Hazards of Immobility PDF

Immobility Immobility Hazards of Immobility Dr. Manal Moustafa Prof. of Medical Surgical Nursing Faculty of Nursing Cairo University Objectives: Define mobility, immobility, and bed rest. Recognize the most common causes and risk factors of immobility....

Immobility Immobility Hazards of Immobility Dr. Manal Moustafa Prof. of Medical Surgical Nursing Faculty of Nursing Cairo University Objectives: Define mobility, immobility, and bed rest. Recognize the most common causes and risk factors of immobility. Discuss the benefits and hazards of immobility. Identify changes in metabolic rate associated with immobility. Describe physical changes associated with immobility. Objectives Cont.: Describe musculoskeletal changes associated with immobility. Discuss factors that contribute to pressure ulcer. Discuss psychosocial effects of immobilization. List appropriate nursing interventions for an immobilized patient,.  HAZARDS OF IMMOBILITY Outline:- ▪ Introduction ▪ Definitions: ▪ 1. Mobility ▪ 2. Immobility ▪ Purpose of Movement ▪ Factors Affecting Body Alignment and Mobility ▪ Reasons for Client Immobility ▪ Levels of Immobility ▪ Benefits of Bed-rest ▪ Conditions Requiring Bed-rest ▪ Clients at Risk for Complications of Immobility ▪ Scope of the Problem Outline(cont.) Effect of Immobility on Different Body Systems ▪ Cardiovascular Complications ▪ Respiratory Complications ▪ Gastrointestinal Complications ▪ Urinary Complications ▪ Musculoskeletal Complications ▪ Integumentary Complications ▪ Metabolic Complications ▪ Neurological Complications Outline(cont.) Preventing Complications of Immobility ▪ Assessing Problems of Immobility ▪ Health History ▪ Physical Examination ▪ Common Nursing Diagnosis and Collaborative Problems ▪ Planning and Intervention Mobility & Immobility Mobility & Immobility  HAZARDS OF IMMOBILITY Introduction:- Physical mobility is important in our society. Movement of body part or the entire body is essential for maintenance of total wellbeing including physiological, psychological, and developmental dimensions. 40% of our body muscles are used for mobility. The body is always dynamic (in continuous motion). Coordination of muscles is enhanced by activation of some muscles and inhibition of others. Introduction cont:- To maintain normal physical mobility, the nervous, muscular, and skeletal systems of the body must be intact and functioning. When a body part or the entire body is immobilized, secondary disabilities may develop in body systems. The greater the degree of immobility and the longer the immobilization, the greater the risk for development of disabilities.  Definitions Mobility: a person’s ability to move about freely and is often essential to the perception of health. Immobility: Unavoidable restriction of movement in any area of person’s life. Movement restriction in the environment and/or in the body. It does not necessarily mean complete lack of movement, it refers to a decrease in activity from normally carried out. An Alteration in the amount and control of movement a person has.  Definitions Inactivity: An alteration in a person’s ability to ambulate independently. Bed rest: Is an intervention in which the patient is restricted to bed for therapeutic reasons such as: ▪ Reducing physical activity and the oxygen needs of the body. ▪ Allowing ill or debilitating patients to rest & regain strength. ▪ Preventing further injury to traumatizes structure (e.g. spinal & vertebral injury).  Purposes of Movement Movement serves as: ▪ Expression of an emotion with nonverbal gesture. ▪ Self-defense. ▪ Satisfaction of basic needs and activities of daily living. ▪ Recreational activities.  Factors Affecting Body Alignment and Mobility ▪ Growth and development(Age) ▪ Physical health(Client’s overall health) ▪ Mental Health ▪ Nutrition ▪ Life-style ▪ Personal values ▪ Fatigue and stress ▪ External factors ▪ Degree of immobility experienced.  Reasons for Client Immobility There are three reasons for immobility: ▪ Therapeutic: restriction of movement, e.g., following injury to a limb or surgery (internal fixation / traction) ▪ Unavoidable: restriction because of primary disability, e.g., muscle paralysis following CVA ▪ Voluntary: restrictions due to life style  Levels of Immobility There are varying degrees of immobility. The unconscious client is often completely immobile, whereas the client with a fractured leg is only partially immobile. In addition, some clients restrict activity for health reasons. Level of immobility: ▪ Completely independent. ▪ Needs assistance or help. ▪ Bed-rest with bathroom privilege. ▪ Complete bed-rest. ▪ Dependent (immobile) e.g., unconscious patient.  