Transcript Musculoskeletal changes

The effects of Immobility
Factors Influencing obility/Immobility
 Mobility
 Ability to move about freely
 Immobility
 Inability to move about freely
 Bed rest
 An intervention that restricts patients for therapeutic
reasons
Systemic Effects
Metabolic
Endocrine, calcium
absorption, and GI function
Respiratory
Atelectasis and hypostatic
pneumonia
Cardiovascular
Orthostatic hypotension
Thrombus
Musculoskeletal changes
Loss of endurance and muscle
mass and decreased stability and
balance
Muscle effects
Loss of muscle mass
Muscle atrophy
Skeletal effects
Impaired calcium absorption
Joint abnormalities
Urinary elimination
Urinary stasis
Renal calculi
Integumentary
Pressure ulcer
Ischemia
Metabolic Changes
Respiratory Changes
Cardiovascular Changes
 Orthostatic hypotension
 Increased cardiac
workload
 Thrombus formation
Musculoskeletal Changes
 Muscle effects
 Patient loses lean body mass.
 Muscle weakness/ atrophy
 Skeletal effects
 Disuse osteoporosis
 Joint contracture
Urinary Elimination Changes
 Urinary stasis
 Renal calculi
 Infection
Integumentary Changes
 Pressure ulcers
 Inflammation
 Ischemia
 Older adults at greater risk
Psychosocial Effects
 Emotional and behavioral responses
 Hostility, giddiness, fear, anxiety
 Sensory alterations
 Altered sleep patterns
 Changes in coping
 Depression, sadness, dejection
Developmental Changes
Infants, Toddlers,
Adolescents
Preschoolers
Delayed in gaining
Prolonged immobility delays
independence and in
gross motor skills,
accomplishing skills
intellectual development, or Social isolation can occur
musculoskeletal
development
Adults
Older Adults
Physiological systems are at Decreased physical activity
risk
Hormonal changes
Changes in family and social
Bone reabsorption
structures
Nursing Process: Assessment (cont’d)
 Mobility
 Gait (a particular manner or style of walking)
 Exercise (physical activity for conditioning the body,
improving health, and maintaining fitness)
 Activity tolerance
 Physiological
 Emotional
 Developmental
Nursing Process: Assessment (cont’d)
 Mobility
 Body alignment is used for:
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Determining normal physical changes
Identifying deviations in body alignment
Patient awareness of posture
Identifying postural learning needs of patients
Identifying trauma, muscle damage, or nerve dysfunction
Obtaining information on incorrect alignment (i.e., fatigue,
malnutrition, psychological problems)
Nursing Process: Assessment (cont’d)
 Body alignment
 Lying
Nursing Process: Assessment (cont’d)
 Immobility
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Metabolic
Respiratory
Cardiovascular
Musculoskeletal
Integumentary
Elimination
Psychosocial
Developmental
Nursing Diagnosis and Planning
Impaired physical mobility
Risk for disuse syndrome
Ineffective airway clearance
Ineffective coping
Risk for injury
Risk for impaired skin
integrity
Insomnia
Social isolation
Nursing Diagnosis and Planning (cont’d)
 Planning
 Goals and outcomes
 Setting priorities
 Teamwork and collaboration
Implementation: Acute Care
 Metabolic
 Provide high-protein, high-calorie diet with vitamin B and C
supplements.
 Respiratory
 Cough and deep breathe every 1 to 2 hours.
 Provide chest physiotherapy.
Implementation
 Cardiovascular
 Progress from bed to
chair to ambulation.
 SCDs, TED hose, and leg
exercises
 Musculoskeletal
 Passive ROM
 CPM
 Active ROM
CPM, Continuous passive motion; ROM, range of motion; SCD, sequential compression device;
TED, thromboembolic deterrent.
Implementation
 Integumentary system
 Reposition every 1 to 2 hours.
 Provide skin care.
 Elimination system
 Provide adequate hydration.
 Serve a diet rich in fluids, fruits, vegetables, and fiber.
 Psychosocial changes
 Developmental changes
Implementation (cont’d)
 Positioning techniques
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Supported Fowler’s
Supine
Prone
Side-lying
Sims’
Implementation
 Restorative
and continuing
care
 IADLs
 ROM exercise
 Walking
IADLs, Instrumental activities of daily living; ROM, range of motion.
Evaluation
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Have the patient’s goals been met?
Have outcomes been met? If not, ask questions:
 Are there ways we can assist you to increase your activity?
 Which activities are you having trouble completing right now?
 How do you feel about not being able to dress yourself and
make your own meals?
 Which exercises do you find most helpful?
 What goals for your activity would you like to set now?
Safety Guidelines
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Communicate clearly.
Mentally review transfer steps.
Assess patient mobility and strength.
Determine assistance needed.
Raise side rail on opposite side of bed.
Arrange equipment.
Evaluate body alignment.
Understand use of equipment.
Educate patient.