Activity & Immobility Flashcards
effects of immobility: metabolic
decreases metabolic rate, creates negative nitrogen balance (protein breakdown), poor nutrition, decreases muscle mass
effects of immobility: GI
constipation, pseudo diarrhea (esp w/ long term pt w/ poor hydration & nutrtion), overall depressed intentional function, fluid/electrolyte imbalances
effects of immobility: respiratory
atelectasis, increased risk of pneumonia, static secretions, decreased oxygenation
effects of immobility: cardio
orthostatic hypotension, increased cardiac workload, increased risk of clots (thrombus formation)
effects of immobility: musculoskeletal
lose lean muscle mass, disuse atrophy (shirking), impaired calcium metabolism, joint abnormalities (disuse osteoporosis), contractures, foot drop
effects of immobility: urinary elimination
urinary stasis, increased risk of UTI, increased risk of renal calculi (kidney stones), dehydration
effects of immobility: integumentary
pressure injuries
what causes pressure injuries
ischemia (lack of oxygen & nutrients) of tissues due to inflammation over bony prominence
where are pressure injuries most likely seen?
coccyx, heels, back of head, elbows
venous thrombo-embolism
clot which has detached from the wall (the main thing we want to prevent)
deep vein thrombosis
clot within the vein blocking flow
3 main contributing factors (virchow’s triad) to thrombus/VTE/DVT
-damage to vessel wall
-alteration in blood flow
-alterations in blood constituents
signs ofthrombus/VTE/DVT
often times none redness, pain, edema at site
how to prevent immobility complications: metabolic
-high protein, high Kcal (do not delay feeding)
-supplement w/ vit B&C
foods high in vit B
-whole grains
-meats
-milk
foods high in vit C
green, yellow and red fruits & vegetables
how to prevent immobility complications: respiratory
-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)
how to prevent immobility complications: cardio
-reduce orthostatic hypotension
-mobilize early
-avoid valsalva maneuvers (bearing down)
how to reduce orthostatic hypotension
change position slowly, elevate in phases (sit up, wait, stand up, wait, begin walking) adequate hydration
how to prevent immobility complications: musculoskeletal
-in bed exercise
-passive/active ROM
-walk the pt
-encourage activity in anyway possible (move to chair for meals)
how to prevent immobility complications: integumentary
-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!
how to prevent immobility complications: elimination
-keep hydrated (800-2000 ml/d fluid)
-encourage out of bed voiding
-high fiber diet, fiber supplement
-stool softeners/laxatives when needed (last resort)
what is the deadliest complication of immobility
DVTS -> pulmonary embolism
how to prevent DVT
-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)
care for pts on anti coagulants
- 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)
who do you not use gait belts on
-pt’s w/ osteoporosis & spinal injuries
-do not use on skin or abdominal surgery scar
semi fowlers
15-45 degrees (most common)
fowlers
-45-60 degrees
-good to promote lung expansion & drainage
high fowlers
-60-90 degrees
-best for resp. distress, eating and heart burn
lateral
-pt laying on side w/ knees bent
-pillow is often put between legs
-suppository
lithotomy
-pt lay flat on back w/ legs elevated to hip level or above
-common at gyno or childbirth
prone
-pt lays on stomach w/ head turned to the side
-allows for drainage of the mouth after oral or neck surgery
trendelenburg
-pt supine w/ head lowered and feet rose (“upside down”)
-helpful for gyno complications, abdominal hernia surgeries, or placement of central line
reverse trandelenburg
-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
sim’s position
-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
