Acute Care PT Flashcards
What are some consequences of prolonged bed rest?
- fluid volume redistribution
- altered distribution of body weight/pressure
- muscular inactivity
- aerobic deconditioning
PTs must establish a ________ in acute care units
Culture of Mobility
How is the cardiovascular system affected by bed rest/immobility?
- HR, SV, CO affected leading to poor endurance and ability to complete ADLs
- reduced cardiac, vagal tone, increased plasma NE enhanced beta-adrenergic receptor sensitivity
- hypovolemia
- increased venous compliance → venous pooling
- Orthostatic hypotension
what are some treatments for OH?
- early mobilizations → specifically getting them to EOB and sitting up
- LE exercises to increase blood circulation
- compression stockings
- Tilt table for very prolonged immobilization or profound ANS issues (SCI)
How is the hematologic system affected by bed rest/immobility?
- changes in blood composition place pts at risk for DVT and PEs
- RBC mass reduced by 5-25%
- decreased total blood volume, RBC mass, and plasma volume
- elevated HCT → increased risk for DVT
- reduced capillarization of peripheral muscle beds
what are the components of Virchow’s triad?
- Venous stasis
- hypercoagulability
- blood vessel damage
T/F: the length of bed rest is directly related to frequency of DVT
TRUE
there are often no clinical signs of DVT best way to screen/catch them is via doppler US, contrast venography
how are venous thromboembolisms treated?
- early ambulation, LE exercises
- compression stockings
- leg elevation
- Prophylactic methods
- low-dose heparin, intermittent, pneumatic compression
- pharmalogically to decrease blood coagulability
- unfractionated heparin (UFH)
- low molecular weight heparin (LMWH)
how is the MSK system affected by bed rest/immobility?
- changes in soft tissue affect muscle strength and size and greatly impair functional mobility
- immobilization in shortened position → enhances atrophy
- immobilization in lengthened/stretched position → may decrease loss of muscle fiber proteins
- changes in muscle metabolism greatly impairs endurance
- decreased aerobic metabolism
- early fatigue
- fiber atrophy reduced mitochondria content
what are some factors that contribute to joint contractures?
- denervated muscle (no opposition to antagonist)
- spasticity
- improper bed positioning
- adaptive shortening (cast)
- disease process (scleroderma, OA, burns)
what are some treatment options for MSK dysfunction resulting from bed rest/immobility?
- early mobilization is key
- perform AROM/PROM manual stretching
- modalities
- Splinting
- static vs dynamic
- hinged casts
- CPM
what is disuse osteoporosis?
reduced bone mass density (occurs within one week of bedrest)
hypercalciuria and negative calcium balance results from immobilization
loss of bone is the result of increased bone reabsorption
how is the neurologic system affected by bed rest/immobility?
- sensory and sleep deprivation
- decreased dopamine, noradrenaline, and serotonin levels
- depression, restlessness, insomnia
- decreased balance, coordination, visual acuity
- increased risk compression neuropathy
- reduced pain threshold
how is the integumentary system affected by bed rest/immobility?
changes in skin and prolonged immobility lead to decubitus ulcers
describe the pathogenesis of a pressure ulcer
- pressure causes ischemia (compresses capillaries and occludes blood flow)
- excessive pressure can lead ot tissue necrosis
- if pressure relieved, we can see temporary reactive hyperemia and no tissue damage
- if it is NON-BLANCHABLE ERYTHEMIA (Stage 1) then damage has begun
describe stages 2-4 for a decubitus ulcer
- Stage 2 → worn down to epidermis and dermis
- Stage 3 → worn down to the subcutaneous tissue
- Stage 4 → worn down to muscle and bone
describe the treatment for pressure ulcers
Prevention is key!!
bed-positioning with bed-bound pts (reposition high-risk pt at least every 2 hours)
wheelchair cushioning and unweighting/pressure relief exercises
how is the respiratory system affected by prolonged bed rest/immobility?
- reduced lung volumes, airflow rates, respiratory muscle strength, gas exchange
- supine position + prolonged bed rest = diminished vital capacity
- increased RR
- decreased FRC, FVC, and FEV1
prolonged bed rest increased the risk for what respiratory conditions?
- pneumonia
- atelectasis
- dyspnea on minimal exertion
how does prolonged bed rest/immobility impact metabolic systems?
- overall decreased metabolism
- insulin resistance
- muscle activity essential for expression of Glut4 proteins
- can occur after only 3 days
- plasma and urinary electrolyte concentrations
- endocrine function changes
- decreased EPO concentration
how does prolonged bed rest/immobility impact thermoregulatory systems?
- threshold for cutaneous vasodilation and sweating (for heat dissipation) shifted to higher core temp
- exercise limited by impaired regulation of body temp
- increased risk for heat-related abnormalities
- cramping, fatigue, syncope, heat stroke
what are some psychiatric effects of prolonged bed rest/immobility?
- more than 50% of pts of all ages experienced mood alterations during prolonged hospitilizations
- anxiety, agitation, delirium, depression
- reduced pysch functioning leads to increased morbidity and mortality
- intellectual and perceptual deficits result from altered sleep patterns, circadian rhythms, presence of noxious stimuli
list some acquired neuromuscular disorders
- CIP (critical illness polyneuropathy)
- CIM (critical illness mylopathy)
- CIPNM (ciritical illness polyneuromyopathy)
- Steroid induced myopathy
- Rhabdomyolysis
what is CIP?
impaired neuromuscular system
- weakness, decreased DTRs, impaired pain, temp and vibratory sense
- facial weakness (CNs spared)
- associated w/abnormal nerve conduction studies
- electrodiagnostic testing critical to confrim dx