Most common causes & Risk factors of immobility  Client at Risk for Complications of Immobility ▪ A large body area is immobilized. ▪ Immobilization lasts for a long period. ▪ The immobilized client is elderly. ▪ The client experience pain or muscle spasm. ▪ The client sensitivity to temperature, pain, or pressure is decreased. ▪ The client is poorly nourished. ▪ The client is immobilized in one position for a long time.  Effect of Immobility on Different Body Systems Cardiovascular Complications: ▪ Increase work load on the heart ▪ Orthostatic hypotension ▪ Thrombus formation ▪ Dependent edema Effects of Immobilization on Cardiovascular System Decreased Activity ↓ Increased Work Load on Heart ↓ Decreased Blood Perfusion ↓ Orthostatic Hypotension ↓ Thrombus Formation ↓ Tissue Hypoxia  Increase Work Load of the Heart The heart works 30% harder when a person is in the recumbent position than when it is in a sitting position Due to ↓ Release of Gravity Pressure ↓ Which Will Lead to ↓ Decrease Ability of Cardiovascular Function ↓ ↓ ↓ Increased Cardiac Output Increased Stroke Volume Increased Heart Rate  Orthostatic Hypotension Due to the Following Factors ↓ Loss of General Muscle Tone Decrease of Efficiency of the ↓ Orthostatic Neurovascular Leads to Reflexes ↓ ↓ Result From a. Defects in Venous Valves Which Prevent the Back Flow of Blood ↓ b. The Venous Blood Tends to Pool in the Lower Parts of the Body a. Lower Pressure ↓ b. Higher Flow Dependent Edema c. Increased Diameter  Thrombus Formation Due to ↓ ↓ ↓ Venous Stasis b. Hyper-Coagulability c. External Pressure of the Blood of the Veins ↓ Result From ↓ Increased Concentration of the Formed Elements in the Blood by Increasing Viscosity ↓ Would Predispose to Clotting Respiratory Complications: ▪ During immobility, the basal metabolism is decreased, and the cells require less oxygen for use, and less CO2 is produced. Respiration become slower and less deep ending up with three physiologic effects on the respiratory system: ▪ Decreased respiratory movement ▪ Stasis of secretions ▪ Oxygen-Carbon Dioxide imbalance Effects of Immobility on Respiratory System Decreased Activity ↓ Decreased O2 Need ↓ Decreased Respiratory Volume ↓ Pooling & Stasis of Respiratory Secretions ↓ Pneumonia  Decrease Respiratory Movement Due to the Following Factors ↓ ↓ Counter Resistance of Bed or Chair ↓ Chest or Abdominal Pain ↓ Preventing Lung Expansion ↓ ↓ ↓ ↓ ↓ Increased Intra-Abdominal Pressure ↓ ↓ Preventing the Descent of the Diaphragm ↓ ↓ ↓ ↓ Due to ↓ Decreased Muscular Power & Poor ↓ Coordination (Muscles Involved Are: 1.bdominal 1.Abdominal Distension / Constipation 2.Internal &External Intercostals. 2.Abdominal Viscera When in the Recumbent Position 3. Diaphragm. 3.Tight Abdominal Binders Administration of Sedative Anesthesia, …etc. → Depressing the Respiratory Center → Limit the Rate & Depth of Respiration  Decreased Respiratory Movement ↓ Leads to ↓ ↓ ↓ O2 Stasis of Bronchial ↑CO2 Secretions ↓ Secretions are Protein Materials Which are ↓ ↑ Viscosity of Secretion a Good Media for the Growth of Microorganisms ←←←← Plugging the Bronchi & Bronchioles ↓ Infection → Triggers an Inflammatory Process → Edema Narrowing the Bronchi & Bronchioles ↓ ↓ ↓ ↓ Tracheitis Bronchitis Hypostatic Pneumonia Obstruction of the ↓ Airway ↓ Dyspnea Hypoxia Atelectasis ←←← ←←← ←←← ← ↓ Cyanosis ↓ Nervous Manifestation ( Restlessness- Forgetfulness) Immobility and the Gastrointestinal System  Gastrointestinal Complications: The main functions of the GI tract are ingestion, digestion, absorption, storage, and elimination. The muscles involved in these functions are abdominal, diaphragm, and levator ani. The contraction of these muscles increases the intra- abdominal pressure, which is necessary for the expulsion of fecal material. Immobility affects elimination by: ↓ the expulsion power, due to generalized muscle weakness. Suppression of the defecation. Effects of Immobility on the GI Tract ↓ Activity ↓ Lessened Energy Expenditure ↓ Anorexia ↓ Lessened Food Intake ↓ Constipation  1) Anorexia ↓ Due to ↓ ↓ Negative Nitrogen Balance Stress Stimulation of Parasympathetic ↓ ↓ Immobilization Decrease Mobility of Stomach & Intestine ↓ ↑ Catabolic Activity Intestinal Stasis (Rapid Breakdown of Cellular Material) ↓ ↓ ↓ Protein Deficiency Constipation Abdominal Dist ension ↓ ↓ If Prolonged ↓ (↑ Fermentation ↓ ↓ Due to Stasis of ↓ Gastric Stasis Intestinal content) ↓ ↓ ↓ ↓ Dyspepsia ↓ ↓ ↓ ↓ ↓ ↓ → → → → Anorexia ← ← ← ←  As Regards Elimination, the Bed Ridden Patient Suffers From ↓ ↓ ↓ Generalized Muscle Weakness Use of Bedpan Rather Disruption of Than Bathroom Defecation Habits ↓ ↓ ↓ Diminished Expulsive Unnatural Position Embarrassment Power ↓ ↓ ↓ Patient Unable to Assist Normal Mechanisms Postponement and With the Elimination Process and