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Preventing the Complications of Immobility
NATCEP Day Twenty-Eight
Objectives
List the negative effects of immobility on the bodyDescribe activities that promote self-care Define range of motion (ROM)Describe ROM exercises for all joints including safety measuresIdentify measures that help prevent complications of immobility
Slide 2
Nurses use the nursing process to promote exercise and activity in all persons to the extent possible.To help promote exercise and activity, you need to understand:
BedrestHow to prevent complications from bedrestHow to help with exercise
Slide 3
Bedrest
Generally bedrest is ordered to:Reduce physical activityReduce painEncourage restRegain strengthPromote healing
Slide 4
Types of Bedrest
Strict bedrestEverything is done for the person
BedrestSome activities of daily living (ADL) are allowed.
Bedrest with commode privilegesBedrest with bathroom privileges (bedrest with BRP)
Slide 5
Complications of Bedrest and/or Immobility
Skin: Pressure ulcersMuscles: AtrophyJoints: ContracturesBones: Lose Calcium = become brittle & weakKidneys: stones (calcium)Bladder: stagnant urine = infections Bowel Function: Constipation and fecal impactionLungs: Fluid collects = Pneumonia (inflammation and infection of the lung)Circulation: sluggish = blood clots, especially in the lower legs
Slide 6
Good nursing care prevents complications from bedrest.
Encourage self careFrequent position changes
These are part of the care plan.
Good alignmentRange-of-motion exercises
Slide 7
What You Can Do – Prevention
Change a resident’s position every 2 hours or more frequently based on the resident’s plan of careSitting in chair?
Change position every hour in chair
Slide 8
Promote Activity through Self Care
Encourage to feed selfEncourage to groom and/or dress selfEncourage to independently performs ADLsPromote use assistive devices as needed Assist with bladder and bowel training
Slide 9
Exercise – encourage the resident to be active!
Exercise helps prevent:ContracturesMuscle atrophyOther complications of
bedrest
Some exercise occurs:With ADLPlanned Activities When turning and moving
in bed without help
Hydration!Slide 10
Elastic StockingsUsed to exert pressure on the veins, promoting the return of venous blood to the heart – check plan of care
Slide 11
Elastic StockingsInformation you need from the care plan and nurse before apply:
SizeLengthWhen to remove and for how long
Typically on for 8 hours and off for 30 minutes
What observations to report and recordWhen applied and/ or removedSkin color and temperatureLeg and foot swellingSigns of skin breakdownComplaints of numbness and/or tinglingWhen you washed stockings
Slide 12
Devices for support or maintaining position
Splints: Keep joints in a normal position
Slide 13
Trapeze Used for exercises to strengthen arm musclesTo move up and turn in bed
Slide 14
Bed CradlesKeep the weight of
top linens off the feet and toes
Slide 15
Foot BoardsPlaced at the foot of the mattress to prevent plantar flexion that leads to foot drop (foot falls at ankle permanently)
Slide 16
Trochanter RollsPrevent the hip and legs from turning outward
Slide 17
Hip Abduction WedgeA wedge to keep the hips abducted – away from the midline
Slide 18
RANGE-OF-MOTION EXERCISES
Range-of-motion exercises involve moving the joints through their complete range of motion.
Active range-of-motion exercises are done by the person.With passive range-of-motion exercises, someone moves the joints through their range of motion.With active-assistive range-of-motion exercises, the person does the exercises with some help. Slide 19
Key Terms
AbductionMove body part away from the midline of the body
AdductionMove body part toward the midline of the body
ExtensionStraightening a body part
FlexionBending a body part
HyperextensionExcessive straightening of a body part
DorsiflexonBending the toes and foot at the ankle
Slide 20
More Key Terms
RotationTurning the joint
Internal RotationTurning the joint inward
External RotationTurning the joint outward
Plantar FlexionBending the foot down at the ankle
PronationTurning the joint downward
SupinationTurning the joint upward
Slide 21
Joints to be Exercised
NeckShoulderElbowWristFingersHipKneeAnkleToes
Slide 22
Safety ConsiderationsNEVER FORCE A JOINT TO MOVE; only exercise to the point of painNEVER perform therapies unless you have been trained and approved by your facility
Slide 23