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Problems of Immobility
Benefits
- Reduces 02 demand
- directs resourses toward healing
- may reduce pain
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Not a benefit?
Bedrest can kill your patient!!!!
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Physiological response to immobility
Musculoskeletal
- ↓Muscle strength
- ↓Muscle mass
- disuse osteoporsis- Ca extracted from bone = brittle & break
- fibrosis → contractions
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Musculoskeletal
How to assess for it
- Observe for joint stifness
- coordination
- ROM
- Labs: serum: protein, Ca (higher) urine: Ca (spilling out)
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Musculoskeletal
how to manage
- Aligment: specific turning schedule
- weight bearing
- indep ADL's
- AROM and PROM
- meds: calcium
- Diet
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Skin should always be?
Warm and dry
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The Valsalva Maneuver is dangerous for two reasons.
- The increased pressure in the thoracic cavity reduces the amount of blood flowing into the thoracic cavity, especially in the veins leading to the right atrium of the heart.
- The maneuver can also cause cause blood clots to detach, bleeding, irregular heart rhythms and cardiac arrest.Many of the heart attacks which occur in bathrooms have been linked to the Valsalva Maneuver, which in turn, is closely associated with sitting toilets...
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Thrombophlebitis
is swelling (inflammation) of a vein caused by a blood clot.
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Cardiovascular
- General weakness
- disrupted ANS ↑heart rate (0.5 bpm/day)
- ↓diastolic pressure coronary blood flow cardiac ability to respond to demands
- Basically- tachy and pain with slight exertion
- Valsalva Maneuver
- ortho hypotension ( Body does not respond ↓B/P)
- thrombophlebitis
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Cardiovascular
How to assess for it (Watch for this)
- Heart rate
- Narrowed pulse pressure ( not widening)
- Edema (↓ venous return)
- Skim temp
- Clots
- Chest pain, pressure
- B/P
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Cardiovascular
How to manage it:
- Teach not to do the Valsalva Maneuver
- TEDS (Anti embolism stockings and medical support stockings.)
- Good leg positioning
- Meds: anticogulants, stool softners, anti-htpn's
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Females sign of heart attack:
Heart Burn
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Always pay attention to pain in
Arm = MI's or Clot's
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Respiratory Response to Immobility:
- Chest movement impaired→ abdominal organs move↑ →difficult expansion
- Pt doesn't sigh (pt doesn't get air out since they are laying down to long)
- Joints get fixed
- ↓Blood flow to lungs, esp dependant areas + ↓
- cough+ weak cilia ➞atelectasis (is the collapse of part or (much less commonly) all of a lung) and pneumonia (cilia don't move like they have to)
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Respiratory
How to assess for it (Watch out for)
- Listen!!!! Diminshed breath sounds, wheezing (narrowed airway)
- Cough (good)
- Temp
- Pulse ox/ Blood gas (sign of life look at color)
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Respiratory
How to manage it:
- Deep breathe and cough (you want them to do this)
- Turn, turn, Turn!!!
- Meds: expectorants (thin the mucus that blocks the air tubes leading to the lungs), No cough meds! Bronchodialators (is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lungs), ? suctioning
- Fluids (clear water & tea)
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Metabolism & Nutrition responds to Immobility
- ↓BMR (not moving)
- ↓GI mobility
- ↓Digestive scretions and then they're not hungry!
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Metabolism & Nutrition responds to Immobility
How to assess it:
- Weight loss (little muscle tone)
- Nutrition
- Labs:↓serum protein ↑serum Ca↑BUN
- slow wound healing
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Metabolism & Nutrition responds to Immobility
How to manage it:
- ↑protein↑calories↑fiber easy to chew and swallo
- may need enteral or parenteral support
- Food they like!
