lOMoAR cPSD| 67756003
Exam 3
Chapter 28
• Effects of Immobility of body systems o Musculoskeletal
system
Atrophy- wasting (muscle start to shrink)
Contracture- permanent fixation of a joint
Disuse osteoporosis- loss of bone mass due to lack of activity (it can lead to
pathologic bone fractures. Our joints may become really stiff and painful)
Decreased in muscle tone- can occur within just a few days of inactivity
o Nervous system
Balance (Proprioception & Equilibrium altered)
• Make sure to let the patient dangle their legs at the side of
the bed before standing for the first time.
o Cardiopulmonary
Decreased in lung expansion- the body weight against the bed puts pressure
on the rib cage. The diaphragm has less room to expand than in the upright
position due to pressure from abdominal organs.
• Leads to pooling of secretions in the lungs
Decreased lung expansion can lead to
• Pooling of secretions in the lungs (unable to cough up any secretions
• Pneumonia (#1 cause of death in immobile patients)
• Atelectasis (collapse of a portion or all of the lungs)
DVT’s
Orthostatic Hypotension: a form of low blood pressure that happens when
standing after sitting or lying down.
o Nutrition
Decrease in Basal Metabolic Rate (BMR)
• When this decreases the body begins breaking down muscle protein
for energy. Catabolism of protein leads to a negative and nitrogen
balance in the body, especially if people aren’t getting enough dietary
protein in their diet because the body starts breaking down the
muscle, protein or energy.
• Anorexia- decreased appetite
• Nausea
o Elimination
Inactivity, decreased appetite, and decreased fluid intake cause hypomotility
of gastrointestinal tract (GI moves slowly). This is manifested by decreased
bowel sounds on auscultation and by constipation.
, lOMoAR cPSD| 67756003
• Constipation o Fecal impaction (build up of hardened feces in the
lower intestine) due to unrelieved constipation. Monitor for adequate
fiber and fluid volume while on bed rest. o Urinary stasis may
develop, and may result in UTI, and renal calculi (Kidney stones) due
to inability to use bathroom. Using bedpan leads to GI track to slow
down.
o Skin
Pressure injuries (Pressure sores, pressure ulcers, bedsores, or decubitus
ulcers)
• The impact of immobility on skin integrity is potentially catastrophic.
Pressure on bony prominences can cause tissue ischemia. o
Prolonged tissue ischemia may lead to necrosis and destruction of all
layers of the skin, muscle and fat. o Areas most at risk for pressure
injuries: buttocks, coccyx, heels, hips, shoulders, elbows and ears.
o Psychosocial
Isolation may result from inactivity and bed rest, causing a variety of
psychosocial challenges for patients. With limited ability to ambulate or
interact with people outside of their immediate space, immobile patients
may become lonely, anxious, angry, depressed, or confused.
Sensory deprivation (lack of stimuli) may result from decreased interaction
with others. A patient’s self-concept may be altered by the inability to
interact with the environment. Traditional coping strategies may not be
effective, causing irregular patterns of behavior.
Sleep and rest patterns may be disturbed.
• Nursing interventions for each body system o
Musculoskeletal
One of the most important is exercise and early ambulation
• Early ambulation after injury, illness or surgery promotes
muscle strength, retains joint flexibility, minimizes joint pain
and stiffness, and arrests bone reabsorption.
Types of Exercise
• Isotonic – involves active movement with constant muscle
contraction. o Walking, turning in bed and self-feeding
• Isometric – requires tension and relaxation of muscles without
joint movement
o Kegels
• Aerobic – requires oxygen metabolism to produce energy o
Rigorous walking, or repeated stair climbing
• Anaerobic – builds power and body mass. Without oxygen to
produce energy for activity o Heavy weightlifting
Exam 3
Chapter 28
• Effects of Immobility of body systems o Musculoskeletal
system
Atrophy- wasting (muscle start to shrink)
Contracture- permanent fixation of a joint
Disuse osteoporosis- loss of bone mass due to lack of activity (it can lead to
pathologic bone fractures. Our joints may become really stiff and painful)
Decreased in muscle tone- can occur within just a few days of inactivity
o Nervous system
Balance (Proprioception & Equilibrium altered)
• Make sure to let the patient dangle their legs at the side of
the bed before standing for the first time.
o Cardiopulmonary
Decreased in lung expansion- the body weight against the bed puts pressure
on the rib cage. The diaphragm has less room to expand than in the upright
position due to pressure from abdominal organs.
• Leads to pooling of secretions in the lungs
Decreased lung expansion can lead to
• Pooling of secretions in the lungs (unable to cough up any secretions
• Pneumonia (#1 cause of death in immobile patients)
• Atelectasis (collapse of a portion or all of the lungs)
DVT’s
Orthostatic Hypotension: a form of low blood pressure that happens when
standing after sitting or lying down.
o Nutrition
Decrease in Basal Metabolic Rate (BMR)
• When this decreases the body begins breaking down muscle protein
for energy. Catabolism of protein leads to a negative and nitrogen
balance in the body, especially if people aren’t getting enough dietary
protein in their diet because the body starts breaking down the
muscle, protein or energy.
• Anorexia- decreased appetite
• Nausea
o Elimination
Inactivity, decreased appetite, and decreased fluid intake cause hypomotility
of gastrointestinal tract (GI moves slowly). This is manifested by decreased
bowel sounds on auscultation and by constipation.
, lOMoAR cPSD| 67756003
• Constipation o Fecal impaction (build up of hardened feces in the
lower intestine) due to unrelieved constipation. Monitor for adequate
fiber and fluid volume while on bed rest. o Urinary stasis may
develop, and may result in UTI, and renal calculi (Kidney stones) due
to inability to use bathroom. Using bedpan leads to GI track to slow
down.
o Skin
Pressure injuries (Pressure sores, pressure ulcers, bedsores, or decubitus
ulcers)
• The impact of immobility on skin integrity is potentially catastrophic.
Pressure on bony prominences can cause tissue ischemia. o
Prolonged tissue ischemia may lead to necrosis and destruction of all
layers of the skin, muscle and fat. o Areas most at risk for pressure
injuries: buttocks, coccyx, heels, hips, shoulders, elbows and ears.
o Psychosocial
Isolation may result from inactivity and bed rest, causing a variety of
psychosocial challenges for patients. With limited ability to ambulate or
interact with people outside of their immediate space, immobile patients
may become lonely, anxious, angry, depressed, or confused.
Sensory deprivation (lack of stimuli) may result from decreased interaction
with others. A patient’s self-concept may be altered by the inability to
interact with the environment. Traditional coping strategies may not be
effective, causing irregular patterns of behavior.
Sleep and rest patterns may be disturbed.
• Nursing interventions for each body system o
Musculoskeletal
One of the most important is exercise and early ambulation
• Early ambulation after injury, illness or surgery promotes
muscle strength, retains joint flexibility, minimizes joint pain
and stiffness, and arrests bone reabsorption.
Types of Exercise
• Isotonic – involves active movement with constant muscle
contraction. o Walking, turning in bed and self-feeding
• Isometric – requires tension and relaxation of muscles without
joint movement
o Kegels
• Aerobic – requires oxygen metabolism to produce energy o
Rigorous walking, or repeated stair climbing
• Anaerobic – builds power and body mass. Without oxygen to
produce energy for activity o Heavy weightlifting
