Problem Caused by Immobilization

In older people, a variety of illnesses and issues frequently lead to increased impairment through immobility. Improvements in mobility are almost always achievable, even in the most immobile elderly individuals. Immobility is frequently unavoidable, but many of its negative effects can be. Mobility enhancements can enhance patient wellbeing, lessen the frequency and severity of complications, and make life easier for caregivers.

Causes

Several environmental, psychological, and physical factors can make older people immobile. Musculoskeletal, neurological, and cardiovascular disorders are the most frequent causes. Immobility caused by these disorders frequently results from pain.

Common problem Caused by Immobility

Pressure Sore

Bedsores, also known as pressure sores or pressure ulcers, are wounds to the skin and underlying tissue brought on by sustained pressure. The skin covering bony parts of the body, such as the heels, ankles, hips, and tailbone, is where bedsores most frequently appear.

Those with medical conditions that make it difficult for them to change positions, necessitate the use of a wheelchair, or keep them confined to a bed for an extended period of time are most at risk for developing bedsores.

Bed sores can appear suddenly and are frequently hard to treat. Several factors can aid in healing and help prevent some bedsores.

Cardiovascular System

Deep vein thrombosis, (DVT)

Calf muscle pumping and breathing-induced suction in the inferior vena cava help blood flow from the limbs back to the heart. Legs do not move and respirations are not as deep when someone is immobile in bed.

Blood flow to the lower limbs is slowed as a result. Leg vein compression from the bed and bones slows blood flow even more and may harm the vein lining, causing platelets to clump together and form a thrombus.

Signs and Symptoms

• Sharp pain
• The affected limb swelling
• A favorable Homan's sign
• Increased pulse and temperature

Risk factors

• Immobility
• Oral contraceptives
• Smoking
• Personal and family history
• Pelvic and leg fracture
• Pregnancy
• Hypercoagulable states

Prevention of DVT

• Leg exercises are performed passively if the patient is unable to move actively once an hour throughout the day.
• Avoid lying with your legs crossed or a cushion beneath your calf muscles.
• Exercises for deep breathing
• Regular positional shifts
• To relieve the weight of bedclothes from calves, use a bed cradle.
• Put on anti-embolic socks.
• Heparin subcutaneous prophylaxis may be administered.

Pulmonary embolism, (PE)

After a DVT, a thrombus in the calf may migrate along the right side of the heart's venous circulation before being ensnared in the pulmonary circulation channels. When a thrombus detaches from the vessel wall and moves freely through the circulation, it is referred to as an embolus.

Signs and Symptoms

• Chest pain
• Tachypnea and tachycardia
• Dyspnoea
• A cough that is hemoptysizing
• Veins in the neck are dilated
• Shock and unexpected demise

Prevention

• Dependent in large part on DVT prevention and/or early detection.

Treatment

• Treatment with anticoagulants, fibrinolytics, and embolectomy

Postural hypotension

The diminished effect of gravity causes vaso-dilation in the patient. The patient may experience nausea and dizziness when they stand up for the first time or move from a horizontal to a vertical position.

Prevention

If possible allow the patient to:

• As often as possible, let the patient to sit up in bed while being supported by pillows.
• Gradually increase in difficulty

Increase in cardiac workload

• The distribution of circulating blood changes when someone is lying flat; 11% of the legs' blood supply transfers to the thorax, venous return is enhanced, and the heart's workload is raised.
• as much as you can, sit up
• The heart rate rises due to inactivity, and further exertion will amplify the tachycardia.
• There is a loss of endurance from which recovery could take several weeks.

Prevention

• Keep as much of your time still as possible.
• Progressive rehabilitation over time
• Observe your blood pressure and pulse.

Respiratory system

Hypostatic pneumonia/chest infections

occurs when the lungs become overfilled with typical bronchial secretions. Infection and accumulation of lung tissue constitute pneumonia.

Signs and Symptoms

• Cyanosis and dyspnea
• Increased pulse and temperature
• Successful cough

Prevention

• To allow each lung to expand on inspiration and to allow chest secretions to drain, turn the patient's position from side to side once or twice every hour.
• Encourage deep breathing, expectorating coughing, and chest physical therapy.
• Keeping people from getting sick from you
• Continue to drink water to avoid mucous viscosity
• Earlier infection detection

Muscular skeletal system

Osteoporosis

Reduced activity results in demineralization of the bones, which can alter their size, strength, chemistry, and appearance.

Normally, this only causes issues in the medium to long term, but the first week of immobility can cause some increased calcium secretion in the urine.

Prevention

Stress bones whenever possible, e.g occasional standing if possible.

Muscle wasting and joint stiffness

After 3 to 7 days of bed rest, muscle weakness and atrophy can start to appear. These changes are most pronounced in the "anti-gravity" muscles used for standing and walking.

