Term
| Immobility and NS Impairment |
|
Definition
Neurological disease/ trauma can cause muscles to become stiff or lose function
- MS
- Parkinson's
- Huntington's
- myasthenia gravis
- Guillain-Barre Syndrome
- creutzfeldt-jakob disease
- head/ sprinal cord trauma
- CVA
|
|
|
Term
Musculoskeletal Impairment
|
|
Definition
Trauma
Disease:
- osteomyelitis
- tumors
- osteoporosis
- scoliosis
|
|
|
Term
|
Definition
- chronic conditions that limit the supply of oxygen and nutrients to the body resulting in activity intolerance
- COPD, CHF, Obesity, Diabetes
|
|
|
Term
|
Definition
advancing age:
- decrease in muscle tone, flexibility, bone mass and reaction time
- change in posture and balance
Chronic Illness (i.e., fatigue)
|
|
|
Term
| Medically Induced Immobility |
|
Definition
- Physicial ordered bedrest (confinment to bed; reducing physical activity will reduce oxygen need, reduce pain, all the ill/debilitated time to rest)
- Immobilization Devices (cast, splint, traction, braces)
- Normal individual when confined to bedrest will lose muscle strength from baseline levels at 3% daily
|
|
|
Term
Bed Rest
CLINICAL ALERT!!!!! |
|
Definition
| Studies have shown that bedrest causes more problems for patient and early ambulation is best. Bed rest may delay recovery or cause actual harm to the pt!! |
|
|
Term
Major Complications of Immobility
(musculoskeletal system) |
|
Definition
Disuse atrophy
Disuse osteoporosis
joint contractures |
|
|
Term
|
Definition
•Loss of muscle tissue due to decrease use
•Reduced muscle mass is unable to sustain activity without increased fatigue
•Increased fatigue leads to further decrease in activity which leads to further muscle loss (atrophy)
•Muscle weakness ALWAYS occurs with prolonged immobility
|
|
|
Term
|
Definition
•Without the stress of weight-bearing activities, bones demineralized due increased rate of bone resorption
•Bone resorption depletes calcium (which gives bones strength & density)
•Bones become spongy
Gradually deform & fracture easily |
|
|
Term
|
Definition
•When muscle fibers are not able to shorten & lengthen, a permanent shortening of the muscle develops limiting joint mobility
•Develops when the normally elastic connective tissues are replaced by inelastic fibrous tissue
•May leave joints non-functional and permanently fixated (affected area resistant to stretching and prevents normal movement)
•Contractures occur primarily in the skin, underlying tissues, muscle, tendons and joint areas
•Most common cause is immobilization or inactivity
|
|
|
Term
Major Complications from Immobility
(Cardiovascular System) |
|
Definition
•Venous vasodilatation & stasis
•Dependent edema
•Orthostatic hypotension
•Thrombus formation
Increased cardiac workload
|
|
|
Term
Venous Vasodilation and Stasis
(in a mobile person) |
|
Definition
•Skeletal muscles in an active person contract with each movement – compressing the blood vessels in those muscles helping to pump the blood back to the heart against gravity
•Tiny valves in the leg veins aid in venous return to the heart by preventing backward flow of blood & pooling
|
|
|
Term
Venous Vasodilation and Stasis
(immobile person) |
|
Definition
•Skeletal muscles DO NOT contract sufficiently and muscles atrophy – skeletal muscles can no longer assist in pumping blood back to the heart against gravity
•
•Blood pools in legs causing vasodilatation & engorgement – valves in vein can no longer work effectively to prevent backward flow of blood & pooling
•
•Blood continues to pool in the veins causing greater volume which increases venous blood pressure
|
|
|
Term
|
Definition
Edema in Body parts positioned below the heart
•Blood continues to pool in the veins causing greater volume which increases venous blood pressure
•When venous blood pressure is increased serous fluid is forced out of the vessel & seeps into the interstitial space surrounding the vessel
•Causing edema
•Edema further impedes venous return leading to more pooling; hence more edema
|
|
|
Term
|
Definition
•Decrease of 20+ mmHg systolic or 10+ mmHg diastolic when rising from lying or sitting position
•Caused by:
–Atrophy of skeletal muscle
–Pooling of blood in the lower extremities
–Causes decrease in central blood pressure
–Causes decrease venous return
–Results in decreased cardiac output
–Results in decrease cerebral perfusion (dizzy, faint)
|
|
|
Term
|
Definition
•Thrombus = blood clot attached to a vessel wall
•May occlude vessel lumen
•Conditions favorable to formation:
–Slow blood flow
–Injury to vessel wall
–Change in coagulation
|
|
|
Term
|
Definition
- Deep veins lead to the vena cava which runs directly to the heart
- Deep vein thrombosis (DVT) is a blood clot in one of the deep veins
- DVT occurs in your pelvis, thigh, or calf, but it can also occur less commonly in your arm, chest, or other locations.
