Chapter 16

A set of vocabulary flashcards covering key concepts related to patient care and the effects of immobility in nursing.

Complications of Immobility

A wide range of adverse health consequences stemming from prolonged physical inactivity, impacting multiple body systems, specifically including venous thromboembolism (blood clots), hypostatic pneumonia, skin breakdown, and functional decline.

Effects of Immobility on Musculoskeletal System

• Muscle atrophy

• Decreased joint flexibility

• Decreased range of motion

• Contractures

• Risk of osteoporosis

Muscle Atrophy

The pathological decrease in size and strength of muscle fibers due to disuse (immobility), leading to severe muscle wasting and impaired physical function, often visible within days of persistent inactivity.

Range of Motion (ROM) Exercises

Therapeutic movements applied to a joint to maintain or increase its mobility, prevent joint contractures and stiffness, and maintain muscle tone. ROM can be active (patient performs) or passive (performed by caregiver).

Effects of Immobility on the Cardiovascular System

• VENOUS STASIS

• BLOOD CLOT

• EMBOLUS

• HEART ATTACK

• ORTHOSTATIC HYPOTENSION
  
  

Orthostatic Hypotension

A sudden and significant drop in blood pressure ($20 ext{ mmHg}$ SBP or $10 ext{ mmHg}$ DBP) when a patient moves from a lying or sitting position to standing, caused by impaired baroreceptor response and venous pooling related to prolonged horizontal positioning.

Nursing Measures to Prevent Cardiovascular Complications

• encourage movements of the extremeties

• apply ordered devices to prevent pooling of blood in the legs'

• encourage movement of the extremities

• change patients position frequently

Effects of Immobility on the Respiratory

System

§ Respiratory muscle

weakness

§ Pulmonary emboli

§ Hypostatic pneumonia

§ Atelectasis

Atelectasis

The partial or complete collapse of a lung or segment of lung tissue (alveoli), resulting in reduced surface area for gas exchange and leading to hypoxemia. It is a common respiratory complication of immobility due to shallow breathing and retained secretions.

Nursing Measures to Prevent Respiratory

Complications

• Turn the patient from side to side at least every 2 hours.

• Elevate the head of the bed 45 degrees or more.

• Encourage cough and deep breathing exercises every hour.

• Encourage the patient to use an incentive spirometer.

Peristalsis

The involuntary, wave-like muscular contractions that move ingested material through the esophagus, stomach, and intestines. Immobility commonly slows peristaltic action, contributing to gastrointestinal complications like constipation.

Nursing Measures to Prevent Gastrointestinal Complications

• ensure patient moves every 2 hours

• inquire about patients food preferences

• help patient select well balanced meals

• encourage patient to choose food with fiber

• provide a laxative or stool softener as needed

Urinary Retention

The inability to fully or partially empty the bladder, resulting in accumulated urine, bladder distention, and an increased risk for urinary tract infections (UTIs) and renal calculi formation due to urinary stasis.

Pressure Injuries

Localized damage to the skin and/or underlying soft tissue, usually occurring over a bony prominence, as a result of intense and/or prolonged pressure, or pressure combined with shear. They are categorized by depth of tissue damage (Stages 1-4, unstageable, DTI).

Incentive Spirometer

A medical device used post-operatively or in immobile patients to promote sustained maximal inspiration, encouraging deep breaths to expand the lungs, clear airways, and prevent pulmonary complications such as atelectasis and pneumonia.

Compression Neuropathy

Damage or injury to a peripheral nerve caused by excessive mechanical pressure or prolonged entrapment, often due to improper or protracted positioning in an immobile patient, leading to sensory and motor deficits.

Constipation

A gastrointestinal condition characterized by infrequent or difficult passage of stool, passage of hard or dry feces, and incomplete evacuation. It is frequently associated with poor abdominal muscle tone, decreased physical activity, and insufficient fluid intake in immobile patients.

Musculoskeletal Complications

Adverse health effects on the joints, muscles, and bones resulting from inactivity, including loss of muscle mass (atrophy), disuse osteoporosis (bone calcium loss), and permanent joint fixation (contractures).

Neurological Checks

A systematic set of assessments used by nurses to monitor nerve function and brain activity, typically including evaluation of level of consciousness (LOC), patient orientation, pupillary response, motor response, and sensory status.

Psychological Effects of Immobility

Mental and emotional changes resulting from restricted movement and social isolation, encompassing alterations in coping mechanisms, disturbances in sleep patterns, cognitive impairment, increased anxiety, and clinical depression.

Dorsiflexion

The movement of raising the foot upwards towards the shin, decreasing the angle between the foot and the leg.

Plantar Flexion

The movement of the foot where the toes are pointed downwards towards the ground, typically occurring at the ankle joint.

Body Mechanics

The calculated and efficient use of the body during movement, lifting, and repositioning activities to prevent injury to the caregiver and patient, maximizing muscle strength and minimizing strain on joints and ligaments.

Shearing

A force that occurs when gravity pulls a patient downward across a surface (e.g., sliding down in bed) while the skin remains relatively stationary, causing underlying fascia and tissue layers to separate and leading to capillary rupture and tissue damage.

Logroll

A crucial patient turning technique used to move a patient as a single unit while maintaining the neutral, straight alignment of the head, neck, and spine. This procedure is mandatory for clients with actual or suspected spinal/vertebral injury.

Repositioning

The scheduled, purposeful changing of a patient's body alignment (e.g., every two hours) to redistribute pressure across different areas of the skin, thereby preventing pressure injuries and improving respiratory function and comfort.

Transfer Belts

Safety devices, typically made of durable nylon or canvas, secured around a patient's waist to provide the caregiver with a firm, secure handhold during transfers (bed to chair) or when assisting with ambulation.

Fowler's Position

A standard seated position in bed where the head of the bed is elevated. Semi-Fowler's is $30^{\circ}$-$45^{\circ}$; High Fowler's is $60^{\circ}$-$90^{\circ}$. This position is utilized to promote lung expansion and reduce strain on abdominal muscles.