The collagen fibers and connective tissue of the tendons, ligaments, and joint capsules stiffen and become dense when immobile, leading to further loss of motion and joint stiffness within a few days that may take months to reverse.

Contractures

a persistent contraction of a muscle or group of muscles brought on by the shortening and fibrosis of the muscle fibers, which results in a loss of function.

They develop as a result of poor posture and limb alignment while in bed. may begin after a week or so of inactivity.

Footdrop

A condition that makes it difficult for the patient to keep his foot in the proper position. Gravity and the additional weight of the bedclothes pull the foot downward, shortening the calf muscles and tendons as a result.

Prevention

• Support the limb and hold it in a position that is physiologically appropriate.
• Lift the weight of the bedclothes off limbs using the bed cradle.
• Active or passive exercises can help you maintain a full range of joint motion.
• wherever possible, isometric exercise
• Depending on the patient's condition, perform each exercise five times each, several times per day.
• Exercises should not be performed on inflamed or infected joints; instead, the patient should see a physiotherapist.

Urinary system

• Urinary calculi
• Urinary retention
• Urinary incontinence
• Urinary infection

Urinary calculi

Demineralization of the bone releases calcium. The precipitation of calcium results in the formation of calculi or stones as a result of this and urinary stasis or immobility.

Signs and Symptoms

• Pain
• Dysuria
• Haematuria

Prevention

Ensure adequate fluid intake of 3000 mls each day.

Urinary retention

Calcium concentration in the urine reduces the sensitivity of the bladder, which can result in urine retention. This problem can be made worse by positioning oneself improperly in bed when urinating.

Signs and Symptoms of Urinary Retention

• Pain/discomfort
• Distended Abdomen (palpable bladder)

Prevention

• Make sure to drink 2,000–3,000 cc of fluid per day.
• Whenever possible, allow patient to use toilet or commode to aid in urination of gravity
• Protect privacy.
• To determine whether the bladder is fully empty, note the fluid balance.
• Use catheterization only as a last resort.

Urinary incontinence

As stated before, urinary calculi and urinary retention can occur. These may lead to incontinence by the irritation of the urinary sphincter by a stone or increased pressure from urine when the bladder's capacity is reached.

These situations can be compounded by poorly situated toilets and if the patient has to wait too long for a bed pan or assistance from a nurse.

Prevention

As for retention, but in addition:

• Up to the restroom or commode.
• Make sure there are lots of urinals around.
• At regular intervals, provide toilet facilities or bed pans.
• Make sure the patient can use a buzzer or bell to call a nurse's attention and request assistance if necessary.

Urinary infection

If the bladder cannot completely drain, the stagnant urine becomes contaminated, which is made worse by ascensing bacteria.

Signs and Symptoms

• Dysuria
• Frequency
• Urgency
• Raised temperature and pulse
• Offensive smelling urine

Prevention

• Ensure adequate fluid intake - 3000 mls daily
• Ensure patient empties bladder completely.

Gastrointestinal system

Constipation

• When we are moving, the tone of our skeletal muscles aids in defecation.
• Standing helps with peristalsis and prevents pressure on interior organs.
• Environmental and psychological variables may interfere with established bowel routines.
• Diets may shift for various reasons, such as fasting or anorexia.

Prevention

• Know your regular bowel movements
• To ensure privacy, use the restroom rather than hand out bedpans.
• Permit urination in the regular position.
• diet high in fiber
• Fluids: 3000 ml per day

Metabolic Changes

Decreased basal metabolic rate

Psychological/psychiatric

• Depression
• Boredom
• Loss of non-verbal communication - frustration, inability to express emotion
• Anger
• Anxiety
• Altered body image
• Grieving
• Feelings of helplessness and hopelessness

Care deficits

• Inability to move away from noxious stimuli
• Inability to defend self
• Loss of self-care ability
• ADL defects

 References

• www.bestonlinemd.com/bedsores-or-pressure-sores/3/
• https://books.google.com/books?isbn=0702044202
• https://books.google.com/books?isbn=1483631648
• patient.info/health/deep-vein-thrombosis-leaflet
• www.lifeextension.com/Magazine/2017/1/As-We-See-It/Page-01
• www.lifeextension.com/protocols/heart-circulatory/blood-clot/page-01
• Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013
• www.mayoclinic.org/diseases-conditions/bedsores/basics/definition/con-20030848
• www.nursinginpractice.com/article/warning-signs-deep-vein-thrombosis
• nursekey.com/superficial-thrombophlebitis-and-deep-vein-thrombosis/
• https://www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed Central (PMC)
• www.pathophys.org/vte/
• studydroid.com/printerFriendlyViewPack.php?packId=208956
• www.slideshare.net/sagardalal98/immobility-16960986

• https://www.ncbi.nlm.nih.gov/pubmed/5090825