Immobility & Body Mechanics

stickshrivelMechanics

Oct 24, 2013 (3 years and 7 months ago)

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Immobility & Body Mechanics


Refers to the ability to engage in activity and
free movement, which includes walking,
running, sitting, standing, lifting, pushing,
pulling and performing ADLs (Activities of
Daily Living)


Is a therapeutic intervention that achieves:


Rest for client’s who are exhausted

?C
Decreases body’s O2 consumption


Reduces pain and discomfort


To reverse effects of gravity
-
abdominal hernia


After 48 hr of bed rest
-
structural changes in joints
and shorten muscles occur


7 days are needed to restore function lost after 1
day of bed rest (Eliopoulos, 1999)


Metabolic: decrease in BMR r/t decreased
energy requirements, which is directly r/t
cellular 02 demands


Results in > % body fat & loss of lean body
mass


Altered carbohydrates ,proteins, fats
metabolism


Fluid and electrolyte imbalances


Orthostatic hypotension due to prolonged bed rest.
Drop of 15 mm Hg or more in systolic BP with
position change

`
Decrease circulating volume, pooling of blood in
lower extremities(edema), decreased autonomic
response results in decrease in venous return,
central venous pressure, stroke volume, increase in
HR=>>>cardiac workload,02 demand

`
Due to stasis >>> risk thrombus formation





Increase activity slowly but progressively


Avoid crossing legs, pressure behind knee


Encourage antiembolic leg exercises q 2
hours, other isometric exercises


Ant embolic hose


Gradually raise client noting BP, HR, assess
dizziness/lightheadedness



Decrease in lung expansion, generalized
respiratory muscle weakness, and stasis of
secretions


Decreased hemoglobin levels


Atelectasis
--
collapse of alveoli resulting in
decrease of 02 / C02 exchange



Hypostatic pneumonia


inflammation of the
lung from stasis or pooling of secretions



Change of position q 1


2 hr which
allows elastic recoil property of lungs
and clears dependent lung secretions



Cough and deep breath q 2 hr, incentive
spirometry, chest physiotherapy



Fluids to 3000 ml / 24 h to thin
secretions


Decrease in appetite, peristalsis, constipation



NI: high fiber foods, fluids to 3000 ml/24hr


Small frequent foods of choice


Monitor bowel sounds q shift


Monitor bowel patterns 24 hours


Stool softeners daily as ordered



Muscle atrophy


Loss of strength and decreased endurance


Joint contractures


Decreased stability or balance


Disuse osteoporosis, a disorder characterized
by bone reabsorption
-
results from impaired
calcium metabolism


Frequent ROM: active, passive, active assist q
4 hours



Develop an individualized progressive
exercise program



Isometric and isotonic exercises q 4 hours


Urine formed by the kidney must enter the
bladder against gravity due to recumbent
position


Ureters insufficient to overcome gravity, renal
pelvis may fill with urine
-
urinary stasis which
increases risk for UTI & renal calculi


Renal calculi
-
calcium stones lodged in in
renal pelvis and pass through ureters



Position change q 1
-
2 hours


Position 30 degrees of higher to enhance
gravitational forces required for normal urine
flow through kidney, ureters, bladder


I & O q 8 hours


Fluids to 3000 ml 24 hours


RD for diet plan r/t calcium intake


Increase isolation, passive behavior, changes
in sleep/wake cycles, stressors, sensory
deprivation/overload



Decrease in self
-
identity, self
-
esteem, coping
strategies


Anticipate changes
-
provide routine and
informal socialization

interact with staff q
1
-
2 hours


Place in room with others


Encourage family and friends to visit
-
space


Activity and recreational consult


Schedule nursing cares from 10pm
-
7am to
minimize interruptions


Increase in dependence


Regression in development



NI: care should stimulate client mentally,
focus on activities that promote cognitive
awareness, allow client to make care
decisions, allow to be as independent as
condition permits


Previously called: a decubitus ulcer


A pressure sore


A pressure ulcer


A bedsore


is a wound caused by unrelieved pressure
that damages underlying tissue


Jury still out: caused by external pressure
transmitted inward or from the bone and proceeds
outward


Pressure ulcers is a wound caused by unrelieved
pressure that damages underlying tissue.


The pressure interferes with the tissue blood
supply, leading to vascular compromise, tissue
anoxia, and cell death


Tend to be located over bony prominences:
*elbows, posterior calf, *sacrum/coccyx ischial
tuberosities, trochanter, lateral malleous, *heel,
lateral edge of foot also: ears, occiput, great toe
region


AHCPR: Agency for Health Care Policy and
Research establish guidelines to identify at
-
risk individuals needing prevention and the
specific factors placing them at risk



Risk assessment tool: Braden Scale or Norton
Scale are most commonly used.


Assesses sensory perception: ability to
respond meaningfully to pressure
-
related
discomfort


Moisture: degree to which skin is exposed to
moisture


Activity: degree of physical activity


Mobility: ability to change and control body
position


Nutrition: usual intake pattern




Friction and Shear:


Each category measured from 1
-
4 with low
score having most limitation


Overall score: Maximum of 23, little or no risk
A score of 16 or < indicates ‘at risk”
A score of 9 or < indicates ‘high risk”


Implement preventive measures for ‘at risk’
and ‘high risk’ clients


Tissue ischemia is localized absence of blood
or major reduction of resulting in mechanical
obstruction. The reduction of blood floe
caused blanching (to become pale
-
blotchy)


When obstruction of blood flow is removed
normally there will be reactive hyperemia, the
blood vessels dilate and skin is red


Will last for less than 1 hr and is effective



only if there is no necrosis of tissue



Abnormal reactive hyperemia is an excessive
vasodilatation and induration in response to
pressure.


