1. Immobility King Saud University Nursing College Concept of Nursing –NUR 123

2. Immobilization Physical restriction of movement to body or a body segment Physical restriction of movement to body or a body segment Degrees of mobility Complete immobility e.g. unconscious patient Complete immobility e.g. unconscious patient Partial mobility e.g. patient with fracture Partial mobility e.g. patient with fracture

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

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

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

6. Cardiovascular system Weakness of cardiovascular system Weakness of cardiovascular system Postural hypotension Postural hypotension Thromophlebitis e.g, DVT Thromophlebitis e.g, DVT Decrease venous return Decrease venous return Decrease blood pressure Decrease blood pressure

7. Interventions Movement and exercise Movement and exercise Encourage normal breathing pattern Encourage normal breathing pattern Elastic stocking Elastic stocking

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

9. Interventions Deep breathing and coughing exercise Deep breathing and coughing exercise Changing position and exercise Changing position and exercise CPT CPT Incentive spirometry Incentive spirometry

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

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

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

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

14. Fecal elimination Constipation Constipation Fecal impaction Fecal impaction

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

16. Neurosensory system  Decreased motor activity  Restlessness  Drowsiness  Irritability  Confusion, decrease coordination/balance  Unrealistic perception

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

18. Psychological responses of immobility Social, emotional and intellectual changes Social, emotional and intellectual changes Self concept changes Self concept changes Feeling of worthlessness and hopelessness Feeling of worthlessness and hopelessness Impaired decision making and problem solving abilities 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 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 It is a wound with a localized area if tissue necrosis Other names: Docubitus ulcer, bed sores Other names: Docubitus ulcer, bed sores Pressure is the most prominent cause Pressure is the most prominent cause

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

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