Nursing 105

Essentials of Nursing Study Guide

©2018 Achieve Page 108 of 160 5.4 Effects of Immobility The Musculoskeletal System • Disuse osteoporosis: ones de-mineralize without activity; may become spongy and deform or fracture easily • Disuse atrophy: loss of strength and normal function • Contractures: limit joint mobility (foot drop, external hip rotation) • Stiffness/pain: in the joints; joints become ankylosed (permanently immobile) The Cardiovascular System • Diminished cardiac reserve: rapid heart rate; reduced diastolic pressure; decreased coronary blood flow; increased use of the Valsalva maneuver interferes with the return of blood flow to the hear • Orthostatic hypotension: blood pools in lower extremities and blood pressure drops • Venous vasodilation/stasis : muscles do not contract sufficiently; no longer assisting the pumping of blood back to the heart against gravity; blood pools in leg veins causing vasodilation and engorgement • Dependent edema : serous part of blood is forced into the interstitial spaces surrounding the blood vessel • Thrombus formation: also known as Virchow’s triad; caused by impaired venous return to the heart, hypercoagulability, and vessel wall injury; thrombophlebitis is a clot that is loosely attached to an inflamed vein wall The Respiratory System • Decreased respiratory movement: The rigid bed presses against the body and curtails chest movements. Abdominal organs push against the diaphragm, further restricting the chest movement. Cartilaginous intercostal joints become fixed in an expiratory phase further restricting the potential for maximal ventilation. These changes contribute to shallow respirations and reduced vital capacity (possible decrease of 25-50%). • Pooling of respiratory secretions: Inactivity allows secretions to pool by gravity, interfering with normal diffusion of oxygen and carbon dioxide. Cough can be hindered by dehydration, loss of muscle tone, or sedatives that depresses the cough reflex. • Atelectasis: This occurs when ventilation is decreased. • Hypostatic pneumonia: This is the development of pneumonia in an immobile client related to pooling of respiratory secretions, which are an excellent medium for bacterial growth The Metabolic System • Decreased metabolic rate: Causes decreased energy requirements. GI motility and digestive secretions are also reduced.