Immobility 1

Question 1

What is immobility?

Answer 1


Individuals who have inactive lifestyles or who are faced with inactivity because of illness or injury are at risk for many problems that can affect major body systems.

inability to move about freely

Question 2

Mobility?

Answer 2

a person’s ability to move about freely

Question 3

Deconditioning?

Answer 3

out of shape

muscle wasting and progressive loss of function

Question 4

Alterations in the level of physical mobility can result from?

Answer 4

prescribed restriction of movement in the form of bed rest

physical restriction of movement because of external devices( cast)

voluntary restriction of movement

impairment of motor or skeletal function.

Question 5

Total immobility as in bed rest and can produce complications including ?

Answer 5

bedsores, pneumonia, or contractures

Question 6

common complication of partial immobility or impaired physical mobility?

Answer 6

edema, thrombus

Question 7

Bed Rest?

Answer 7

Pt is restricted to bed rest for therapeutic reasons

Question 8

The general objectives of bed rest?

Answer 8

To reduce physical activity and the oxygen needs of the body

To reduce pain, including post op pain , and the need for large doses of analgesics

To promote safety for pts recovering from the effects of anaesthetics or who are sedated

To allow pts who are ill or debilitated to rest

To allow pts who are exhausted the opportunity for uninterrupted rest

Question 9

Pathological influences on Mobility?

Answer 9

Impaired muscle development: eg. muscular dystrophy

Direct trauma to the musculoskeletal system : eg. fractures

Damage to the Central nervous system: eg. head injury, stroke

Postural Abnormalities: eg. scoliosis

Question 10

Causes of Immobility?

Answer 10

Bone surgery (Knee replacements, Hip replacements)
Abdominal Surgery

Question 11

Common Joint Surgical Procedures indications?

Answer 11

Relieving chronic pain
Improving joint motion
Correcting deformities & malalignment
Removing intra- articular causes of erosion
Movement of a painful joint is often avoided , and if not corrected contraction with permanent limitation of motion often occurs ( contractures)

Question 12

Types of joint surgeries?

Answer 12

Synovectomy
Debridement
Arthroplasty

Question 13

Synovectomy?

Answer 13

removal of the synovial membrane for pt with Rheumatoid arthritis

Question 14

Debridement?

Answer 14

removal of degenerative debris such as loose bodies, osteophytes, joint debris, and degenerative menisci from a joint. Also termed arthroscopy.

Question 15

Arthroplasty?

Answer 15

reconstruction or replacement of a joint to relieve pain, improve or maintain range of motion and correct deformities.

Most commonly in pts with Osteoarthritis, Rheumatoid arthritis.

Question 16

Nursing intervention for impaired physical mobility?

Answer 16

Exercise therapy for joint mobility and ambulation

Question 17

impaired mobility after THA/TKA

Answer 17

related to pain , stiffness, and physical deconditioning as evidenced by limited joint movement, difficulty ambulating, inability to participate in physical rehabilitation, and guarded movement.

Question 18

Why are elderly more at risk?

Answer 18

With the longer life expectancy, the incidence of disease and disability continues to grow (i.e. strokes, leg fracture, trauma, morbid obesity, multiple sclerosis)

Mobility is also related to body changes from aging. Loss of muscle mass, reduction in muscle strength and function, joints becoming stiffer and less mobile, and gait changes affecting balance can significantly compromise the mobility of elder patients.

Related Factors:
Activity intolerance (pneumonia)
Perceptual or cognitive impairment 
Musculoskeletal impairment 
Neuromuscular impairment 
Medical restrictions 
Prolonged bed rest 
Limited strength 
Pain or discomfort 
Depression or severe anxiety

Question 19

Effects on Mobility 
: Any disorder which impairs?

Answer 19

Respiratory System (pneumonia)
Musculoskeletal System (sprain, turning the wrong way)
Cardiovascular System(low BP, high BP, complete heart block)
Metabolic System (thyroid)

Question 20

Effects on Musculoskeletal System?

