jueves, 4 de abril de 2013

IMMOBILITY


Decrease of the capacity to do the daily activities because of the motor function deterioration.

Causes of the immobility
Physiological:
  - Decrease of mass and strength muscular, senile march.
  - Decrease of sensibility and reflex.
  - Decrease of cardiac frequency, aerobic capacity.
  - Decrease of elasticity of thoracic wall.
Usual diseases:
  - Osteoarthritis, arthritis, osteoporosis, fractures…
  - Brain damage, Parkinson, dementias…
  - Cardiac insufficiency…
  - Visual deficits, vertigo.
  - Depression.
Environmental causes:
  - Obstacles.

Nursing evaluation
Anamnesis:
  - Determine the type and frequency that the patient realize exercise like footing, ride a bike…
  - How start de immobility and the rank.
  - Pharmacology history.
  - Risk factors.
  - Analyze social factors.

General exploration
We must explore all the systems like cardiorespiratory, musculoskeletal, neurologic, skin, sensorial…

Mental evaluation
  - Memory, attention, concentration… We’ll use Mini-examen cognitive
  - Detect anxiety or depression. For this we’ll use Geriatric Depression Scale

LEVEL MOBILITY EXPLORATION
To do that, the patient have to wear his usual clothe and help mechanisms (cane). It will be examined the mobility in the bed, in the chair, in the bathroom… all the rooms in the house.

Next, we’ll test de march and equilibrium with scales and tests.
  • Timed Up and Go test: the patient has to stand up and sit down in a chair. This test predicts the capacity to move independent. 
  • Tinetti scale: evaluate the march and the equilibrium. 
Actuation plane
  - Treatment the cause of the immobility.
  - Plane rehabilitation.
  - Use of helps and adaptations to patient’s house.

General cares
  - Postural changes.
  - Hygiene.
  - Massage.
  - Padded.
  - Liquids and food contribution.

Prevention of complications
  • Control de cardiac frequency, blood pressure…
  • Tell to patient that he must cough and expectorate, use clapping…
  • Inspect the mouth, teeth. Promote to have lunch with someone, to not be alone.
  • Maintain a correct position during the urination. Exercise the abdominal wall.
  • Promote the expression of the feelings and emotions. 
IMMOBILITY PATIENT IN BED
The changes would be realized every 2 hours. If it’s possible, the patient must do exercises in the bed.

In the armchair, the patient has to stay straight with pillows. The legs must to be elevated over a footstool to prevent the edema.

WALK
The patient must walk every day, slowly and increasing the distances. He/she can use a cane or not.


It’s important motivate and promote the exercise in the ageing because the immobility together with the natural process of ageing result in serious problems like depression, ulcers, loss of muscle mass…

We must show them different ways to do exercise, if its possible with other old people. This helps will tell to the family to, to guarantee us that our patients do something to combat with the immobility and her consequences.


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