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Causes, Effects, Complications, Technologies, and Prevention. Immobility Fall 2006 By: Lee Resurreccion. Definition: Immobility. Immobility refers to a reduction in the amount and control of movement a person has. By: Kozier, et. al. p. 847.

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definition immobility
Definition: Immobility
  • Immobility refers to a reduction in the amount and control of movement a person has.

By: Kozier, et. al. p. 847

nursing interventions to prevent deep vein thrombosis dvt include all the following except
Nursing interventions to prevent deep vein thrombosis (DVT) include all the following EXCEPT:
  • wearing sequential compression devices (SCD’s)
  • encouraging early ambulation
  • avoiding keeping TED hose stocking from rolling down the leg
  • restricting fluids
nursing interventions to prevent deep vein thrombosis dvt include all the following except4
Nursing interventions to prevent deep vein thrombosis (DVT) include all the following EXCEPT:
  • wearing sequential compression devices (SCD’s)
  • encouraging early ambulation
  • avoiding keeping TED hose stocking from rolling down the leg
  • restricting fluids
which of the following clients is most at risk for developing complications of immobility
Which of the following clients is MOST at risk for developing complications of immobility?
  • a 30 year old with a fractured ankle
  • an 80 year old with a fractured leg
  • a three year old with a burned hand
  • a 42 year old who is one day post abdominal surgery
which of the following clients is most at risk for developing complications of immobility6
Which of the following clients is most at risk for developing complications of immobility?
  • a 30 year old with a fractured ankle
  • an 80 year old with a fractured leg
  • a three year old with a burned hand
  • a 42 year old who is one day post abdominal surgery
which of the following clients is most at risk for developing complications of immobility7
Which of the following clients is MOST at risk for developing complications of immobility?
  • a 30 year old with a fractured ankle
  • an 80 year old with a fractured leg
  • a three year old with a burned hand
  • a 42 year old who is one day post abdominal surgery
the body s response to immobility
The Body’s Response to Immobility
  • “It is always assumed that the first thing in any illness is to get the patient to bed…yet we should think twice before ordering our patients to bed and realize that beneath the comfort of the blanket there lurks a host of formidable dangers.”

British Medical Journal, 1947.

causes of immobility
Causes of Immobility
  • Congenital Problems: Spinal bifida
  • Neuromuscular Deficits: MS
  • Musculoskeletal Deficits: Arthritis
  • Chronic Health Problems: low back pain
  • Trauma: Fractures, Head Injury
  • Affective Disorders: Uncontrolled Depression
  • Therapeutic Modalities: DVT’s, Chemo
complications of immobility
Complications of Immobility

Dependent on:

  • duration of inactivity
  • baseline health status
  • sensory awareness
patients on bed rest
Patients on Bed Rest
  • Difficulty in defining bed rest
  • Benefits
    • Relieves pain
    • Initially promotes healing and repair
    • Decreases oxygen needs by body’s cells
    • Restful both physiologically and psychologically
impact of immobility on body systems
Impact of Immobility on Body Systems
  • Complications of bed rest or immobilization are sometimes referred to as immobilization disabilities, a.k.a. - iatrogenic consequences of immobility
  • Immobilization effects every system and every major organ in the body
    • Skin, heart, brain, kidney, bones,

lungs, muscle.

musculoskeletal system
Musculoskeletal System
  • Musculoskeletal iatrogenic consequences of

immobility include:

    • Disuse Osteoporosis: demineralization of the bones resulting to bones become spongy, deformed, & fracture easily.
    • Disuse Atrophy: muscles decrease and loose strength and normal function
    • Contractures: muscle fibers no longer shorten and lengthen and eventually permanently shortens limiting joint mobility.
    • Stiffness and Pain in Joints: without movement collagen (connective tissue) becomes stiffened and permanently immobile.
cardiovascular system
Cardiovascular System
  • Tachycardia
  • Increased use of Valsalva maneuver
  • Orthostatic hypotension:
  • Venous stasis
  • Dependent edema
  • Thrombosis generation :

--- Causes of Thrombus formation in immobile patients:

Impaired venous return

Hypercoagulability

respiratory system
Respiratory System
  • Decreased respiratory movement
  • Pooling of respiratory secretions
  • Hypostatic pneumonia
  • Atelectasis
metabolic system
Metabolic System
  • Decreased metabolic rate
  • Negative Nitrogen Balance:
    • anabolism : Protein synthesis
    • Catabolism: protein breakdown

*the anabolic process decreases and the catabolic process increases which then depletes the protein stores essential for muscle tissue and wound healing.

urinary system
Urinary System
  • Urinary stasis: Stoppage or slowing of flow
  • Renal calculi: If urine becomes more alkaline, calcium salts precipitate out and become “stones”
  • Urinary retention: Decreased muscle tone of bladder inhibits its ability to empty completely.
  • Urinary incontinence: Involuntary urination because of poor bladder muscle tone.
  • Urinary infection: Eschericia coli
  • urinary reflux: Contaminated urine back flow
gastrointestinal system
Constipation:

Decreased peristalsis and colon motility

decreased perineal muscle tone

bedpan use causes a disruption of normal bowel habits.