- DVT can cause sudden swelling, pain, or a sensation of warmth.
- DVT can be dangerous, because it can cause a complication known as pulmonary embolism. In this condition, a blood clot breaks free from your deep veins, travels through your bloodstream, and lodges in your lungs. This clot can block blood flow in your lungs, which can strain your heart and lungs. A pulmonary embolism is a medical emergency. A large embolism can be fatal in a short time.
- Change in clotting factors or increased platelet activity
|
|
|
Term
|
Definition
•Embolus = blood clot that has moved from its place of origin causing obstruction to circulation elsewhere
•Embolus entering the pulmonary circulation from the legs may occlude vessels that nourish the lung causing an infarction
•Seriously compromises pulmonary function; may lead to death
|
|
|
Term
Major Complications from Immobility:
Respiratory System |
|
Definition
•Decreased respiratory movement
•Pooling of respiratory secretions
•Atelectasis
•Hypostatic pneumonia
|
|
|
Term
| Decreased Respiratory Movement |
|
Definition
•Recumbent ventilation is passively altered
–Chest movement curtailed by bed
–Abdominal organs push against diaphragm restricting lung movement
•Overall muscle atrophy affects respiratory muscles
•Shallow respirations reduce vital capacity (max amt. of air able to exhale after maximum inhalation)
•Decrease oxygenation & increase CO2 retention
|
|
|
Term
| Pooling of Respiratory Secretions |
|
Definition
•Inactivity allows respiratory secretions to pool by gravity
•Overall muscle atrophy hinders ability to cough effectively
•Inadequate oxygenation & retention of CO2 can lead to respiratory acidosis (acidosis resulting from reduced gas exchange in the lungs (as in emphysema or pneumonia); excess carbon dioxide combines with water to form carbonic acid which increases the acidity of the blood)
|
|
|
Term
|
Definition
Atelectasis is a state of incomplete expansion of a lung or any portion of it. There is a reduction or no air in the alveoli. The volume of the involved lung is decreased.
•Pooled secretions accumulate in dependent areas of bronchioles and create a blockage of mucous
•Immobility decreases amount of surfactant (enable the alveoli to remain open) produced
•Combination of decreased surfactant & blocked bronchioles results in collapse of alveoli distal to the mucous blockage
•Hypoventilation results
Extent of atelectasis is determined by the site of blockage – could be the entire lung
|
|
|
Term
|
Definition
•Pooled secretions provide excellent medium for bacterial growth
•Infection caused by static respiratory secretions
•Impairs O2 – CO2 exchange in the alveoli
•Common cause of death among weakened, immobile persons
Once organisms enter the lungs, they usually settle in the air sacs of the lung where they rapidly grow in number. This area of the lung then becomes filled with fluid and pus as the body attempts to fight off the infection. In other cases, pneumonia is caused when bacteria or viruses that are normally present in the mouth, throat, or nose inadvertently enter the lung.
|
|
|
Term
Major complications of Immobility:
Metabolic system |
|
Definition
•Lowered basal metabolic rate & slower gastric motility
–Decreased energy requirements
•Negative nitrogen balance
•Anorexia
•Negative calcium balance
|
|
|
Term
| Negative Nitrogen Balance |
|
Definition
The breakdown of proteins release nitrogen!
