Immobility

1. Immobility

2. Degrees of mobility • Complete immobility e.g. unconscious patient • Partial mobility e.g. patient with fracture

3. Physiological responses of immobility • Musculoskeletal system • Cardiovascular system • Respiratory system • Metabolic and nutrition • Urinary system • Fecal elimination • Neurosensory system • Integumentry system

4. Musculoskeletal system • Decrease in muscle strength • Decrease in physical stability • Muscle atrophy • Osteoporosis • Stiff painful joints • Muscle contracture

5. Interventions • Body repositioning • Weight beering activities • Independence in activities of daily living • Active and passive range of motion

6. Cardiovascular system • Weakness of cardiovascular system • Postural hypotension • Thromophlebitis e.g, DVT

7. Interventions • Movement and exercise • Use vertical positions • Encourage normal breathing pattern • Elastic stocking

8. Respiratory system • Reduced gaseous exchange • Respiratory acidosis • Accumulation of secretion • Atelectasis • Upper respiratory tract infections • Pneumonia

9. Interventions • Deep breathing and coughing exercise • Diaphragmatic abdominal exercise • Changing position and exercise

10. Metabolic and nutrition • Decreased basal metabolic rate • Reduced gastrointestinal motility • Imbalance in protein synthesis • Anorexia • Hypoproteinemia • Negative calcium balance

11. Interventions • High protein, calories and fibre diet • Vitamin and minerals supplements • Weight bearing exercises • Enteral and Parenteral supplements

12. Urinary system • Urinary stasis • Renal calculi formation • Urinary incontinence • Urinary retention • Urinary tract infection

13. Interventions • Turning, positioning and exercise • Improving hydration • Perianal hygiene • Position and relaxation of urination

14. Fecal elimination • Constipation • Fecal impaction

15. Interventions • Well hydration • Ambulate as much as possible • High fibre diet

16. Neurosensory system • Decreased motor activity • Hyperactive sympathetic stimulation • Increased heart rate • Restlessness • Drowsiness • Irritability • Confusion • Unrealistic perception

17. Integumentry system • Loss of skin turger and elasticity • Decubitus ulcer formation

18. Psychological responses of immobility • Social, emotional and intellectual changes • Self concept changes • Feeling of worthlessness and hopelessness • Impaired decision making and problem solving abilities

19. Pressure Ulcer • Is impaired in skin integrity resulting from decrease mobility and direct pressure occurring most frequently over bony prominence • It is a wound with a localized area if tissue necrosis • Other names: Docubitus ulcer, bed sores • Pressure is the most prominent cause

20. Predisposing factors increase the possibility of pressure sores: • Immobility and lack of normal movement • Friction and moisture • Poor personal hygiene • Decrease level of consciousness • Advance Age • Malnutrition • Immunosuppression • Edema

24. Principles of Pressure Management • Maximize the surface area • Redistribute body weight • Training for pressure relief • Dietary instruction • Instruction for lifting/ transferring • Personal hygiene and skin care