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COMPLICATIONS of PROLONGED BED REST
Marija Buttery Version 4 2012
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Pressure Area Care (PAC)

• What are pressure ulcers?
• What are pressure sores?
• What are decubitis ulcers?
• What causes them?
• How do we prevent them?

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Pressure Ulcers

• Any lesion caused by unrelieved pressure
  resulting in damage of underlying tissue (AHCPR
  1994)
• Pressure ulcers can occur anywhere on the body
• Pressure Ulcers, Pressure Sores and Decubitis
  Ulcers are all the same thing

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Pressure ulcer staging

• Stage I Persistent redness
• Stage II Partial thickness skin loss
• Stage III Full thickness skin loss
• (subcutaneous)
• Stage IV Full thickness loss (to fascia)

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Pressure Area Care

• One of the vital roles of the nurse after
  assessment is to prevent damage/illness.
• There are a variety of patients who we assess and
  determine as being at increased risk of
  developing pressure sores.
• Implementation of Norton Risk Assessment scale,
  Braden Scale, Gosnell Scale (and possibly others)
  is meant to reduce development of new pressure
  ulcers in high risk patients

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Pressure ulcer causes

• Prolonged pressure
• Duration and intensity
• Location
• Extended pressure that blocks flow to the tissue
  between the source of pressure and the bone
• Shear
• Friction

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Pressure ulcer etiology

• Pressure exerted by bony prominences on the body
  that stop capillary flow to the tissues.
• Deprives tissues of oxygen and nutrients causing
  cell death.
• Pressure greater than 32mmHg exerted by bony
  prominences disrupts blood flow.

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Pressure ulcer etiology

• Function of both time and pressure
• 70mmHg pressure for two hours produces
  irreversible injury
• greater pressure takes less time
• lower pressure takes more time
• obese may be much lower emaciated may be much
  higher risk
• TURNING SCHEDULES MUST BE INDIVIDUALISED!!!!

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Pressure Prevention

• The main prevention of these ulcers is to stop
  the damage before it starts. This includes all
  three causes
• pressure
• friction
• shearing
• Management also includes assessment, monitoring
  and evaluation of the person as a whole and
  improving aspects such as
• nutrition
• fluid balance
• skin integrity
• movement/mobility
• underlying health conditions
• cognitive function

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Pressure Causing Things

• Class discussion
• Sheets and blankets
• Monitors
• Tubing (oxygen, drips and drains etc.)
• Clothing (including nappies)

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WHERE ARE THE POTENTIAL PRESSURE POINTS?

• Positions
• Supine
• Prone
• Lateral
• Orthopnoeic

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MOBILITY

• To care for clients who have limited mobility,
  the nurse needs to understand the physical and
  psychological effects of immobility, the
  complications these may lead to and nursing
  interventions that can prevent these
  complications.
• One of the nurses roles is to encourage mobility,
  whether that be passive or active.

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MOBILITY

• The provision of various devices may help the
  client to be more independent. It may also
  assist the nurse in not having to use as much of
  their own physical force to ambulate the patient.
• Assessment of the patients mobility should be
  assessed each time they require assistance,
  whether that be in bed or out.
• This constant update of information allows for
  the nurse to better protect themselves against
  injury and be in a better position to provide the
  most appropriate assistance to their client.

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USE OF MOBILITY AIDS

• Ensure the equipment is in working condition
• Adjust the aid to the correct height for the
  individual
• Ensure the patient knows how to use the walking
  aid correctly
• Maintain a safe environment
• Evaluation

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MOBILITY AND EXERCISE

• The musculoskeletal, nervous and cardiovascular
  systems combine to allow for movement.
• Exercise can be active or passive.
• Active exercise involves voluntary effort.
• Passive exercise is movement by another
  individual.

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Why Exercise?

• Stimulation
• Promote circulation
• Muscle tone and strength
• Joint mobility
• Relaxation - can promote sleep
• Combat boredom
• Combat stress

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Complications Of Decreased Mobility and Bed Rest

• Pressure on bony prominences decubitis ulcers
• Decreased use of muscles and joints muscle
  wasting and contractures
• Venous stasis Deep Vein Thrombosis (DVT)
• Pulmonary Stasis lung congestion
• Urinary Stasis infection or calculi
• Decreased intestinal peristalsis constipation
• Decreased vasomotor tone hypotension
• Decreased independence depression, boredom,
  anxiety
• Foot drop

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Thrombosis

• Some people are at greater risk of a DVT forming
  than others
• If a DVT does form it needs to be treated quickly
  to prevent the clot from breaking , travelling
  around the body causing greater damage such as
• Cerebrovascular Accident (CVA)
• Myocardial Infarction (MI)
• Pulmonary Embolis (PE)
• Treatment includes restricting mobility,
  medication to reduce blood clotting, and treating
  the symptoms

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Sequential Compression Devices (SCD) - also known
as calf stimulators, for prevention of
DVT.Should be used in conjunction with
anti-embolic stockings
Sequential Calf Compression
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Relief of Pressure On Feet

• Pleat in the sheets/blankets
• Bed Cradle - reduces the pressure on the top of
  the feet for pain relief or the prevention of
  foot drop (another complication of prolonged bed
  rest)

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The LungsPooling of secretions in the lungs
from prolonged bed rest and lack of movement can
lead to lung damage and pneumonia. Deep
breathing and huffing exercises are needed to
expand the lungs and expectorate the secretions
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The KidneysPooling of urine in the urinary
bladder from lying in one position increases the
risks of urinary tract infections
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Any Questions?