NUR 155 - Exam 3 Study Material: Effects of Immobility & Nursing Care galen college of nursing Questions And Answers With Verified Study Solutions Rated A+

Exam 3 Chapter 28 • Effects of Immobility of body systems o Musculoskeletal system ▪ Atrophy- wasting (muscle start to shrink) ▪ Contracture- permanent fixation of a joint ▪ Disuse osteoporosis- loss of bone mass due to lack of activity (it can lead to pathologic bone fractures. Our joints may become really stiff and painful) ▪ Decreased in muscle tone- can occur within just a few days of inactivity o Nervous system ▪ Balance (Proprioception & Equilibrium altered) • Make sure to let the patient dangle their legs at the side of the bed before standing for the first time. o Cardiopulmonary ▪ Decreased in lung expansion- the body weight against the bed puts pressure on the rib cage. The diaphragm has less room to expand than in the upright position due to pressure from abdominal organs. • Leads to pooling of secretions in the lungs ▪ Decreased lung expansion can lead to • Pooling of secretions in the lungs (unable to cough up any secretions • Pneumonia (#1 cause of death in immobile patients) • Atelectasis (collapse of a portion or all of the lungs) ▪ DVT’s ▪ Orthostatic Hypotension: a form of low blood pressure that happens when standing after sitting or lying down. o Nutrition ▪ Decrease in Basal Metabolic Rate (BMR) • When this decreases the body begins breaking down muscle protein for energy. Catabolism of protein leads to a negative and nitrogen balance in the body, especially if people aren’t getting enough dietary protein in their diet because the body starts breaking down the muscle, protein or energy. • Anorexia- decreased oaded_by • Nausea o Eoaded_by ▪ Inactivity, decreased appetite, and decreased fluid intake cause hypomotility of gastrointestinal tract (GI moves slowly). This is manifested by decreased bowel sounds on auscultation and by constipation. • Constipation o Fecal impaction (build up of hardened feces in the lower intestine) due to unrelieved constipation. Monitor for adequate fiber and fluid volume while on bed rest. o Urinary stasis may develop, and may result in UTI, and renal calculi (Kidney stones) due to inability to use bathroom. Using bedpan leads to GI track to slow down. o Skin ▪ Pressure injuries (Pressure sores, pressure ulcers, bedsores, or decubitus ulcers) • The impact of immobility on skin integrity is potentially catastrophic. Pressure on bony prominences can cause tissue ischemia. o Prolonged tissue ischemia may lead to necrosis and destruction of all layers of the skin, muscle and fat. o Areas most at risk for pressure injuries: buttocks, coccyx, heels, hips, shoulders, elbows and ears. o Psychosocial ▪ Isolation may result from inactivity and bed rest, causing a variety of psychosocial challenges for patients. With limited ability to ambulate or interact with people outside of their immediate space, immobile patients may become lonely, anxious, angry, depressed, or confused. ▪ Sensory deprivation (lack of stimuli) may result from decreased interaction with others. A patient’s self-concept may be altered by the inability to interact with the environment. Traditional coping strategies may not be effective, causing irregular patterns of behavior. ▪ Sleep and rest patterns may be disturbed. • Nursing interventions for each body system o Musculoskeletal ▪ One of the most important is exercise and early ambulation • Early ambulation after injury, illness or surgery promotes muscle strength, retains joint flexibility,oaded_by minimizes joint pain and stiffness, and arrests bone reabsorption. ▪ Types of Exercise • Isotonic – involves active movement with constant muscle contraction. o Walking, turning in bed and self-feeding • Isometric – requires tension and relaxation of muscles without joint movement o Kegels • Aerobic – requires oxygen metabolism to produce energy o Rigorous walking, or repeated stair climbing • Anaerobic – builds power and body mass. Without oxygen to produce energy for activity o Heavy weightlifting • If patients are restricted to bed rest active or passive ROM exercises must be employed to prevent joint contractures. o Positioning devices that help with proper body alignment and positioning of the joints. ▪ Place pillows between legs- placing a pillow between the legs and arms of a side-lying patient helps prevent pressure on the bony prominences of the knees and elbows. ▪ Use splints and braces – used on extremities to keep joints in functional positions. ▪ Trochanter rolls – are used to keep the hip from externally rotating when the patient is in the supine position. (often used after hip surgery) ▪ Logrolling – moving the body as a unit o Fall prevention ▪ Use call light when getting up o Assistive devices ▪ Canes, crutches, walkers, gait belts, mechanical lifts (review the different devices and how to use them pg. 565) ▪ Mechanical lifts are the preferred method-always need a second person there with your for safety reasons. • Also if a patient is on bedrest we can teach them to use things like the side rails to help pull themselves up in bed, or they can use a trapeze bar. o Cardiopulmonary ▪ Raise head of bed to prevent pneumonia ▪ Coughing and deep breathing (Incentive spirometer)