Answer 20

Disuse osteoporosis: bones demineralize (osteoporosis) Loss of Calcium

Disuse atrophy: unused muscles atrophy

Contractures: a shortening of the muscle

Stiffness and pain of the joint: collagen
tissue “ankyloses” -> as bone demineralizes, excess Calcium becomes deposited in the joint

Question 21

Assessments/Interventions: 
Musculoskeletal System ?

Answer 21

Check muscle tone (Health assessment)
Assessment of ROM (Health assessment)
Falls Risk (Morse Scale)
Range of Motion=ROM (passive and active)

Question 22

Types of dance of motion exercises?

Answer 22

passive
active passive
active
resistive
isometric/isotonic

Question 23

passive exercises?

Answer 23

keeps ROM for joint so it won’t be lost

exercises are carried out by the nurse, without assistance from the patient.

Passive exercises will not preserve muscle mass or bone mineralization because there is no voluntary contraction, lengthening of muscle, or tension on bones.

Question 24

active passive?

Answer 24

performed by the patient with assistance from the nurse.

Active assistive exercises encourage normal muscle function while the nurse supports the distal joint.

Question 25

active?

Answer 25

performed by the patient, without assistance, to increase muscle strength.

Question 26

resistive?

Answer 26

active exercises performed by the patient by pulling or pushing against an opposing force

Question 27

isometric/isotonic?

Answer 27

performed by the patient by contracting and relaxing muscles while keeping the part in a fixed position maintain muscle strength when joint is immobilized

Question 28

USCR REST & ACTIVITY?

Answer 28

Rest: altered sleep wake pattern ``` Activity: ↓ muscle size, tone and strength ↓ joint mobility, flexibility, bone demineralization ↓ endurance, stability ↑ risk of contracture formation ```

Question 29

Assessments/Interventions: Musculoskeletal System 
 Nursing intervention?

Answer 29

Exercise therapy for joint mobility and ambulation by: Early ambulation Encourage ROM exercises Work with the medical team to ensure best possible mobility Use appropriate aids for safe ambulation

Question 30

Examples of Nursing Directives for USCR Rest and Activity Musculoskeletal System (TNP)?

