Health Skills II Unit 201 Immobility. Definition incapable of movement may involve a specific part...

Health Skills IIUnit 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: brain damage due to

trauma or illness stroke cerebral palsy spinal injuries

Brain

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

Causes of Immobility

Medication examples: 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 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

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.

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

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

Effects of ImmobilityMusculoskeletal System ankylosis

a fixation or fusion of a joint due to abnormal stretching/shortening of a muscle

Effects of ImmobilityCardiovascular System

normal muscle activity squeezes veins & returns blood to the heart

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

Effects of ImmobilityCardiovascular System prolonged inactivity

causes sluggish circulation & pooling of blood in the veins of lower extremities

Effects of ImmobilityCardiovascular System phlebitis

is an inflammation of a vein. This frequently is the result of immobilization

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

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

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

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)

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

Effects of ImmobilityIntegumentary System (Skin) skin breaks down easily when circulation

is impaired and new cells can’t regenerate

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

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

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

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

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

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

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

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

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

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

Effects of ImmobilityGastrointestinal (GI) System appetite is often

reduced when immobilized, creating nutritional deficiencies that may lead to fatigue and depression

Effects of ImmobilityPsychosocial Aspects

becoming immobile drastically changes a persons life

whether sudden or gradual onset, the response varies per individual

Effects of ImmobilityPsychosocial Aspects

mental attitude & motivation suffer & the patient may experience: 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: 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

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

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

used to lift blanket off body

side rails of bed provide safety

trapeze allow the patient to assist in positioning

changes and other activities

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

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 betweenfoot & 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 preventsrotationof 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 preventswrist drop & contracturesof 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 prevent use of hands from pulling out tubes or destroying equipment

wrist/ankle to restrict injury of self & to others

wrist vest

mittalarm belt

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

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 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

Guidelines for Using Restraints

RESTRAINT DOES NOT REPLACE OBSERVATION

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

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