Card Set Information
Bed rest hospitalisation
why bed rest in hospitals?
- to help manage pathologies
- but in saying this bed risk increases the risk of other pathologies
Why are pts on bed rest?
- prescribed- DVT, back surgery
- pt decision
- pt has nothing else to do
What are the indications of bed rest?
- critically ill- sedated etc
- imediate post op period eg day 0
- ortho injury
- immediately following AMI (acute myocardail infarct)
- unstable cardiac conditions
- mltiple wounds and fractures
- severe peripheral oedema
WHat can bed rest include?
- sitting up or in a special chair
- rare for someone to lie flat and still- many pts can be positioned or sat into a special chair
- upright is best
What are some adverse consequences of bed rest?
all depends on the prior condition of the pt, level of activity, fitness, strength
- length of time of the condition
- amount of reduction of the effects of gravity
- mm expect and need to move and be activeand they need regular stimulation by motor nerves
- decrease inactivity - deconditioning
- mm beome smaller- atrophy
- reduction in strength
- postural and ll mm
What happens to the mm system when someone is on constant bed rest?
- postural mm strength drops quickly
- total losses of slow twitchmm mass is greater but the loss of cross sectional area is also very large in fast twitch mms eg quads
- reported drop in strenght 1- 1.5%/day
- loss continues for about 130 days
- 15-20% in quads
- upper body is less than lower
- mm endurance is also reduced knee 15-20% about 4 weeks
- contractile protein lost- not mm fibres
- O2- insufficient use and increased demand for simple thing
- changes in mm length
- loss of mm strength and size can be prevented by pretraining
what are the clinical implications of mm and bed rest?
- pts on prolonged bed rest have reduced mm strength and endurance
- increased difficulty in transferring, standing and walking
- reduced balance and increased risk of falling
what are some adverse consequences of bed rest?
- bone responds to PA- needs mechanical stress to balance the ratio of bone formation to bone absorption
- bone reflects mechanical stress applied to them
- bones with increased stress become thicker and heavier
- inactivity and lack of weight bearing exercise cause changes in the bony skeleton
- bone use force to get stronger will weak if not used therefore bone is absorbed rather than formed
- loss of mineral eg calcium from bone- hypercalcaemia- direct result
- trabecular bone is particularly sensitive to demineralisation due to inactivity. The bone normally protects against stress from diff directions
- loss of bone density is not uniform
- more significantwith long term bed rest etc
what are the clinical effects of bed rest for bones?
- renal calculi (more calcium in blood)
- greater risk of # due to reduced bone density
- development of osteoporosis
What are the adverse consequences of bed rest on the CVS?
- changes occur within a few days
- as well as immediate changes, chronic inactivity is a risk factor for CVS disease eg IHD
- deconditioning on CVS
- increased HR at rest and sub max exercise
- reduced SV
- reduced VO2 max
What are the adverse effects of bed rest on blood?
- fluid loss
- changes in fluid regulating mechanisms- diresis- pee more, reduce plasma volume
- increased blood viscosity
- increased fibrinogen and platelets- risk of clotting
- venous statis-lack of mm pump
- risk of DVT
What occurs with diuresis from bed rest?
- occurs quickly
- 15-20% of body's extracellular fluid may be lost within 3 days
what are the significant effects of bed rest on CVS?
- reduced blood volume
- reduced venous return
- reduce CVP (central venous pressure)
- HR need to increase to maintain CO
What are the adverse effects of bed rest on orthostatic hypotension?
- reduces BV
- dysfunction of baroreceptors
- pooling of blood in lower limbs
- pt dizzy
- can start after 3-4 days of bed rest
what are the clinical implications of bed rest on CVS?
- heart less able to meet increase demands- SOB, fatigue
- more O2 consumed for less work
- orthostatic hypotension- need to assume pt has this
- increased risk of DVT
What are the adverse effects of bed rest on neuro system?
- not much research
- bed rest has -ve effects on neural firing rate and motor unit recruitment
- evidence may effect postural control, gait, proprioception
what are the adverse effects of bed rest on psyc status?
-fear of activity
- sensory deprivation
- clinical implications- reluctant to be active, afraid of further activity, not modified with treatment
What are the adverse effects of bed rest on the skin?
- pressure areas/ ulcers/ bed sores
- ischemic and breakdown
- ischial tuberosity
- greater trochanter
- lateral malleolus
What are the contributing factors to pressure olcers?
