Immobility Immobility

Degrees of mobility Degrees of mobility

• Complete immobility e.g. Complete immobility e.g. unconscious patient unconscious patient

• Partial mobility e.g. patient with Partial mobility e.g. patient with fracture fracture

Physiological responses of Physiological responses of immobility immobility • Musculoskeletal system Musculoskeletal system • Cardiovascular system Cardiovascular system • Respiratory system Respiratory system • Metabolic and nutrition Metabolic and nutrition • Urinary systemUrinary system• Fecal elimination Fecal elimination • Neurosensory system Neurosensory system • Integumentry system Integumentry system

Musculoskeletal system Musculoskeletal system

• Decrease in muscle strength Decrease in muscle strength

• Decrease in physical stability Decrease in physical stability

• Muscle atrophy Muscle atrophy

• Osteoporosis Osteoporosis

• Stiff painful joints Stiff painful joints

• Muscle contracture Muscle contracture

Interventions Interventions

• Body repositioningBody repositioning

• Weight beering activities Weight beering activities

• Independence in activities of daily Independence in activities of daily living living

• Active and passive range of motion Active and passive range of motion

Cardiovascular system Cardiovascular system

• Weakness of cardiovascular system Weakness of cardiovascular system

• Postural hypotension Postural hypotension

• Thromophlebitis e.g, DVTThromophlebitis e.g, DVT

InterventionsInterventions

• Movement and exercise Movement and exercise

• Use vertical positions Use vertical positions

• Encourage normal breathing pattern Encourage normal breathing pattern

• Elastic stocking Elastic stocking

Respiratory system Respiratory system

• Reduced gaseous exchange Reduced gaseous exchange

• Respiratory acidosis Respiratory acidosis

• Accumulation of secretion Accumulation of secretion

• AtelectasisAtelectasis

• Upper respiratory tract infectionsUpper respiratory tract infections

• Pneumonia Pneumonia

Interventions Interventions

• Deep breathing and coughing Deep breathing and coughing exercise exercise

• Diaphragmatic abdominal exercise Diaphragmatic abdominal exercise

• Changing position and exercise Changing position and exercise

Metabolic and nutrition Metabolic and nutrition

• Decreased basal metabolic rate Decreased basal metabolic rate

• Reduced gastrointestinal motility Reduced gastrointestinal motility

• Imbalance in protein synthesis Imbalance in protein synthesis

• Anorexia Anorexia

• Hypoproteinemia Hypoproteinemia

• Negative calcium balanceNegative calcium balance

Interventions Interventions

• High protein, calories and fibre diet High protein, calories and fibre diet

• Vitamin and minerals supplements Vitamin and minerals supplements

• Weight bearing exercises Weight bearing exercises

• Enteral and Parenteral supplements Enteral and Parenteral supplements

Urinary systemUrinary system

• Urinary stasis Urinary stasis

• Renal calculi formation Renal calculi formation

• Urinary incontinenceUrinary incontinence

• Urinary retention Urinary retention

• Urinary tract infection Urinary tract infection

Interventions Interventions

• Turning, positioning and exercise Turning, positioning and exercise

• Improving hydrationImproving hydration

• Perianal hygiene Perianal hygiene

• Position and relaxation of urination Position and relaxation of urination

Fecal elimination Fecal elimination

• Constipation Constipation

• Fecal impaction Fecal impaction

Interventions Interventions

• Well hydration Well hydration

• Ambulate as much as possible Ambulate as much as possible

• High fibre diet High fibre diet

Neurosensory system Neurosensory system

• Decreased motor activity Decreased motor activity • Hyperactive sympathetic stimulation Hyperactive sympathetic stimulation

– Increased heart rate Increased heart rate – Restlessness Restlessness – Drowsiness Drowsiness – Irritability Irritability – Confusion Confusion – Unrealistic perception Unrealistic perception

Integumentry system Integumentry system

• Loss of skin turger and elasticity Loss of skin turger and elasticity

• Decubitus ulcer formation Decubitus ulcer formation

Psychological responses of Psychological responses of immobilityimmobility

• Social, emotional and intellectual Social, emotional and intellectual changeschanges

• Self concept changes Self concept changes

• Feeling of worthlessness and Feeling of worthlessness and hopelessnesshopelessness

• Impaired decision making and Impaired decision making and problem solving abilities problem solving abilities

Pressure Ulcer Pressure Ulcer

• Is impaired in skin integrity resulting from Is impaired in skin integrity resulting from decrease mobility and direct pressure occurring decrease mobility and direct pressure occurring most frequently over bony prominencemost frequently over bony prominence

• It is a wound with a localized area if tissue It is a wound with a localized area if tissue necrosis necrosis

• Other names: Docubitus ulcer, bed soresOther names: Docubitus ulcer, bed sores

• Pressure is the most prominent cause Pressure is the most prominent cause

Predisposing factors increase the Predisposing factors increase the possibility of pressure sores:possibility of pressure sores:

• Immobility and lack of normal movementImmobility and lack of normal movement

• Friction and moistureFriction and moisture

• Poor personal hygiene Poor personal hygiene

• Decrease level of consciousness Decrease level of consciousness

• Advance AgeAdvance Age

• Malnutrition Malnutrition

• ImmunosuppressionImmunosuppression

• Edema Edema

Principles of Pressure Principles of Pressure ManagementManagement

• Maximize the surface area Maximize the surface area

• Redistribute body weightRedistribute body weight

• Training for pressure reliefTraining for pressure relief

• Dietary instructionDietary instruction

• Instruction for lifting/ transferringInstruction for lifting/ transferring

• Personal hygiene and skin carePersonal hygiene and skin care