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ImmobilityFundamentals of Nursing

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Question Answer
A deficiency in ____ leads to a negative nitrogen balance in immobile patients.
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Proteins and calories (body excretes more nitrogen than proteins ingested).
What are the end results of a (-) nitrogen balance?
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Tissue catabolism leading to weight loss, decreased muscle mass and weakness
What calcium changes occur from immobility?
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Calcium leaches from the bones and isn't resorbed leading to hypercalcemia
What impairments to the GI functioning occur from immobility?
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Constipation, pseudodiarrhea from fecal impaction, decreased appetite
What causes pseudodiarrhea, a common complication of immobility, and what happens if left untreated?
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Constipation leads to fecal impaction which causes liquid stool to pass around the area of impaction. If left untreated it leads to bowel obstruction, distention and increased pressure and will decrease intestine function leading to dehydration and fluid and electrolyte imbalances.
What are common respiratory changes due to immobility?
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atelectasis, hypostatic pneumonia
____ occurs when secretions block a bronchiole or bronchus and the distal lung tissue collapses leading to hypoventilation. It commonly develops secondary to immobility.
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Atelectasis (alveolar collapse)
What are the three major cardiovascular changes due to immobility?
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Orthostatic hypotension, increased cardiac workload, and thrombus formation
Orthostatic hypotension is an increase of heart rate of more than ____% and a drop of more than ____ in systolic or ____ in diastolic pressure on position change.
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15%; 15mm systolic; 10mm diastolic
As immobilization increases, cardiac output is ____(increased or decreased), which in turn ____(increases or decreases) cardiac efficiency and ____(increases or decreases) cardiac workload.
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Decreased CO, decreases cardiac efficiency, increases workload (and oxygen requirements)
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What are the three factors that contribute to thrombus formation in immobilized clients?
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Damage to vessel wall, alterations to blood flow (decreased due to best rest), alterations of blood constituents (increased coagulability)
What is Virchow's triad?
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Venous stasis (decreased blood flow), endothelial injury (damage to vessel wall), hypercoagulability (alteration of blood constituents)
What increases the risk of falls in an immobilized patient?
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Loss of endurance, decreased muscle mass and strength, joint instability from disuse atrophy, and orthostatic hypotension
What two skeletal changes occur from immobilization?
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Disuse osteoporosis caused by impaired calcium metabolism and joint abnormalities such as contracture and foot drop
Joint contractures can begin to form after ____ of immobility in an older adult.
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8 hours
Footdrop means a client's foot is permanently fixed in the ____ position.
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Plantar flexion
Clients who have suffered ____ are at highest risk for footdrop.
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CVA with left or right hemiplegia
What urinary elimination changes occur from immobility?
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Urinary stasis, increased UTI, increased renal calculi, and urine reflex to ureters
Why are immobilized clients at risk for renal calculi?
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They frequently have hypercalcemia
Urine becomes more concentrated around the ____(length of time) of immobilization. This increases the risk of calculi and infection.
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5th or 6th day
What two actions increase the risk of UTIs in an immobilized patient?
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Poor perineal care, insertion/use of indwelling catheter
  
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