CP

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jessiekate22
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181399
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CP
Updated:
2012-11-03 19:34:01
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Bed rest hospitalisation
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exam
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  1. why bed rest in hospitals?
    • - to help manage pathologies
    • - but in saying this bed risk increases the risk of other pathologies
  2. Why are pts on bed rest?
    • - prescribed- DVT, back surgery
    • - pt decision
    • - pt has nothing else to do
  3. What are the indications of bed rest?
    • - critically ill- sedated etc
    • - unconscious
    • - imediate post op period eg day 0
    • - ortho injury
    • - immediately following AMI (acute myocardail infarct)
    • - unstable cardiac conditions
    • - mltiple wounds and fractures
    • - hypotension
    • - severe peripheral oedema
    • - DVT?
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  11. What are the adverse effects of bed rest on blood?
    • - fluid loss
    • - changes in fluid regulating mechanisms- diresis- pee more, reduce plasma volume
    • -hypovolaemia
    • - increased blood viscosity 
    • - increased fibrinogen and platelets- risk of clotting
    • - venous statis-lack of mm pump
    • - risk of DVT
  12. What occurs with diuresis from bed rest?
    • - occurs quickly
    • - 15-20% of body's extracellular fluid may be lost within 3 days
  13. 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
  14. 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
  15. 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
  16. 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
  17. what are the adverse effects of bed rest on psyc status?
    • - depression
    • - anxiety
    • -fear of activity
    • - sensory deprivation
    • - clinical implications- reluctant to be active, afraid of further activity, not modified with treatment
  18. What are the adverse effects of bed rest on the skin?
    • - pressure areas/ ulcers/ bed sores
    • - ischemic and breakdown
    • common on:
    • - sacrum
    • - ischial tuberosity
    • - greater trochanter
    • - heels
    • - lateral malleolus
  19. What are the contributing factors to pressure olcers?
    • - immobility
    • - 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
  20. Stage 1 of skin changes
    - skin non blancheable erythema of the intact skin
  21. Stage 2 of skin changes
    • - partial thickness skin loss
    • - skin surface is broken
  22. stage 3 of skin changes
    • - full thickness skin lss
    • - extension into subcutaneous fat
  23. Stage 4 of skin changes
    - extensive destruction involving damage to m, bone or tendon
  24. What are the consequences of pressure ulcers?
    • - infection- wound, bone, sepsis
    • - dvelopment of sinus tract- may commnicate with bladder/ bowel
    • Less commonly:
    • - septic arthritis
    • - endocarditis- infection of heart
    • - meningitis

    Psychological effects
  25. How can you prevent pressure spots?
    • - improve general health
    • - relief of pressure- positioning, mattresses- gel, foam, air
    • - mobility 
    • - manage moisture
    • - adequate nutrition
    • - do not drag pt along bed or chair
    • - dressing by specialists
    • - topical agents
    • - antibiotics
    • - surgery
  26. 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
    • Clinical implications
    • - increased risk of collapse, infection
    • - increased risk of sputum retention and pneumonia
  27. What are nosocomial infections?
    • nosocomial- pertaining to or originating in hopsital
    • - UTI
    • - Pneumonia
    • - wound infection
  28. what is Iatrogenic infection?
    caused by medical intervention
  29. 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
  30. Nococomial infections?
    • - single celled organisms
    • Typing:
    • - 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
    • staph aureus
    •   - major human pathogen
    •   - gram +ve
    •   - carries- intermittent colonisation- nacophayrnx, skin, 20% prolonged, 60% intermittent, 20% never colonised
    • - common in health care workers
    • staphylocci
    • 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
    • Enterobacteriacae
    • - gram -ve
    • - ecoli
    • - 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
    • Pseudomonas
    • - isolated fom soil, water, plants, animals and humans
    • - likes moist envt
    • - reservoirs- resp equ, sinks, shower heads, swimming pools, contact lens solutions
    • - opportunistic
    • - rarely causes disease in healthy people
    • Effects:
    • - preumonia
    • - ICU
    • - bronchiectasis, CF, chronic bronchitis, excessive secretions
    • - UTI
    • - surgical site infection
    • - blood stream infection
    • Acinetobacter:
    • - gram -ve
    • - soil, human secretions, ventilator equp
    • - 25% of healthy adults have cutaneous colonisation
    • - common
    • - increasing in incidence and resistance
    • Effects:
    • - pneumonia
    • - sepsis
    • - wound infection
    • - UTI
  31. 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
  32. 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
    • - malnutrition
    • - ETOH abuse
    • - severisty of underlying factos
    • - reduces immune defenses- immunocompromise
    • - major surgery
    • - reduced LOC
    • - increased age
    • - presence of a NGT
  33. What are common organisms causing nosocomial pneumonia?
    • gram -ve bacterial (50-80%)
    • - pseudomona aurugonia
    • - enterobacter
    • - acinetobacter
    • - haemophyillis
    • gram +ve bacteria (20-30%)
    • - staphylococcus
    • - streptococcus
    • Other anaerobes, fungi
  34. Nosocomial pneumonia- where do the bugs come from?
    • - other sites in body
    • - translocation from GIT
    • - cross infection- other pts, staff
    • - contam equip
  35. 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
  36. 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

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