W7 : Complications with immobility part A Flashcards
Respiratory system
Pathophysiology
- Supine position impacts on ability to take deep breaths; diameter of bronchus is reduced; there is increase in mucous production
- Weight of chest and pressure from abdominal organs further limits chest expansion
- Weakened cough, reducing ability to clear normal bronchial secretions, pooling and stasis of mucous in the lungs/chest
- Blood flow changes result in decrease in production of surfactant resulting in alveolar
collapse
-Impaired gas (oxygen & carbon dioxide) exchange
Atelectasis
- Condition of the lung characterised by
collapsed airless alveoli; lung collapse - Assessment data – dyspnoea, cough, fever,
tachypnoea, low oxygen saturations
Chest infections & Hypostatic pneumonia
- Pooled secretions result in inflammation
- Excellent media for microorganism growth
- Assessment data – fever, chills, dry or productive or cough, malaise, pleural
pain, dyspnoea, haemoptysis
Cardiovascular system
Pathophysiology
- Immobility lessens the effectiveness of the calf muscle
‘pumping’ of blood back to heart - Venous return is also impeded as a result of less effective respiration (deep breaths facilitates blood returning to inferior vena cava)
- Fluid changes – dehydration
- Venous stasis; pooling of blood; compression of veins in the leg between the bones and the bed; likelihood of blood
coagulation
Cardiovascular system
complications
- Increased cardiac workload – elevated pulse
- Orthostatic hypotension
- Falls risk
Venous
thromboembolism (VTE)
The blocking of a blood vessel by a blood clot.
Includes deep vein thrombosis (DVT) & pulmonary embolism. (PE)
Thrombus
A blood clot
Embolus
A blockage in vascular flow- usually a thrombus, but can be fat, air and many other types of blockages
Phlebitis
Inflammation of a vein, usually in the legs. Most commonly seen in superficial veins.
Thrombophlebitis
Inflammation of a vein caused by a blood clot.
Venous stasis
Slow blood flow in the veins (usually legs).
Associated with long periods of immobility: hospitalisation,
bedrest, sitting for long periods (flying or driving), orthopaedic cast.
what is deep vein thrombosis?
a blood clot (thrombus) that forms in a deep vein of the leg or pelvis either partially or totally blocking the flow of blood
What is pulmonary embolism (PE) ?
a pulmonary embolism is caused when:
1: a deep vein thrombosis (blood clot) or part of it, breaks off from the vein
2:The break away clot travels through the bloodstream to the heart and migrates towards the lung
3: The clot blocks a vessel in the lung, interrupting blood supply
Venous thromboembolism: Deep vein thrombosis (DVT) signs and symptoms
Deep vein thrombosis (DVT)
May be a symptomatic or
symptomatic (pain, swelling, redness).
Venous thromboembolism: Pulmonary embolism (PE) signs and symptoms
Pulmonary embolism (PE) -
medical emergency
Signs & symptoms include chest pain,
dyspnoea, low oxygen saturation,
haemoptysis, anxiety.
Are gloves an important strategy in the
goal to prevent needle stick injury?
❑ Gloves need not be worn for subcutaneous, intramuscular or intradermal injection unless exposure to blood is anticipated
❑ Gloves do not prevent needle stick injuries
❑ However, studies have shown that transmission of
blood-borne pathogens can be significantly reduced due to the
‘cleaning’ effect the latex or vinyl has on the instrument as it passes through the glove
Tips for preventing
needle stick injury
Use best practice techniques:
✓ Perform the procedure slowly and carefully
✓ Minimise the handling of sharp instruments
✓ Sharp instruments must not be passed from the hand of a health care
worker to another person
✓ Needles must not be re-sheathed, except in special circumstances, then use
a single handed technique
✓ Needles must not be removed from disposable syringes for disposal
Reporting
- Both clean & contaminated sharps injuries must be reported
- Essential for your safety & the safety of other workers
- Reporting of all sharps injuries makes a
significant contribution to the risk management process and to the process
involved in purchasing decisions
Sharps safety
- Sharps injuries are the most efficient method of
transmitting blood borne pathogens from patients
to health care workers - Nurses most at risk
- Nursing students may be at greater risk due
to inexperience, nervous, less dexterous,
distracted … - What is the most common pathogen?
- Hepatitis B virus (2 in 5 chance)
- Hepatitis C virus (1 in 10 chance)
- HIV (1 in 300 chance)
Subcutaneous enoxaparin
injection
o Abdomen preferred site for anticoagulants
such as enoxaparin and heparin
o Consider product administration
instructions - deep s/c injection; air bubble
o Assess amount of subcutaneous tissue &
inject at a angle 90 degree (or less)
o Do not draw back on syringe
Practice points for
subcutaneous injection
o Consider age, nutritional status,
weight & distribution of
subcutaneous fat
o Use appropriate syringe and
needle length
o Rotate site if injection
administered regularly
o Skin cleaning
o Care of the injection site
Subcutaneous
injection
o Injecting into the subcutaneous
tissue beneath the skin
o Medications are absorbed
slowly, sustained effect
o Less nerve endings &
blood vessels
o 45-90 degree angle
o Small volume
(generally up to 1 mL)
o Heparin, insulin
Factors impacting on
needle selection
o Site of the injection
o Depth of subcutaneous tissue
covering the muscle
o Medication viscosity
o Persons age
Pharmacological
prophylaxis
- Anticoagulants
- Alter the process of blood
coagulation to prevent
VTE
Contraindications for
mechanical interventions
o Skin ulceration
o Severe peripheral vascular disease
o Massive oedema
o Morbid obesity
o Lower leg trauma/deformity
o Stroke patients
o Peripheral neuropathy
Mechanical
prophylaxis
- Devices that increase
blood flow velocity in leg veins, reducing venous stasis. - graduated compression stockings
- anti-embolic stocking
- intermittent pneumatic compression device
- foot impulse device
Graduated compression stockings (GCS)
Provide graduated compression, which is firmest at the ankle. Used mainly for ambulant patients
Anti-embolic Stocking
Standard compression throughout.
Used for bedbound or non-ambulant patients
Foot Impulse Device (FID)
Stimulates legs veins to mimic walking and reduce
stasis. Used for immobilised patients
Intermittent Pneumatic
Compression Device (IPC)
Inflatable garment wrapped around legs which is
inflated by pneumatic pump. Enhances venous return
