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What are the causes of immobility?
Injury, disease process, neurological, surgery, physician ordered, self-inflicted
What regulates/restricts movement?
- •Skeletal muscle
What are the risks associated with bladder infection?
- •Body temperature
- •Use of catheters
- •Poor Hygiene
What are the 3 general phases of healing?
- •Phase I: Inflammatory response
- •Phase II: Repair response
- •Phase III: Remodeling
What are the classifications of muscle strains, and what defines them?
- Mild /first-degree - Tear of a few minor fibers, minor swelling, local tenderness
- Moderate/2nd degree - Greater damage to the muscle & clear loss of strength
- Severe/3rd degree - Tear extending across the whole muscle belly
What is tendinitis?
- Inflammation of the tendon
- Pain and loss of function
- Common places: rotator cuff, tennis elbow, patella tendon, IT Band, Shin Splints, Achilles, etc.
What is tendinosis?
Chronic alteration of the tendon accompanied by tissue degeneration, cell atrophy, and pain
What is paratenonitis?
Used to describe inflammatory disorder of tissues surrounding the tendon
How are ligament injuries classified? What are their characteristics?
- •Grade I – stretching but no fiber damage
- Normal ROM, little/no swelling, localized tenderness
- Early return to training with protection/supervision
- •Grade II – stretching and some tearing
- Significant structural weakening, bruising, swelling
- Tendency to recur, need protection/modified immobilization
- •Grade III – complete ligament disruption
- Loss of structural integrity, marked abnormal motion
- Needs prolonged protection, surgery, permanent functional instability
Describe the 3 types of articular cartilage injury?
- Type I Microscopic damage to chondrocytes and extracellular membrane (ECM)
- Type 2: partial thickness
- Microscopic disruption of articular cartilage
- POOR prognosis because inflammatory response is not provoked
- Type 3: full thickness - Disruption of articular cartilage with penetration into subchondral bone
What factors impact immobility?
- Extent and duration of immobilization
- Age of individual
- Physical condition
- Nutritional intake
What are the pathological influences on immobility?
- Postural abnormalities
- Impaired muscle development
- CNS damage
- Musculoskeletal trauma
What are the musculoskeletal effects of immobility?
- Bone loss
- Cartilage degeneration
- Decreased mechanical & structural properties of ligaments
- Muscular atrophy
- Loss of muscular endurance
- Decreased elastacity and extensibility
What are the cardiovascular effects of immobility?
- venous stasis
- blood pooling
- thrombus vs. embolus
- potentially decreased cardiac output
- orthostatic hypotension
What are the respiratory effects of immobility?
- decreased metabolic rate
- decreased movement of the rib cage
- -secretion stasis
- -shallow breathing
- decreased ability to expand chest wall and lung tissue
What are the GI effects of immobilization?
- Decreased peristalsis and segmentation
- decreased dietary intake
what are the urinary effects of immobilization?
- urinary retention & stasis
- Poor ability (supine) to completely empty bladder
- increased protein dumping in urine
- At risk for bladder infection (catheters, hygiene, body temp)
- At risk for kidney stones
What are the metabolic effects of immobility?
- decreased metabolic rate
- increased body temp if infection is present
- increased perspiration
- loss of electrolytes
- -fever: through persperation
- -w/o fever: lost in interstitial space
What are the psychological effects of immobility?
- decreased sensory experience
- altered sense of body image
- loss of indepence
physiological assessment of immobility includes what?
- Metabolic: anthropometric measurements, wound healing,
- Respiratory system: ventilatory status, breath sounds
- Cardiovascular system: BP, pulse, peripheral circulation, signs of DVT
- Musculoskeletal: ROM; muscle strength, tone, and mass (disuse atrophy)
- Integumentary: color, integrity, turgur
- Elimination: bowel/bladder habits
What is included in the psychosocial assessment?
- Reaction to immobility
- Depression, loss of indepence
- Developmental stages
- Client expectations
How are the hazards of immobility prevented?
- ~ Nutritional needs: protein, calories, vitamins (B and C)
- •Respiratory system
- ~ Promotion of chest and lung expansion
- ~ Removal of secretions
- ~ Maintenance of patent airway
- •Musculoskeletal system
- ~ ROM
- ~ Isometric exercise
- •Integumentary system
- ~ Turning every 1 to 2 hours
- ~Hygienic care
- ~Protection: preventive aids
- ~ Hydration
- ~Nutritional intake: fiber
- ~Client participation
- ~ Supports: footboards, trochanter rolls, hand rolls, and splints
- ~ Trapeze bar
- ~ Bed position: Fowler’s, supine, prone, side-lying
How is health promotion implemented following immobility?
- •Lifting techniques
- •Exercise (which results in)
- 1.Improves cardiac output
- 2.Decreasing resting heart rate
- 3.Increasing respiration rate and depth
- 4.Decreasing work of breathing
- 5.Increase basal metabolic rate
- 6.Increase use of glucose and fatty acids
- 7.Increase gastric motility
- 8.Improved muscle tone
- 9.Increased joint mobility
- 10.Reduce bone loss
- 11.Decrease fatigue
- 12.Reports of decrease in illness
- 13.Reports of “feeling better”
What is included in restorative care after immobility?
- Instrumental activities of daily living
- Physical and occupational therapy
- Ambulation: canes, walkers, crutches, etc