Answer 30

``` Out of bed up in chair for all meals Walk three times a day Teach isotonic exercises Assist with ROM exercises twice a day Walk with high walker 20 m daily ```

Question 31

Effects on Cardiovascular System?

Answer 31

Tachycardia: (less blood flow to the coronary arteries) Increased used of Valsalva manoeuvre: (contraction of chest muscles on a closed glottis with simultaneous contraction of abd muscles =increases intra-abdominal pressure) Orthostatic hypotension: (blood pooling of the blood in lower extremities) associated with a drop of 20 mm Hg or more in the systolic Bp. Venous dilation (blood pooling results in damage to the valves in the lower extremities)


Question 32

Valsalva Manoeuvre? *

Answer 32

Occurs during straining to pass a hardened stool May cause serious problems in patients with congestive heart failure, cerebral edema, hypertension, and coronary artery disease. During straining the pt takes a deep inspiration, the breathe is held, & the glottis closes and traps the air. Simultaneously with the contraction of the chest muscles against the closed airway , the abd muscles contract and try to push against the colon. Increases in intra abdominal pressure & intrathoracic pressure occur, reducing venous return to the heart. There is bradycardia, cardiac output decreases, & a transient drop in BP. When the pt relaxes there is a sudden flow of blood to the heart causing distension & an increase in heart rate. Fatal for pt who cannot compensate for the sudden return of blood flow to the heart.

Question 33

Effects on Cardiovascular System cont. Pooling of blood?

Answer 33

Dependent edema: (increased venous pressure) - noted in sacrum and heels; feet; feet and ankles when up in chair Thrombus formation: -abnormalities in blood flow such as slow blood flow in calf veins . Hypercoagulation as a response to stress.

Question 34

Assessments/Interventions: Cardiovascular System ?

Answer 34

BP monitoring orthostatic hypotension a drop in systolic blood pressure of 20 mmHg upon moving to an upright position (sitting or standing) Associated with dizziness, fainting, pale, sweating, fast heart beat Evaluate peripheral pulses Check for venous stasis and edema Education regarding Valsalva manoeuvre (encourage to breathe thru mouth) Prevent Deep Vein Thrombus: Use of Pneumatic stockings or Ted Stockings diuretic= relieve interstitial fluid

Question 35

Assessments/Interventions: Cardiovascular System?

Answer 35

Fall prevention for orthostatic hypertension Teaching measures to reduce edema (extremities elevation) Promote venous return (Teds, pneumatic stockings, elevate extremities, no leg crossing…) Give anticoagulant as prescribed

Question 36

ORTHOSTATIC HYPOTENSION? *

Answer 36

drop of 20 mmHg or more in systolic and of 10 mmHg in diastolic BP within 3 minutes of when the pt rises from a lying or sitting position to a standing position. Decreased circulating fluid volume , pooling of blood in the lower extremities and decreased autonomic response occurs when a pt is immobile. These factors result in a decrease in venous return, followed by a decrease in cardiac output, which is reflected by a decrease in BP. GI bleeding/meds can contribute to orthostatic hypotension

Question 37

ASSESSMENT OF ORTHOSTATIC HYPOTENSION?

Answer 37

Take the BP and pulse in the supine position to determine a baseline. Request that the pt sit on the side of the bed for 3 minutes, take BP and pulse again. Monitor for dizziness or lightheadedness. If no drop in BP > than 20 mmHg systolic, and no dizziness, assist the pt to the standing position. Take the BP immediately and then 3 minutes after the pt is standing. Continue to monitor for dizziness.

Question 38

DVT prevention?

Answer 38

ted stockings | pneumatic stockings

Question 39

USCR AIR? circulation?

Answer 39

↑ risk of orthostatic hypotension ↑ risk of venous thrombosis

Question 40

Examples of Nursing Directives for USCR Air Cardiovascular System (TNP)?

Answer 40

Monitor for orthostatic hypertension Teach positions that promote venous return (elevate legs) Antiembolic ( Ted) stockings at all times Monitor for DVT. Administer anticoagulant

Question 41

Effects on Respiratory System ?

Answer 41

Decreased respiratory movement (shallow breathing and client rarely sighs) Pooling of secretions (rarely sighs, lack of coughing) Atelectasis or secretions pool in one area of lung (collapse of lobe or lung) Hypostatic Pneumonia (pooled secretions = excellent medium for bacterial growth)

Question 42

Assessments/Interventions: Respiratory System 
?

Answer 42

``` Auscultate the lungs Monitor O2 saturation Ambulate ASAP Turn and Position (T&P) if ambulation is not possible Encourage deep breathing and coughing Use incentive spirometer ```

Question 43

USCR AIR: | Lungs?

Answer 43

↓ depth of respiration ↓ rate of respirations pooling of secretions impairing gas exchange

Question 44

Examples of Nursing Directives for USCR Air Respiratory System (TNP)?

Answer 44

Teach deep breathing & coughing exercises Assist with incentive spirometer every hour Monitor for respiratory infection Change position frequently

Question 45

Effects on the Urinary System

Answer 45

*Urinary Stasis (incomplete emptying of kidneys and bladder) resulting in Urinary Retention (bladder doesn’t empty completely, decreased muscle tone) can be caused by meds Urinary Infection (increased alkalinity of the urine = excellent medium for bacterial growth)

Question 46

Assessments/Interventions: Urinary System ?

Answer 46

``` Monitor I & O, turn & position Check bladder for extension Ask patient about S&S of UTI Monitor temperature Offer BR frequently Hydration (increase to 2liter a day) ```

Question 47

Effects on the Urinary System: Renal Calculi

Answer 47

excess amount of calcium -> calcium salts precipitate to form renal stones

Question 48

USCR ELIMINATION: Urine?

Answer 48

↑ urinary stasis ↑ risk of renal calculi ↓ bladder muscle tone

Question 49

Examples of Nursing Directives for USCR Elimination GU System (TNP)?

Answer 49

Offer use of bathroom for urination q3 hrs Monitor I&O Up to commode to void Increase fluid intake to 2 liter per day (increases renal blood flow)