Concept: Mobility 1

Mobility, the ability to move freely, easily, rhythmically, and purposefully in the environment, is an essential part of living. 2

Systemic Effects of Immobility Mindmap 1.Metabolic changes 2.Psychosocial Effects: Depression 3.Respiratory Changes 4.Cardiovascular Changes 5.Musculoskeletal changes 6.Integumentary changes 7.Urinary elimination 8.Bowel elimination 3

Gas Exchange Respiratory Changes Atelectasis (collapse of alveoli) Hypostatic pneumonia (inflammation of the lung from stasis or pooling of secretions) 4

Gas Exchange Respiratory Changes Atelectasis and Hypostatic Pneumonia Assessments Monitor RR and characteristics of respiratory system Monitor Breath Sounds every 2 hrs Interventions Deep breathing and coughing Incentive spirometer Encourage Fluids 5

Perfusion Orthostatic hypotension When you stand up, gravity causes blood to pool in your legs. This decreases blood pressure because there's less blood circulating back to your heart to pump. Orthostatic or postural hypotension occurs when something interrupts the body's natural process of counteracting low blood pressure. 6

Perfusion Orthostatic Hypotension Assessment Vital Signs before and after OOB (↑pulse rate; ↓BP) Interventions Dangle before getting OOB OOB: chair or ambulate 7

Perfusion Thrombus Thrombus is an accumulation of platelets, fibrin, clotting factors, and the cellular elements of the blood attached to the interior wall of a vein or artery, which sometimes occludes the lumen of the vessels. 8

Perfusion Thrombus Assessment Determine if pt is at risk Monitor for S/S – Calf pain – Tenderness, swelling warmth, and erythema – Cyanotic – Edema – A cord may be palpated over the vein Interventions Leg, foot, and ankle exercises q 1 hr Encourage fluids Change position q 2hr OOB: chair or ambulate Administer anticoagulant therapy: heparin SCD: sequential compression devices/TEDs 9

VTE: Mortality and Morbidity 300,000 to 650,000 with VTE per year 100,000 to > 200,000 deaths per year Most are hospital related. VTE is primary cause of fatality in half – More than HIV, MVAs, Breast Ca combined – Equals 1 jumbo jet crash/day 10% of hospital deaths Huge costs and morbidity 10

Concept: Perfusion Anti-embolism Stockings 11 Sequential Compression Device Purpose: Decreases venous stasis by increasing venous return through the deep veins of the legs.

Perfusion Pulmonary embolism 12 Pulmonary embolism A blockage of a pulmonary artery by foreign matter. The obstruction may be fat, air, tumor tissue or a thrombus

Skeletal Effects osteoporosis, joint contracture, footdrop Muscle Effects: – Lose of lean body mass – Decreased muscle mass strength – Atrophy 13

Skeletal Effects Disuse osteoporosis Disuse osteoporosis: Immobilization results in bone resorption – These patients are at risk for pathological fractures 14

Skeletal Effects Joint Contracture Joint contracture is an abnormal and possible permanent condition characterized by fixation of the joint. 15

Skeletal Effects osteoporosis, joint contracture, footdrop Assessment Determine if patient is at risk (Immobility) Interventions Exercise Active ROB Passive ROM CPM (continuous passive motion) Use splints when ordered 16

Splints used for foot-drop 17

Urinary Elimination Urinary status & renal calculi Urinary stasis: – Risk for UTI – Risk for Renal Calculi: calcium stones that lodge in the renal pelvis or pass through the ureters 18

Urinary Elimination Urinary status & renal calculi Assessment Determine if patient is at risk: Risk factors for UTI Poor peri care after BM Use of indwelling catheters Renal Calculi: Risk factors Hypercalcemia Dehydration Interventions Encourage fluids Toilet q 2 hrs Encourage mobility Discontinue Foley ASAP Teach how to perform correct peri care after BM 19

Bowel elimination Constipation Constipation is due to stasis of fecal material in the rectum and sympathetic nervous system activity. May present as ribbon-like diarrhea and fecal smearing 20

Bowel elimination Constipation Assessment Determine if patient is at risk Monitor/record frequency and consistency of stool Intervention Encourage fluids Encourage mobility Provide diet: fruits, vegetables, and fiber Administer stool softeners or enemas 21

Integumentary Pressure ulcers A pressure ulcer is a specific tissue injury caused by unrelieved pressure that results in ischemia and damage to the underlying tissue Pressure ulcers occur most commonly over bony prominences. 22

Integumentary Pressure ulcers Assessment Determine if patient is at risk Interventions Turn q 2 hrs/shift weight q 15 min Pad bony prominences Apply skin lotion Apply air mattress 23

Metabolic changes ↓ Appetite → Negative Nitrogen Balance What is Negative Nitrogen Balance? The resting body requires less energy, the cellular demand for oxygen is decreased, leading to a decreased metabolic rate. In the immobilized patients, however, factors such as fever, trauma, chronic illness, or poor nutrition can actually increase the body’s metabolic demands and increase catabolism. If unchecked, this process results in muscle wasting and a negative nitrogen balance. 24

Metabolic changes ↓ Appetite (anorexia) → Negative Nitrogen Balance – Wt loss, ↓muscle mass, and weakness Hypercalcemia – Pathological fractures ↓GI mobility – Constipation – Fecal impactions 25

Metabolic changes Assessment Monitor labs for hypercalcemia Monitor for constipation and fecal impactions Interventions Provide high-protein, high- calorie diet 26

Psychosocial Effects Depression Immobilization often leads to emotional and behavioral responses, sensory alterations, and changes in coping. Sensory deprivation: altered sleep patterns and significant increases in anxiety, hostility, and depression. Depression: feelings of sadness, melancholy, dejection, worthlessness, emptiness, and hopelessness 27

Psychosocial Effects Depression Assessment Determine if patient is at risk Observe the patient’s coping strategies Intervention Provide personal routine Provide/encourage informal socialization Talk with patient during activities Encourage reading newspaper and books Provide radio, TV and videotapes 28