Causes and Effects of Immobility

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Questions and Answers

Which of the following is a physical cause of immobility?

Sedatives

Bone fracture (correct)

Decreased motivation

Stress

Which environmental factor can contribute to immobility?

Narcotics

Cancer

Side rails on a bed (correct)

Stroke

What is a neurological cause of immobility?

Muscle atrophy

Hospitalization

Cerebral palsy (correct)

Bone fracture

How does immobility affect the musculoskeletal system?

Decreases bone mineral density Signup and view all the answers

Which psychological factor can lead to immobility?

Long-term care facility Signup and view all the answers

What is a common physiological response to atelectasis?

Increased respiratory rate Signup and view all the answers

Which of the following assessments would be appropriate during a respiratory evaluation?

Auscultate for pulmonary secretions Signup and view all the answers

What is a typical starting indicator of a pressure ulcer?

Reddish areas on the skin Signup and view all the answers

What condition increases the risk of pressure ulcer development due to impaired movement recognition?

Paralysis Signup and view all the answers

Which intervention can help maintain an open airway?

Encouraging deep breathing exercises Signup and view all the answers

What condition results from prolonged immobility and leads to a permanent shortening of a muscle?

Contracture Signup and view all the answers

What is the effect of improper positioning and excessive weight on the ankle joint?

Foot drop Signup and view all the answers

Which condition is characterized by a blood clot moving within the vascular system and causing an obstruction?

Embolism Signup and view all the answers

What assessment is necessary for monitoring potential blood flow complications during immobility?

BP measurements with postural changes Signup and view all the answers

What is a common respiratory complication that results from prolonged immobility?

Atelectasis Signup and view all the answers

What intervention helps in preventing venous stasis during immobility?

Dangling feet before standing Signup and view all the answers

What happens to respiration patterns when a person is immobilized?

Decreased demand for oxygen Signup and view all the answers

Which of the following describes orthostatic hypotension?

Drop in blood pressure upon moving to an upright position Signup and view all the answers

What is one main goal of rehabilitation?

Enhance the client's ability Signup and view all the answers

What nursing diagnosis is related to immobility and potential breathing difficulties?

Ineffective Breathing Patterns Signup and view all the answers

Which function is NOT part of the rehabilitation team's responsibilities?

Evaluate hospital administration policies Signup and view all the answers

How does effective rehabilitation nursing primarily serve the client?

By facilitating the development of a care plan Signup and view all the answers

Which of the following is a psychosocial effect of immobility?

Isolation and depression Signup and view all the answers

What should be assessed to understand a patient's mobility issues?

Range of motion and gait Signup and view all the answers

What does family-centered care in rehabilitation aim to achieve?

Inclusive involvement of family members Signup and view all the answers

What is a primary factor involved in the ethical delivery of rehabilitation services?

Ensuring culturally competent care Signup and view all the answers

What is a crucial intervention for preventing skin breakdown in patients at risk?

Changing positions every 2 hours Signup and view all the answers

What are the recommended daily changes in protein intake for wound healing in malnourished patients?

Increase by 2-4 times normal Signup and view all the answers

Which position can lead to urinary stasis and potential infections?

Supine position Signup and view all the answers

What should be assessed daily to monitor gastrointestinal health in immobilized patients?

Bowel movements Signup and view all the answers

What can be a psychosocial response to becoming immobile?

Exaggerated emotional responses Signup and view all the answers

Which of the following is important for managing incontinence-related skin breakdown?

Regular perineal care Signup and view all the answers

What is a potential consequence of immobility in the urinary system?

Bladder distention Signup and view all the answers

What intervention can help manage constipation in immobilized patients?

Encouraging fluids Signup and view all the answers

In the context of skin care, what is the purpose of massaging patients?

To stimulate circulation Signup and view all the answers

What is a common effect of immobility on appetite?

Reduced appetite Signup and view all the answers

Study Notes

Causes of Immobility

Physical causes:
- Bone fracture
- Surgical procedure
- Major sprain or strain
- Cancer
- Aging process
Environmental causes:
- Side rails on a bed
- Restraints on bed or chair
Neurological causes:
- Brain damage due to trauma or illness
- Stroke
- Cerebral palsy
- Spinal injuries
Psychological/Social causes:
- Stress
- Decreased motivation
- Hospitalization and long-term care facility residents
- Sedentary lifestyle created by voluntary or involuntary action
Medication examples:
- Those that induce a comatose state
- Sedatives
- Narcotics

Effects of Immobility

Loss of the force of gravity acting on the body in an upright position due to immobility, greatly affects natural body functions.

Musculoskeletal System

Decrease in tonus: Resting tension in a muscle that determines tonicity or firmness
Muscular atrophy: Decrease in muscle size; muscles lose strength, endurance, and mass quickly when inactive
Demineralization: Immobility results in loss of calcium in bones due to lack of activity and weight bearing, leading to osteoporosis and potential spontaneous fractures
Plantar flexion of ankle (foot drop): Caused by improper positioning of the foot or excess weight on the ankle joint, leading to loss of ability to move the ankle into dorsiflexion
Contracture: Permanent shortening/tightening of a muscle due to prolonged immobility, replacing muscle cells with fibrous tissue, affecting flexibility
Assessment: Anthropometric measurements and ROM measurements
Interventions: Active and passive ROM, individualized and progressive exercise program

