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Ch. 35

Factors that contribute to immobility length/severity of illness, presence of pain, cognitive/emotional status (i.e. depression)
Respiratory changes due to immobility decr lung expansion, stasis of secretions, lead to atelectasis (collapse of alveoli), hypostatic pneumonia
Metabolic changes b/c of immobility BMR decr, decr ability to produce insulin or metabolize glucose, negative nitrogen balance (breakdown of protein)
Fluid/electrolyte changes Diuresis(incr. urine excretion), affects CA levels leads to hypercalcemia(release of CA in circulation)
Gastro changes risk for constipation
Cardio changes Orthostatic hypotension, incr workload, need O2, incr resting HR 4-15 bpm, risk for DVT, peripheral edema
What is a thrombus? accumulation of platelets, fibrin, to int. wall of vein/artery
What is Virchow's triad loss of integrity of vessel wall(injury), slow blood flow from bedrest, change in clotting factors
Musculoskelatal changes loss of strength and endurance, decr muscle mass, decr balance/stability, joint contractures(footdrop), disuse osteoporosis(bone reabsorption)
Integument Changes risk for pressure ulcers, ischemia (decr. blood flow)
Urinary elimination changes urinary stasis incr UTI's, renal calculi(CA stones)
Psychosocial Changes depression, sleep wake disturbances, impaired coping
Two most common nursing diagnoses related to immobility impaired physical mobility and risk for disuse syndrome (multisystem complications)
Nursing interventions for musculoskeletal immobility managed excercise progs, ROJM exercises, pedal pulse, walking
Respiratory interventions position changes q2h for lung expansion, fluid intake of 2000mL/day, coughing/deep breaths
Metabolic interventions dietary plan (carbs,proteins, fats),
skin interventions position changes q2h, dry/clean, balance nutrition, pressure relief devices
elimination interventions good hydration, timely toileting, monitor I/O, stool softeners
Psychosocial interventions socialization, keep pxt involved in care, stimuli for orientation
cardio interventions sequential suppresion devices, isometric excercises (tighten, heparin therapy (anticoagulant)
What is the Valsalva maneuver? pxt in defecation, holds breath, strains, incr intrathoracic pressure, decr venous return and CO, lead to death Pxt must breathe out in moving
Goals of restorative and continuing care for immobilized pxts maximize independence, incr endurance and prevent injury
IADL's instrumental activities of daily living: shopping, preparing meals, banking, taking meds
Created by: palmerag