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Immobilization

Immobilization. Dr. Rose Dinda Martini, SpPD. The Guinness Book of World Records  the fastest 100-year-old to run 100 meters. Geriatric Giant. Immobility Instability Incontinence (urinary & alvi) Intellectual impairment (MCI, Dementia) Infection (Pneumonia, etc)

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Immobilization

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  1. Immobilization Dr. Rose Dinda Martini, SpPD

  2. The Guinness Book of World Records  the fastest 100-year-old to run 100 meters.

  3. Geriatric Giant • Immobility • Instability • Incontinence (urinary & alvi) • Intellectual impairment (MCI, Dementia) • Infection (Pneumonia, etc) • Impairment of hearing & vision • Impaction (constipation) • Isolation (depression) • Inanition (malnutrition) • Impecunity (poverty) • Iatrogenesis • Insomnia • Immune deficiency • Impotence Kane, Ouslander Abrass. (from Solomon 1988),Essentials of Clinical Geriatrics.2004 .p.13-14.

  4. The Bed • Look at a patient lying long in bed. What a pathetic picture he makes! The blood clotting in his veins, the lime draining from his bones, the scybala stacking up in his colon, the flesh rotting from his seat, the urine leaking from his distended bladder, and the spirit evaporating from his soul. • (R Asher: The Dangers of Going to Bed: BMJ 1947)

  5. Penyulit Akibat Imobilisasi

  6. Complications of immobilization • Ulcus decubitus (pressure ulcer) • Muscle atrophy & joint contracture • Baroreseptor desensitization • Orthostatic hypotension • Atelectasis & Pneumonia • Decrease bone density, Hypercalcemia, Osteoporosis • Constipation • Deep vein thrombosis & Pulmonary embolism Resnick NM, Dosa D. Geriatric Medicine. Harrison’s Principles of Internal Medicine. Ed.16. 2005: 43-53

  7. Faktor Risiko dan Etiologi

  8. Imobilization • Keadaan tidak bergerak atau tirah baring selama 3 hari atau lebih dengan gerak anatomik yang hilang akibat perubahan fungsi.

  9. Pasien Imobilisasi

  10. DAERAH PREDILEKSI BMJ 2006;332;472-475

  11. KLASIFIKASI Stadium 1 Stadium 2 Stadium 3Stadium 4

  12. Dermatologic Therapy, Vol. 19, 2006, 356–364

  13. Prevalensi Imobilisasi di RSUPNCM

  14. PATOFISIOLOGI BMJ 2006;332;472-475

  15. PATOGENESIS Tekanan Daya Regang Gesekan Kelembaban

  16. DVT and PE

  17. Local trauma to the vessel wall (surgical) Stasis of blood (Immobilization) Hypercoagulability (Deficiency of Protein C, Protein S, AT III) Factors That Trigger Thrombosis TRIAD OF VIRCHOW

  18. Pathophyisiology of DVT Immobilization Loss of muscle contraction Stasis Hypoxia Endothelial dysfunction  Coagulation factor secretion Aging process •  coagulation factors • Vein valve rigidity Blood turbulance Accumulation of coagulation factors DVT

  19. Emboli Paru

  20. “Pulmonary Embolism” (PE)

  21. Pendekatan Klinis

  22. Thank You

  23. SITI SETIATI, Geriatri IPD FKUI/RSUPN-CM, 2003 Obat Instabilitas Jatuh Inkontinensia urin Infeksi Fraktur Kesadaran  Hipotermia Imobilisasi Depresi Gangguan Ulkus tidur Trombosis vena Pneumonia ISK Dehidrasi konstipasi Atrofi otot Asupan makanan Malnutrisi Asupan cairan 

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