Transcript Effects of Immobility Integumentary System (Skin)

Health Skills II
Unit 201
Immobility
Immobility
 Definition

incapable of movement




may involve a specific part of the body due to
injury
may involve lower part of body (paraplegia)
may involve one side of body (hemiplegia)
or may involve entire body from the neck
down (quadriplegia)
Causes of Immobility
 Physical
 Environmental
 Neurological
 Psychological/Social
 Medication
Causes of Immobility
 Physical examples:
 a bone fracture
 a surgical procedure
 a major sprain or
strain
 cancer
 the aging process
Causes of Immobility
 Environmental examples:


side rails on a bed
restraints on bed or chair
Causes of Immobility
 Neurological
examples:

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
brain damage due to
trauma or illness
stroke
cerebral palsy
spinal injuries
Brain
Causes of Immobility
 Psychological/Social examples:
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stress
decreased motivation
hospitalization, long term care facility
residents
a lifestyle that is sedentary created by a
voluntary or involuntary action
Causes of Immobility
 Medication
examples:

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those that
induce a
comatose state
sedatives
narcotics
Effects of Immobility
 the loss of the force of gravity acting on
our body in an upright position due to
immobility greatly affects our natural body
functions
Effects of Immobility
Musculoskeletal System
 decrease in tonus

the resting tension in a muscle that
determines tonicity or firmness
 atrophy

a decrease in the size of a muscle.
Muscles lose strength, endurance and
mass very quickly when inactive
Effects of Immobility
Musculoskeletal System
 demineralization
 bone is a living tissue and requires
muscle activity and weight bearing to
provide for the formation of new bone
growth
 immobility results in a loss of calcium in
the bones due to lack of activity and
weight bearing.

this can lead to osteoporosis and possible
spontaneous fractures.
Effects of Immobility
Musculoskeletal System
 plantar flexion of ankle (foot drop)

caused by improper positioning of the foot
or resulting from a heavy blanket on the
foot putting excessive weight or stretching
at the ankle joint

lose the ability to move the ankle into
dorsiflexion
Effects of Immobility
Musculoskeletal System
 contracture
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is a permanent shortening/tightening of a
muscle due to prolonged immobility
fibrous tissue replaces muscle cells that
eventually waste away, weaken and lose
flexibility
contractures can cause a loss of function
Effects of Immobility
Musculoskeletal System
 ankylosis

a fixation or fusion of a joint due to
abnormal stretching/shortening of a
muscle
Effects of Immobility
Cardiovascular System
 normal muscle
activity squeezes
veins & returns
blood to the heart
Effects of Immobility
Cardiovascular System
 the immobilized body
initially pools blood in
the trunk of the body
causing :
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increased workload to the
cardiovascular system
increased heart rate
increased stroke volume
Effects of Immobility
Cardiovascular System
 prolonged inactivity
causes sluggish
circulation & pooling
of blood in the veins
of lower extremities
Effects of Immobility
Cardiovascular System
 phlebitis
 is an inflammation of
a vein. This
frequently is the
result of
immobilization
Effects of Immobility
Cardiovascular System
 thrombus
 a blood clot that
originates at the site
of obstruction
Inside view of arteries
Fatty streak
Thrombus
formation
 embolism
 a blood clot that
dislodged from a site
of origin & moved
within the system until
it became “stuck”,
Embolus
causing an
obstruction
Plaque build-up
Total occlusion
complication
Thrombus
Effects of Immobility
Cardiovascular System
 orthostatic
hypotension
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a drop in systolic blood
pressure of 20 mmHg
upon moving to an
upright position (sitting
or standing)
dizziness, fainting,
pale, sweating, fast
heart beat
Effects of Immobility
Respiratory System
 initially:
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when a person is immobilized, the bodies
metabolism decreases
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unless there is an infection
this results in a decreased demand for
oxygen
the respirations will be slow and shallow
Effects of Immobility
Respiratory System
 prolonged immobility causes:
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decrease in oxygen & increase in carbon
dioxide in the blood due to poor gas
exchanges
an inability to deep breathe & cough
adequately results in respiratory
secretions pooling in the lungs

