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Health Skills IIUnit 201
Immobility
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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)
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Causes of Immobility
Physical
Environmental
Neurological
Psychological/Social
Medication
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Causes of Immobility
Physical examples: a bone fracture a surgical procedure a major sprain or
strain cancer the aging process
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Causes of Immobility
Environmental examples: side rails on a bed restraints on bed or chair
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Causes of Immobility
Neurological examples: brain damage due to
trauma or illness stroke cerebral palsy spinal injuries
Brain
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Causes of Immobility
Psychological/Social examples: stress decreased motivation hospitalization, long term care facility
residents a lifestyle that is sedentary created by a
voluntary or involuntary action
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Causes of Immobility
Medication examples: those that
induce a comatose state
sedatives narcotics
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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
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Effects of ImmobilityMusculoskeletal 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
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Effects of ImmobilityMusculoskeletal 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.
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Effects of ImmobilityMusculoskeletal 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
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Effects of ImmobilityMusculoskeletal System contracture
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
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Effects of ImmobilityMusculoskeletal System ankylosis
a fixation or fusion of a joint due to abnormal stretching/shortening of a muscle
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Effects of ImmobilityCardiovascular System
normal muscle activity squeezes veins & returns blood to the heart
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Effects of ImmobilityCardiovascular System the immobilized body
initially pools blood in the trunk of the body causing : increased workload to the
cardiovascular system increased heart rate increased stroke volume
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Effects of ImmobilityCardiovascular System prolonged inactivity
causes sluggish circulation & pooling of blood in the veins of lower extremities
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Effects of ImmobilityCardiovascular System phlebitis
is an inflammation of a vein. This frequently is the result of immobilization
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Effects of ImmobilityCardiovascular System thrombus
a blood clot that originates at the site of obstruction
embolism a blood clot that
dislodged from a site of origin & moved within the system until it became “stuck”, causing an obstruction
Inside view of arteriesFatty streak Plaque build-up
Thrombus Total occlusionformation complication
Thrombus
Embolus
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Effects of ImmobilityCardiovascular System orthostatic
hypotension 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
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Effects of ImmobilityRespiratory System initially:
when a person is immobilized, the bodies metabolism decreases
unless there is an infection this results in a decreased demand for
oxygen the respirations will be slow and shallow
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Effects of ImmobilityRespiratory System prolonged immobility causes:
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)
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Effects of ImmobilityRespiratory System prolonged immobility causes:
atelectasis 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
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Effects of ImmobilityIntegumentary System (Skin) skin breaks down easily when circulation
is impaired and new cells can’t regenerate
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Effects of ImmobilityIntegumentary 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
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Effects of ImmobilityIntegumentary System (Skin) pressure ulcers
begin with reddish areas and may develop into large open and deep wounds
Graphic: www.hamill.law.com
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Effects of ImmobilityIntegumentary System (Skin) conditions that put patients at risk for
pressure ulcers include: paralysis
due to inability for spontaneous movement and inability to recognize pressure when taking place
medications may alter the ability for movement or
recognition of pressure points
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Effects of ImmobilityIntegumentary System (Skin) cont.
restraints the inability for spontaneous movement and
the restraint may be the cause of pressure points
obesity 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
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Effects of ImmobilityIntegumentary System (Skin)
cont. emaciated/malnourished
with little tissue over the bony prominences, the areas are at risk for pressure ulcers developing
patients incontinent of feces and/or urine will create a site of bacteria accumulation that
will create skin break down
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Effects of ImmobilityIntegumentary System (Skin) cont.
improperly positioned patients are at risk when support devices have not been used or improperly placed
NOTE: injury to skin is minimized by frequent position changes, massage and proper support device placement
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Effects of ImmobilityUrinary 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
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Effects of ImmobilityUrinary System
the supine position also causes residual urine to accumulate in the bladder, as it is difficult to empty the bladder from this position
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Effects of ImmobilityUrinary System
stasis of urine leads to: infections of the urinary system the development of stones within the urinary
system bladder distention and incontinence of urine
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Effects of ImmobilityGastrointestinal (GI) System immobility decreases
the muscle activity in the GI system leads to constipation
and impaction of stool
weak muscles make it difficult to eliminate stool from the supine position into a bedpan
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Effects of ImmobilityGastrointestinal (GI) System appetite is often
reduced when immobilized, creating nutritional deficiencies that may lead to fatigue and depression
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Effects of ImmobilityPsychosocial Aspects
becoming immobile drastically changes a persons life
whether sudden or gradual onset, the response varies per individual
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Effects of ImmobilityPsychosocial Aspects
mental attitude & motivation suffer & the patient may experience: exaggerated emotional
responses disorientation feelings of
dependency inability to sleep well fear
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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?
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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
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Devices Used for Immobilized Patients
Purpose of devices: to provide comfort reduce pressure areas used to maintain proper alignment
definition of alignment is placing or maintaining of body structures in their proper anatomical positions
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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
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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
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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
examples of specialty beds Rotorest, Kinair, Ciroelectric & Stryker
foot board assists in maintaining correct foot position
and in preventing plantar flexion
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Devices Used to Reduce Effects of Immobility cradle
used to lift blanket off body
side rails of bed provide safety
trapeze allow the patient to assist in positioning
changes and other activities
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Devices Used to Reduce Effects of Immobility blanket rolls or foot splints
used to support proper lower extremity alignment by preventing external (lateral) rotation
forearm pan splint or hand cones minimize contracture of the hand(s) and
provide proper wrist alignment
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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
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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 betweenfoot & lower extremity
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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 preventsrotationof hip
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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 preventswrist drop & contracturesof the hand
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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
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Restraints
definition chemical restraint
a psychopharmacologic drug that is used for discipline or convenience and is not required to treat medical symptoms
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Acceptable Uses of Restraints
prevent patient from harming self or others
prevent disruption of treatment methods
only when absolutely necessary
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Types of Restraints
mitt for hands to prevent use of hands from pulling out tubes or destroying equipment
wrist/ankle to restrict injury of self & to others
wrist vest
mittalarm belt
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Types of Restraints
jacket or vest to keep patient in bed or chair
bed or chair alarms to notify staff when a patient has gotten out of a bed or chair that shouldn’t have
wrist vest
alarm belt mitt
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Types of Restraints
full length padded side rails
elbow restraint to prevent bending of the elbow
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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
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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
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Guidelines for Using Restraints
use the appropriate size for the patient to be 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. Re-apply. DO NOT remove all restraints simultaneously, this could be dangerous
keep skin clean & dry minimize pressure on bony prominences reposition patient every 2 hours
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Guidelines for Using Restraints
RESTRAINT DOES NOT REPLACE OBSERVATION
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Alternatives to Restraints
provide pain relief involve family in
care reduce noise allow restless
patient to walk if possible
use pillows/supports to maintain position
assist in frequent toileting
maintain a safe environment for the patient
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Health Skills II
Graphics in this presentation from:
Physical Therapy Aide, 2nd Ed. Delmar Publishers
Pathophysiology for the Health Professionals, W.B. Saunders Co.
Health Occupations, 5th Ed., Prentice Hall Health