Hazards of Immobility

1. Hazards of Immobility Module 8

2. Purpose • To review nursing content while thinking like a nurse • To use Concept Maps to visualize how a wide variety of nursing information can fit together • Practice some NCLEX questions!

3. Immobility Cannot move about freely

4. F&E GI Musculoskeletal Endocrine Hazards of Immobility Integument Renal Concept Mapping Psychosocial Cardiovascular Respiratory

5. F&E GI Musculoskeletal Endocrine Hazards of Immobility Integument Renal Concept Mapping Psychosocial Cardiovascular Respiratory

6. F&E GI Musculoskeletal Endocrine Hazards of Immobility Integument Renal Concept Mapping Psychosocial Cardiovascular Respiratory

7. Musculoskeletal • 3% Muscle Strength loss/day • Effect on physical therapy? Fatigue? • Atrophy • Joint Mobility • Complication? • Nursing care (i.e. prevention)? • Calcium metabolism (F&E, Endocrine) • Disuse osteoporosis

8. Integumentary • Skin integrity • Pressure Ulcers! • Nursing Care?

9. Cardiovascular • Orthostatic hypotension (F&E) • Increased Cardiac Workload • Thrombus (clots) • DVT • Pulmonary embolism

10. Respiratory • Atelectasis • Hypostatic pneumonia • Decreased ability to cough • Nursing Care? • Diagnoses? • Interventions?

11. Endocrine • Decreased metabolic rate (in general) • Increase in metabolic rate in presence of fever/infection • Negative Nitrogen Balance • More protein broken down than ingested • Weight loss • Decreased muscle mass • weakness • F&E imbalances

12. Gastro-Intestinal • Decreased Appetite • Slower peristalsis • Constipation! • Fecal impaction: assessment finding? • Calorie and Protein deficiency common • What does this mean for pt diet? • Nursing interventions?

13. Fluid & Electrolyte • Calcium resorption • Hypercalcemia if kidneys can’t cope • Respiratory acidosis

14. Urinary Elimination • Lack of gravity • Urinary stasis • Renal calculi • Risk due to urinary stasis & bone resorption • Decreased fluid intake • Dehydration • Poor perineal care • UTI • Use of Foley catheter

15. Psychosocial • Depend on age and level of development • Infants/Toddlers: delay in gross motor skills • Adolescents: social isolation • Adults: change in family, social, career identity • Elders: BIG risk of functional losses (encourage ADLs) • Depression, hostility, fear, anxiety • Sleep-wake changes • Coping mechanisms

16. NCLEX Practice Which of the following is an appropriate complete outcome statement for a patient with the diagnosis of immobility? • Patient will be free of DVT by doing quadricep muscle contractions correctly 4 times a day. • Patient will do active range of motion exercises daily. • No evidence of skin breakdown will occur. • Patient will have a daily bowel movement.

17. NCLEX Practice Which of the following is an appropriate complete outcome statement for a patient with the diagnosis of immobility? • Patient will be free of DVT by doing quadricep muscle contractions correctly 4 times a day. • Patient will do active range of motion exercises daily. • No evidence of skin breakdown will occur. • Patient will have a daily bowel movement.

18. A 67 year-old male client has chronic respiratory acidosis caused by end-stage COPD. Oxygen is delivered at 1 L/min per nasal cannula. Which statement by the nurse best explains to the client’s daughter how this therapy prevents respiratory depression? NCLEX Practice • “Your father’s breathing effort is driven by lower oxygen levels.” • “Your father’s breathing effort is driven by a low carbon dioxide level.” • “Your father will retain metabolic acids if the oxygen level is too high.” • “Your father will breathe best when he has a moderately high oxygen level.”

19. A 67 year-old male client has chronic respiratory acidosis caused by end-stage COPD. Oxygen is delivered at 1 L/min per nasal cannula. Which statement by the nurse best explains to the client’s daughter how this therapy prevents respiratory depression? NCLEX Practice • * “Your father’s breathing effort is driven by lower oxygen levels.” • “Your father’s breathing effort is driven by a low carbon dioxide level.” • “Your father will retain metabolic acids if the oxygen level is too high.” • “Your father will breathe best when he has a moderately high oxygen level.”

20. One day postoperative, the client reports shortness of breath. The respiratory rate is 35 and slightly labored and there are no breath sounds in his lower right base. The nurse would suspect which of the following? NCLEX Practice • Cor pulmonale • Atelectasis • Pulmonary embolus • Cardiac tamponade

21. One day postoperative, the client reports shortness of breath. The respiratory rate is 35 and slightly labored and there are no breath sounds in his lower right base. The nurse would suspect which of the following? NCLEX Practice • Cor pulmonale • * Atelectasis • Pulmonary embolus • Cardiac tamponade

22. A nurse is preparing to obtain a sputum specimen from the client. Which nursing action will facilitate obtaining the specimen? NCLEX Practice • Limiting fluids • Having the client take three deep breaths • Asking the client to spit into the collection container • Asking the client to obtain the specimen after eating.

23. A nurse is preparing to obtain a sputum specimen from the client. Which nursing action will facilitate obtaining the specimen? NCLEX Practice • Limiting fluids • * Having the client take three deep breaths • Asking the client to spit into the collection container • Asking the client to obtain the specimen after eating

24. A client with a burn injury is transferred to the nursing unit and a regular diet has been prescribed. The nurse encourages the client to eat which dietary items to promote wound healing? NCLEX Practice • Veal, potatoes, Jello-O, orange juice • Peanut butter and jelly sandwich, cantaloupe, tea • Chicken breast, broccoli, strawberries, milk • Spaghetti with tomato sauce, garlic bread, ginger ale

25. 5. A client with a burn injury is transferred to the nursing unit and a regular diet has been prescribed. The nurse encourages the client to eat which dietary items to promote wound healing? NCLEX Practice • Veal, potatoes, Jello-O, orange juice • Peanut butter and jelly sandwich, cantaloupe, tea • * Chicken breast, broccoli, strawberries, milk • Spaghetti with tomato sauce, garlic bread, ginger ale

26. The nurse caring for a client with a low basal metabolic rate (BMR) recognizes the client will most likely experience which of the following nutritional problems? NCLEX Practice • Under-nutrition • Obesity • Low serum albumin • Low hemoglobin

27. The nurse caring for a client with a low basal metabolic rate (BMR) recognizes the client will most likely experience which of the following nutritional problems? NCLEX Practice • Under-nutrition • * Obesity • Low serum albumin • Low hemoglobin

28. An elderly woman is climbing out of bed. What is the nurse’s first action? • Document patient’s behavior in her chart. • Notify her physician • Check her airway to make sure her brain is receiving enough oxygen. • Coax her back to bed.

29. An elderly woman is climbing out of bed. What is the nurse’s first action? • Document patient’s behavior in her chart. • Notify her physician • Check her airway to make sure her brain is receiving enough oxygen. • * Coax her back to bed.

30. 40 year old male patient asks for medication for back pain. He says, “I am useless. I am no longer a man and cannot be a father. What is the most appropriate response by the nurse? • “I will get your pain medication.” • “Tell me more about how you feel.” • “I will report this to the doctor and see what we can do.” • “Why are you useless?”

31. 40 year old male patient asks for medication for back pain. He says, “I am useless. I am no longer a man and cannot be a father. What is the most appropriate response by the nurse? • “I will get your pain medication.” • * “Tell me more about how you feel.” • “I will report this to the doctor and see what we can do.” • “Why are you useless?”

32. Your Nursing Tutor P.A.S.S. Program Good luck!