Complications of Immobility

Overview

1. Complications of Immobility
   1. Psychologic
   2. Cardiovascular
   3. Pulmonary
   4. Gastrointestinal and renal
   5. Musculoskeletal and skin

Nursing Points

General

1. Psychologic
   1. Frustration
   2. Anxiety and depression
   3. Delirium
      1. Increases length of stay
      2. Decreases compliance
2. Cardiovascular
   1. Coagulopathies
      1. Blood pooling
      2. Increased risk of deep vein thrombosis
         1. Increased risk of pulmonary embolism
   2. Edema
   3. Changes in blood pressure
      1. Orthostatic hypotension
3. Pulmonary
   1. Decreased gas exchange
      1. Due to decreased thoracic expansion
      2. Increased risk of pneumonia
   2. Weakened cough
      1. Inability to clear secretions
4. Renal and gastrointestinal
   1. Urinary
      1. Urinary stasis
         1. Increased risk of UTI
      2. Risk of urinary incontinence
         1. Due to positioning
   2. Gastrointestinal
      1. Risk of aspiration
      2. Malnutrition
      3. Difficulty with bowel movements
         1. Mobility increases peristalsis
5. Musculoskeletal & skin
   1. Musculoskeletal
      1. Atrophy
      2. Foot drop
      3. Decreased strength
   2. Skin
      1. Pressure and poor oxygenation
         1. Skin breakdown
      2. Friction and shearing
         1. Increases abrasions, skin injuries
            1. Infections
            2. Pain

Assessment

1. Psychologic
   1. Complete neurologic assessments as ordered
   2. Observe for changes in mentation or alertness
   3. Observe for signs of delirium or withdrawn affect
2. Cardiovascular
   1. Observe for changes in blood pressure, and orthostatic hypotension
   2. Assess for new leg pain or difficulty breathing
3. Pulmonary
   1. Assess lung sounds for adventitious sounds
   2. Watch for any changes in cough, secretions or sputum
   3. Like cardiovascular, watch for changes in breathing
      1. Breathing difficulty and a feeling of “impending doom” could be pulmonary embolism
4. Renal and gastrointestinal
   1. Complete ins and outs to verify fluid and nutrition status
   2. Ensure regularity of bowel movements
5. Musculoskeletal and skin
   1. Assess range of motion and strengths daily
   2. Check over bony prominences for skin breakdown

Therapeutic Management

1. Promoting mobility
   1. Increases strength, cardiovascular functioning, respiratory strength
2. Turn patient or assist in turning patient to reduce skin breakdown
3. Use orthotics to prevent foot drop
4. Work with physical therapy and occupational therapy to assess and promote mobility
5. Work with registered dieticians to promote optimal nutrition

Nursing Concepts

1. Patient-Centered Care
2. Safety
3. Mobility
4. Health Promotion

Patient Education

1. Encourage patient to participate in their own care by promoting education
2. Educate patient on different types of mobility exercises
3. Reinforce teachings from other disciplines such as PT & OT, speech therapy and respiratory therapy

Study Tools