Preventing the Hazards of
Immobility
Hazards of Immobility
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.
Bedrest
 Objectives
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Reduces oxygen needs
Decreases pain levels
Helps in regaining of strength
Uninterrupted rest has psychological and emotional
benefits
 Types of bedrest
 Bed rest
 Bed rest with bathroom privileges
Effects of Immobility
 Phisiologically
 No body system is immune to affects of
immobility
 Effects depend upon a client’s health, age, and
degree
Metabolic System
 Immobility causes:
 Decrease in BMR which causes:
 Altered metabolism of carbohydrates, fats, and
proteins which causes:
 Fluid, electrolyte and calcium imbalances which
causes:
 GI disturbances which causes:
 Decrease in appetite and decrease in peristalsis
Metabolic System
 Effects of the metabolic alterations=
 Fluid and electrolyte changes
 Bone demineralization
 Altered exchange of nutrients (also affected by
decreased appetite)
 Altered gastrointestinal functioning:
 Constipation
 Nausea/ vomiting
 Gas
 Indigestion
 Decreased appetite
Metabolic System
 Metabolic assessment
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Anthropometric measurements
Fluid Intake and Output measurements
Lab tests for electrolyte imbalances/ nutritional status
Assess ability to heal and fight infection
 Metabolic interventions
 High protein, high calorie diet
 Supplemental vitamin C
 Vitamin B complex
Respiratory System
 Effects
 Decreased lung expansion
 Pooling of secretions
 Decreased surface area for exchange of CO2
and O2 (secondary to lung expansion)
 Most common complication w/ respiratory
system= hypostatic pneumonia
Respiratory System
 Respiratory assessment
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Observe chest movements
Auscultate for pulmonary secretions
Check O2 saturations
Observe for respiratory difficulties
 Respiratory interventions
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TCDB q 2 hours
Chest physiotherapy (CPT)
Maintain patent airway
Incentive spirometer
Cardiovascular System
 Effects
 Orthostatic hypotension
 Increased cardiac workload
 Thrombus formation
 May become emboli
 Most dangerous complication of bedrest
 Valsalva maneuver
Cardiovascular System
 Assessment
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BP measurements with postural changes
Monitor pulse
Monitor for edema
Watch for s/s of DVT
Cardiovascular System
 Interventions
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“Dangling” feet before standing
Discourage valsalva
Prevent venous stasis
Exercise
ROM
Anti-embolic stockings (TED hose, SCD’s)
 Never massage extremities
 Observe for s/s DVTs (warmth, redness,
+Homans)
Musculoskeletal System
 Effects
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Decreased muscle mass
Muscular atrophy
Reduced muscle endurance
Decreased stability
Joint contractures
Disuse osteoporosis
Decreased skeletal mass
Musculskeletal System
 Assessment
 Anthropometric measurements
 ROM measurements
 Interventions
 Active and passive ROM
 Individualized, progressive exercise program
Genitourinary System
 Effects
 Urinary Stasis
 Renal Calculi
 UTI
Genitourinary System
 Assessment
 Analysis of Intake and Output (I & O)
 Proper perineal care
 Signs and symptoms of UTI
 Interventions
 Force fluids
 Record I & O
 Strain urine if there are stones
Gastrointestinal System
 Effects
 Constipation
 Fecal Impaction
Gastrointestinal System
 Assessment
 Assessing BM’s daily
 Observe for passage of liquid stool
 Interventions
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Record daily LBM
Encourage fluids
Administer enemas, prn
Digital removal of fecal impactions
Integumentary System
 Effects
 The effect on the skin in compounded by impaired body
metabolism and:
 Pressure
 Shearing Force
 Friction
 Any break in the skin is difficult to heal, which can lead
to further immobilization
 Break in skin is called a bedsore, pressure sore, or
decubitus ulcer (decubitus means bed lying)
Integumentary System
 Assessment
 Assess positions and the risks with each
position
 Identify clients at risk
 Observe for skin breakdown
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Stage 1
Stage 2
Stage 3
Stage 4
Integumentary System
 Interventions
 Prevention
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Identify at risk clients
Daily skin exam
Change positions every 2 hours
Massage
Skin care products (lubricate and protect)
Stimulate circulation
 Pressure support devices
Integumentary System
 Treat skin breakdowns
 Keep area dry and clean
 Change dressings prn
 Debridement of ulcer
 Must debride to healthy tissue
 Remove eschar
 Increase protein, calories, vitamins
 Protein= 2-4 times normal
 Calories= 1 1/2 times normal
 Vitamin C= wound healing
Psychosocial Responses
 Assessment
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Assess for behavioral changes
Any changes in sleep-wake cycle
Decreased coping abilities
Signs and symptoms of depression
 Interventions
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Socialization
Meaningful stimuli
Maintain body image
Avoid sleep interuptions
Utilize resources, I.e. pastoral care or social services