Cardiovascular System

Blood pooling in the trunk of the body due to immobility:
- Increased workload on the cardiovascular system
- Increased heart rate
- Increased stroke volume
- Venous pooling in the lower extremities
Phlebitis: Inflammation of a vein, frequently resulting from immobilization
Thrombus: Blood clot that originates at the site of obstruction
Embolism: Dislodged blood clot that travels within the system until it becomes stuck, causing obstruction
Orthostatic hypotension: Drop in systolic blood pressure by 20 mmHg upon moving to an upright position, leading to dizziness, fainting, paleness, sweating, and rapid heartbeat.
Assessment: Blood pressure measurements with postural changes, pulse monitoring, edema monitoring, and observing for signs of deep vein thrombosis (DVT)
Interventions: “Dangling” feet before standing, prevention of venous stasis, exercise, ROM, anti-embolic stockings (TED hose, SCD’s), and observing for signs of DVTs

Respiratory System

Initially:
- Decreased metabolism unless there is an infection
- Decreased demand for oxygen
- Slow and shallow respirations
- Decreased oxygen and increased carbon dioxide in the blood due to poor gas exchange
- Inability to deep breathe and cough adequately, leading to respiratory secretions pooling in the lungs
- Potential for respiratory infections (hypostatic pneumonia)
Prolonged immobility:
- Atelecatasis: Collapsed small air sacs within the lungs responsible for providing oxygen to the blood and removing carbon dioxide, resulting in obstructions of the smaller airways and increased respiratory rate
Assessment: Observe chest movements, auscultate for pulmonary secretions, check O2 saturations, and monitor for respiratory difficulties
Interventions: Chest physiotherapy (CPT), maintain patent airway, and utilize an incentive spirometer.

Integumentary System (Skin)

Skin breaks down easily when circulation is impaired and new cells cannot regenerate.
Pressure ulcers: Compression of body soft tissue and/or bony prominences between mattress or adaptive devices.
Pressure ulcer development: Reddish areas progressing to large, open, and deep wounds.
Risk factors for pressure ulcers:
- Paralysis
- Medications that alter movement ability or pressure recognition
- Restraints
- Obesity
- Emaciated/malnourished patients
- Patients incontinent of feces and/or urine
Assessment: Assess positions and risks associated with each position, identify at-risk clients, and observe for skin breakdown.
Interventions:
- Prevention: Identify at-risk clients, daily skin exams, position changes every 2 hours, massage, skin care products, stimulate circulation
- Pressure support devices
Pressure ulcer treatment: Keep area dry and clean, change dressings as needed, debridement of ulcer to healthy tissue, and increase protein, calories, and vitamin C for wound healing.

Urinary System

Supine positioning:
- Residual urine in the calyces of the kidneys, impeding the urine’s normal flow of gravity to the bladder
- Residual urine accumulation in the bladder, making bladder emptying difficult from this position.
Urine stasis:
- Urinary tract infections
- Urinary stones
- Bladder distention and incontinence
Assessment: Analysis of intake and output (I & O), proper perineal care, and signs and symptoms of urinary tract infection (UTI).
Interventions: Force fluids, record I & O, and strain urine if there are stones.

Gastrointestinal (GI) System

Decreased GI muscle activity:
- Constipation and impaction of stool
- Difficult stool elimination from the supine position into a bedpan.
Reduced appetite: Nutrition deficiencies, leading to fatigue and depression.
Assessment: Assessing bowel movements (BM’s) daily and observing for passage of liquid stool.
Interventions: Record daily bowel movements, encourage fluids, administer enemas as needed, and digitally remove fecal impactions.

Psychosocial Aspects

Immobility drastically changes a person’s life, whether sudden or gradual onset.
Mental attitude and motivation suffer, potentially resulting in:
- Exaggerated emotional responses
- Disorientation
- Feelings of dependency
- Inability to sleep well
- Fear
Assessment: Assess for behavioral changes, alterations in the sleep-wake cycle, decreased coping abilities, and signs and symptoms of depression.
Interventions: Socialization, meaningful stimuli, maintain body image, avoid sleep interruptions, and utilize resources such as pastoral care or social services.

Nursing Intervention

Assessment of Impaired Mobility:
- Underlying conditions affecting mobility
- Range of motion (ROM), gait steadiness, standing erect
- Immobility effects on body systems
- Psychosocial effects
- Developmental effects
- Client expectations
Nursing Diagnosis:
- Ineffective Breathing Patterns related to immobility
- Risk for Impaired Skin Integrity related to immobility
- Risk for Injury related to impaired movement

Rehabilitation

Goals of rehabilitation:
- Improve client’s ability
- Improve client’s quality of life
- Provide family-centered care
- Achieve wellness
- Provide culturally competent care.
Rehabilitation Nursing:
- Diagnosis and treatment of human responses of individuals and groups to actual or potential health problems stemming from altered lifestyles
Function of the Rehabilitation Team:
- Establish realistic goals with the client and family
- Ensure continuity of care and coordination of available resources
- Evaluate the progress of the patient and the quality of care
Basic Nursing Activities in Rehabilitation:
- Establish an effective relationship with the client and significant others to facilitate the development of a plan of care.

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Description

This quiz explores the various causes of immobility, including physical, environmental, neurological, psychological, and medication-related factors. It also examines the effects of immobility on the musculoskeletal system and overall health. Test your knowledge on how immobility can impact individuals in different ways.