activity + fatigue part 2

integumentary potential consequences

- pressure ulcers

- impaired flow of lymph and blood causes ischemic lesions

pressure ulcers where

- sacrum

- sitting bone (ischial tuberosity)

- greater trochanter (hip bone)

- heel

- ankle

integumentary nursing interventions

- Reposition Q2H

- Adequate nutrition and hydration

- Regulate body temperature

- Adaptive bed equipment

- Keeping the skin dry

- Use egg crate beed or nice foaming

GI/GU nursing interventions

- Increase vitamin and mineral intake

- Encourage fluids

- Increase activity- walk

- Monitor BM

- Administer stool softeners (esp. w Opioids)

- Prop person up with pillows following each meal

- Find a diet that is more appealing

GI/GU potential consequences

- diverticuli due to peristalsis

- GERD

- loss of appetite

- swallowing is harder when laying down

- peristaltic rate slows when laying

Peristaltic rate slows when laying

- constipation in opioid pt is a double risk

- eat fiber + stay hydrated

- vitamin and mineral deficiencies

Neuro/sensory disturbance nursing interventions

- Inc interaction with them such as communication

- Encourage social interaction, exercise and early mobility

- Prevent common feelings of helplessness by encouraging any action of autonomy within the ability of the patient

- Help distract and keep at attention

Neuro/sensory disturbance potential consequences

- Blunting of baroreceptors which causes an increase in the risk of orthostatic hypotension and balance issues

- Loss of grey material

- Reduced serotonin levels

- Pt with bed rest can act in completely different ways

endocrine system potential consequences

- loss of muscle mass (sarcopenia)

- cortisol secretion leads to skeletal breakdown

- thyroid hormone stays relatively stable but plasma T concentration dec

- lean mass dec but fat inc

- glucose intolerance and insulin resistance

- elevate blood triglycerides and LDL

- renin angiotensin aldosterone cascade

- get hyperglycemia and Hyperinsulinemia

Loss of muscle mass (sarcopenia)

Exacerbated by changes in the levels of adrenal glucocorticoid hormones

Cortisol secretion leads to skeletal breakdown

Amino acids and carbohydrates help preserve muscle function and strength

Glucose intolerance and insulin resistance

- Direct link to staying in bed

- Insulin receptors increase with activity

Renin-angiotensin-aldosterone cascade

Key role in regulating blood pressure

Hematology potential consequences

- inc blood viscosity

- dec hemoglobin and red cell mass

- reduced oxygen transport

- virchow's triad

- risk of embolism

inc blood viscosity

- from loss of plasma and subsequent Hematocrit increase

- DVT

decreased hemoglobin and red cell mass

muscle atrophy dec oxygen demand which causes reduced erythropoiesis (generation of RBCs) and therefore hemoglobin

reduced oxygen transport

- due to muscle atrophy and dec lung function

- hypoxia can cause confusion and inability to focus

hematology nursing interventions

- Ted Hose

- Foot exercises (point and flex, ankle rolls), calf pump exercises

- inc water consumption

- Anticoagulant therapy to reduce the incidence of DVT

- Early mobilization of patients (for older patients, helpful to inc progressive mobility)

Ted hose for

muscle massaging/pressure for increased blood and oxygen flow

Anticoagulant therapy such as

- warfarin

- low molecular weight heparin

thrombosis

blood clot that reduces blood flow through blood vessel, develops near cusp of venous valve

embolism

chunk of blood clot that breaks off valve (could also be piece or fat, air bubble, or other piece of bodily fluid) largely obstructs vessel

Renal nursing interventions

- Changing position (upright position)

- Inc movement as much as possible

- Encourage fluid and electrolyte supplements

- Encourage urination

- Catheter if necessary (I&O preferred)

- Fresh fruit and vegetables

Fresh fruit and vegetables will help

- alkalise urine

- impedes formation of stone

renal potential consequences

- inc risk of UTI + kidney stones (renal calculi)

- reduction in glomerular filtration rate

- urea conc inc in blood and urine

- diuresis

- sodium loss

- plasma calcium level inc

- urine retention

Urine pooling

- along w excess ca causes stones

- causes bacteria to grow and make their way up urine tract

- inc pH of urine (alkaline)

Diuresis brings loss of

- electrolytes such as sodium, potassium, calcium, zinc, phosphorus, sulphur, magnesium

- Especially in older adults due to loss of kidney function

sodium loss occurs

- rapidly in the early stages of bedrest

- Reduced blood volume causes a trigger release of

aldosterone but then this leads to potassium loss in urine

Plasma calcium level increase due to

- bone demineralization

- Mild hypercalcaemia is usually seen also

- This can lead to dysrhythmias and coma

Urine retention is common in patients taking

NSAIDS bc they mess w prostaglandins

immune system potential consequences

- red bone marrow activity is inc

- leads to inc lymphocytes and pro inflammatory phagocytic neutrophils

- leads to inflammation

- reactivate latent viruses like herpes

immune system nurse interventions

stay hydrated and mobile