W8 : Complications with immobility part B Flashcards
(31 cards)
Urinary System
Pathophysiology
- Supine position impedes normal kidney contraction and emptying of bladder resulting in urinary stasis
- Increase in microorganism growth
- Increase in calcium excretion (associated with demineralisation of
bones); high amounts leads to formation of crystals (process of precipitation) - Bladder sensitivity decreased due to higher levels of calcium in urine impacting on ability to void
- loss in muscle tone
Urinary calculi
- Kidney stones associated with precipitation of calcium
- Assessment data - extreme pain, dysuria, haematuria, urinary spasm/colic,
infection
Urinary retention
- Inability to effective empty the bladder; extreme cases may even lead to
reflux back up ureter to kidney (hydronephrosis) - Assessment data – discomfort, abdominal distention, palpate and percuss
bladder above the symphysis pubis, retention with ‘overflow’ (incontinence)
Urinary System
Nursing Interventions
- Avoid bed rest and immobility
- Promote activity and weight bearing exercises to ‘stress’
the bones and reduce likelihood of demineralisation and excessive calcium production - Push fluids (3 litres) to flush out the calcium and small stones;
adequate fluid intake to fill the bladder (2 litres) - Privacy; call bell; facilitate correct upright position to pass urine
- Monitor fluid balance, 1mL/kg/hour; or approximately
200-300 mL 6 times a day
Skeleton : Musculoskeletal System
Pathophysiology
Immobility affects bone health by altering bone metabolism and structure, leading to weakened skeletal support.
Muscles: Musculoskeletal System
Pathophysiology
- Become weak and stiff; lose 7-10% of
strength weekly - Atrophy and shortening of muscle begins
in 3-7 days; deconditioning - Progressive loss of range of motion over
2 weeks - Tendons become resistant to movement
Musculoskeletal System
Complications
- Joint stiffness & pain
- Muscle atrophy
- Pain on movement
- Unsteadiness, balance problems, falls
- Foot drop – unable to maintain foot in correct
position, shortening of tendons/muscles,
trouble walking, drag toes on floor
Contractures
- A permanent contraction of a muscle group caused by shortening and fibrosis of
the muscle fibres, leading to loss of/alteration in function - Contractures complicate care, and cause pain & capillary occlusion
at bony prominences, contributing to pressure injury
Contractures
Assessment data – permanent shortening
of muscle, deformity of a joint, reduced range of motion
Osteoporosis
Loss of bony tissue resulting in bones that are brittle and liable to fracture
Assessment data Osteoporosis
Assessment data – ‘silent disease’,
fractures (hip, vertebrae), back pain, loss of
height, spinal deformities (kyphosis)
Musculoskeletal Nursing Interventions
- Mobilise or stand the patient; promote low impact weight bearing exercises –
walking, weights - Correct positioning and body alignment; splinting
- Support, cushioning, avoid weight on feet (bed cradle, bed sheet ‘tuck’
- Active and passive exercises; ROM; isometric (tense muscle) exercises
- Vitamin D and calcium supplements; calcium rich diets – milk, yogurt,
cottage cheese, seafood (sardines), green vegetables (spinach”, almonds - Exposure to sunlight (15 min, 4-6 times a week)
- Hip protectors; avoid smoking and excessive alcohol consumption
Neurological System
- Lack of activity results in lower levels of endorphins, mood elevating
substances - Boredom; lack of stimulation; communication patterns altered
- Self concept and esteem impacted upon reduced ability to carry out
previous functions and roles; may lead to depression, withdrawal; ‘pyjama
paralysis’ - Exaggerated responses and behaviours associated with frustration
Nursing interventions Neurological System
Nursing interventions
* Holistic nursing care – person-centred approached; active participate in
plan of care and decision making
* Spend time; active listening; promote social interaction, stimulate with
purposeful activities – interests, hobbies, sunshine, outdoors, visitors
Gastrointestinal System
Pathophysiology
- Peristalsis impaired due to immobility
- Poor digestion, gastric reflux, indigestion
- Nausea, gas
- Constipation – weakening of muscles of skeletal and abdomen,
peristalsis is aided by standing - Other contributing factors - disturbed bowel regimes (environmental
and psychological factors), dietary changes (anorexia, fasting),
dehydration
Gastrointestinal Signs and
Symptoms…
- Abdominal discomfort
- Abdominal pain
- Bloating
- Stomach cramps
- Painful bowel movements
- Rectal bleeding
- Incomplete bowel movement
- Bowel movement too small
or hard - Straining or squeezing
Faecal Impaction
- Accumulation of hardened faeces in the rectum or sigmoid
colon that cannot be expelled - May result in faecal incontinence – overflow diarrhoea
Faecal Impaction Nursing Interventions
- Removal of hard faeces – manually with lubricated glove and caution as to
not damage rectal wall (scope of practice!) - Cleansing enemas; regular aperient
- High fibre diet (bulk) – caution not to ‘dry out’ faeces
- Hydration; promote exercise
- Bowel regime (what is normal for that patient), privacy and toilet rather than
bedpan, positioning (squat, sitting, feet supported)
What causes impaired bone health during immobility?
Lack of exercise or weight-bearing activity reduces mechanical stress on bones, impairing osteoblast activity (cells that build bone)
What happens to bone minerals during immobility?
There is demineralisation – a loss of calcium and phosphorus from bones, which can begin after just 1 week of immobility.
What are the long-term skeletal effects of immobility?
Progressive loss of bone mass and deterioration of bone tissue, leading to reduced bone size and strength.
How is skin risk assessed?
Using a recognized tool for risk assessment, such as the Braden Scale, to evaluate the potential for skin breakdown.
What is involved in a skin assessment?
Regular examination of the skin for early signs of pressure injuries, irritation, or breakdown, noting any changes in appearance or condition.
Why is patient and family education important?
To raise awareness of preventative care measures and ensure that both patient and family understand the importance of skin protection.
