Activity & Immobility

Question 1

effects of immobility: metabolic

Answer 1

decreases metabolic rate, creates negative nitrogen balance (protein breakdown), poor nutrition, decreases muscle mass

Question 2

effects of immobility: GI

Answer 2

constipation, pseudo diarrhea (esp w/ long term pt w/ poor hydration & nutrtion), overall depressed intentional function, fluid/electrolyte imbalances

Question 3

effects of immobility: respiratory

Answer 3

atelectasis, increased risk of pneumonia, static secretions, decreased oxygenation

Question 4

effects of immobility: cardio

Answer 4

orthostatic hypotension, increased cardiac workload, increased risk of clots (thrombus formation)

Question 5

effects of immobility: musculoskeletal

Answer 5

lose lean muscle mass, disuse atrophy (shirking), impaired calcium metabolism, joint abnormalities (disuse osteoporosis), contractures, foot drop

Question 6

effects of immobility: urinary elimination

Answer 6

urinary stasis, increased risk of UTI, increased risk of renal calculi (kidney stones), dehydration

Question 7

effects of immobility: integumentary

Answer 7

pressure injuries

Question 8

what causes pressure injuries

Answer 8

ischemia (lack of oxygen & nutrients) of tissues due to inflammation over bony prominence

Question 9

where are pressure injuries most likely seen?

Answer 9

coccyx, heels, back of head, elbows

Question 10

venous thrombo-embolism

Answer 10

clot which has detached from the wall (the main thing we want to prevent)

Question 11

deep vein thrombosis

Answer 11

clot within the vein blocking flow

Question 12

3 main contributing factors (virchow’s triad) to thrombus/VTE/DVT

Answer 12

-damage to vessel wall
-alteration in blood flow
-alterations in blood constituents

Question 13

signs ofthrombus/VTE/DVT

Answer 13

often times none redness, pain, edema at site

Question 14

how to prevent immobility complications: metabolic

Answer 14

-high protein, high Kcal (do not delay feeding)
-supplement w/ vit B&C

Question 15

foods high in vit B

Answer 15

-whole grains
-meats
-milk

Question 16

foods high in vit C

Answer 16

green, yellow and red fruits & vegetables

Question 17

how to prevent immobility complications: respiratory

Answer 17

-pulmonary toilet (turn, cough, deep breathing)
-get up / mobilize (best)
-up right position
-incentive spirometer
-adequate hydration (to thin secretions)
-CPT (post drainage, vibration, cough assist)

Question 18

how to prevent immobility complications: cardio

Answer 18

-reduce orthostatic hypotension
-mobilize early
-avoid valsalva maneuvers (bearing down)

Question 19

how to reduce orthostatic hypotension

Answer 19

change position slowly, elevate in phases (sit up, wait, stand up, wait, begin walking) adequate hydration

Question 20

how to prevent immobility complications: musculoskeletal

Answer 20

-in bed exercise
-passive/active ROM
-walk the pt
-encourage activity in anyway possible (move to chair for meals)

Question 21

how to prevent immobility complications: integumentary

Answer 21

-turning q2 (essential)
-encourage pt sitting up in the chair to move around, assist w/ repositioning if weak every hour
-adequate hydration & nutrition
-special mattresses
-special dressings over pressure prone areas
-assess!

Question 22

how to prevent immobility complications: elimination

Answer 22

-keep hydrated (800-2000 ml/d fluid)
-encourage out of bed voiding
-high fiber diet, fiber supplement
-stool softeners/laxatives when needed (last resort)

Question 23

what is the deadliest complication of immobility

Answer 23

DVTS -> pulmonary embolism

Question 24

how to prevent DVT

Answer 24

-aggressive prophylaxis
-early ambulation
-leg, foot, ankle exercises (anti embolic strategies)
-adequate fluid
-frequent position changes
-pt teaching
-SCDs & anti embolic stockings (assess skin min 1x per shift)
-anticoagulation therapy (meds)

Question 25

care for pts on anti coagulants

Answer 25

• high risk for GI & head bleeds
• monitor labs (PT/PTT, INR, Anti-Xa)
  -dietary considerations (vit K and coumadin)
  -concerns of falls
  -know when might need to stop (pre procedure)
  -educate on signs of bleeding (bleed in stool, GI discomfort, weak, dizzy)

Question 26

who do you not use gait belts on

Answer 26

-pt’s w/ osteoporosis & spinal injuries
-do not use on skin or abdominal surgery scar

Question 27

semi fowlers

Answer 27

15-45 degrees (most common)

Question 28

fowlers

Answer 28

-45-60 degrees
-good to promote lung expansion & drainage

Question 29

high fowlers

Answer 29

-60-90 degrees
-best for resp. distress, eating and heart burn

Question 30

lateral

Answer 30

-pt laying on side w/ knees bent
-pillow is often put between legs
-suppository

Question 31

lithotomy

Answer 31

-pt lay flat on back w/ legs elevated to hip level or above
-common at gyno or childbirth

Question 32

prone

Answer 32

-pt lays on stomach w/ head turned to the side
-allows for drainage of the mouth after oral or neck surgery

Question 33

trendelenburg

Answer 33

-pt supine w/ head lowered and feet rose (“upside down”)
-helpful for gyno complications, abdominal hernia surgeries, or placement of central line

Question 34

sim’s position

Answer 34

-prone/lateral position where pt lies on side w/ upper leg flexed and drawn towards chest and arms are flexed at the elbow
-useful for administering enemas, perineal exams, and comfort during pregnancies

Question 34

reverse trandelenburg

Answer 34

-pt supine w/ head elevated and feet lowered
-may be used in surgery to help promote profusion of obese pt, treating venous air embolism, and preventing pulmonary aspiration