Module 6 Flashcards
Facts about hospital immobilisation
-Between 35-50% hospitalised patients experience a decline in their functional status between hospital admission and discharge
-Up to 30% of hospitalised older patients do not recover their premorbid functional status
-Increased risk of death and prolonged disability
-Reduced activity participation in the community after prolonged hospitalisation in older adults
Why is mobilisation important?
-Important to assess ADLs + mobility (sit without assistance, how far can walk, can walk independently or needs assistant…)
-MOBILITY=moving, or to make mobile
-Mobilisation is low intensity activity that elicit acute cardiopulmonary and cardiovascular responses to enhance oxygen transport
Bed rest, immobilisation or sedentary lifestyle frequently results in the loss of beneficial aspects of activity
Why is immobilisation important too?
-Allows the repair of a damaged tissue
-Avoiding unnecessary physical exertion, metabolic resources may be utilised for process of healing and recovery from injury
- Someone having a segment immobilised- broken bone causing bone healing- periods of rest will assist tissue to heal
Postural hypotension as a result of immobilisation
-Decreased blood pressure within 3 minutes of upright tilt (lightheaded, dizziness, blurred vision, confusion, nausea
-Usual standing up hearts have an increased cardiac output and blood pressure as well as sympathetic simulation (this doesn’t happen for immobilised individuals)
DVT and blood viscosity as a result of immobilisation
diuresis causes lower plasma volume, increased red cell volume and higher blood viscosity
-Virchows triad (venous stasis, hypercoagulability and blood vessel damage)
-Increased risk of DVT and emboli
-Lower haemoglobin and o2 transport
-Arterial 02 saturation is lowered
Increased risk of respiratory infections due to immobilisation
-Lower lung volumes, mucuous retention, reduced cilliary beating, reduced cough, dehydration and thicker mucuous
Other effects of immobilistion
-Sense of taste, smell and loss of appetite
-Constipation
-UTIS
-Insomnia, aggression, reduced pain threshold, glucose intolerance and impaired insulin response
Musculoskeletal effects of immobilisation
-Disused atrophy of muscles, lower strength, lowered endurance, increased muscle fatigue, stiffness, shortening, contractures, osteoporosis, fractures, altered sensation, capillary compression, pressure ulcers, lowered immunity
What is a contracture?
A permanent tightening of the muscles, tendons, skin, and nearby tissues that causes the joints to shorten and become very stiff. This prevents normal movement of a joint or other body part. Contractures may be caused by injury, scarring, and nerve damage, or by not using the muscles.
Why mobilise patients?
To prevent the deleterious effects of immobilistion, to gain the benefits of mobilisation and increase or maintain function
Why assess mobility?
-Provide goals for treatment
-Evaluate effects of treatment
-Plan treatment interventions
-Advice to other medical team/family members on safe methods of moving/mobilising the patient
-Advice on level of care required
-Determine whether a patient is safe to discharge
What is in a mobility assessment?
moving in bed, getting out of bed, standing up, sitting down, walking, distance able to walk, manage going up and down steps
Main physiological factors that impact someones ability to mobilise
Cognitive function, cardiovascular function, endurance, muscle strength and length, balance and coordination, vision and hearing, sensation (pre-morbid status, medical presentation, goals of patient, living environment, presence of ssistance, access to lifting equipment, use of gait aids, WBs, IV infusion, drains and catheters)
OHS and safety issues for mobilisation
-Lifting equipment and gait aid accessibility, assistance (min max 1 and 2), environment, patients weight, compliance and ability of patient, stability of equipment locking wheels
Physiotherapy assessment when mobilising must include
Medical notes, subjective history taking and physical assessment (objective)
-The patient is up for the first time (how do you ensure the patient is safe when mobilising, what are you going to monitor?)