this may lead to respiratory infections
(hypostatic pneumonia)
Effects of Immobility
Respiratory System
 prolonged immobility causes:
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atelectasis
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collapsed small air sacs within the lungs that
are responsible for providing oxygen to the
blood and removing the carbon dioxide from
the blood.
atelectasis results in obstructions of the
smaller airways
increased respiratory rate
Effects of Immobility
Integumentary System (Skin)
 skin breaks down easily when circulation
is impaired and new cells can’t regenerate
Effects of Immobility
Integumentary System (Skin)
 common effect of immobility and skin
breakdown is a pressure ulcer
 this is due to the compression of the body
soft tissue and/or bony prominence
compressed between mattress or adaptive
devices
Effects of Immobility
Integumentary System (Skin)
 pressure ulcers
begin with reddish
areas and may
develop into large
open and deep
wounds
Graphic: www.hamill.law.com
Effects of Immobility
Integumentary System (Skin)
 conditions that put patients at risk for
pressure ulcers include:
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paralysis
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due to inability for spontaneous movement
and inability to recognize pressure when
taking place
medications
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may alter the ability for movement or
recognition of pressure points
Effects of Immobility
Integumentary System (Skin)
 cont.
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restraints
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the inability for spontaneous movement and
the restraint may be the cause of pressure
points
obesity
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more heat and moisture are created and this
can lead to quick skin break down
this patient may be less active and create
more friction when they do move
Effects of Immobility
Integumentary System (Skin)
 cont.
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emaciated/malnourished
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with little tissue over the bony prominences,
the areas are at risk for pressure ulcers
developing
patients incontinent of feces and/or urine
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will create a site of bacteria accumulation that
will create skin break down
Effects of Immobility
Integumentary System (Skin)
 cont.
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improperly positioned patients are at risk
when support devices have not been used
or improperly placed
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NOTE: injury to skin is minimized by
frequent position changes, massage and
proper support device placement
Effects of Immobility
Urinary System
 positioning patients
in a supine position
leads to residual
urine in the calyces
of the kidneys

impeding the urine’s
normal flow of
gravity to the
bladder
Effects of Immobility
Urinary System
 the supine position also causes residual
urine to accumulate in the bladder, as it is
difficult to empty the bladder from this
position
Effects of Immobility
Urinary System
 stasis of urine leads to:
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infections of the urinary system
the development of stones within the urinary
system
bladder distention and incontinence of urine
Effects of Immobility
Gastrointestinal (GI) System
 immobility decreases
the muscle activity in
the GI system
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leads to constipation
and impaction of stool
 weak muscles make it
difficult to eliminate
stool from the supine
position into a bedpan
Effects of Immobility
Gastrointestinal (GI) System
 appetite is often
reduced when
immobilized,
creating nutritional
deficiencies that
may lead to fatigue
and depression
Effects of Immobility
Psychosocial Aspects
 becoming immobile
drastically changes a
persons life
 whether sudden or
gradual onset, the
response varies per
individual
Effects of Immobility
Psychosocial Aspects
 mental attitude &
motivation suffer &
the patient may
experience:
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exaggerated emotional
responses
disorientation
feelings of
dependency
inability to sleep well
fear
Can You Imagine
 not being able to
take care of
yourself?
 the anxiety over
what is to happen
next?
 the frustration over
loss of
independence?
Preventive Measures to
Effects of Immobility
 educate the patient & family on how to
prevent the effects of immobility by being
active
 encourage patient & family to be involved
with care & activities of daily living
 provide range of motion exercises
according to the PT or MD’s orders
 provide regular position changes
Devices Used for
Immobilized Patients
 Purpose of devices:
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to provide comfort
reduce pressure areas
used to maintain proper alignment
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definition of alignment is placing or maintaining
of body structures in their proper anatomical
positions
Normal Alignment
 spine and
extremities are in a
true anatomical
position

