Effects of Immobility and Ambulation

Question 0

Effects of immobility - musculoskeletal

Answer 0

• disuse osteoporosis - someone who does not or cannot do range of motion exercises
• decrease muscle mass (aka disuse atrophy)
• contractures - without use, joints may become deformed; occur at joints - almost like the joints freeze and they can no longer move or use that joint
• stiffness and pain in the joints
• any time a patient is able to do something for themselves, they should do it, we want to make sure the patient doesn’t lose their muscle mass

Question 1

What systems does immobility affect?

Answer 1

• musculoskeletal
• cardiovascular
• respiratory
• gastrointestinal/urinary
• integument
• psychosocial

Question 2

Effects of immobility - cardiovascular

Answer 2

• diminished cardiac reserve - heart rate increase, heart can’t fill effectively, has to work harder
• postural/orthostatic hypotension - when we change position, blood can’t always get to brain, blood pressure can decrease; blood pools in lower extremities; need to make position changes very slowly
• venous vasodilation - leads to (dependent) edema; stasis - thrombus formation (clots that stick to the side of a vessel wall) - dangerous because it can stop stop blood flow through that vessel - DVT - deep vein thrombosis; want to make sure the thrombus doesn’t become an embolus, because then it will travel (pulmonary embolus - can cause death); consequence for people on prolonged bed rest
• want people to get up and move to prevent blood pooling

Question 3

Effects of immobility - respiratory

Answer 3

• decreased respiratory movement - want to be sure lungs are expanding
• pooling of secretions - may lead to atelectasis (collapsing of airways) and/or (hypostatic) pneumonia (due to secretions pooling in lungs - good place for pathogens to grow and survive); if we don’t change positions and move out some of the moisture, we can get some pooling in lungs;

Question 4

Effects of immobility - metabolism/gastrointestinal/urinary

Answer 4

• anorexia - decrease in appetite; when you are not moving, your body has no need for calories; can lead to electrolyte imbalances
• constipation - not moving around enough to encourage feces through gut; may have a problem passing stool - prolonged use of bed pans can cause problems
• urinary statis (when urine sits in the kidney or bladder) - may lead to renal calculi - can develop stones
• urinary retention - may lead to incontinence and infection

Question 5

Effects of immobility - integument

Answer 5

• reduced skin turgor - skin is not as pliable; more delicate
• impaired circulation; pressure over bony parts in our body - leads to skin breakdown… pressure (decubitis) ulcers
• Braden Scale - predicts patients risk for developing pressure ulcers; the lower the score, the increase in the risk for an ulcer to develop

Question 6

Effects of immobility - psychosocial

Answer 6

• depression; loss of purpose
• dependency on other people
• loneliness; people need to visit them, they can’t go out and visit other people
• hopelessness - unable to do the things they once did
• anger/frustration - loss of role

Question 7

Canes

Answer 7

• least amount of support
• standard, tripod or quad; ideally, hold cane on the strong (unaffected) side of your body, but patient preference comes first

Question 8

Walkers

Answer 8

• standard, four or two-wheeled; patient has to have the strength to lift and move a standard walker

Question 9

Crutches

Answer 9

• most amount of support
• bear weight in arms (not axillae) - must be able to flex elbow to a certain degree; hands must bear weight, not armpits - can cause nerve damage; on stairs: good leg first when going UP; bad leg and crutches first when going DOWN.