Immobilization

Dr. Rose Dinda Martini, SpPD

Juni 2012

The Guinness Book of World Records the fastest 100-year-old to run 100 meters.

• Immobility• Instability• Incontinence (urinary & alvi)• Intellectual impairment (MCI, Dementia)• Infection (Pneumonia, etc)• Impairment of hearing & vision• Impaction (constipation)• Isolation (depression)• Inanition (malnutrition)• Impecunity (poverty)• Iatrogenesis• Insomnia• Immune deficiency• Impotence

Geriatric Giant

Kane, Ouslander Abrass. (from Solomon 1988), Essentials of

Clinical Geriatrics.2004 . p.13-14.

The Bed

Look at a patient lying long in bed. What a pathetic picture he makes! The blood clotting in his veins, the lime draining from his bones, the scybala stacking up in his colon, the flesh rotting from his seat, the urine leaking from his distended bladder, and the spirit evaporating from his soul.

(R Asher: The Dangers of Going to Bed: BMJ 1947)

Penyulit Akibat Imobilisasi

Neurologi Respirasi KardioVaskular

MuskuloSkeletal

Gastro intestinal

Urologi Lain-Lain

Depresi PneumoniaAtelektasis

DVTPEHipotensipostural

Lemah ototKontrakturOsteo porosis

KonstipasiInkontinensia alvi

ISKBatu saluran kemih

Ulkus dekubitusHipoalbuminemia

Ulcus decubitus (pressure ulcer)

Muscle atrophy & joint contracture

Baroreseptor desensitization

Orthostatic hypotension

Atelectasis & Pneumonia

Decrease bone density, Hypercalcemia, Osteoporosis

Constipation

Deep vein thrombosis & Pulmonary embolism

Complications of immobilization

Resnick NM, Dosa D. Geriatric Medicine. Harrison’s Principles of Internal Medicine. Ed.16. 2005: 43-53

Faktor Risiko dan Etiologi

Neurologi Respirasi KardioVaskular

MuskuloSkeletal

Visual Eksternal Lain-Lain

-Stroke-Parkinson-Gangguan Serebelum

-PPOK -SKA-CHF-PAD

-OA-Osteoporosis

-Katarak-Glaukoma

-Alat bantu yang tidak adekuat

-Malnutrisi-Depresi-Efek Samping Obat

Imobilization

• Keadaan tidak bergerak atau tirah baring selama 3 hari atau lebih dengan gerak anatomik yang hilang akibat perubahan fungsi.

Pasien Imobilisasi

DAERAH PREDILEKSI

BMJ 2006;332;472-475

Stadium 1 Stadium 2

Stadium 3 Stadium 4

Dermatologic Therapy, Vol. 19, 2006, 356–364

Prevalensi Imobilisasi di RSUPNCM

BMJ 2006;332;472-475

Tekanan Daya Regang

Gesekan Kelembaban

Factors That Trigger Thrombosis

TRIAD OF VIRCHOW

Stasis of blood

(Immobilization)

Local trauma to the

vessel wall

(surgical)

Hypercoagulability

(Deficiency of Protein C,

Protein S, AT III)

Aging process coagulation

factors• Vein valve rigidity

Blood turbulance

Accumulation of coagulation factors

DVT

Pathophyisiology of DVT

Immobilization

Loss of muscle contraction

Stasis

Hypoxia

Endothelial dysfunction

Coagulation factor secretion

Emboli Paru

Emboli Parudapat terjadi di bagian mana saja pada paru-paru

“Pulmonary Embolism” (PE)

Pendekatan KlinisEvaluasi KeteranganAnamnesis - Riwayat dan lama disabilitas atau imobilisasi

- Kondisi medis yang merupakan faktor risiko dan penyebab imobilisasi - Kondisi pre morbid- Nyeri- Obat-obatan yang dikonsumsi- Dukungan pramuwerdha- Interaksi sosial- Faktor psikologis- Faktor lingkungan

Pemeriksaan Fisik - Status kardiopulmonal- Kulit- Muskuloskeletal: kekuatan dan tonus otot, lingkup gerak sendi, lesi dan deformitas

kaki- Neurologis: kelemahan fokal, evaluasi persepsi dan sensorik- Gastrointestinal- Genitourinarius

Status Fungsional Pemeriksaan Indeksi Aktivitas Kehidupan Sehari-hari (AKS) Barthel

Status Mental Penapisan dengan Geriatric Depression Scale (GDS)Status Kognitif Penapisan dengan Mini Mental State Examination (MMSE), Abbreviated Mental Test

(AMT)Tingkat Mobilitas Mobilitas di tempat tidur, kemampuan transfer, mobilitas di kursi roda, keseimbangan

saat duduk dan berdiri, cara berjalan, nyeri saat bergerak

Pemeriksaan Penunjang

Penilaian berat ringannya kondisi medis penyebab imobilisasi (foto lutu, ekokardiografi) dan komplikasi akibat imobilisasi (pemeriksaan albumin, elektrolit, glukosa darah, hemostasis)

Instabilitas

Jatuh Inkontinensia urin Infeksi

Fraktur Kesadaran

Hipotermia Imobilisasi

Depresi Gangguan

Ulkus tidur

Trombosis vena

Pneumonia

ISK Dehidrasi konstipasi

Atrofi otot

Asupan makanan Malnutrisi

SITI SETIATI, Geriatri IPD FKUI/RSUPN-CM, 2003

Asupan cairan

Obat