Immobilization: L.M.b

result:- N.O.P.C.M نبصم dwap =دواب
cardiovascular
1. heart:(tachy.c) ⬆HR=0,5bpm/day -exaggerated with exercise (increase sympathic tone) angina decrease LV-EDV ⬇s.v15%in 2w -decrease C.efficiency C muscle mass
2. B.V:- B pools: =b.v Loss abitity to constrict in response posture change : =decrease :- Venous .R (dv.t) ⬇S.V (blood.V) ⬇blood.Pressure (p.hypoT) =orthostasis TTT:M.I.P.F.M
3. fluid balance:- prolong recumbece lead to Volume.Loss:- 700cc to thorax ⬆co by25% -gradual diuresis (protein loss) -⬇plasma.volume 10-15%, Hct ⬆ ⬇ RBC mass decrease anemia *cv:DvT *v.stasis⬇b f ⬆viscosity *hypercoagulabilty:⬆ blood fibrinogen location:calf veins 20%propagate to popliteal , 50%of popliteal will embolize TTT:scD.TED sQ prophylaxia ambulation
respiratory s: potential ⬇decrese in lung cuz (MWeakness, positioning /restriction) decrease -vital.capacity - total LC,residual v, E.reserve ,F rasidual C -regional changes in ventilation perfusion ⬆RR -impairment in coughing : cough⬇(abdominal w,ciliary action) pneumonia atelectasis aspiration TTT:-early mobilization position changes chest PT incentive spirometry assisted cough chest percussion fluids medication
muscular s: 1-decrease in muscle strength :_ 1-3%day 10-20% 25-40%in3-5wk greater in antigravity m.s larger m.s (quadriceps back extensors planterflexors both ms types affect more affected in type 1 (slow twitch oxidative)muscles 2-progressive decrease in muscle endurance due to diminish efficiency of cardivascuar system 3-fatigability:-decrease ATP glucose stores and ability to use fatty acids 4-⬇in musle tension :⬇fiber diameter (decrease myofibersو cross s 5-m atrophy 6-poor m coordination 7-body composition changed 8-⬇lean body mass up to 3%⬆body ffat up to 12%
1. prevent and T:- daily isometric c can prevent deterioration &take 2,3 times longer -20to 30of maximal c for several t -50maxmial c for1 s
soft tissues (contracture):- decrease PROM of joint due to joint limitation connective t or m shortening) *one of the most fuction limiting complications -with immobility collagen develops cross link and become less flexible as -joint synovial tightening -connective T Loose to dense -muscle:decrease saromeres muscles especially 2joint, tendon ligaments may involved
1. risk factors for contractures: 1-positioning 2-pain:local Trama , infection, edema,DjD amputation 3-muscle imbalance :paralysis ,plasticity,weakness 4-muscles most affected:hip flexors hands gastrocnemius shoulder abd /IR 's
2. contracture prevention : 1-bed positioning 2-graduated Rom (terminal sustained) 3-splinting static serial cast 4-heat (40-43) 5-surgery 6-nerve MP block
ligaments and tendon:- the parallel arrangement of type 1collagen crucial for functions ,new fibers may laid down in random obliquely case decrease strength and elasticity -water and intracellular substance of GAG content of the tissue decrease with diuse
1. TTT:periodic stress can prevent deterioration
bone:- Wolf's law build up و breakdown of bone is proportionate to the forces being applied *osteoporosis :-peak at 4to 6 w 1-bone density decrease 40%after 12weeks (x ray not sensitive (35-50%)bone loss 2-⬆osteoclastic activity (b resorption) 3-⬇rate of b formation *the weight bearing b are the first to loss mass -vertebral c lose up to 50%can lead fracture even with minor T
1. prevention :weight bearing and muscle contraction -immobility :hyperkalemia may 2-4week after onset -symptoms; N/V abdominal pain ,lethargy m w TTT :in neurological osseous muscular trauma
joint :- 1-cartilage degeneration (proteoglycan diminish )then decrease overall thickness of articular cartilage of 99%after 11week 2-synovial atrophy &fatty infiltrate➡underlying bone degeneration 3-benign joint effusion may occur spontaneously in sci 4-contractures of soft T around the joint
gastrointestinal: 1-⬇fluid intake,appetite (anoroxia) 2-⬆transit time in esophagus stomach 3-⬇small bowel motility due to ⬆adrenergic activity 4-constipation
1. TTT:-bowel meds,fluids mob ,fiber rich diet avoid narcotics
genitourinary:- 1-diuresis due to fluid 're mobilization 2-difficulty voiding due to positioning 3-UTL's (urinary tract infection 4-calculus formation(10 -15)hypercalciuria (SCI,fxs )
1. TTT :-mob,fluids,upright positioning d/c catheter
skin :- 1-skin atrophy 2-pressure ulcers:-risk: positioning, ⬇T mass,poor skin care sites:sacrum heels ischium, occiput,trochanter
1. prevention :- turning, positioning, seating,skin hygiene -edema:may predispose to cellulitis -subcutaneous bursitis due to pressure Rx:NSAiD, steroid injection
endocrine : 1-impaired glucose tolerance :- -hyperinsulinemia -muscles develop insulin resistance 2-altered regulation of parathyroid thyroid and adrenal, pituitary, growth hormones
metabolic:-urinary loss of :nitrogen calcium,phosphorus -reversible post mobilisation
neurological : 1-compression Neuropathies:- -ulnar nerve -peroneal nerve 2-⬇coordination 3-⬇visual acuity
psychological :- sensory deprivation ⬇attention span awareness coordination ⬆increase depression, sleep disturbing increase auditory threshold decrease pain threshold

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Immobilization: L.M.b

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	Created by Rania Kamel about 8 years ago