chapter 39: Immobility

Question 1

Pathological fractures

Answer 1

those caused by weakened bone tissue

Question 2

5 main pathological influences on mobility

Answer 2

Postural abnormalities
Muscle abnormalities
Damage to CNS
Direct trauma to musculoskeletal system
Joint disease

Question 3

Postural abnormalities

Answer 3

disorders of stance results in inequal muscle tone

Congenital stuff: scoliosis

Limits ROM

Question 4

Damage to CNS

Answer 4

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

Question 5

Reasons for a fracture

Answer 5

trauma (obvi)

Deformities of bone:
-osteoporosis
-Paget’s disease
-metastatic cancer
-osteogenesis imperfecta

Question 6

Joint disease

Answer 6

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

Question 7

Reasons for bed rest

Answer 7

-limit oxygen needs of body
-reduce cardiac workload and pain
-allow debilitated person to rest

-They physically can’t move

Question 8

Why do old people stay voluntarily inactive?

Answer 8

1. fear of bothering staff
2. not wanting to further overburden staff
3. viewing asking for help as negative
4. not wanting to be dependent

Question 9

How fast does muscle deteriorate when on bed rest (for a normal person)?

Answer 9

within days
lose 3% muscle strength per day
disuse atrophy –> muscle fibers get smaller

Question 10

Metabolic changes due to immobility

Answer 10

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

Question 11

Respiratory changes from immobility

Answer 11

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

Question 12

Cardiovascular changes with immobility

Answer 12

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

Question 13

Virchow triad

Answer 13

Factors contributing to thrombus formation

1. damage to vessel wall
2. alterations in blood flow
3. alteration in blood constituents

Question 14

Pulmonary embolus

Answer 14

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

Question 15

Bone changes in immotility

Answer 15

-obvi increased Ca+ resorption –> Disuse osteoporosis

Question 16

Joint changes in immobility

Answer 16

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

Question 17

Urinary elimination changes with immobility

Answer 17

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

Question 18

Skin changes with immobility

Answer 18

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

Question 19

• Caution: don’t provide too much help

Answer 19

This could keep someone - esp old ppl- from regaining mobility and lead to rapid loss of many functions

Question 20

ROM

Answer 20

sagital plane: flexion, extension, hyperextension, plantar flexsion, dorsiflexion

frontal plane: adduction, abduction, eversion, inversion

transverse plane: supination, pronation, internal and external hip rotation

Question 21

How to assess body alignment of immobile or unconscious person?

Answer 21

remove pillows/positioning supports and place patient in suppine position

Question 22

Whose sitting posture is important to assess?

Answer 22

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

Question 23

How should a conscious, lying down patient’s posture be assessed?

Answer 23

in the lateral position without any supports

Question 24

How often do you do a respiratory assessment for an immobile patient?

Answer 24

every 2 hrs –> auscultate

Question 25

signs of pneumonia

Answer 25

productive cough with green-yellow sputum
fever
pain on breathing
crackles, wheezes, and syspnea

Question 26

Signs of DVT

Answer 26

occur in one side of body at a time
-swelling of limb
-warm cyanotic skin
pain

measure calves or thighs regularly

Question 27

how often to change compression devise?

Answer 27

every 8 hrs

Question 28

Results of sensory deprivation (consequence of immobility)

Answer 28

retlessness, increased aggression, and insomnia

Question 29

Abrupt changes in personality

Answer 29

usually have physiological cause like surgery, meds, PE or infection

e.g. UTI or fever in old ppl = confusion/delerium

Question 30

Two diagnoses most directly related to mobility probs

Answer 30

Impaired mobility

Risk for Dissuse Syndrome

Question 31

How to bolster metabolic system of someone who’s immobile

Answer 31

high-cal ntake to meet body needs to func and replace subcutaneous tissue
vit B for energy metabolism
vit C for skin integrity and wound healing

Question 32

What happens if ppl who are immobile dont regularly fill lungs to capacity

Answer 32

they lose the elastic revcoil

Question 33

link between mucus and hydration

Answer 33

ppl need AT LEAST 1100-1400 mL of uncaffeinated liquid a day
w/o adequate hydration pulmonary secretions become thick, tenacious, and difficult to remove

Question 34

how to reduce:
Orthostatic hypotension
Cardiac Workload
Thrombus Formation

Answer 34

Ortho:
-get them moving/mobile ASAP –> isometric exercises don’t help

Cardiac Workload:
-valsalva maneuver when moving up in bed

Thrombus:
-compression stockings and VTE prophylaxis (anticoagulant therapy)
-IPCs are best (cuffs rather than stockings)
-foot pumps –> mimics walking
-calf pump, ankle pump, knee flexion

Question 35

How often to do ROM?

Answer 35

2-3 times a day

5 reps per joint

head to toe –> larger to smaller joints –> support the joints in cupped hand

Question 36

foot boots and ankle foot orthotic (AFO) devices

Answer 36

prevents drop foot by keeping feet in dorsiflexion

Question 37

Trochanter roll

Answer 37

prevents external rotation of hips when patient is in supine position

Question 38

hand roll

Answer 38

maintains thumb in slight adduction and in oppostition to fingers

Question 39

when actual or potential pressure areas exist, what angle should bed be at?

Answer 39

30 derees

Question 40

max time someone should be in chair

Answer 40

1 hr

Question 41

Instrumental activities of daily living

Answer 41

activities that are necessary to be independant in society beyond eating, grooming, transferring, and toiinting

include shopping, cooking, banking, taking meds…

Question 42

hemiplegia and hemiparesis

Answer 42

one sided paralysis

one sided weakness

Question 43

Supported fowlers