Preventing the Hazards of Immobility

1. Preventing the Hazards of Immobility

2. Hazards of Immobility When a body part or the entire body is immobilized, secondary disabilities may develop in body systems. The greater the degree of immobility and the longer the immobilization, the greater the risk for development of disabilities.

3. Bedrest • Objectives • Reduces oxygen needs • Decreases pain levels • Helps in regaining of strength • Uninterrupted rest has psychological and emotional benefits • Types of bedrest • Bed rest • Bed rest with bathroom privileges

4. Effects of Immobility • Phisiologically • No body system is immune to affects of immobility • Effects depend upon a client’s health, age, and degree

5. Metabolic System • Immobility causes: • Decrease in BMR which causes: • Altered metabolism of carbohydrates, fats, and proteins which causes: • Fluid, electrolyte and calcium imbalances which causes: • GI disturbances which causes: • Decrease in appetite and decrease in peristalsis

6. Metabolic System • Effects of the metabolic alterations= • Fluid and electrolyte changes • Bone demineralization • Altered exchange of nutrients (also affected by decreased appetite) • Altered gastrointestinal functioning: • Constipation • Nausea/ vomiting • Gas • Indigestion • Decreased appetite

7. Metabolic System • Metabolic assessment • Anthropometric measurements • Fluid Intake and Output measurements • Lab tests for electrolyte imbalances/ nutritional status • Assess ability to heal and fight infection • Metabolic interventions • High protein, high calorie diet • Supplemental vitamin C • Vitamin B complex

8. Respiratory System • Effects • Decreased lung expansion • Pooling of secretions • Decreased surface area for exchange of CO2 and O2 (secondary to lung expansion) • Most common complication w/ respiratory system= hypostatic pneumonia

9. Respiratory System • Respiratory assessment • Observe chest movements • Auscultate for pulmonary secretions • Check O2 saturations • Observe for respiratory difficulties • Respiratory interventions • TCDB q 2 hours • Chest physiotherapy (CPT) • Maintain patent airway • Incentive spirometer

10. Cardiovascular System • Effects • Orthostatic hypotension • Increased cardiac workload • Thrombus formation • May become emboli • Most dangerous complication of bedrest • Valsalva maneuver

11. Cardiovascular System • Assessment • BP measurements with postural changes • Monitor pulse • Monitor for edema • Watch for s/s of DVT

12. Cardiovascular System • Interventions • “Dangling” feet before standing • Discourage valsalva • Prevent venous stasis • Exercise • ROM • Anti-embolic stockings (TED hose, SCD’s) • Never massage extremities • Observe for s/s DVTs (warmth, redness, +Homans)

13. Musculoskeletal System • Effects • Decreased muscle mass • Muscular atrophy • Reduced muscle endurance • Decreased stability • Joint contractures • Disuse osteoporosis • Decreased skeletal mass

14. Musculskeletal System • Assessment • Anthropometric measurements • ROM measurements • Interventions • Active and passive ROM • Individualized, progressive exercise program

15. Genitourinary System • Effects • Urinary Stasis • Renal Calculi • UTI

16. Genitourinary System • Assessment • Analysis of Intake and Output (I & O) • Proper perineal care • Signs and symptoms of UTI • Interventions • Force fluids • Record I & O • Strain urine if there are stones

17. Gastrointestinal System • Effects • Constipation • Fecal Impaction

18. Gastrointestinal System • Assessment • Assessing BM’s daily • Observe for passage of liquid stool • Interventions • Record daily LBM • Encourage fluids • Administer enemas, prn • Digital removal of fecal impactions

19. Integumentary System • Effects • The effect on the skin in compounded by impaired body metabolism and: • Pressure • Shearing Force • Friction • Any break in the skin is difficult to heal, which can lead to further immobilization • Break in skin is called a bedsore, pressure sore, or decubitus ulcer (decubitus means bed lying)

20. Integumentary System • Assessment • Assess positions and the risks with each position • Identify clients at risk • Observe for skin breakdown • Stage 1 • Stage 2 • Stage 3 • Stage 4

21. Integumentary System • Interventions • Prevention • Identify at risk clients • Daily skin exam • Change positions every 2 hours • Massage • Skin care products (lubricate and protect) • Stimulate circulation • Pressure support devices

22. Integumentary System • Treat skin breakdowns • Keep area dry and clean • Change dressings prn • Debridement of ulcer • Must debride to healthy tissue • Remove eschar • Increase protein, calories, vitamins • Protein= 2-4 times normal • Calories= 1 1/2 times normal • Vitamin C= wound healing

23. Psychosocial Responses • Assessment • Assess for behavioral changes • Any changes in sleep-wake cycle • Decreased coping abilities • Signs and symptoms of depression • Interventions • Socialization • Meaningful stimuli • Maintain body image • Avoid sleep interuptions • Utilize resources, I.e. pastoral care or social services