Exam 3: Immobility Flashcards
Think of a ____ with varying degrees
Continuum
Mobility —>
Immobility
The longer the patient is immobile, the
Greater and more pronounced the consequences. Duration impacts outcome
Nature of movement
Optimized mobility correlates POSITIVE patient outcomes
Mobility
Ability to move freely
Immobility
Inability to move about freely
Bed rest
An intervention that restrict patients for therapeutic reasons
Metabolic changes
- Decrease metabolic rate
- Slows metabolism of CHO, protein, fat
- GI disturbances
- Negative nitrogen balance from amino acid breakdown exceeding protein intake
- calcium resorption
- weight loss
- fluid & electrolyte imbalances
- Dehydration
- Slowed wound healing
Respiratory changes
- High risk of respiratory complications
- Atelectasis
- Pneumonia
- Decrease oxygenation
- Decrease cough
- Increase secretions
Cardiovascular changes
- Orthostatic hypotension
- Increased cardiac workload
- Thrombus formation
Musculoskeletal changes can be
Permanent or temporary
Musculoskeletal changes
- Muscle effects
- Skeletal effects
Urinary elimination changes
Urinary stasis
Urinary stasis
Urine in renal pelvis longer r/t lying flat
- –renal calculi from hypercalcemia
- UTIs!!
Integumentary changes
Pressure ulcers
- Ischemia
- inflammation
- over bones prominences
individuals high risk for pressure ulcers
Older adults at greater risk Paralyzed/MS/ALS Hip Fracture Long-term Care Residents Diabetics Those in critical care units
Psychosocial effects
- Emotional and Behavioral
- Sensory alterations (sleep patterns/sensory deprivation)
- Changes in coping
Immobility changes in infants, toddlers, and preschoolers
- -Typically immobilized r/t trauma or correction of congenital issue
- -May delay gross motor skills, cognitive development, and musculoskeletal development.
Immobility changes in adolescents
- Trauma, illness, or surgery
- Social Isolation, loss or delay of experiences (driving, prom, etc.)
Immobility changes in adults
- All systems at risk
- Family/social structure may be disrupted
- Job loss and socio-economic status jeopardized
Immobility changes in older adults
- Significant risks
- Often experience major mobility and ADL losses
- Increased dependence on others
- Long term health outcomes increased in this population
Mobility assessment
- Gait
- Energy level
- Exercise/Activity tolerance
- —Physiological
- —Emotional
- —Developmental
- Fatigue
- Body alignment
Body alignment assessment
- Standing
- Lying
- Functional alignment is extremely important to maintain mobility
- ——How do you achieve correct body alignment/posture in an immobilized patient?
ROM:
Active and passive
Positioning techniques
Pillows
Ankle Foot Orthotic devices
Trochanter roll
Trapeze bar
Fowlers position
Sitting up right
Trendelenburg
Supine but bed is on incline where feet above head
Supine
Laying on back
Prone
Laying on stomach
Sim’s position
“rescue position”
Symptoms of Deep Vein thrombosis
Swollen extremity Pain Warmth Temperature elevation 80% asymptomatic Homan sign not reliable
Treatment for DVT
Enoxaparin (QD)
Heparin (BID)
Avoid massage/movement
Nurses are exposed to
Hazards related to lifting and transferring patients
Safety guidelines for transferring
Communicate clearly. Mentally review transfer steps. Assess patient mobility and strength. Determine assistance needed. Raise side rail on opposite side of bed. Arrange equipment. Evaluate body alignment. Understand use of equipment. Educate patient.
