Immobility

Degrees of mobility Complete immobility e.g. unconscious patient Partial mobility e.g. patient with fracture

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

Musculoskeletal system Decrease in muscle strength Decrease in physical stability Muscle atrophy Osteoporosis Stiff painful joints Muscle contracture

Interventions Body repositioning Weight beering activities Independence in activities of daily living Active and passive range of motion

Cardiovascular system Weakness of cardiovascular system Postural hypotension Thromophlebitis e.g, DVT

Interventions Movement and exercise Use vertical positions Encourage normal breathing pattern Elastic stocking

Respiratory system Reduced gaseous exchange Respiratory acidosis Accumulation of secretion Atelectasis Upper respiratory tract infections Pneumonia

Interventions Deep breathing and coughing exercise Diaphragmatic abdominal exercise Changing position and exercise

Metabolic and nutrition Decreased basal metabolic rate Reduced gastrointestinal motility Imbalance in protein synthesis Anorexia Hypoproteinemia Negative calcium balance

Interventions High protein, calories and fibre diet Vitamin and minerals supplements Weight bearing exercises Enteral and Parenteral supplements

Urinary system Urinary stasis Renal calculi formation Urinary incontinence Urinary retention Urinary tract infection

Interventions Turning, positioning and exercise Improving hydration Perianal hygiene Position and relaxation of urination

Fecal elimination Constipation Fecal impaction

Interventions Well hydration Ambulate as much as possible High fibre diet

Neurosensory system Decreased motor activity Hyperactive sympathetic stimulation Increased heart rate Restlessness Drowsiness Irritability Confusion Unrealistic perception

Integumentry system Loss of skin turger and elasticity Decubitus ulcer formation

Psychological responses of immobility Social, emotional and intellectual changes Self concept changes Feeling of worthlessness and hopelessness Impaired decision making and problem solving abilities

Pressure Ulcer Is impaired in skin integrity resulting from decrease mobility and direct pressure occurring most frequently over bony prominence It is a wound with a localized area if tissue necrosis Other names: Docubitus ulcer, bed sores Pressure is the most prominent cause

Predisposing factors increase the possibility of pressure sores: Immobility and lack of normal movement Friction and moisture Poor personal hygiene Decrease level of consciousness Advance Age Malnutrition Immunosuppression Edema

Principles of Pressure Management Maximize the surface area Redistribute body weight Training for pressure relief Dietary instruction Instruction for lifting/ transferring Personal hygiene and skin care