- Meds: appetite stimulants (magaze), supplements, pleasant meal time environment
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Urinary system problems with immobility
- Initial diuresis→↑excretion Na excretion
- unable to empty bladder →stasis (stopping of the normal flow)
- stasis compromised by ↓muscle tone
- ↑serum Ca→urine more alkaline crystals→ calculi (15-30%)
- Incontinence/retention/ overflow
- static urine →↑bacterial growth→↑UTI's
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Urinary system problems with immobility
How to assess:
- I&O
- urine appearance
- frequency, urgency, pain
- Labs: ↑Spe gravity, BUN, Hct, Urine pH, bacateria, WBC's, cultures
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Urinary system problems with immobility
How to manage it:
- Turn turn turn
- Push clear fluids-cranberry juice
- perineal hygiene
- good environment
- answer lights
- cath is a last resort
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Intestinal System problems with immobility
- ↓peristalsis
- ↓Motility
- contracted anal sphincter
- disruption of habits/ bedpan
- water extracted from stool →hard, dry, impaction
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Intestinal System problems with immobility
How to assess for it:
- Bowel patterns
- bowels sounds
- general malaise (feeling discomfort)
- temp ( ↑when constipated)
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Intestinal System problems with immobility
How to manage:
- Exercise
- turn turn turn
- position and privacy
- fluids(caffine, water, prune juice)
- ↑fiber and fruit
- meds: only as last resort Laxatives
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Pressure ulcer
If it has eschar can't stage until its debrided.
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Integumentary system problems with immobility
- Skin trophies
- decreased turgpr
- basic problem is pressure sores
- aka decubiti, bedsore
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Integumentary system problems with immobility
def: reddened areas, open sores or ulcers usually occuring over bony prominences
- caused by: interupton of blood circulation to tissues
- localized ischemia
- tissue caught between 2 hard surfaces
- cells dprived of 02 & nutrients
- cellular waste accumulates tissue dies
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Integumentary system problems with immobility
Causes:
- 1. Pressure -perpendicular force (↓↑) highest pressure in sarcrum, buttocks, and heels. Pressure →skin turns white→if relieved→reactive hyperemia last 1/2-3/4 as long as the pressure.
- If redness disapperas in that time, no damage.
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Friction
2. Forces parallel to skin(↔) abrades the skins, removes superficial layers increase risk of breakdown.
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Shearing Force
3. comination of pressue and friction seen with smi-fowlers seen if sliding rather that lifting.
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Staging 1
- intact reddened
- non-blanching
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Staging 2
- Break in epidermis
- blister, abrasion
- surrounding red
- serous drainage (clear or bleeding)
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Staging 3
- Break thru dermis and sub q
- serous or purulent drainage
- progresses rapidly
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Staging 4
- breaks into: fascia, muscle, bone
- Drainage, osteo, sepsis
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Factors affecting formation of pressure sores:
- Mositure
- hygiene
- nutrition
- hard support
- body heat
- anemia
- mobility
- poor lifting
- poor position
- injections
- hard support surfaces
- incorrect applications of devices
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Factors affecting formation of pressure sores:
What to assess:
- Skin turgor
- edema
- redness
- labs: H&H
- temp
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Factors affecting formation of pressure sores:
How to manage:
- Turn turn turn-all positions every 2 hrs
- bed making
- HOB ↑< 30º
- clean and dry
- bony prominences
- better to prevent than to treat
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Psychological Responses Problems with Immobility:
- More gradual and subtle
- ↑dependance feeling of worthlessness, hopelessness and empitness
- ↓intellectual abilities, ability to concentrate, coping mechanism.
- May have financial concerns, work concerns
- Changes in sexuality and role performance
- May be evidence by hosility, confusion, belligience, withdrawal, apathy and anxiety
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Psychological Responses Problems with Immobility:
How to assess:
More gradual and subtle ↑dependance feeling of worthlessness, hopelessness and empitness↓intellectual abilities, ability to concentrate, coping mechanism. May have financial concerns, work concerns Changes in sexuality and role performanceMay be evidence by hosility, confusion, belligience, withdrawal, apathy and anxiety
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Psychological Responses Problems with Immobility:
How to manage:
- Social stimulation
- consistency
- involve significant others
- encourage ADL's
- appearance, won clothes
- Sleep
- Intellectual stimulation
- hobbies
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