Gastrointestinal System
integumentary system
Integumentary System
  • Reduced skin turgor
  • Skin Breakdown (Decubiti) = pressure ulcers
    • Other complicating factors
      • inadequate nutrition
      • incontinence
      • decreased mental status
      • diminished sensation
      • increased body heat
      • elderly
      • other chronic conditions (diabetes, heart disease)
staging pressure ulcers
Staging Pressure Ulcers
  • Stage 1
  • Stage 2
  • Stage 3
  • Stage 4
wound debridement
Wound Debridement

Types of debridement:

  • Sharp: scapel is used
  • Mechanical: scrubbing method
  • Chemical: agents are applied
  • Autolitic: body fluids are trapped over the escar and the body’s own enzymes remove the escar
factors affecting wound healing
Factors affecting wound healing
  • Developmental: Elderly
  • Nutrition: decreased protein, carbohydrates, vitamin C.
  • Lifestyle: smoking
  • Medications: steroids
assessment of pressure ulcers
Assessment of Pressure Ulcers
  • Risk assessment tools
    • Braden Scale
    • Norton’s Pressure Area Risk Assessment Scale
    • RAPS: (Risk Assessment Pressure Score) *
  • Descriptive tool
    • RYB color code

*Lindgren, et al (2004). Immobility - a major risk factor of pressure ulcers among adult hospitalized patients: A prospective study. Scand J. Caring Sci, 18, 57-64.

braden scale for predicting pressure sore risk
Six subscales:

1. sensory perception

moisture

activity

mobility

nutrition

friction/shear risk

Points given on a Likert-like scale.

The higher the points, the less risk for pressure ulcers.

Maximum score is 23:

19 – 23 no risk

< 18 at risk

< 12 high risk

Braden Scale: for Predicting Pressure Sore Risk
norton s pressure area risk assessment scale
Norton’s Pressure Area Risk Assessment Scale

Subscales include:

a. general physical condition

b. mental status

c. activity

d. mobility

e. incontinence

raps risk assessment pressure score
RAPS: Risk Assessment Pressure Score

Modified Norton Scale.

It measures instead of incontinence it measures moisture.

Instead of mental status it measures sensory perception.

And includes friction and shear and serum albumin level.

ryb color code often used as a documentation tool
RYB color code:(often used as a documentation tool)

Red – transparent type dressing

Yellow– Clean to remove non-viable tissue (wet to damp, hydrogel, or other exudate absorbers)

Black– necrotic tissue (escar) present, debridement necessary.

documenting pressure ulcers
Documenting Pressure Ulcers
  • Location
  • Size (length, width, depth)
  • Sinus tract involvement
  • Stage
  • Color
  • Condition of margins
  • Integrity of surrounding skin
  • S/S of infection (odor/purulent drainage…)
promoting skin healing
Promoting Skin Healing
  • Nutrition
  • Preventing infection
  • Positioning
psychoneurologic system
Self esteem: Role change and dependence

Frustration: Exaggerated emotional reactions

Emotions vary: Apathy, anger, regress, withdraw

Decreased intellectual stimulation:

Life view narrows, decision making and problem

solving abilities deteriorate

Social development : particularly for peds patients

Motor development: particularly for peds patient

Psychoneurologic System
the nursing process assessments of immobility
The Nursing Process:Assessments of Immobility
  • Objective Assessments:

Body alignment, joint movement, capabilities and limitations, muscle mass and strength, activity tolerance, need for assistance, baseline data.

  • Subjective Assessments:

Includes clients sensations, feelings, values, beliefs, attitudes, and perception of personal health, and life situations.

planning nursing interventions
Planning (Nursing Interventions)
  • Turning and ROM exercises
  • Foot and leg exercises
  • Anticoagulant Therapy
  • Deep breathing exercises
  • Skin care
  • Nutritional Interventions
  • Diversional Activities
planning interventions cont d
Planning ( Interventions cont’d)
  • Maintaining relationships; support people for patient’s psychosocial needs
  • Technologies designed to prevent complications of immobility
nursing actions for immobility
Nursing Actions for Immobility
  • Identify among patients assigned to you those who are most susceptible to the complications of immobility
  • Assess patients who are on bed rest in order to prevent the possible complications of immobilization.
  • Draw up a specific plan of care for patients on bed rest and put the plan into action.