Long-Term Care

Complications from immobility by body system

LTC Clinical Pearls: Powered by HCPro's Long-Term Care Nursing Library, November 27, 2012

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Circulatory

  • Pooling of blood, reduced circulation, increased pressure on legs leading to blood clots.
  • Increased risk of edema.
  • Increased workload on heart.
  • Decreased blood pressure when resident gets up.

Endocrine

  • Changes in utilization of food leading to increased fat stores and glucose intolerance.
  • Increased insulin requirements for carbohydrate metabolism.
  • Changes in hormone balance.
  • Disturbed sodium-water balance.

Gastrointestinal

  • Risk for heartburn, indigestion, and aspiration due to positioning and inability to sit upright during meal and for one hour after meals.
  • Loss of appetite from reduced activity, depression, boredom, and illness.
  • May have impaired taste and smell due to aging changes or drugs. This further reduces pleasure of eating, increases loss of appetite, and reduces intake of fluids.
  • Weight loss and malnutrition from inadequate intake of nutrients.
  • Decreased peristalsis, decreased intake of fluids, and unnatural positioning for having a bowel movement using a bedpan promotes and contributes to constipation, impaction, nausea, vomiting, and ileus.
  • Difficulty pushing to eliminate stool when lying on back.
  • Digestive enzymes break down food. They will cause skin breakdown with prolonged contact with feces.

Genitourinary

  • Calcium drains from long bones, causing kidney stones and osteoporosis.
  • Position may cause difficulty voiding and inability to empty bladder completely.
  • Frequency of urination or overflow incontinence may occur.
  • Urine pools in bladder, increasing the risk of infection.
  • Skin contact with urine increases the risk of pressure ulcers.

Integumentary

  • Heat, pressure and reduced oxygenation of skin increases the risk of pressure ulcers.
  • Healthy adults normally change positions approximately every 11.6 minutes during sleep. The inability to reposition independently further increases pressure ulcer risk.
  • Friction and shearing during movement promotes abrasions, skin injuries, and breakdown, leading to pain, infection, and other complications.

Muscular

  • Often the first system to show the effects of immobility; reduced muscle mass, strength, and oxidative capacity.
  • Muscles begin to feel stiff and sore on movement; movement progressively becomes more difficult.
  • Muscles weaken and atrophy. Most prominent problems usually affect muscles associated with ambulation and upright posture.
  • Resident loses up to 7% to 10% of strength weekly.
  • Immobility and disuse of muscles in abdomen and spine combined with uncomfortable positioning and aging changes may cause low back pain.
  • Contractures may begin in as little as four days. Range of motion is lost by day 14 or 15.
  • Contractures complicate care and cause pain.
  • Contractures cause capillary occlusion at bony prominences, contributing to pressure ulcers. As much as 50% to 70% of all pressure ulcers are related to untreated contractures.

Nervous

  • Weakness, loss of independence, and limited mobility may cause depression, anxiety, restlessness, irritability, boredom, apathy, disorientation, passive-aggressive verbal and nonverbal communication, mood swings, listlessness, withdrawal, social isolation, regression, altered body image, and feelings of helplessness.
  • Lack of stimulation and social isolation increases the risk of delirium and disorientation.
  • The resident may sleep during the day and be unable to sleep at night.
  • Alterations in the sleep pattern may cause dissatisfaction, disorientation, and inability to participate in therapeutic programs and care during the day.

Respiratory

  • Difficulty expanding lungs fully/taking a deep breath due to position.
  • Weight of chest further limits lung expansion in large residents.
  • Cough weakens, reducing ability to clear secretions.
  • Retained secretions remain in airway, causing collapse of alveoli.
  • Ability to exchange oxygen and carbon dioxide is impaired, causing under ventilation and inadequate oxygen level in blood (hypoventilation and hypoxemia).
  • Difficulty taking a deep breath causes anxiety and may result in dyspnea.
  • Blood redistribution and fluid shifts increase the risk for pulmonary edema and blood clots.
  • Pooling of secretions increases the risk of pneumonia and lung infections.
  • Deaths have been reported when secretions block the airway

Skeletal

  • Calcium drains from long bones due to immobility.
  • Immobility and decreased weight bearing cause hormone imbalances.
  • Risk for osteoporosis, pathologic fractures of the vertebrae, hips, pelvis, and shoulders is increased.

Pain

  • Pain is not a major complication of immobility. However, residents who are having unrelieved pain often remain still and immobile. Thus, most of the complications listed here are also seen in residents who are immobile due to pain. Immobility is the primary cause of the problem. Pain is the secondary cause.

 



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