Reflexes are not Stimulated Suppression of Defecation ↓ Prolonged Retention of Fecal Material in Colon ↓ Colon Absorbs the Water Content of the Fecal Material ↓ Fecal Material Becomes Dry and Hard This Condition is Called Constipation  Effects of Immobility ON Urinary System positioning patients in a supine position leads to: ▪ Residual urine in the calyces of the kidneys ▪ Impeding the urine’s normal flow of gravity to the bladder Effects of Immobility on Urinary System Decreased Activity ↓ ↑ Kidney Perfusion ↓ Renal Calculi ↓ Urinary Tract Infection ↓ Bladder Retention Effects of Immobility on Urinary System Urinary Stasis: Occur in the kidney in the recumbent position Urinary stasis increases the possibility of urinary tract infection Stone Formation: Increased calcium excretion through the urinary system and impaired metabolic function leads to formation of renal stones Effects of Immobility on Urinary System Urinary Retention: Urinary retention is due to: Patient is unable to assume a position that is physiologically best for voiding Disease of central nervous system Lack of privacy Painful urination Urinary Incontinence: Urinary incontinence due to affected central nervous system by a disease.  Immobilization ↓ ↓ ↓ Muscular Activity ↓Stress on the Bone ↓ ↓ ↓ Lactic Acid Formation Escape of Calcium Phosphate from Bone ↓ ↓ Urine Becomes Alkali ↓ ↓ Phosphates are Precipitated in an ← ← ← Excess of Calcium Phosphate Alkali Medium Found in the Urine ↓ Phosphate Deposit in the Kidney ↓ Renal Stones Formation Musculoskeletal Complications: Effect of Immobility on Musculoskeletal System ↓ Activity ↓ Muscle Wasting & Fibrosis of Joints ↓ Muscle Atrophy & Joint Contractures ↓ Loss of Function  Musculoskeletal Complications Immobilization ↓ ↓ Stress Over the Bones ↓ Escape of Calcium Phosphate from the Bone ↓ Bones Become Fragile and Porous (Osteoporosis) Musculoskeletal Complication Immobility ↓ Reduced Activity ↓ ↓ Muscle Bulk (Size) & Strength ↓ Muscle Atrophy ↓ Muscle Becomes Weak & Fatigue Easily Musculoskeletal Complications Immobility ↓ Disuse of the Joint & Adjoining Muscles ↓ ↓ Range of Motion in the Joint & Muscles Unable to Shorten and Lengthen ↓ Contractures (Joint Stiffness)  Integumentary Complications Pressure sores develop quickly because oxygen supply is curtailed (reduced) and pressure is elevated. Pressure Areas Effect of Immobility on Integumentary System Immobility ↓ ↓ Activity ↓ Sustained pressure on body parts ↓ Tissue Hypoxia & Necrosis ↓ Bed Sore, Pressure Sore ↓ ↓ Muscle Activity ↓ ↓ Blood Circulation  Effects of Immobility Integumentary System (Skin) pressure ulcers begin with reddish areas and may develop into large open and deep wounds  Effects of Immobility On Psychosocial Aspects Becoming immobile drastically changes a persons life whether sudden or gradual onset, the response varies per individual Effects of Immobility On Psychosocial Aspects Mental attitude & motivation suffer & the patient may experience: Exaggerated emotional responses Disorientation Feelings of dependency Inability to sleep well Fear Effects of Immobility on Neurological System ↓ Activity ↓ Reduced Social Contacts ↓ Decreased Time Orientation ↓ Lack of intellectual Stimulation ↓ Reduced Problem Solving & Decision making Abilities ↓ Loss of Control over Events ↓ Anxiety Effects of Immobility on Neurological System Immobility ↓ Unable to Carry out Usual Activities ↓ Awareness of Increased Dependence ↓ Decreased Self-Esteem & Frustration ↓ Decreased Coping Ability ↓ Emotional Reactions  Glossary Osteoporosis: Demineralization of the bone Atrophy: Wasting away, decrease in size of organ and tissue Contractures: Abnormal shortening of muscle and/or joint fibrosis Paralysis: The impairment or loss of motor function of body part Paraparesis, Paraplegia: Weakness / paralysis of both legs and the lower part of the trunk Hemiparesis, Hemiplegia: Weakness or paralysis of one side of the body , or part of it due to an injury to the motor areas of the brain. Flaccid: Limp, floppy, absence of muscle tone  Glossary Tone: The normal tension present in a muscle at rest Bursa: Fluid-filled sac found in connective tissue usually in the areas of joints Ossification: Process in which mineral (calcium) are deposited in bone matrix Osteoblast: Bone-forming cell Osteocyte: Mature bone cell Osteoclast: Bone resorption cell Osteogenesis: Bone formation Spastic: Greater than normal muscle tone  Nursing Care Range-of-motion exercises Progressive mobility activities  Chest physiotherapy Breathing Exercise Coughing Exercise Percussion Vibration Back massage ▪ Change position According to the schedule ▪ Increase fluid intake Well-balanced diet  Psychological Care: Spiritual Care: Thank You –Questions?? Questions??