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Which of the following is a physical cause of immobility?
Which environmental factor can contribute to immobility?
What is a neurological cause of immobility?
How does immobility affect the musculoskeletal system?
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Which psychological factor can lead to immobility?
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What is a common physiological response to atelectasis?
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Which of the following assessments would be appropriate during a respiratory evaluation?
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What is a typical starting indicator of a pressure ulcer?
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What condition increases the risk of pressure ulcer development due to impaired movement recognition?
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Which intervention can help maintain an open airway?
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What condition results from prolonged immobility and leads to a permanent shortening of a muscle?
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What is the effect of improper positioning and excessive weight on the ankle joint?
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Which condition is characterized by a blood clot moving within the vascular system and causing an obstruction?
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What assessment is necessary for monitoring potential blood flow complications during immobility?
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What is a common respiratory complication that results from prolonged immobility?
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What intervention helps in preventing venous stasis during immobility?
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What happens to respiration patterns when a person is immobilized?
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Which of the following describes orthostatic hypotension?
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What is one main goal of rehabilitation?
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What nursing diagnosis is related to immobility and potential breathing difficulties?
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Which function is NOT part of the rehabilitation team's responsibilities?
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How does effective rehabilitation nursing primarily serve the client?
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Which of the following is a psychosocial effect of immobility?
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What should be assessed to understand a patient's mobility issues?
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What does family-centered care in rehabilitation aim to achieve?
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What is a primary factor involved in the ethical delivery of rehabilitation services?
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What is a crucial intervention for preventing skin breakdown in patients at risk?
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What are the recommended daily changes in protein intake for wound healing in malnourished patients?
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Which position can lead to urinary stasis and potential infections?
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What should be assessed daily to monitor gastrointestinal health in immobilized patients?
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What can be a psychosocial response to becoming immobile?
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Which of the following is important for managing incontinence-related skin breakdown?
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What is a potential consequence of immobility in the urinary system?
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What intervention can help manage constipation in immobilized patients?
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In the context of skin care, what is the purpose of massaging patients?
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What is a common effect of immobility on appetite?
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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)
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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.
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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.
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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.
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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
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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
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Nursing Diagnosis:
- Ineffective Breathing Patterns related to immobility
- Risk for Impaired Skin Integrity related to immobility
- Risk for Injury related to impaired movement
Rehabilitation
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Goals of rehabilitation:
- Improve client’s ability
- Improve client’s quality of life
- Provide family-centered care
- Achieve wellness
- Provide culturally competent care.
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Rehabilitation Nursing:
- Diagnosis and treatment of human responses of individuals and groups to actual or potential health problems stemming from altered lifestyles
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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
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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.