- pressure > arteriolar prevents dlivery of nutrients to the skin
- accumulation of waste product products
- greatest over bony prominences
- shearing forces
- tissue moving in oposite directions eg dermis in contact with matress
- occurs when someone is on a incline
- increase temp
- increased moisture
- poor nutrition
- cirulatory factors- poor circulation, low BP
- neurological disease
- surface/ matress quality
Stage 1 of skin changes
- skin non blancheable erythema of the intact skin
Stage 2 of skin changes
- partial thickness skin loss
- skin surface is broken
stage 3 of skin changes
- full thickness skin lss
- extension into subcutaneous fat
Stage 4 of skin changes
- extensive destruction involving damage to m, bone or tendon
What are the consequences of pressure ulcers?
- infection- wound, bone, sepsis
- dvelopment of sinus tract- may commnicate with bladder/ bowel
- septic arthritis
- endocarditis- infection of heart
How can you prevent pressure spots?
- improve general health
- relief of pressure- positioning, mattresses- gel, foam, air
- manage moisture
- adequate nutrition
- do not drag pt along bed or chair
- dressing by specialists
- topical agents
What are the adverse consequence of bestrest on the resp system?
- less dramatic consequences to other systems
- usually worse if combined with pathology eg surgery
- loss of resp mm strength
- recumbent position- reduce lung volume, risk of atelectasis
- not moving around- reduce clearance
- increased risk of collapse, infection
- increased risk of sputum retention and pneumonia
What are nosocomial infections?
nosocomial- pertaining to or originating in hopsital
- wound infection
what is Iatrogenic infection?
caused by medical intervention
What are contributing factors to nococomial infections
- hospital setting eg ICU
- health status
- underlying disease/ comorbidties
- immune status
- skin integrity
- presence of invasive devices eg IDC, IVC
- antibiotic use and resistance
- single celled organisms
- gram stain (gram negative, gram positive)
- morphology (cocci, bacilli, spirchetes)
- metabolic properties (O2 tol)
- analysis of genetic material
Aim of a bacteria is to become 2 bacterial
- very adaptive to diff envts
- major human pathogen
- gram +ve
- carries- intermittent colonisation- nacophayrnx, skin, 20% prolonged, 60% intermittent, 20% never colonised
- common in health care workers
MRSA- methicillin resistant staph
epidemic in health care systems
- resistant to a variety of antibiotics
- able to be treated with Vancomycin
- effects- infection, wound infection
- gram -ve
- common constituents of GI flora
- can cause infection elsewhere- diarhoea, UTI, sepsis, pneumonia
VRE- vancomycin resistant enterococcus
- vancomycin resistant
- generally harmless bacteria
- live in intestines of healthy people
- difficult to manage
- isolated fom soil, water, plants, animals and humans
- likes moist envt
- reservoirs- resp equ, sinks, shower heads, swimming pools, contact lens solutions
- rarely causes disease in healthy people
- bronchiectasis, CF, chronic bronchitis, excessive secretions
- surgical site infection
- blood stream infection
- gram -ve
- soil, human secretions, ventilator equp
- 25% of healthy adults have cutaneous colonisation
- increasing in incidence and resistance
- wound infection
WHat is nosocomial pneumonial?
- pneumonia developing 2 or more days after admission for another reason
- accounts for 15% of all nosocomial infections 2nd most common, 1st UTI
- affects 0.5-2% of all hospitalised pts
What are predisposing factors of nosocomial neumonia?
- mechanical ventilation > 48 hrs
- prior AB use and resistance
- duration of hospital stay
- other health problems- chronic diseases eg COPD
- ETOH abuse
- severisty of underlying factos
- reduces immune defenses- immunocompromise
- major surgery
- reduced LOC
- increased age
- presence of a NGT
What are common organisms causing nosocomial pneumonia?
gram -ve bacterial (50-80%)
- pseudomona aurugonia
gram +ve bacteria (20-30%)
Other anaerobes, fungi
Nosocomial pneumonia- where do the bugs come from?
- other sites in body
- translocation from GIT
- cross infection- other pts, staff
- contam equip
How can you prevent secondary complications of bed rest and hospitalisation?
- early and regular activity and mobs even position changes
- physios help where they can
- self management- pretraining, optimise mobility, teach bed exercises, resp exercises, group treatment
Prevention of nosocomial pneumonia
- must assess if
- mech ventilation >48 hrs
- prolonged bed rest
- post major surgery
- past history of sig resp diesases
- those with mob disorders