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Health Skills II Unit 201 Immobility. Definition incapable of movement may involve a specific part of the body due to injury may involve lower part of.

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Presentation on theme: "Health Skills II Unit 201 Immobility. Definition incapable of movement may involve a specific part of the body due to injury may involve lower part of."— Presentation transcript:

1 Health Skills II Unit 201 Immobility

2 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)

3 Causes of Immobility Physical Environmental Neurological Psychological/Social Medication

4 Causes of Immobility Physical examples: a bone fracture a surgical procedure a major sprain or strain cancer the aging process

5 Causes of Immobility Environmental examples: side rails on a bed restraints on bed or chair

6 Causes of Immobility Neurological examples: brain damage due to trauma or illness stroke cerebral palsy spinal injuries Brain

7 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

8 Causes of Immobility Medication examples: those that induce a comatose state sedatives narcotics

9 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

10 Effects of Immobility Musculoskeletal 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

11 Effects of Immobility Musculoskeletal 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.

12 Effects of Immobility Musculoskeletal 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

13 Effects of Immobility Musculoskeletal 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

14 Effects of Immobility Musculoskeletal System ankylosis a fixation or fusion of a joint due to abnormal stretching/shortening of a muscle

15 Effects of Immobility Cardiovascular System normal muscle activity squeezes veins & returns blood to the heart

16 Effects of Immobility Cardiovascular 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

17 Effects of Immobility Cardiovascular System prolonged inactivity causes sluggish circulation & pooling of blood in the veins of lower extremities

18 Effects of Immobility Cardiovascular System phlebitis is an inflammation of a vein. This frequently is the result of immobilization

19 Effects of Immobility Cardiovascular 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 arteries Fatty streak Plaque build-up Thrombus Total occlusion formationcomplication Thrombus Embolus

20 Effects of Immobility Cardiovascular 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

21 Effects of Immobility Respiratory 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

22 Effects of Immobility Respiratory 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)

23 Effects of Immobility Respiratory 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

24 Effects of Immobility Integumentary System (Skin) skin breaks down easily when circulation is impaired and new cells can’t regenerate

25 Effects of Immobility Integumentary 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

26 Effects of Immobility Integumentary System (Skin) pressure ulcers begin with reddish areas and may develop into large open and deep wounds Graphic:

27 Effects of Immobility Integumentary 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

28 Effects of Immobility Integumentary 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

29 Effects of Immobility Integumentary 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

30 Effects of Immobility Integumentary 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

31 Effects of Immobility Urinary 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

32 Effects of Immobility Urinary System the supine position also causes residual urine to accumulate in the bladder, as it is difficult to empty the bladder from this position

33 Effects of Immobility Urinary 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

34 Effects of Immobility Gastrointestinal (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

35 Effects of Immobility Gastrointestinal (GI) System appetite is often reduced when immobilized, creating nutritional deficiencies that may lead to fatigue and depression

36 Effects of Immobility Psychosocial Aspects becoming immobile drastically changes a persons life whether sudden or gradual onset, the response varies per individual

37 Effects of Immobility Psychosocial Aspects mental attitude & motivation suffer & the patient may experience: exaggerated emotional responses disorientation feelings of dependency inability to sleep well fear

38 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?

39 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

40 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

41 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

42 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

43 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

44 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

45 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

46 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

47 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 between foot & lower extremity

48 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 prevents rotation of hip

49 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 prevents wrist drop & contractures of the hand

50 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

51 Restraints definition chemical restraint a psychopharmacologic drug that is used for discipline or convenience and is not required to treat medical symptoms

52 Acceptable Uses of Restraints prevent patient from harming self or others prevent disruption of treatment methods only when absolutely necessary

53 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 wristvest mittalarm belt

54 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

55 Types of Restraints full length padded side rails elbow restraint to prevent bending of the elbow

56 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

57 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

58 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

59 Guidelines for Using Restraints RESTRAINT DOES NOT REPLACE OBSERVATION

60 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

61 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


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