Preventing the Complications of Immobility

NATCEP Day Twenty-Eight

Objectives

List the negative effects of immobility on the bodyDescribe activities that promote self-care Define range of motion (ROM)Describe ROM exercises for all joints including safety measuresIdentify measures that help prevent complications of immobility

Slide 2

Nurses use the nursing process to promote exercise and activity in all persons to the extent possible.To help promote exercise and activity, you need to understand:

BedrestHow to prevent complications from bedrestHow to help with exercise

Slide 3

Bedrest

Generally bedrest is ordered to:Reduce physical activityReduce painEncourage restRegain strengthPromote healing

Slide 4

Types of Bedrest

Strict bedrestEverything is done for the person

BedrestSome activities of daily living (ADL) are allowed.

Bedrest with commode privilegesBedrest with bathroom privileges (bedrest with BRP)

Slide 5

Complications of Bedrest and/or Immobility

Skin: Pressure ulcersMuscles: AtrophyJoints: ContracturesBones: Lose Calcium = become brittle & weakKidneys: stones (calcium)Bladder: stagnant urine = infections Bowel Function: Constipation and fecal impactionLungs: Fluid collects = Pneumonia (inflammation and infection of the lung)Circulation: sluggish = blood clots, especially in the lower legs

Slide 6

Good nursing care prevents complications from bedrest.

Encourage self careFrequent position changes

These are part of the care plan.

Good alignmentRange-of-motion exercises

Slide 7

What You Can Do – Prevention

Change a resident’s position every 2 hours or more frequently based on the resident’s plan of careSitting in chair?

Change position every hour in chair

Slide 8

Promote Activity through Self Care

Encourage to feed selfEncourage to groom and/or dress selfEncourage to independently performs ADLsPromote use assistive devices as needed Assist with bladder and bowel training

Slide 9

Exercise – encourage the resident to be active!

Exercise helps prevent:ContracturesMuscle atrophyOther complications of

bedrest

Some exercise occurs:With ADLPlanned Activities When turning and moving

in bed without help

Hydration!Slide 10

Elastic StockingsUsed to exert pressure on the veins, promoting the return of venous blood to the heart – check plan of care

Slide 11

Elastic StockingsInformation you need from the care plan and nurse before apply:

SizeLengthWhen to remove and for how long

Typically on for 8 hours and off for 30 minutes

What observations to report and recordWhen applied and/ or removedSkin color and temperatureLeg and foot swellingSigns of skin breakdownComplaints of numbness and/or tinglingWhen you washed stockings

Slide 12

Devices for support or maintaining position

Splints: Keep joints in a normal position

Slide 13

Trapeze Used for exercises to strengthen arm musclesTo move up and turn in bed

Slide 14

Bed CradlesKeep the weight of

top linens off the feet and toes

Slide 15

Foot BoardsPlaced at the foot of the mattress to prevent plantar flexion that leads to foot drop (foot falls at ankle permanently)

Slide 16

Trochanter RollsPrevent the hip and legs from turning outward

Slide 17

Hip Abduction WedgeA wedge to keep the hips abducted – away from the midline

Slide 18

RANGE-OF-MOTION EXERCISES

Range-of-motion exercises involve moving the joints through their complete range of motion.

Active range-of-motion exercises are done by the person.With passive range-of-motion exercises, someone moves the joints through their range of motion.With active-assistive range-of-motion exercises, the person does the exercises with some help. Slide 19

Key Terms

AbductionMove body part away from the midline of the body

AdductionMove body part toward the midline of the body

ExtensionStraightening a body part

FlexionBending a body part

HyperextensionExcessive straightening of a body part

DorsiflexonBending the toes and foot at the ankle

Slide 20

More Key Terms

RotationTurning the joint

Internal RotationTurning the joint inward

External RotationTurning the joint outward

Plantar FlexionBending the foot down at the ankle

PronationTurning the joint downward

SupinationTurning the joint upward

Slide 21

Joints to be Exercised

NeckShoulderElbowWristFingersHipKneeAnkleToes

Slide 22

Safety ConsiderationsNEVER FORCE A JOINT TO MOVE; only exercise to the point of painNEVER perform therapies unless you have been trained and approved by your facility

Slide 23