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
signs of pneumonia
productive cough with green-yellow sputum
fever
pain on breathing
crackles, wheezes, and syspnea
Signs of DVT
occur in one side of body at a time
-swelling of limb
-warm cyanotic skin
pain
measure calves or thighs regularly
how often to change compression devise?
every 8 hrs
Results of sensory deprivation (consequence of immobility)
retlessness, increased aggression, and insomnia
Abrupt changes in personality
usually have physiological cause like surgery, meds, PE or infection
e.g. UTI or fever in old ppl = confusion/delerium
Two diagnoses most directly related to mobility probs
Impaired mobility
Risk for Dissuse Syndrome
How to bolster metabolic system of someone who’s immobile
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
What happens if ppl who are immobile dont regularly fill lungs to capacity
they lose the elastic revcoil
link between mucus and hydration
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
how to reduce:
Orthostatic hypotension
Cardiac Workload
Thrombus Formation
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
How often to do ROM?
2-3 times a day
5 reps per joint
head to toe –> larger to smaller joints –> support the joints in cupped hand
foot boots and ankle foot orthotic (AFO) devices
prevents drop foot by keeping feet in dorsiflexion
Trochanter roll
prevents external rotation of hips when patient is in supine position
hand roll
maintains thumb in slight adduction and in oppostition to fingers
when actual or potential pressure areas exist, what angle should bed be at?
30 derees
max time someone should be in chair
1 hr
Instrumental activities of daily living
activities that are necessary to be independant in society beyond eating, grooming, transferring, and toiinting
include shopping, cooking, banking, taking meds…
hemiplegia and hemiparesis
one sided paralysis
one sided weakness
Supported fowlers
