Immobility
Degrees of mobility
• Complete immobility e.g. unconscious
patient
• Partial mobility e.g. patient with fracture
Physiological responses of immobility
• Musculoskeletal system
• Cardiovascular system
• Respiratory system
• Metabolic and nutrition
• Urinary system
• Fecal elimination
• Neurosensory system
• Integumentry system
Musculoskeletal system
• Decrease in muscle strength
• Decrease in physical stability
• Muscle atrophy
• Osteoporosis
• Stiff painful joints
• Muscle contracture
Interventions
• Body repositioning
• Weight beering activities
• Independence in activities of daily living
• Active and passive range of motion
Cardiovascular system
• Weakness of cardiovascular system
• Postural hypotension
• Thromophlebitis e.g, DVT
Interventions
• Movement and exercise
• Use vertical positions
• Encourage normal breathing pattern
• Elastic stocking
Respiratory system
• Reduced gaseous exchange
• Respiratory acidosis
• Accumulation of secretion
• Atelectasis
• Upper respiratory tract infections
• Pneumonia
Interventions
• Deep breathing and coughing exercise
• Diaphragmatic abdominal exercise
• Changing position and exercise
Metabolic and nutrition
• Decreased basal metabolic rate
• Reduced gastrointestinal motility
• Imbalance in protein synthesis
• Anorexia
• Hypoproteinemia
• Negative calcium balance
Interventions
• High protein, calories and fibre diet
• Vitamin and minerals supplements
• Weight bearing exercises
• Enteral and Parenteral supplements
Urinary system
• Urinary stasis
• Renal calculi formation
• Urinary incontinence
• Urinary retention
• Urinary tract infection
Interventions
• Turning, positioning and exercise
• Improving hydration
• Perianal hygiene
• Position and relaxation of urination
Fecal elimination
• Constipation
• Fecal impaction
Interventions
• Well hydration
• Ambulate as much as possible
• High fibre diet
Neurosensory system
• Decreased motor activity
• Hyperactive sympathetic stimulation
– Increased heart rate
– Restlessness
– Drowsiness
– Irritability
– Confusion
– Unrealistic perception
Integumentry system
• Loss of skin turger and elasticity
• Decubitus ulcer formation
Psychological responses of immobility
• Social, emotional and intellectual changes
• Self concept changes
• Feeling of worthlessness and hopelessness
• Impaired decision making and problem
solving abilities
Pressure Ulcer
• Is impaired in skin integrity resulting from decrease
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mobility and direct pressure occurring most frequently
over bony prominence
It is a wound with a localized area if tissue necrosis
Other names: Docubitus ulcer, bed sores
Pressure is the most prominent cause
Predisposing factors increase the possibility
of pressure sores:
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Immobility and lack of normal movement
Friction and moisture
Poor personal hygiene
Decrease level of consciousness
Advance Age
Malnutrition
Immunosuppression
Edema
Principles of Pressure Management
• Maximize the surface area
• Redistribute body weight
• Training for pressure relief
• Dietary instruction
• Instruction for lifting/ transferring
• Personal hygiene and skin care