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What are the causes of immobility?
Injury, disease process, neurological, surgery, physician ordered, self-inflicted
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What regulates/restricts movement?
- •Bones
- •Joints
- •Ligaments
- •Tendons
- •Cartilage
- •Skeletal muscle
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What are the risks associated with bladder infection?
- •Body temperature
- •Use of catheters
- •Poor Hygiene
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What are the 3 general phases of healing?
- •Phase I: Inflammatory response
- •Phase II: Repair response
- •Phase III: Remodeling
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What are the classifications of muscle strains, and what defines them?
- Mild /first-degree - Tear of a few minor fibers, minor swelling, local tenderness
- Moderate/2nd degree - Greater damage to the muscle & clear loss of strength
- Severe/3rd degree - Tear extending across the whole muscle belly
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What is tendinitis?
- Inflammation of the tendon
- Pain and loss of function
- Common places: rotator cuff, tennis elbow, patella tendon, IT Band, Shin Splints, Achilles, etc.
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What is tendinosis?
Chronic alteration of the tendon accompanied by tissue degeneration, cell atrophy, and pain
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What is paratenonitis?
Used to describe inflammatory disorder of tissues surrounding the tendon
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How are ligament injuries classified? What are their characteristics?
- •Grade I – stretching but no fiber damage
- Normal ROM, little/no swelling, localized tenderness
- Early return to training with protection/supervision
- •Grade II – stretching and some tearing
- Significant structural weakening, bruising, swelling
- Tendency to recur, need protection/modified immobilization
- •Grade III – complete ligament disruption
- Loss of structural integrity, marked abnormal motion
- Needs prolonged protection, surgery, permanent functional instability
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Describe the 3 types of articular cartilage injury?
- Type I Microscopic damage to chondrocytes and extracellular membrane (ECM)
- Type 2: partial thickness
- Microscopic disruption of articular cartilage
- POOR prognosis because inflammatory response is not provoked
- Type 3: full thickness - Disruption of articular cartilage with penetration into subchondral bone
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What factors impact immobility?
- Extent and duration of immobilization
- Age of individual
- Physical condition
- Nutritional intake
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What are the pathological influences on immobility?
- Postural abnormalities
- Impaired muscle development
- CNS damage
- Musculoskeletal trauma
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What are the musculoskeletal effects of immobility?
- Bone loss
- Cartilage degeneration
- Decreased mechanical & structural properties of ligaments
- Muscular atrophy
- Loss of muscular endurance
- Decreased elastacity and extensibility
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What are the cardiovascular effects of immobility?
- venous stasis
- blood pooling
- thrombus vs. embolus
- edema
- potentially decreased cardiac output
- deconditioning
- orthostatic hypotension
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What are the respiratory effects of immobility?
- decreased metabolic rate
- decreased movement of the rib cage
- -secretion stasis
- -shallow breathing
- decreased ability to expand chest wall and lung tissue
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What are the GI effects of immobilization?
- Decreased peristalsis and segmentation
- constipation
- decreased dietary intake
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what are the urinary effects of immobilization?
- urinary retention & stasis
- Poor ability (supine) to completely empty bladder
- increased protein dumping in urine
- At risk for bladder infection (catheters, hygiene, body temp)
- At risk for kidney stones
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What are the metabolic effects of immobility?
- decreased metabolic rate
- increased body temp if infection is present
- increased perspiration
- loss of electrolytes
- -fever: through persperation
- -w/o fever: lost in interstitial space
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What are the psychological effects of immobility?
- decreased sensory experience
- altered sense of body image
- loss of indepence
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physiological assessment of immobility includes what?
- Metabolic: anthropometric measurements, wound healing,
- Respiratory system: ventilatory status, breath sounds
- Cardiovascular system: BP, pulse, peripheral circulation, signs of DVT
- Musculoskeletal: ROM; muscle strength, tone, and mass (disuse atrophy)
- Integumentary: color, integrity, turgur
- Elimination: bowel/bladder habits
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What is included in the psychosocial assessment?
- Reaction to immobility
- Depression, loss of indepence
- Developmental stages
- Client expectations
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How are the hazards of immobility prevented?
- •Metabolic
- ~ Nutritional needs: protein, calories, vitamins (B and C)
- •Respiratory system
- ~ Promotion of chest and lung expansion
- ~ Removal of secretions
- ~ Maintenance of patent airway
- •Musculoskeletal system
- ~ ROM
- ~ Isometric exercise
- •Integumentary system
- ~ Turning every 1 to 2 hours
- ~Hygienic care
- ~Protection: preventive aids
- •Elimination
- ~ Hydration
- ~Nutritional intake: fiber
- •Psychosocial
- ~Orientation
- ~Communication
- ~Client participation
- •Positioning
- ~ Supports: footboards, trochanter rolls, hand rolls, and splints
- ~ Trapeze bar
- ~ Bed position: Fowler’s, supine, prone, side-lying
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How is health promotion implemented following immobility?
- •Lifting techniques
- •Exercise (which results in)
- 1.Improves cardiac output
- 2.Decreasing resting heart rate
- 3.Increasing respiration rate and depth
- 4.Decreasing work of breathing
- 5.Increase basal metabolic rate
- 6.Increase use of glucose and fatty acids
- 7.Increase gastric motility
- 8.Improved muscle tone
- 9.Increased joint mobility
- 10.Reduce bone loss
- 11.Decrease fatigue
- 12.Reports of decrease in illness
- 13.Reports of “feeling better”
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What is included in restorative care after immobility?
- Instrumental activities of daily living
- Physical and occupational therapy
- Exercises-ROM
- Ambulation: canes, walkers, crutches, etc
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