Bed, Rest, Deconditioning & Hospital Acquired Weakness

Question 1

how is the CV system affected by bed rest/immobility

Answer 1

• reduced VO2max
• increased resting HR
• decreased CO
• reduced cardiac vagal tone
• increased norepiniphrine
• enhanced beta-adrenergic receptor sensitivity
• hypovolemia
• venous pooling

Question 2

orthostatic hypotension

Answer 2

• a drop in BP during a change in position
• decreased upright position tolerance
• drop in 20 in systolic
• and 10 in diastolic

Question 3

when can OH occur

Answer 3

within 3 wks of bed rest, sooner for elderly

Question 4

what is a main complication that occurs with OH that has to do with circulation

Answer 4

excessive pooling of blood in LEs –>
decreased circulating blood volume –>
rapid HR = diminished diastolic ventricular filling and decline in cerebral perfusion

Question 5

treatment for OH

Answer 5

exercises in bed before sitting them up 
early mobilization
LE exercises to increase blood circulation 
compression stocking 
tilt table

Question 6

how is the hematologic system affected by bed rest

Answer 6

• RBC mass reduction by 5% to 25%

- decreased total blood volume, red blood cell mass and plasma volume

Question 7

you can also have elevated HCT due to bed rest, what can this lead to

Answer 7

increased risk for DVT

you have decreased blood plasma and increased RBC = dehydration

Question 8

reduced capillarization of peripheral muscle beds is a complication of the hemtologic system due to bed rest, why do we need to know this as a PT

Answer 8

you have reduced blood flow to exercising muscles which will decrease exercise tolerance

Question 9

what is a venous thromboembolism and what are the 3 things involved

Answer 9

• virchow triad
• venous stasis
• hypercoagulability
• blood vessel damage

Question 10

primary site for venous thromboembolism

Answer 10

calf and soleus sinus

Question 11

what is directly related to frequency of DVT

Answer 11

length of bed rest

Question 12

what pharmacology will decrease blood coagulability

Answer 12

unfractioned heparin (UFH)
low molecular weight heparin (LMWH)

Question 13

what are the key elements of bed rest contributing to MSK changes

Answer 13

lack of LE WB forces

decreased number/magnitude of muscle contractions

Question 14

when does adaptations to decreased loading of muscles occur

Answer 14

within days

Question 15

where does atrophy occur greatest

Answer 15

in antigravity muscles (quads) than antagonist muscles (hamstrings)

Question 16

what muscle fibers are affected the most

Answer 16

type IIB (fast twitch) more than type 1 and type IIA

Question 17

if a pt is immobilized in the shortened position what happens

Answer 17

enhances atrophy

Question 18

if a pt is immobilized in the lengthened/stretched position what happens

Answer 18

decrease loss of muscle fiber proteins

Question 19

disuse osteoporosis is due to what

Answer 19

bone loss due to not enough stress placed on the bone

Question 20

what two things can result from immobilization

Answer 20

hypercalciuria and negative calcium balance results

Question 21

what happens to calcium balance within one week of bedrest

Answer 21

negative calcium balance

Question 22

pathogenesis of a pressure injury

Answer 22

pressure causes ischemia, compresses capillaries and occludes blood flow –> excessive pressure can lead to tissue necrosis

Question 23

stage 1 decubitus ulcers

Answer 23

skin intact

non-blanchable

Question 24

stage 2 decubitus ulcers

Answer 24

broken skin

top epidermis

Question 25

stage 3 decubitus ulcers

Answer 25

broken skin into subcutaneous layer

Question 26

stage 4 decubitus ulcers

Answer 26

ulcer into muscle and bone

Question 27

for a cushion in a WC which type is the best pressure relief

Answer 27

air

Question 28

what happens to NA, K, Ca and phosporus due to prolonged bed rest and what can this lead to

Answer 28

increase excretion after on 7 days

kidney stones

Question 29

what happens to erythropoietin concentrations due to prolonged bed rest

Answer 29

decreases concentration

Question 30

muscle activity is essential for what relating to insulin? what happens due to that

Answer 30

expression of Glut 4 (glucose transporter)
can occur after only 3 days
pt becomes insulin resistance

Question 31

what are u at an increased risk for relating to thermoregulatory of the body

Answer 31

heat related abnormalities - cramping, fatigue, syncope, heat stroke
body shifts to a higher core temp

Question 32

reduced psycho functioning leads to what

Answer 32

increased morbidity and mortality

Question 33

anxiety

Answer 33

apprehension, increased motor activity

shaking, tremor, avoidance behaviors

Question 34

agitation

Answer 34

excessive motor behavior including inappropriate verbal behavior and physical aggression

Question 35

delirium

Answer 35

disturbances in consciousness, orientation, memory, perception
caused by something else, typically if you can fix that the delirium goes away

Question 36

depression

Answer 36

persistence low mood

Question 37

intellectual and perceptual deficits result from what

Answer 37

altered sleep patterns
circadian rhythms
presence of noxios stimuli