•Immobility creates an imbalance between anabolism (building molecules using energy) and catabolism (breaking down molecules to produce energy)
•Catabolic processes exceed anabolic processes(breaking down more than producing or taking in)
•Catabolized muscle mass releases nitrogen
•Over time more nitrogen is excreted than is ingested
NNB means a depletion of protein stores that are essential for building muscle & wound healing
|
|
|
Term
|
Definition
•Loss of appetite because of decreased metabolic rate
•Reduced calories intake is the response to the decreased energy requirements
•If protein intake is decreased, negative nitrogen balance will be exacerbated causing malnutrition
|
|
|
Term
|
Definition
•Greater amount of calcium are removed from bone than can be replaced
•Absence of weight–bearing is a direct cause of calcium loss from bones
•Weight-bearing MUST be present for calcium to be replaced in bone
|
|
|
Term
Major Complications from Immobility:
Urinary System |
|
Definition
•Urinary stasis
•Renal calculi
•Urinary retention
•Urinary infection
|
|
|
Term
|
Definition
•Complete emptying of the bladder is best achieved in an upright position because of the role gravity plays
•If body is horizontal, gravity impedes emptying of urine from kidneys & bladder
•Results in incomplete emptying
•Overall muscle atrophy hinders the tone of the detrusor muscle (bladder muscle; weave like muscle that is responsible for emptying the bladder)
|
|
|
Term
|
Definition
•Renal calculi = kidney stone
•Elevated level of calcium in the blood from bone demineralization
•Immobility can lead to a decline in fluid intake leading to concentrated urine which increases risk of stone formation
•Elevated level of calcium in the urine increases the pH (becomes more alkaline)
|
|
|
Term
|
Definition
•Accumulation of urine in the bladder
•Can cause bladder distention(bloating, enlarged)
•Overall muscle atrophy hinders the tone of the detrusor muscle (bladder muscle) inhibiting the ability to empty completely
•Difficulty relaxing the perineal muscles due to unnatural position of urinating while lying in bed
Discomfort of using bedpan, lack of privacy, embarrassment |
|
|
Term
| Urinary Retention leads to Reflux |
|
Definition
•Reflux = backward flow of urine
•Urine from overly distended(bloating) bladder backs up the ureter and into the kidney
•Urine becomes stagnant in the bladder
•With unrelieved over-distention of the bladder, the urge to urinate is inhibited
|
|
|
Term
|
Definition
•Stagnant urine provides excellent medium for bacterial growth
•Distention(bloating) can traumatize the bladder mucosa causing minute tears
•Flushing action of frequent, upright positioned urination prevents infection
•Elevated level of calcium in the urine increases the alkalinity which supports bacterial growth
|
|
|
Term
Major complications of Immobility:
Integumentary System |
|
Definition
•Reduced skin turgor
•Skin breakdown
|
|
|
Term
|
Definition
•Skin can atrophy due to prolonged immobility
•Shifts in body fluids can affect the consistency of dermis and subcutaneous tissue in dependent parts of body (edema)
•Causing gradual loss of skin elasticity
|
|
|
Term
|
Definition
•Direct effect of pressure on the skin due to immobility is compounded by changes in metabolism (negative nitrogen balance)
•Breaks in skin integrity have difficulty healing
•Major risk for pressure ulcers
|
|
|
Term
|
Definition
•An observable pressure related alteration of intact skin whose indicators as compared to the adjacent or opposite area on the body may include changes in one or more of the following:
–Skin temperature (warmth or coolness),
–Tissue consistency (firm or boggy feel) and/or
–Change in sensation (pain, itching)
|
|
|
Term
|
Definition
