Preventing the Hazards of Immobility Hazards of Immobility

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Preventing the Hazards of Immobility
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Hazards of Immobility

• When a body part or the entire body is
  immobilized, secondary disabilities may develop
  in body systems. The greater the degree of
  immobility and the longer the immobilization, the
  greater the risk for development of disabilities.

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Bedrest

• Objectives
• Reduces oxygen needs
• Decreases pain levels
• Helps in regaining of strength
• Uninterrupted rest has psychological and
  emotional benefits
• Types of bedrest
• Bed rest
• Bed rest with bathroom privileges

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Effects of Immobility

• Phisiologically
• No body system is immune to affects of immobility
• Effects depend upon a clients health, age, and
  degree

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Metabolic System

• Immobility causes
• Decrease in BMR which causes
• Altered metabolism of carbohydrates, fats, and
  proteins which causes
• Fluid, electrolyte and calcium imbalances which
  causes
• GI disturbances which causes
• Decrease in appetite and decrease in peristalsis

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Metabolic System

• Effects of the metabolic alterations
• Fluid and electrolyte changes
• Bone demineralization
• Altered exchange of nutrients (also affected by
  decreased appetite)
• Altered gastrointestinal functioning
• Constipation
• Nausea/ vomiting
• Gas
• Indigestion
• Decreased appetite

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Metabolic System

• Metabolic assessment
• Anthropometric measurements
• Fluid Intake and Output measurements
• Lab tests for electrolyte imbalances/ nutritional
  status
• Assess ability to heal and fight infection
• Metabolic interventions
• High protein, high calorie diet
• Supplemental vitamin C
• Vitamin B complex

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Respiratory System

• Effects
• Decreased lung expansion
• Pooling of secretions
• Decreased surface area for exchange of CO2 and O2
  (secondary to ?lung expansion)
• Most common complication w/ respiratory system
  hypostatic pneumonia

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Respiratory System

• Respiratory assessment
• Observe chest movements
• Auscultate for pulmonary secretions
• Check O2 saturations
• Observe for respiratory difficulties
• Respiratory interventions
• TCDB q 2 hours
• Chest physiotherapy (CPT)
• Maintain patent airway
• Incentive spirometer

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Cardiovascular System

• Effects
• Orthostatic hypotension
• Increased cardiac workload
• Thrombus formation
• May become emboli
• Most dangerous complication of bedrest
• Valsalva maneuver

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Cardiovascular System

• Assessment
• BP measurements with postural changes
• Monitor pulse
• Monitor for edema
• Watch for s/s of DVT

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Cardiovascular System

• Interventions
• Dangling feet before standing
• Discourage valsalva
• Prevent venous stasis
• Exercise
• ROM
• Anti-embolic stockings (TED hose, SCDs)
• Never massage extremities
• Observe for s/s DVTs (warmth, redness, Homans)

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Musculoskeletal System

• Effects
• Decreased muscle mass
• Muscular atrophy
• Reduced muscle endurance
• Decreased stability
• Joint contractures
• Disuse osteoporosis
• Decreased skeletal mass

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Musculskeletal System

• Assessment
• Anthropometric measurements
• ROM measurements
• Interventions
• Active and passive ROM
• Individualized, progressive exercise program

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Genitourinary System

• Effects
• Urinary Stasis
• Renal Calculi
• UTI

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Genitourinary System

• Assessment
• Analysis of Intake and Output (I O)
• Proper perineal care
• Signs and symptoms of UTI
• Interventions
• Force fluids
• Record I O
• Strain urine if there are stones

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Gastrointestinal System

• Effects
• Constipation
• Fecal Impaction

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Gastrointestinal System

• Assessment
• Assessing BMs daily
• Observe for passage of liquid stool
• Interventions
• Record daily LBM
• Encourage fluids
• Administer enemas, prn
• Digital removal of fecal impactions

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Integumentary System

• Effects
• The effect on the skin in compounded by impaired
  body metabolism and
• Pressure
• Shearing Force
• Friction
• Any break in the skin is difficult to heal, which
  can lead to further immobilization
• Break in skin is called a bedsore, pressure sore,
  or decubitus ulcer (decubitus means bed lying)

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Integumentary System

• Assessment
• Assess positions and the risks with each position
• Identify clients at risk
• Observe for skin breakdown
• Stage 1
• Stage 2
• Stage 3
• Stage 4

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Integumentary System

• Interventions
• Prevention
• Identify at risk clients
• Daily skin exam
• Change positions every 2 hours
• Massage
• Skin care products (lubricate and protect)
• Stimulate circulation
• Pressure support devices

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Integumentary System

• Treat skin breakdowns
• Keep area dry and clean
• Change dressings prn
• Debridement of ulcer
• Must debride to healthy tissue
• Remove eschar
• Increase protein, calories, vitamins
• Protein 2-4 times normal
• Calories 1 1/2 times normal
• Vitamin C wound healing

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Psychosocial Responses

• Assessment
• Assess for behavioral changes
• Any changes in sleep-wake cycle
• Decreased coping abilities
• Signs and symptoms of depression
• Interventions
• Socialization
• Meaningful stimuli
• Maintain body image
• Avoid sleep interuptions
• Utilize resources, I.e. pastoral care or social
  services