spine is straight
 shoulders & hips are
level with each other
and parallel to the
sides of bed
 toes pointed forward
Devices Used to Reduce Effects
of Immobility
 pillows
 provide support
 elevate body parts to promote return
venous blood flow to the heart
 bed boards
 provide support
 aids in good body alignment
Devices Used to Reduce Effects
of Immobility
 adjustable bed
 allow for changes in position
 decrease pressure of affected areas
 assist in getting patient in & out of bed
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examples of specialty beds
 Rotorest, Kinair, Ciroelectric & Stryker
 foot board
 assists in maintaining correct foot position
and in preventing plantar flexion
Devices Used to Reduce Effects
of Immobility
 cradle
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used to lift blanket off body
 side rails of bed
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provide safety
 trapeze
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allow the patient to assist in positioning
changes and other activities
Devices Used to Reduce Effects
of Immobility
 blanket rolls or foot splints
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used to support proper lower extremity
alignment by preventing external (lateral)
rotation
 forearm pan splint or hand cones
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minimize contracture of the hand(s) and
provide proper wrist alignment
Indications for
Foot & Hand Splints
 splinting will be necessary to prevent
complications of long term immobilization
for patients who will have a lengthy
immobilization & who are unable to
voluntarily reposition their self
Indications for
Foot & Hand Splints
 when there is a
loss of dorsiflexion
the patient may
need a foot splint

the ankle must be
able to achieve a
90 degree angle
in order to have
balance, transfer
and walk
90 degree angle between
foot & lower extremity
Indications for
Foot & Hand Splints
 when evidence of
external rotation
of hip is present,
use foot splints or
trochanter rolls to
maintain a neutral
position to avoid
muscle tightening
Splint
prevents
rotation
of hip
Indications for
Foot & Hand Splints
 when evidence that
wrist drop is
developing, provide
forearm splints for
prevention
 when evidence that
hand contractures are
developing, provide a
hand cone for
prevention
Wrist splint prevents
wrist drop &
contractures
of the hand
Restraints
 definition

physical restraint

any manual method or physical or mechanical
device, material, or equipment attached or
adjacent to the patient’s body that cannot be
removed easily by the patient that restricts
freedom of movement or normal access to one’s
self
Restraints
 definition

chemical restraint

a psychopharmacologic drug that is used for
discipline or convenience and is not required to
treat medical symptoms
Acceptable Uses of Restraints
 prevent patient from harming self or
others
 prevent disruption of treatment methods
 only when absolutely necessary
Types of Restraints
 mitt for hands to
wrist
vest
prevent use of hands
from pulling out
tubes or destroying
equipment
 wrist/ankle to restrict
injury of self & to
others
alarm belt
mitt
Types of Restraints
 jacket or vest to
keep patient in bed
or chair
wrist
vest
 bed or chair alarms
to notify staff when
a patient has
gotten out of a bed
or chair that
shouldn’t have
alarm belt
mitt
Types of Restraints
 full length padded side rails
 elbow restraint to prevent bending of the
elbow
Types of Restraints
 papoose board for infants & toddlers
for total body immobilization
 geri chair with tray that aids in
preventing patient falling forward
 bean bag chair
 recliners
Guidelines for Using Restraints
 use ONLY when necessary
 JCAH and State Governing Agencies rules may
be interpreted differently in varying employer
situations
 need doctor’s order to apply, the order may be
derived from institutional protocols, written
orders that are standing., always follow your
employer’s policy and if it is too low a standard
work with the team there to raise the bar
 written policy must be in place in every facility
Guidelines for Using Restraints
 use the appropriate size for the patient to be
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effective
refer to product info to apply correctly
check patient at regular intervals and remove one
limb at a time to exercise & inspect the skin. Reapply. DO NOT remove all restraints
simultaneously, this could be dangerous
keep skin clean & dry
minimize pressure on bony prominences
reposition patient every 2 hours
Guidelines for Using Restraints
 RESTRAINT DOES NOT REPLACE
OBSERVATION
Alternatives to Restraints
 provide pain relief
 use
 involve family in
pillows/supports to
maintain position
 assist in frequent
toileting
 maintain a safe
environment for
the patient
care
 reduce noise
 allow restless
patient to walk if
possible
Health Skills II
 Graphics in this presentation from:
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Physical Therapy Aide, 2nd Ed. Delmar
Publishers
Pathophysiology for the Health
Professionals, W.B. Saunders Co.
Health Occupations, 5th Ed., Prentice Hall
Health