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Understanding Immobility: Causes and Management

This document discusses immobility and its effects. It begins with defining immobility and listing its common causes such as stroke, spinal cord injury, fractures, and prolonged bed rest. It then discusses the systemic changes associated with immobility, including effects on the respiratory, cardiovascular, musculoskeletal, genitourinary, gastrointestinal, integumentary, and metabolic systems as well as psychosocial responses. For each system, it describes assessments and interventions to manage issues related to immobility. The document provides an in-depth overview of immobility from various medical perspectives.

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mahmoud Shakria
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38 views25 pages

Understanding Immobility: Causes and Management

This document discusses immobility and its effects. It begins with defining immobility and listing its common causes such as stroke, spinal cord injury, fractures, and prolonged bed rest. It then discusses the systemic changes associated with immobility, including effects on the respiratory, cardiovascular, musculoskeletal, genitourinary, gastrointestinal, integumentary, and metabolic systems as well as psychosocial responses. For each system, it describes assessments and interventions to manage issues related to immobility. The document provides an in-depth overview of immobility from various medical perspectives.

Uploaded by

mahmoud Shakria
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd

1 Dr/ Dena Eltabey 02/21/24

OBJECTIVES
1- Definition of immobility
2- Causes of immobility
3- Systemic Changes Associated
With Immobility
4- Management of immobility
hazard
2 Dr/ Dena Eltabey 02/21/24
Definition of immobility

• Any disease or disability that requires


complete bed rest or extremely limits
your activity.

• The restriction of the movement of


whole or part of the body by physical
means (restraint) or chemically by
analgesia, or the use of tranquilizing
agents
3 Dr/ Dena Eltabey 02/21/24
Causes of immobility
stroke resulting in partial or complete -1
paralysis
spinal cord injury resulting in paraplegia or -2
,quadriplegia
fracture -3
4- prolonged bed rest after surgery
Arthritis -5
6- Polymyalgia (joint swelling)
7- Disuse
8- Malnutrition
9- Electrolyte abnormality
10- Myopathy (muscle pain)
4 Dr/ Dena Eltabey 02/21/24
Causes of immobility
• Verterbral fracture
• Metastases (tumor)
• Joint pain
• Foot pain
• Neurological disease
• Orthostatic hypotension
• Medications
• Anxiety
• Depression
5 Dr/ Dena Eltabey 02/21/24
Systemic Changes Associated With
Immobility
• Respiratory Changes
• Cardiovascular Changes
• Musculoskeletal Changes
• Urinary Elimination Changes
• Genitourinary System
• Gastrointestinal System
• Integumentary System
• Psychosocial Responses
6 Dr/ Dena Eltabey 02/21/24
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

02/21/24 Dr/ Dena Eltabey 7


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

02/21/24 Dr/ Dena Eltabey 8


Metabolic System
 Metabolic assessment
 Anthropometric measurements (arm circumstances)
 Fluid Intake and Output measurements
 Lab tests for electrolyte imbalances/ nutritional status

 Metabolic interventions
 High protein, high calorie diet
 Supplemental vitamin C
 Vitamin B complex

02/21/24 Dr/ Dena Eltabey 9


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

02/21/24 Dr/ Dena Eltabey 10


Respiratory System

 Respiratory assessment
 Observe chest movements
 Auscultate for pulmonary secretions
 Check O2 saturations (ABG analysis)
 Observe for respiratory difficulties
 Respiratory interventions
 Breathing and coughing exercise q 2 hours
 Chest physiotherapy (CPT)
 Maintain patent airway
 Incentive spirometer

02/21/24 Dr/ Dena Eltabey 11


Cardiovascular System

 Effects
 Orthostatic hypotension
 Increased cardiac workload
 Thrombus formation
 May become emboli
 Most dangerous complication of bedrest
 Valsalva maneuver (bearing down)

02/21/24 Dr/ Dena Eltabey 12


Cardiovascular System
 Assessment
 BP measurements with postural changes
 Monitor pulse
 Monitor for edema
 Watch for s/s of DVT

02/21/24 Dr/ Dena Eltabey 13


Cardiovascular System
 Interventions
 “Dangling” feet before standing
 Discourage valsalva
 Prevent venous stasis
 Exercise
 ROM (range of motion)
 Anti-embolic stockings
 Never massage extremities
 Observe for s/s DVTs (warmth, redness,
+Homans)
02/21/24 Dr/ Dena Eltabey 14
Musculoskeletal System

 Effects
 Decreased muscle mass
 Muscular atrophy
 Reduced muscle endurance (power decreased)
 Decreased stability
 Joint contractures (joint shortening)
 Disuse osteoporosis (bone destruction)
 Decreased skeletal mass

02/21/24 Dr/ Dena Eltabey 15


Musculoskeletal System
 Assessment
 Anthropometric measurements
 ROM measurements

 Interventions
 Active and passive ROM
 Individualized, progressive exercise program

02/21/24 Dr/ Dena Eltabey 16


Genitourinary System

 Effects
 Urinary Stasis
 Renal Calculi
 UTI

02/21/24 Dr/ Dena Eltabey 17


Genitourinary System

 Assessment
 Intake and Output (I & O)
 perineal care
 Signs and symptoms of UTI

 Interventions
 Force fluids
 Record I & O

02/21/24 Dr/ Dena Eltabey 18


Gastrointestinal System

 Effects
 Constipation
 Fecal Impaction

02/21/24 Dr/ Dena Eltabey 19


Gastrointestinal System
 Assessment
 Assessing BM’s daily
 Observe for passage of liquid stool

 Interventions
 Record daily BM (body mass)
 Encourage fluids
 Administer enemas

02/21/24 Dr/ Dena Eltabey 20


Integumentary System
 Effects
 The effect on the skin in compounded by impaired
body metabolism and:
 Pressure
 Shearing Force
 Friction

 Break in skin is called a bedsore, pressure sore

02/21/24 Dr/ Dena Eltabey 21


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

02/21/24 Dr/ Dena Eltabey 22


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 (air mattres)

02/21/24 Dr/ Dena Eltabey 23


Integumentary System

 Treat skin breakdowns


 Keep area dry and clean
 Change dressings
 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
02/21/24 Dr/ Dena Eltabey 24
Psychosocial Responses

 Assessment
 Assess for behavioral changes
 Any changes in sleep cycle
 Decreased coping abilities
 Signs and symptoms of depression
 Interventions
 Socialization
 Maintain body image
 Avoid sleep interuptions
 Utilize resources, I.e. pastoral care or social
services

02/21/24 Dr/ Dena Eltabey 25

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