Module 6: Altered Mobility and Arthritis Flashcards
(33 cards)
Cardiovascular response to immobility
Blood volume redistributed
Deconditioning of the heart
venous stasis
reduction in total body water
postural hypotension
Increased risk of: DVT, PE and thrombosis
Immobility results in a change in blood volume, what would be some complications of this ?
Headache
Swelling
Nasal Congestion
Swollen eyelids
Immobility also results in a change in thoracic blood volume, what would be some complications of this ?
Increased central venous pressure
Increased cardiac output
Increased stroke volume
what are the complications of extended periods of rest ?
Increased venous distension
decreased venous return
Stabilisation of SV and CO
Tachycardia
Decreased disatolic filling
Increased energy use and oxygen demand by the heart
Describe orthostatic hypotension
Blood flow moves from central circulation to lower extremities:
- bed rest removes affect of gravity and hydrostatic pressure from the CVS
Describe Venous Stasis
- Increased pressure on legs from contact with the bed
- Compression leads to damage in the Intima
THREE factors predisposing to DEEP VEIN THROMBOSIS
1. Stasis of flow
2. Hypercoagulability
3. Vessel injury
List some of the pulmonary changes due to immobility
1.) Decreased tidal volume (TV)
2.) Decreased functional residual capacity (FRC)
3.) Cannot clear lung secretions
4.) Atelectasis (Lung Collapsing)
5.) Positioning effects on work of breathing
6.) Ventilation
List some of the effects on the lungs due to immobility
1.) Inspiratory muscles working in different planes
2.) Abdominal contents push against diaphragm
3.) Collapse of alveoli (atelectasis)
4.) Poor coughing and cough reflex
5.) Predisposition to chest infections
Define and outline causes of Atelectasis (collapsed lung)
Occurs from a blocked airway (obstructive) or pressure from outside the lung (non-obstructive)
GENERAL ANAESTHESIA is a common cause. Changes the regular pattern of breathing and affects the exchange of lung gases, which can cause alveoli to deflate. Almost all patients who have major surgery develop this.
MUCUS PLUG is the build up of mucus in the airways. It commonly occurs during and after surgery if the patient can’‘t cough during bed rest
Immobilisation effects on fluid balance
in SUPINE position
1.) Increased central blood volume
2.) Inhibition of ADH and aldosterone
3.) water and sodium diuresis
4.) Diuresis starts day one in supine position
5.) Increased haematocrit (volume % of RBC) and haemoglobin
Immobilisation effect on metabolism
1.) Negative nitrogen balance (due to protein imbalance, causing elevated nitrogen and loss of muscle mass)
2.) Disuse osteoporosis (Bone demineralisation, causing an imbalance of osteoclasts and osteoblasts which increases serum Ca+
immobilisation effect on elimination
URINARY STASIS
May delay due to needing assistance
Difficulty relaxing perioneal muscles
detrusor muscles overstretched due to full bladder
urine flows upwards into ureters
prostatic enlargement in males
UTI
Stagnant urine
Distension (needs catheter)
RENAL CALCULI
Increased calcium and stagnation
Precipitate to form crystals
dehydration enhances calculi formation
CONSTIPATION
Abdominal and perineal muscles weakened due to muscle atrophy
gravity not assisting stool passage
embarrassment
dehydration frequent
urinary retention
define pressure injury
defined as a localised damage to the skin or underlying tissue, as a result of pressure in combination with a shear.
2 Risk Factors for pressure injuries
1.) Mechanical boundary conditions
2.) Tolerance of individual
describe Mechanical Boundary conditions risk factor
1.) Magnitude and duration of mechanical load
2.) Mechanical load can be from air filled, water filled, medical devices and other types of surfaces
3.) duration of mechanical load has significant impact
TYPE OF MECHANICAL LOAD = Pressure and Shear
Shear is a mechanical load
Describe shear
a wound caused by a shear is asymmetrical, ragged and uneven in shape (Caused by friction)
Stage 1 Pressure Injury
1.) Non-Blanchable redness of a localized area
2.) Area may be painful, firm, soft. , hot or cool
3.) determines at risk persons
Stage 2 Pressure Injury
1.) Partial thickness loss of dermis
2.) Open ulcer/ruptured blister
3.) NO slough
4.) NOT to be used to describe skin tears, burns or dermatitis
Stage 3 Pressure Injury
1.) Full thickness tissue loss
2.) Subcut fat may be visible
3.) bone, tendon + muscle not exposed
4.) NO SLOUGH
5.) depth varies on anatomical position
Stage 4
1.) Full thickness tissue loss
2.) Exposed bone + tendon + muscle
3.) SLOUGH may be present
4.) CAN extend into muscle and tendon
Unstageable
1.) Full thickness tissue loss
2.) Base of ulcer is covered in slough + eschar and the stage cannot be determined
Suspected deep tissue injury
Purple or maroon localised area of discoloured intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear.
The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue
Evolution may include a thin blister over a dark wound bed. The PI may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment
Explain Oseoarthritis
OA is a chronic condition characterised by the breakdown of the cartilage that overlies the ends of bones in joints
This results in the bones rubbing together, causing pain, swelling and loss of motion
Osteoarthritis mostly affects the hands, spine and joints such as hips, knees and ankles, and usually gets worse over time
Incidence of Osteoarthritis
- most common form of arthritis in Australia
- 1 in 5 Australians (22%) over the age of 45 have osteoarthritis
- It is most common in adults aged 75 and over (36%)
