chapter 39: Immobility Flashcards
Pathological fractures
those caused by weakened bone tissue
5 main pathological influences on mobility
Postural abnormalities
Muscle abnormalities
Damage to CNS
Direct trauma to musculoskeletal system
Joint disease
Postural abnormalities
disorders of stance results in inequal muscle tone
Congenital stuff: scoliosis
Limits ROM
Damage to CNS
Long bed rest = sensorimotor dysfunction –> instability
Trauma, ischemia (from stroke), and bacterial infection (meningitis) can damage cerebellum or motor strip in cerebral cortex
Trauma to spinal cord too
Reasons for a fracture
trauma (obvi)
Deformities of bone:
-osteoporosis
-Paget’s disease
-metastatic cancer
-osteogenesis imperfecta
Joint disease
ARTHRITIS!!!!
osteoarthritis is one of most common causes of chronic disability
-hip and knees
- used to be considered “wear and tear” = degenerative joint disease
-now known to involve biomechanical factors, inflammatory factors and proteases
Rheumatoid arthritis is a chronic systemic inflammatory autoimmune disease
-swollen, tender joints –> destruction of synovial joints
-usually fingers, feet, wrists, elbows, ankles, knees
-also affects lungs, heart, and kidneys
-Pain
Reasons for bed rest
-limit oxygen needs of body
-reduce cardiac workload and pain
-allow debilitated person to rest
-They physically can’t move
Why do old people stay voluntarily inactive?
- fear of bothering staff
- not wanting to further overburden staff
- viewing asking for help as negative
- not wanting to be dependent
How fast does muscle deteriorate when on bed rest (for a normal person)?
within days
lose 3% muscle strength per day
disuse atrophy –> muscle fibers get smaller
Metabolic changes due to immobility
changes in mobility alter endocrine metabolism, calcium reabsorption, and GI functioning
decreases BMR (unless fever/inflammation)
Excretes more nitrogen than it ingests in prot –> neg nitrogen balance –> muscle catabolism
Calcium resorption from bones –> possible hypercalcemia
GI slows - constipation or pseudodiarrhea
Respiratory changes from immobility
Pulmonary atelectasis = collapse of alveoli due to blocked bronchi from secretions –> whole lung can collapse! –> can’t cough well –> mucus accumulates in bronchi (esp if supine, prone, or lateral)
Hypostatic pneumonia = inflammation of lung from stasis or pooling of secretions
Cardiovascular changes with immobility
Orthostatic hypotension bc of less circulating fluid, pooling blood, and low ANS respone
Increased cardiac workload: CO falls, so heart works more
Thrombus formation = accumulation of platelets, fibrin, clotting factors, and cellular elements of blood on wall of vessel
Virchow triad
Factors contributing to thrombus formation
- damage to vessel wall
- alterations in blood flow
- alteration in blood constituents
Pulmonary embolus
Can begin as a deep vein thrombosis
thrombus breaks off, travels to pulmonary artery, keeps blood away from lung
Symptoms:
range from nothing to shock and death
usually dyspnea and pleuritic chest pain and cough
Bone changes in immotility
-obvi increased Ca+ resorption –> Disuse osteoporosis
Joint changes in immobility
Joint contracture = fixation of joint
-muscle atrophy = shortening of fibers = contracture
*note: flexors are stronger than extensors
Foot drop is a common contracture –> permanent plantar flexion –> ppl with hemiplegia are at risk
Urinary elimination changes with immobility
Urinary stasis if gravity doesn’t help urine get from pelvis to bladder
Renal calculi due to hypercalcemia bc of bone resorption and lack of fluid intake
Skin changes with immobility
Pressure injuries –> due to prolonged ischemia and superficial shear
-starts out as inflammation
-worse if moist or poor nutrition
-body cant carry out metabolic processes so skin breaks down
- Caution: don’t provide too much help
This could keep someone - esp old ppl- from regaining mobility and lead to rapid loss of many functions
ROM
sagital plane: flexion, extension, hyperextension, plantar flexsion, dorsiflexion
frontal plane: adduction, abduction, eversion, inversion
transverse plane: supination, pronation, internal and external hip rotation
How to assess body alignment of immobile or unconscious person?
remove pillows/positioning supports and place patient in suppine position
Whose sitting posture is important to assess?
those with muscle weakness/paralysis or nerve damage –> can’t tell when they’re cutting off their own circulation
Also those with respiratory disease - might lean on table to make breathing easier
How should a conscious, lying down patient’s posture be assessed?
in the lateral position without any supports
How often do you do a respiratory assessment for an immobile patient?
every 2 hrs –> auscultate
