7 - Hazards of Immobility Flashcards
Mobility
- refers to a person’s ability to move about freely…
- immobility refers to the inability to move about freely
- Mobility and immobility are best understood as the end points of a continuum, with many degrees of partial mobility in between.
- Some patients move back and forth on this continuum, but for other patients, immobility is absolute and continues indefinitely
What is bedrest?
- Bed rest is an intervention that restricts patients to bed for therapeutic reasons
- less commonly used
Why/when would bedrest be used?
- To allow patients who are ill, debilitated, exhausted to rest
- To reduce physical activity and the oxygen needs of the body
- To reduce pain (e.g. postop pain) = amt of analgesic
- To promote safety for patients recovering from the effects of sedation
Immobility
- has effects that can be gradual or immediate and vary from patient to patient
- The greater the extent and the longer the duration of immobility, the more pronounced are the consequences
- Deconditioning (is the enemy)
- it is the physiological decline in muscle strength, cardiovascular function, and endurance that occurs when someone is immobile or has limited physical activity for an extended period
EX. You are caring for a client who had a stroke one week ago and is now stable. You enter the room to transfer the client to a chair for breakfast. The client says they are too tired to get out of bed, and want to rest and recover. What is most important?
The client needs to mobilize
(esp bec they are stable and can)
Risk of Deconditioning
- Deconditioning: loss of muscle and strength due to prolonged inactvity
- When possible, it is imperative that patients, especially older persons, have limited bed rest
- activity is more than movement from bed to chair
- Loss of walking independence increases hospital stays, need for rehabilitation services, or nursing home placement
- Deconditioning increases the risk for falls
Immobility and Metabolic Rate
Impact:
- alters the metabolism of carbohydrates, fats, and proteins
- fluid, electrolyte, and calcium imbalances
- gastrointestinal disturbances (dec appetite, slowing of peristalsis)
- Note re: fever or wound healing and increased cellular oxygen requirements
Metabolic Changes due to Immobility
- metabolic rate decrease
- Immobility = dec appetite = deficiency in calories and protein
- The body is constantly synthesizing proteins/breaking down into amino acids/forming other proteins
- Immobility = the body excretes more nitrogen (end product of amino acid breakdown) than it ingests in proteins = negative nitrogen balance = tissue catabolism = weight loss, decreased muscle mass, weakness
- Calcium
- Hypercalcemia - increases risk of fracture
- Hypercalcemia - calcium is high in the blood (serum levels), thus not high in the bone
- Pathological fracture: from an underlying pathology
- Immobility causes the release of calcium into circulation
- If the kidneys are unable to respond appropriately, hypercalcemia results…impact?
* Impact = risk of fracture; specifically pathological fractures
Immobility and GI
- Impairments of gastrointestinal functioning caused by decreased mobility vary
- Difficulty in passing stools (constipation) is a common symptom, although pseudodiarrhea may result
- Over time, intestinal function becomes depressed, dehydration occurs, absorption ceases, and fluid and electrolyte disturbances worsen
- Fecal impaction - fecal matter is unable to pass through
- Causes pseudo diarrhea (frequent passage of small amounts of stool)
Respiratory and Immobility
- Alveoli
- Atelectasis
- If alveoli become blocked or collapse
- If this happens, they are unable to do gas exchange which puts pressure on oxygenation
- Site of the blockage determines the severity - lung lobe or even a whole lung may collapse
- Stasis & pooling of secretions
- Risk for infection; pneumonia
- Both conditions decrease oxygenation, prolong recovery, and add to discomfort
Prevention/interventions?
- Prevent pneumonia: vaccination
Cardiovascular and Immobility
- Heart works harder and less efficiently during periods of prolonged rest, negatively affects cardiac output
- Orthostatic hypotension
- Can cause drop in bp
- Likely to occur in elderly
- Bad because can cause fainting and dizziness; increasing risk of falls
- Symptoms include dizziness, light-headedness, nausea, tachycardia, pallor, or fainting with a change from lying/sitting to standing position
- Decreased circulating fluid volume, pooling of blood in the lower extremities
- Especially evident in older persons
Deep Vein Thrombosis
What is a thrombus vs. emboli?
- Thrombus: blood clot in blood vessels where plateletes
- Emboli: when it migrates somewhere else
○ Can go to heart or lungs causing pulmonary embolism, heart attack (which are all life-threatening)
Where is a thrombus most likely to occur?
- deep veins of legs
Why is this a concern?
- can travel through the bloodstream and cause a pulmonary embolism
Treatment?
- Compression socks
- Blood thinners (anti-coagulants)
○ Also increases risk of bleeding
- Warfarin
- Injection: fragment
MSK and Immobility
- Loss of skeletal muscle mass, strength and function
- Disuse atrophy - pathological reduction in normal size of muscle fibres (bed rest, trauma, casting, or local nerve damage)
- Also impaired calcium metabolism and joint abnormalities
- Is a marker of frailty
- 80% of all fractures in women > 50 are related to: FALLS
- Bone tissue is less dense, or is atrophied, and disuse osteoporosis results
- Fragility fractures are responsible for excess mortality and morbidity
Treatment?
* Supplements: calcium, vitamin D (aids in calcium reabsorption), mobility/activity
- Joint contracture: an abnormal and possibly permanent condition characterized by fixation of a joint - cannot obtain full ROM/nonfunctional position
- Footdrop: the foot is permanently fixed in plantar flexion
- Can avoid this with movement
Mobilizing
Should you reposition or mobilize your clients?
- YES
How often should you change position for your clients?
- Every 2 hours (q2)
Nurses infrequently initiated mobility events for hospitalized older patients and most often engaged patients in low-level activity (standing & transferring)
- People are not being mobilized enough because
○ Nurses are busy
○ It is not prioritized
- In the upright position, urine flows out of the renal pelvis and into the ureters and bladder because of GRAVITY
- Urinary stasis - increases the risk of urinary tract infection and renal calculi
- If immobility continues, fluid intake can DECREASE increasing the risk for DEHYDRATION
- As a result, urinary output may decline around the fifth or sixth day after immobilization, therefore urine colour?
- More concentrated; darker in color