal cord compression
Cauda equina
Vertigo
When should you be concerned about with vertigo?
If it is central vertigo (central vertigo often comes without warning and may last for long periods of time. The episodes are generally much more intense than peripheral, and you may be unable to stand or walk without help. Nystagmus lasts longer (weeks to months during vertigo episodes) and it does not go away when you’re asked to focus on a fixed point.
Central vertigo can be indicative of a stroke.
Peripheral vertigo is less worrying - more often indicates labrynthitis or benign paroxysmal positional vertigo.
What drugs can cause acute immobility?
Antipsychotics (from the extra pyramidal SEs = rigidity)
Sedatives
Drugs that precipitate bradycardia or postural hypotension
What cardiorespiratory factors can cause acute immobility?
Cardiac failure
Arrhythmias
Acute hypoxia (PE, pneumonia, COPD exacerbation)
Anaemia
What neurological causes can cause chronic immobility?
Parkinson’s
Brain tumour
Peripheral neuropathy
Spinal stenosis
What MSK conditions can cause chronic immobility?
OA
Osteoporosis
Rotator cuff injuries & adhesive capsuliitis
Sarcopenia
What cardiorespiratory causes can cause chronic immobility?
COPD
HF
PVD
What damage to skin can occur as a result of prolonged immobility?
Pressure damage
DVT
Venous stasis -> peripheral oedema
How are pressure ulcers graded?
Grade 1 = redness, discolouration, warmth - skin not broken
Grade 2 = partial thickness skin loss to dermis. Superficial
Grade 3 = full skin necrosis to subcut tissue
Grade 4 = damage to muscle or bone
Where are the most common areas of pressure ulcers to develop?
How are pressure sores managed?
Graded and measured
Relieve pressure and dress wound
Debride grade 3/4 if slough
Good nutrition for P
Prevent infection
Only swab if they look infected
What are the consequences of immobility?
Orthostatic hypotension
Constipation & impaction
Incontinence
Hypostatic pneumonia
Hypothermia
Social isolation
What do you need to do when treating Ps with immobility?
Identify reversible causes
Treat pain
Medication review
Pressure area assessment
VTE prophylaxis
Encourage Ps to be sat out daily and regularly mobilised.
What can you give to Ps when they are at risk of refeeding syndrome?
IV Pabrinex
