Concept: Mobility

Concept: Mobility Mobility, the ability to move freely, easily, rhythmically, and purposefully in the environment, is an essential part of living.

Systemic Effects of Immobility Mindmap Metabolic changes Psychosocial Effects: Depression Respiratory Changes Cardiovascular Changes Musculoskeletal changes Integumentary changes Urinary elimination Bowel elimination

Gas Exchange Respiratory Changes Atelectasis (collapse of alveoli) Hypostatic pneumonia (inflammation of the lung from stasis or pooling of secretions)

Perfusion Orthostatic hypotension When you stand up, gravity causes blood to pool in your legs. This decreases blood pressure because there's less blood circulating back to your heart to pump. Orthostatic or postural hypotension occurs when something interrupts the body's natural process of counteracting low blood pressure. Normally, special cells (baroreceptors) near your heart and neck arteries sense this lower blood pressure and send signals to centers in your brain that in turn signal your heart to beat faster and pump more blood, which stabilizes blood pressure. In addition, these cells cause blood vessels to narrow, which increases resistance to blood flow and increases blood pressure.

Perfusion Thrombus Thrombus is an accumulation of platelets, fibrin, clotting factors, and the cellular elements of the blood attached to the interior wall of a vein or artery, which sometimes occludes the lumen of the vessels.

Skeletal Effects osteoporosis, joint contracture, footdrop Muscle Effects: Lose of lean body mass Decreased muscle mass strength Atrophy

Skeletal Effects Disuse osteoporosis Disuse osteoporosis: Immobilization results in bone resorption These patients are at risk for pathological fractures

Skeletal Effects Joint Contracture Joint contracture is an abnormal and possible permanent condition characterized by fixation of the joint. Footdrop: is permanently fixed in plantar flexion.

Urinary Elimination Urinary status & renal calculi Urinary stasis: Risk for UTI Risk for Renal Calculi: calcium stones that lodge in the renal pelvis or pass through the ureters

Bowel elimination Constipation Constipation is due to stasis of fecal material in the rectum and sympathetic nervous system activity. May present as ribbon-like diarrhea and fecal smearing

Integumentary Pressure ulcers A pressure ulcer is a specific tissue injury caused by unrelieved pressure that results in ischemia and damage to the underlying tissue Pressure ulcers occur most commonly over bony prominences.

Metabolic changes ↓ Appetite → Negative Nitrogen Balance Hypercalcemia Wt loss, ↓muscle mass, and weakness Hypercalcemia Pathological fractures ↓GI mobility Constipation Fecal impactions A deficiency in calories and protein is characteristic of pts with a decreased appetite secondary to immobility. The body is constantly synthesizing proteins and breaking them down into amino acids to form other proteins. When pt is immobile, his body often excretes more nitrogen (the end product of amino acid breakdown) than it ingests in proteins, resulting in negative nitrogen balance. Wt loss, decreased muscle mass, and weakness result from tissue catabolism. Calcium resorption (loss) from bones. Immobility causes the release of calcium into the circulation. Normally the kidneys excreta the excess calcium. However, if the kidneys are unable to respond appropriately, hypercalcemia results. Pathological fractures occur if calcium resorption continues as the pt remains on bed rest or continues to be immobile. Impairment of GI functioning caused by decreased mobility vary. Difficulty in passing stools (constipation) is a common symptom, although pseudodiarrhea often results from a fecal impaction (accumulation of hardened feces)

Psychosocial Effects Depression Immobilization often leads to emotional and behavioral responses, sensory alterations, and changes in coping. Sensory deprivation: altered sleep patterns and significant increases in anxiety, hostility, and depression. Depression: feelings of sadness, melancholy, dejection, worthlessness, emptiness, and hopelessness

VTE: Mortality and Morbidity 300,000 to 650,000 with VTE per year 100,000 to > 200,000 deaths per year Most are hospital related. VTE is primary cause of fatality in half More than HIV, MVAs, Breast Ca combined Equals 1 jumbo jet crash/day 10% of hospital deaths Huge costs and morbidity

Perfusion Pulmonary embolism A blockage of a pulmonary artery by foreign matter. The obstruction may be fat, air, tumor tissue or a thrombus