Immobility PDF

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Summary

Notes for how immobility effects the human body. Break down by body system and different causes for immobility. Miriam Walter was professor. Used course objectives outlined for each section as well as study guides given prior to major exam....

Description

Immobility (Ch 28) System Pathological influences on mobility Resp CHF, peripheral vascular disease, COPD dec ability to deliver O2

Cardiova scular

Skin

compromised cardiac function, dec tissue perfusion, dec resp capacity

Complications/effects of immobility Dec productive cough, pooling secretions, stagnant mucus. Dec lung expansion/resp depth

Assessments & interventions

Assess dec breath sounds, pneumonia  Interventions-turn, cough and deep breathe 10 times per hr, chest Pneumonia, infection, physiotherapy, atelectasis (secretions incentive block bronchiole and spirometer, alveoli collapse, result in hyperinflation hypoventilation) therapy, upright, Risk for PE adequate hydration (2L fluids/day)  keep lungs expanded, if able, raise head of bed to inc lung expansion, reposition pt Circulatory stasis,  Assess vs, pooling blood in lower orthostatic extremities, results in dec hypotension, venous return/CO/BP, unilateral leg orthostatic hypotension, edema, pain (DVT) risk for VTE (DVT, PE)  Interventionsdangle legs, move Edema from dec slowly, foot pumps, peripheral circulation move legs, TED Activity intolerance hose, SCD, anticoagulants Postural hypotension, DVT-leg foot ankle muscle atrophy, exercises, perform passive orthostatic intolerance, range of motion exercises, DVT anticoagulants Position so no pressure on lower extremities or under knees to prevent occlusion of blood flow, don’t cross legs or ankles Pressure on the skin,  Assess skin q shift weight on bony (color, texture, warmth and prominences, skin 

breakdown and pressure injuries (pressure ulcers, decubitus) pressure causes lack of O2 leading to tissue death.

Neuro

Musculos keletal

Renal

CNS-trauma (head injury, paraplegia, quadriplegia, cerebellum damage). CVA (cerebrovascular accident); stroke, brain attack (hemiplegia) Parkinson’s, MS

Postural abnormalities kyphosis, lordosis (pregnant and obesity), scoliosis Disorders/injury affecting musculoskeletal Impaired muscle development/altera tions/dystrophies -pseudarthrosis, osteogenesis imperfecta (brittle bone disease) osteoporosis, rheumatoid arthritis

intactness) Braden scale (risk for compromised skin integrity)  Interventionspressure reduction (turn q 2 hrs), pressure mattress, skin care, lift hips, WC pushups, float heels

Depression, anxiety, forgetfulness, confusion, boredom, sleep/wake disturbances, sensory alterations, behavioral changes, alteration in self concept/role/coping Proprioception, equilibrium changes Depression, anxiety, forgetfulness, confusion Loss of strength/muscle/bone mass, joint contracturesfootdrop (limited joint movement, muscle shortens and joint is permanently flexed, 4 stages, 4-joints have folded into fetal position), accelerated bone loss with osteoporosis dx Altered calcium resorption (hypercalcium) Osteoporosis, atrophy, weakness, contractures Might need foley cath (risk of CAUTI), urinary

Assess-gait, posture, balance Intervention-dangling

InterventionsEarly ambulation after surg, illness, injury Isotonic, isometric, aerobic, anaerobic Pre medicate for pain (NSAIDS, narcotics) Positioning devices to maintain proper body alignment, positioning of joints Fall prevention Ambulation aids

Assess abdominal sounds Intake

stasis/pooling-sepsis, Adequate fluid intake, UTI, calculi, dec bladder promote elimination more tone. frequently Fluid intake dec w/ immobility-urine output dec, urine more concentrated (inc risk for infection and calculi) inc calcium in blood leads to inc risk of kidney stones. Negative nitrogen balance-excreting more N2 than intake Nitrogen-component of proteins, essential for tissue building Constipation, fecal  Assess I&O, food and impaction fluids, last BM  Interventions-fiber, fluids, meds for constipation

GI

Nutrition

 adequate protein Dec BMR and body starts to break down muscle intake (NNB) proteins-NNB  fluid intake Anorexia and nausea d/t body’s lower nutritional demands Activity tolerance-type and amount of exercise person is able to perform.  assess pt limitations, fatigue, DOE, dizziness, pain  note recovery times  how long does is take to perform ADLs independently? Ordered activity: bed rest (BR), bathroom privileges, commode (BSC), up ad lib, up for meals, ambulate 3 times/day, ambulate with assist, PT eval. BR objectives  reduce physical activity/O2 needs  reduce/manage pain  prevent further injuries/complications (PE, DVT)  allow ill/debilitated patients to rest, encourage healing. Deconditioning-average individual without chronic illness loses muscle strength from baseline levels at rate of 3%/day on BR Atrophy-loss of muscle mass Older adult-effects on mobility

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progressive loss of bone mass d/t dec activity, hormone changes, bone resoprtion may walk slower, smaller steps, dec in coordination prescribed meds may cause dizziness balance probs deconditioning-dec ability to move dec respiratory fx (not enough cardiac capacity) osteoporotic fractures (common in hips and wrists)

Pt problems with immobility  impaired mobility/immobility  activity intolerance  self care deficit  risk for falls  risk for skin breakdown  impaired physical/bed/wheelchair mobility, transfer ability, walking  activity intolerance Assess activity tolerance, gait, baseline, aids, ROM, exercise status, alignment, muscle strength, tone, mass, contractures  Interventions q 2 hrs minimum-ROM, bed exercises, up in chair, ambulate, pre medicate for pain  Ambulating-assess if assistance needed, aids, non skid slippers o if able, at least BID, pre-medicate for pain DVT    

may be asymptomatic serious complication-PE may lead to chronic venous insufficiency PTS immobilized more than 3 days, compression of large veins (pelvic tumor, pregnancy, obesity) Venous stasis r/t  prolonged immobility, age, a fib, chronic HF, orthopedic surgery, obesity, pregnancy, post partum, CVA, varicose veins Hypercoagulability r/t  Pregnancy, post partum, estrogen therapy, malignancy, polycythemia-many RBCs, sickle cell disease, dehydration/malnutrition, sepsis, severe anemia S/sx of VTE  unilateral edema, pain, feeling of tightness/tenderness/heaviness in leg, warm skin, erythema, temp>38  Dx-doppler ultrasound, venogram DVT prevention  ambulate, dorsiflexion, ankle rotation q 2-4 hrs, TEDs, SCDs, anticoagulants (heparin, lovenox, Coumadin-warfarin, xarelto, pradaxa, eliquis) VTE treatment

anticoagulants, elevate leg, BR, compression stocking, thrombolysis (med to dissolve clot), mechanical thrombectomy cath to remove clot (used alone or in conjuction with thrombolysis), intravascular filter device or vena cava interruption device Goals for mobility realistic, timed  collaborate with pt/fam  pt will maintain optimal ROM of RLE joints every shift  pt will use IS every 2 hrs  specific, observable criteria to determine goal attainment  pt will have 90 degree flexion in right knee by DC  pt will ambulate full length of hall 3/day Asses CMS Circulation-pulses, warmth, color, cap refill Sensation-can they feel your touch? Numbness or tingling? Movement-wiggle your toes/fingers ...