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