Skin appears bright pink and there is
localized edema under the skin

may last up
to 2 weeks after pressure is removed


Shearing force: sliding down in bed

`
Friction: linens on the bed

`
Moisture: diaphoresis urine, wounds, feces

`
Poor nutrition: neg nitrogen balance

`
Anemia: < 02 carrying capacity

`
Obesity: poor vascular supply, weight

`
Age: epidermis thins with age, < blood flow

`
LOC: drowsy, sedated, comatose=1position



Non blanchable erythema of intact skin.


Does not resolve in 30 minutes but remains
for longer than 2 hours after pressure is
relieved


This occurs as an acute inflammatory
response involving the epidermis


There is partial thickness loss



Pressure area appears as an abrasion, blister,
or shallow crater surrounded by erythema
and induration


Ulcer involves full
-
thickness tissue
destruction involving subcutaneous tissue, as
well as epidermis and dermis



The muscle layer is in tact



Requires Wound Nurse consult, may require
surgical intervention


Includes all of above changes, plus, extensive
damage involving muscle, bone, or
supporting structures such as tendons or
joint capsule



Requires Wound Nurse consult and surgical
intervention


Emphasis is on prevention !!!


Autolysis: uses body’s own enzymes and
moisture to re
-
hydrate, soften and liquefy
necrotic tissue


Use occlusive or semi
-
occlusive dressings:
hydrocolloids, hydrogels, transparent films


Used with wounds with little drainage and
uninfected


Very selective, with no damage to
surrounding skin


Safe, using the body’s own defense
mechanisms to clean the wound of necrotic
tissue


Effective, versatile and easy to perform


Little or no pain for the client


Not as rapid as surgical debridement



Wound must be monitored closely for signs
of infection



May promote anaerobic growth if an occlusive
hydrocolloidal is used



Chemical enzymes are fast acting products
that produce slough of necrotic tissue. Some
enzymatic debriders are selective, while some
are not.


Best uses: on any wound with a large amount
of necrotic tissue


Escar formation


Fast acting



Minimal or no damage to healthy tissue with
proper application





Expensive


Requires a prescription


Application must be performed carefully only
to necrotic tissue


May require secondary dressing


Inflammation or discomfort may occur


Uses force to remove necrotic tissue, for
example wet
-
to
-
dry, whirlpool treatment, or
wound irrigation devices


Cost of the actual material is low


May traumatize healthy or healing tissue


Time consuming


Can be painful


Hydrotherapy can cause tissue maceration
and water borne pathogens may cause
contamination or infection


Disinfecting additives may harm health
tissues


Cutting dead tissue away from the wound


Considered the fastest and most effective
type of debridement


Can be done at bedside, surgical suite, or in
an outpatient setting


Should be considered when infection such as
cellulitis or sepsis suspected


Wounds with a large amount of necrotic
tissue


Used in conjunction with infected tissue


Fast and selective


Cant be extremely effective


Painful


Costly, esp if operating room is required


Requires transport of client to OR


Maggot larvae placed in wound and ingests
the microorganisms


Used extensively in Europe and is gaining
popularity in the US


Develop and post a turning schedule

`
Use a pressure
-
reducing devices

`
Assess pressure points daily

`
After urinating or stooling cleanse, rinse, dry

`
Establish a bowel/bladder program

`
barrier

`
Monitor intake and output q 8 hr

`
Use trapeze and foot boards

`
Protect friction
-
prone areas


Proper diet: good protein intake, Vitamin C,
supplements between meals if necessary

`
Use lift sheets, hoyer lift, smooth roller

`
Personal hygiene measures

keep clean dry and
linens wrinkle free.

`
Avoid use of alkaline and deodorant soaps due to
dryness. Use emollients to preserve natural state
of skin moisture


Coordinated effort
of the
musculoskeletal
system to maintain
posture, balance,
and body alignment
during lifting,
bending, etc.


Refers to the relationship of
body parts to one another.


Reduces muscle strain


Maintains muscle tone


Contributes to balance


Contributes to “system”
functioning


Directly related to alignment
and achieved when:


COG is low


Stable (wide) base of support


Vertical line from COG thru
base of support


Imaginary vertical line which goes thru center
of body


Point at which all of
the mass of an
object is centered;
in the adult, who is
in a standing
position it is in the
pelvis;


Foundation of an object


To stabilize: lower your
center of gravity and
broaden your base of
support


Force exerted by gravity on the
body.


Force that occurs in a direction to oppose
movement.


Reduce surface area


Passive object
produces more
friction


Lift rather than pull
object


Use wide base of support


Keep COG low


Keep line of gravity passing through base of
support


Face direction of movement when possible


Roll, pull, push objects rather than
lift

`
Use largest & strongest muscles

`
Keep object close to COG

`
Reduce area of contact


Move object on flat level, smooth
surface


Bed: Deep breath, neck rolls, knees to chest, pelvic
tilts, head raising, leg lifts, foot dorsi and planter
flex, ankle rotations, rolling, arms over head, side
to side, palms up and rotate

`
Chair: deep breathing, head rolls, knee to chest,
head to knees, shoulder rolls, hands on head, leg
lifts, ankle rotation, push down of legs, lean
forward, lift up.

`
Use Thera bands handball



Refers to the presence of a blood clot in one
of the veins


Risks: prescribed bedrest


General anesthesia for client’s > 40 years of age


Leg trauma resulting in immobilization


Previous venous insufficiency


Obesity


Oral contraceptives


Malignancy


Anti embolic hose: TED are effective in
providing support to vasculature while client
is in bed



Compression Hose: JOBST are effective in
providing support to vasculature while client
is ambulatory

ALWAYS apply BEFORE client
gets out of bed in the AM. Often removed at
HS.`