•Partial-thickness skin loss involving the epidermis, dermis, or both
•Ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater
|
|
|
Term
|
Definition
•Full-thickness skin loss involving damage to or necrosis of subcutaneous tissue
•May extend down to but not though underlying fascia
•Ulcer presents as a deep crater with or without undermining of adjacent tissue
Epidermis, dermis, subq, fascia, muscles, bone
|
|
|
Term
|
Definition
•Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (such as tendon or joint capsules)
•Undermining and sinus tracts also may be present
|
|
|
Term
Major Complications of Immobility:
GI Tract |
|
Definition
|
|
Term
|
Definition
•Due to decreased peristalsis
•Overall muscle atrophy hinders the tone of the abdominal & perineal muscles used for defecation
•Stool becomes hard requiring more strength to pass it
•Unnatural & uncomfortable position on bedpan does not facilitate elimination
|
|
|
Term
Major Complications of Immobility:
Psyconeurologic System |
|
Definition
•Depression
•Behavioral changes
•Sleep-wake disturbances
•Impaired coping
|
|
|
Term
|
Definition
•Exaggerated feelings of sadness, worthlessness, helplessness, hopelessness
•Immobilization creates more time to worry about present & future
|
|
|
Term
|
Definition
•Hostility
•Belligerence
•Fear
•Anxiety
•Recognize grieving process
|
|
|
Term
|
Definition
•Disruption of normal sleeping patterns
•Hospital environment
•Hospital routine
–Turn patient every 2 hours
–Vitals signs & assessment during night
–Medication administered around the clock
|
|
|
Term
|
Definition
•Withdraw
•Become passive
•Loss of desire for independence
|
|
|
Term
Mobility Assessment
Capabilities/ Limitations |
|
Definition
•Health condition influence the ability to move
•Any contraindications for exertion, position or movement
•Encumbrances to movement
–IV line, cast, eye patch
•Stamina & endurance
•Balance & coordination
•Degree of comfort
•Vision
•Mental alertness/ability to follow directions
–Meds can hinder ability to walk safely
|
|
|
Term
Mobility Assessment:
Muscle Mass/ Strength |
|
Definition
•Essential to assess a client's strength & abilities before attempting to move
•Providing assistance during movement lowers risk of muscle strain & injury
|
|
|
Term
Mobility Assessment:
Joint Mobility |
|
Definition
•Physical assessment
–Swelling, redness
–Deformity, asymmetry
–Crepitus, tenderness
–Degree of movement
•Assess through active or passive ROM exercises
•See Kozier Table 44-1 & Table 44-2
DO NOT FORCE A JOINT!!!!!
|
|
|
Term
|
Definition
•Maximum amount of movement available at a joint in one of 3 planes of the body:
–Sagittal(right and left), frontal, transverse
•Joint mobility is limited by ligaments, muscles and joint design
•Obtain baseline to compare & evaluate whether loss in joint mobility has occurred
•Assessing for stiffness, pain, swelling, limited movement, asymmetry of movement
|
|
|
Term
|
Definition
•Important to determine activity levels to prevent unnecessary expenditures of energy
–Bathing
–Walking
•Measures for predicting activity tolerance
–Heart rate, strength, rhythm
–Respiratory rate, depth,
–Blood pressure
•Measure before, during and 3 minutes after activity to determine if able to tolerate
|
|
|
Term
|
Definition
•Stop activity immediately in the event of any physiological change indicating the activity is too strenuous
–Sudden facial pallor
–Dizziness, weakness
–Change in level of consciousness
–Vital signs significantly exceeding baseline
–Dyspnea
–Chest pain
|
|
|
Term
|
Definition
•Keep body weight off injured extremity
•Hands grips adjusted so elbows flex at 30
•Pad of crutches is 3 finger breadths from axilla
•Tip s crutches angled about 4 inches from feet
•Weight is transmitted thru hands not axilla
|
|
|
