Immobility

1 Dr/ Dena Eltabey 02/21/24
OBJECTIVES
1- Definition of immobility
2- Causes of immobility
3- Systemic Changes Associated
With Immobility
4- Management of immobility
hazard
Definition of immobility
• Any disease or disability that requires

complete bed rest or extremely limits
your activity.
• The restriction of the movement of

whole or part of the body by physical
means (restraint) or chemically by
analgesia, or the use of tranquilizing
agents
Causes of immobility
stroke resulting in partial or complete -1
paralysis
spinal cord injury resulting in paraplegia or -2
,quadriplegia
fracture -3
4- prolonged bed rest after surgery
Arthritis -5
6- Polymyalgia (joint swelling)
7- Disuse
8- Malnutrition
9- Electrolyte abnormality
10- Myopathy (muscle pain)
Causes of immobility
• Verterbral fracture
• Metastases (tumor)
• Joint pain
• Foot pain
• Neurological disease
• Orthostatic hypotension
• Medications
• Anxiety
• Depression
Systemic Changes Associated With
Immobility
• Respiratory Changes
• Cardiovascular Changes
• Musculoskeletal Changes
• Urinary Elimination Changes
• Genitourinary System
• Gastrointestinal System
• Integumentary System
• Psychosocial Responses
Metabolic System
 Immobility causes:
 Decrease in BMR which causes:
 Altered metabolism of carbohydrates, fats, and
proteins which causes:
 Fluid, electrolyte and calcium imbalances which
causes:
 GI disturbances which causes:
 Decrease in appetite and decrease in peristalsis
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Metabolic System
 Effects of the metabolic alterations
 Fluid and electrolyte changes
 Bone demineralization
 Altered exchange of nutrients (also affected by
decreased appetite)
 Altered gastrointestinal functioning:
 Constipation
 Nausea/ vomiting
 Gas
 Indigestion
 Decreased appetite

Metabolic System
 Metabolic assessment
 Anthropometric measurements (arm circumstances)
 Fluid Intake and Output measurements
 Lab tests for electrolyte imbalances/ nutritional status
 Metabolic interventions
 High protein, high calorie diet
 Supplemental vitamin C
 Vitamin B complex

Respiratory System
 Effects
 Decreased lung expansion
 Pooling of secretions
 Decreased surface area for exchange of CO2
and O2 (secondary to lung expansion)
 Most common complication w/ respiratory
system= hypostatic pneumonia

Respiratory System
 Respiratory assessment
 Observe chest movements
 Auscultate for pulmonary secretions
 Check O2 saturations (ABG analysis)
 Observe for respiratory difficulties
 Respiratory interventions
 Breathing and coughing exercise q 2 hours
 Chest physiotherapy (CPT)
 Maintain patent airway
 Incentive spirometer

Cardiovascular System
 Effects
 Orthostatic hypotension
 Increased cardiac workload
 Thrombus formation
 May become emboli
 Most dangerous complication of bedrest
 Valsalva maneuver (bearing down)

 Assessment
 BP measurements with postural changes
 Monitor pulse
 Monitor for edema
 Watch for s/s of DVT

 Interventions
 “Dangling” feet before standing
 Discourage valsalva
 Prevent venous stasis
 Exercise
 ROM (range of motion)
 Anti-embolic stockings
 Never massage extremities
 Observe for s/s DVTs (warmth, redness,
+Homans)
Musculoskeletal System
 Effects
 Decreased muscle mass
 Muscular atrophy
 Reduced muscle endurance (power decreased)
 Decreased stability
 Joint contractures (joint shortening)
 Disuse osteoporosis (bone destruction)
 Decreased skeletal mass

Musculoskeletal System
 Assessment
 Anthropometric measurements
 ROM measurements
 Interventions
 Active and passive ROM
 Individualized, progressive exercise program

Genitourinary System
 Effects
 Urinary Stasis
 Renal Calculi
 UTI

Genitourinary System
 Assessment
 Intake and Output (I & O)
 perineal care
 Signs and symptoms of UTI
 Interventions
 Force fluids
 Record I & O

Gastrointestinal System
 Effects
 Constipation
 Fecal Impaction

Gastrointestinal System
 Assessment
 Assessing BM’s daily
 Observe for passage of liquid stool
 Interventions
 Record daily BM (body mass)
 Encourage fluids
 Administer enemas

Integumentary System
 Effects
 The effect on the skin in compounded by impaired
body metabolism and:
 Pressure
 Shearing Force
 Friction
 Break in skin is called a bedsore, pressure sore

 Assessment
 Assess positions and the risks with each
position
 Identify clients at risk
 Observe for skin breakdown
 Stage 1
 Stage 2
 Stage 3
 Stage 4

 Interventions
 Prevention
 Identify at risk clients
 Daily skin exam
 Change positions every 2 hours
 Massage
 Skin care products (lubricate and protect)
 Stimulate circulation
 Pressure support devices (air mattres)

 Treat skin breakdowns

 Keep area dry and clean
 Change dressings
 Debridement of ulcer
 Must debride to healthy tissue
 Remove eschar
 Increase protein, calories, vitamins
 Protein= 2-4 times normal
 Calories= 1 1/2 times normal
 Vitamin C= wound healing
Psychosocial Responses
 Assessment
 Assess for behavioral changes
 Any changes in sleep cycle
 Decreased coping abilities
 Signs and symptoms of depression
 Interventions
 Socialization
 Maintain body image
 Avoid sleep interuptions
 Utilize resources, I.e. pastoral care or social
services

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1 Dr/ Dena Eltabey 02/21/24

• Any disease or disability that requires

• The restriction of the movement of

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 Break in skin is called a bedsore, pressure sore

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 Treat skin breakdowns

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