Unit 5 Notes
Immobility and the Human Body
Causes of immobility: stroke, complications of surgery, amputations, weakness, confusion/restraints,
medications, cancer, fracture, brain damage, spinal injuries, ventilator, organ failure/use of critical
machines.
Immobility: common effects on body systems
Musculoskeletal: you have to get them up and moving
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Muscles are the first to show signs: atrophy, loss of oxidative process
Can lose up to 10% of muscle mass weekly
Contractures can start in 4 days, loss of range of motion in 14 days (foot drop)
Stiff and sore (increases pain)
Contractures cause capillary occlusion
Low back pain from lack of use of abdominal muscles
Lack of movement= increase pain
Footdrop
Circulatory
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Pooling of blood, pressure, lack of venous return= blood clots
Increased edema (heart working harder when laying down)
Increased workload on the heart
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Orthostatic hypotension
Blood clots (DVT)-thrombus
Urinary
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Urinary statis from positional voiding= UTI
Bladder/kidney infection
Calcium drained from bones= increase risk of kidney stones
Overflow incontinence
Skin breakdown/pressure ulcers from contact of urine to skin
Endocrine
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Muscle breakdown and loss of protein
Gastrointestinal
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Increased chance of heartburn (GERD)
Increased risk of aspiration
Appetite loss/impaired taste
Weight loss and malnutrition
Decreased peristalsis
Increased constipation
Decreased fluid intake
Stool contact with skin…enzymes breakdown tissues
Integumentary
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Increase heat, pressure + decreased oxygenation= pressure ulcers
Healthy adults change position in their sleep once every 11.6 minutes
Friction and shearing increase skin breakdown (cool dry sheets, one thing under them, if head is
elevated, then bend the bed that’s under the knees, also use pillows )
Respiratory
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Pneumonia and atelectasis
Decreased lung expansion (positional)
Weight of chest = decreased lung expansion
Cough weakens….can’t clear secretions
Retained secretions impair alveoli opening
Increased risk of pneumonia/lung infections
O2 & CO2 exchange impaired= hypoventilation and hypoxemia
Pulmonary edema due to blood redistribution and fluid shifts
Need to breathe deep, cough and expand lungs
Nervous
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Depression, anxiety, irritability, boredom
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Disorientation/ delirium
Social isolation, withdrawal, helplessness
Altered body image,
Sleep patterns altered (always tired but can’t sleep)
All complicate someone’s ability to participate in therapy
Other factors:
-Nutritional intake
-Infection
-Lack of assistive help
-Medications
-Psychological state/depression
-Lack of resources
-Age
Musculoskeletal
Assessment:
-Neuro
-Mobility
-Transfer
-Sitting
-ROM
-Muscle Strength (0 to 5 in textbook, P&P)
-Activity tolerance
-Gait
Interventions:
-Perform active ROM ( 3 times a day)
-Positioning Techniques
-Assess for tolerance
-FALL RISK INTEVENTIONS (preventions if they are FR)
-get them up and moving
Circulatory
Assessment:
-Assess vital signs
-Edema
-Pulses
-Pain
-Erythema
-Medical history for surgery, obesity, blood clots, immobility
-watch for Orthostatic hypertension and blood clots
Interventions:
- Assist patient slowly
-Watch for neuro, color, changes
-Assess BLE
-SCD’s (compression devices)
-
No crossing legs, sitting still for long periods of time.
ROM (calf pumping)
Respiratory
Assessment:
-Respiratory assessment
-RR
-Depth
-Pattern
-Sounds
-SIT UP or Roll Them for posterior
Interventions:
-Incentive spirometer
-Deep breathing/coughing
-Positioning no supine unless instructed
-CPT
-Drink Lots of fluid
-Move ASAP
Urinary
Assessment:
-Bladder distention
-Continence/incontinence/foley
-Watch for dehydration
Interventions
-Encourage fluid intake
-Assess urine amount color/odor
-Intake/output
Metabolic
Assessment:
-Ht/wt/BMI
-Skin turgor (friction/shear)
-Food intake
-Dietary patterns
Interventions:
-High calorie/high protein
-Vitamin C supplement
-Parental (IV)
-Enteral (tubing)
-Watch lab values (Calcium and potassium)
Gastrointestinal
Assessment:
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Full abdominal assessment
o Bowels, tender/soft
Interventions:
-
Encourage fluid (respiratory, urinary, skin)
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Encourage well balanced diet with fiber
Stool softener( do first before laxative)
Laxative
Integumentary
Assessment:
-
Assess
Collaborate
Interventions:
-
-
Maintain skin integrity
o Clean
o Dry
o Decrease friction/shearing potential
Position
o Go back and review positioning (Mrs. Helton)
o Heal floats
o Pillows
o Special beds
Nervous
Assessment
-
Assess neuro
Assess mood
Assess personality
Interventions:
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Communication!
Family/friends
Cluster interventions
TV/ IPAD/ puzzles, etc.
Test Questions:
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Complications and how we intervene
Make a concept map for each body system