Hi, I'm Meris. And in this video I'm going to be talking to you about the effects of immobility,
deep vein thrombosis, and nursing care for immobility. I'm going to be following along
with our Fundamentals of Nursing flashcards. These are available on our website with many more
at leveluprn.com. If you are following along with me with your own set, I'm
starting on card number 68. So let's get started. So first up, we're talking about the effects that
immobility has on body systems. You'll see here a really nice table on this card that
separates out the body systems and their effects so that way you can clearly see what they are.
There's way too much for me to go into with you in this video so definitely be
sure to look at this card in-depth. But there are some big ones I want to hit on.
Decreased lung expansion and increased risk of atelectasis for your respiratory system.
Very important. Cardiovascular. Increased risk of blood clots. Blood clots. Very, very important.
We're going to be talking about that next, so definitely pay attention to that. Musculoskeletal.
We have muscle atrophy but we also have bone demineralization. Tell me in the comments
which type of cell is responsible for the destruction of bone. Is it osteoblasts
or osteoclasts? Tell me below. So this is going to give us an increased risk for fractures
if a patient begins to be mobile again and they fall and hurt themselves, right?
Gastrointestinal. Decreased GI motility means increased risk for constipation. Renal.
We're going to have kidney stones, right, because that calcium from the bones that
is demineralized from the bones is liberated, is released into the blood. And what filters
the blood? The kidneys. And what do we get when we have a lot of calcium in the blood?
Kidney stones. We may also have UTIs from urinary stasis. And then of course we have the risk for
pressure injuries. Very important stuff here. Now we, on the next card, have effects on
function. So this is how does immobility actually affect the patient's ability to function.
And we see here that we talk about the impact on a patient's ADLs, activities of daily living.
So we're going to see that when you are ill or immobilized or hospitalized your ability to care
for yourself may decrease. So we need to be paying attention to our patient's ability to care for
themselves. Now pay attention here that we have something called instrumental ADLs, IADLs. This
is more about how do I care for the household. So this is meal planning, going to the grocery store,
balancing the budget. Those are IADLs, whereas ADLs are things that I'm doing to my own body,
like dressing, bathing, showering, shaving. All of those things are ADLs.
And then we also want to encourage our patients to participate in their own care as much as possible.
Even if a patient cannot care for themselves fully, I'm not going to provide total care, right?
It's very important to maintain my patient's dignity but also to maintain their function.
So if my patient is very limited and all they can do is take a washcloth and wash their face,
I want them to wash their face every time. I'm going to encourage them to participate in their
own care and help me out in that way. It's really, really, really going to be in the best interest of
your patient. Okay. Now tell me in the comments what's the best way to assess a patient's ability
to perform their ADLs. Is it by asking the family or observing the patient? Let me know below.
Okay. So moving on. This card, I want you to know, is incredibly important for every single thing you
do in nursing school. You've got to learn it, accept it, get a necklace that says it, okay?
This is deep vein thrombosis. You got to know all about it. So DVTs. This is what happens
when we have clotting of blood in a deep vein, so deep vein thrombosis, deep vein clots. This
is typically in the calf. It can be other places, but you will see it most of the time in the calf
and thigh. Big signs and symptoms to be aware of. We're going to have erythema, redness
at the site, so probably the calf. We are going to have swelling, edema, at the site also because
we're getting that vascular congestion where there's a traffic jam. We are going to have
extreme pain at the location, right? And you may hear this called a positive Homans' sign. Positive
Homans' sign is when I am standing with my feet on the floor and I raise my toes to my nose.
On the affected site, it's going to hurt a lot. Don't encourage your patient to do that. We don't
want them to dislodge the clot. But if they say that, then you know that that's a positive Homans'
sign. Things that we need to know. We don't put pillows-- or you'll hear it called knee gatches.
We don't put them directly behind the knee because that cuts off that blood supply. But we do want to
elevate the legs, so maybe an inclined pillow but nothing directly behind the knee. We never massage
the area. Massaging the area puts us at risk for dislodging that clot and developing a pulmonary
embolus. And it's also important to know that we can use warm and moist compresses. That's going to
help to relieve some of that pain. So elevate, don't massage, and warm, moist compresses.
Now, what do I need to tell the provider? I need to tell the provider if my patient with
DVT develops sudden onset chest pain, shortness of breath, if their pulse ox drops, their heart
rate goes up. Anything like that could be a sign that they have developed a pulmonary embolism,
meaning that part of the clot in the deep vein has broken off and traveled to the lungs. Very,
very bad, a true medical emergency. Report those findings immediately. Okay. So last
thing we're going to talk about is how do you as a nurse combat the effects of immobility,
what do you do to help prevent or treat the things that can happen that we've already talked about.
Again, we've got some nice bulleted points here for you. I'm going to tell you: coughing,
deep breathing, and incentive spirometry, those three are going to help keep my lungs
open and moving air, very important. TED hose. Those are going to be those compression hose,
and they're going to help with blood return from the legs. Or SCDs, sequential compression devices,
those are the little devices that give your leg a squeeze every now and then, again, helping to move
that blood back from the legs. Things we can do as well are going to be providing anticoagulation as
ordered. So most hospitalized patients receive Lovenox, which is a low-molecular-weight heparin
also called enoxaparin, subcutaneously to help prevent DVTs. We're going to reposition our
patient every two hours. We're going to encourage range of motion. Even if all I can do is this,
right, I want my patient doing that. That's awesome. Increase fiber and fluid to help with
the bowel and urinary symptoms. We are going to encourage our patient to move as tolerated or
allowed. And then I'm also going to want to work with physical therapy and occupational therapy
as needed to help with these things as well. So I hope that review was helpful. I'm going
to tell you immobility is huge in nursing school. You got to know all about it. So rewatch this if
you need to. Leave me a Like if you thought that this was a helpful comment-- excuse me,
a helpful video. And I'd love to hear your comments below. If you have a really great way
of remembering something, especially when it comes to all the nursing interventions for immobility,
I want to hear it. Be sure you subscribe to the channel so that you are the first to know when the
next video comes out, which is going to be talking about mobility devices such as canes, walkers,
and crutches. Thanks so much, and happy studying. [BLOOPERS]
I took a big breath at the end there. I don't know why. [laughter]
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