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
2 Dr/ Dena Eltabey 02/21/24
 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
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 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)
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 Causes of immobility
• Verterbral fracture
• Metastases (tumor)
• Joint pain
• Foot pain
• Neurological disease
• Orthostatic hypotension
• Medications
• Anxiety
• Depression
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 Systemic Changes Associated With
Immobility
• Respiratory Changes
• Cardiovascular Changes
• Musculoskeletal Changes
• Urinary Elimination Changes
• Genitourinary System
• Gastrointestinal System
• Integumentary System
• Psychosocial Responses
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 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

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 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

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 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

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 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

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 Cardiovascular System

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

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

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Cardiovascular System
 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)
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 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

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 Musculoskeletal System
 Assessment
 Anthropometric measurements
 ROM measurements

 Interventions
 Active and passive ROM
 Individualized, progressive exercise program

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 Genitourinary System

 Effects
 Urinary Stasis
 Renal Calculi
 UTI

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 Genitourinary System

 Assessment
 Intake and Output (I & O)
 perineal care
 Signs and symptoms of UTI

 Interventions
 Force fluids
 Record I & O

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 Gastrointestinal System

 Effects
 Constipation
 Fecal Impaction

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Gastrointestinal System
 Assessment
 Assessing BM’s daily
 Observe for passage of liquid stool

 Interventions
 Record daily BM (body mass)
 Encourage fluids
 Administer enemas

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 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

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 Integumentary System

 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

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 Integumentary System

 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)

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 Integumentary System

 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
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 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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