#2..ALL DONE!

P. 1068-1071

2. Discuss the effects of immobility on each system:

-musculoskeletal system
-Disuse osteoporosis: w/o the stress of weight bearing acivities, the bones demineralize. With osteoporosis the bones are depleted of calcium which gives the bones strength and density.
- Disuse atrophy: unused muscles atrophy(decrease in size) losing most of their strength and function.
-Contractures: permant shortening of the muscles, limiting joint mobility. Eventually involves tendons, ligaments, and joint capsules and is irreversible except by surgery.
-Stiffness and pain in joints: the collagen(connective) tissues at the joint become ankylosed (permanently immobile). Also the bones demineralize and excess calcium may deposit in the joints contributing to stiffness and pain.

-Cardiovascular System:
-Diminished cardiac reserve: imbalance in the autonomic nervous system, resulting in a preponderance of sympathetic activity over cholinergic activity that increases HR. Rapid HR reduces diastolic pressure, coronary blood flow, and the capacity of the heart to respond to any metabolic demands above the basal levels. Experience tachycardia w/ minimal exertion.
- Increased use of valsalva maneuver: holding the breath and straining against a closed glottis. Tachycardia and arrythmias can result if the client has cardiac disease.
-Orthostatic (postural) hypotension: vasoconstriction prevents pooling of the blood in the legs and effectively maintains central BP to ensure adequate blood perfusion of the heart and brain. During prolonged immobility thid reflex becomes dormant. When the immobile person tries to sit or stand, this reconstricting mechanism fails to function properly inspite of increased adrenalin output. Blood pulls in the lower extremities and central BP drops. Cerebral perfusion is compromised and the person feels dizzy or lightheaded and may faint. This is usually accompanied with an increased HR.
-Venous vasodilation and stasis: the skeletal muscles do not contract sufficiently, and the muscles atrophy. The skeletal muscles can no longer assist in pumping blood back to the heart against gravity. Blood pools in the leg veins, causing vasodilation and engorgement. Known as incompetent valves.
-Dependent edema: When the venous pressure is suficiently great, some of the serous part of the blood is forced out of the Blood vessel into the interstitial spaces surrounding the blood vessel, causing edema. Most common in parts of the body below the heart. Most likely to occur in sacrum of the heels and the lower legs.
-Thrombus formation: thrombophlebitis(a clot that is loosely attached to an inflamed vein wall): impaired venous return to the heart, hypercoagulability of the blood, and injury to vessel wall. nA theombus is particularly dangerous if it breaks loosse fromt the vein wall and enters circulation as an embolus.

-Respiratory System:
-decreased respiratory movement: The body presses against the rigid bed and curtails chest movement. The abdominal organs push against the diaphragm, restricting lung movement and making it difficult to fully expand the lungs. B/C an immobile person rarely sighs there is no stretching movements and thge cartilaginous intercostal joints may become fixed in an expiratory phase of respiration. These changes produce shallow respirations and reduce vital capacity.
-Pooling of respiratory secretions:Inactivity allows secretions to pool by gravity interfering w/ the normal difusion of oxygen and CO2 in the alveoli.
- Atelectasis:Bed rest reduces the amount of surfactant produced. The combo of decreased surfactant and blockage of a bronchiole with mucus can cause atelectasis (collapse of a lobe or an entire lung).
-Hypostatic pneumonia: Pooled secretions allow for bacterial growth. Under these conditions, a minor upper respiratory infection can evolve rapidly into a severe infection of the lower respiratory tract. Pneumonia caused by static respiratory secretions can severely impair oxygen-carbon dioxide exchange in the alveoli and cause death.

-Metabolic System:
-Decreased metabolic rate: basal metabolic rate and gastrointestinal motility and secretionsof various digestive glands decrease as the energy requirements of the body decrease.
- Negative Nitrogen balance: catabolic processes(protein breakdown) exceed the anabolic processes(protein synthesis). Catabolized muscle mass realease nitrogen. Over time, more nitrogen is excreted than ingested. The negetave nitrogen balance represents a depletion of protein stores that are essential for building mudcle tissue and for wound healing.
-Anorexia: Loss of appetite b/c of the decreased metabolic rate and the increased catabolism that accompany immobility.caloric intake is decreased.
-Negative Calcium balance: direct result of immobility. Greater amts. of Ca are extracted from the bone than replaced. Bones need weight bearing and stress for Ca to be replaced.

-Urinary System:
-Urinary stasis: when a person remains in a horizontal position, gravity impedes the emptying of urine from the kidneys and the urinary bladder. The renal pelvis may fill w/ urine before before it is pushed into the ureters, and empyting is not as complete. Also, muscle tone is decreased in immobility, including the detrusor muscle and bladder emptying is also compromised.
-Renal calculi: The urine becomes more alkaline and the calcium salts precipitate out as crystals to form renal calcculi (stones). As the stones pass along the long narrow ureters they cause extreme pain and bleeding and can sometimes obstruct the urinary tract.
-Urinary retention: (accumulation of urine in the bladder). bladder distention, and urinary incontinence(unvoluntary urination). This is caused by decreased muscle tone and the immobolized person is unable to relax the perineal muscles sufficiently to urinate. The bladder may stretch excessively, eventually inhibiting the urge to void.
-Urinary infection: static urine provides an excellent medium for bacteria to grow.urinary distention often causes minute tears in bladder mucosa, allowing infectious organisms to enter. The increased alkalinity caused by hypercalcuria supports bacterial growth.E. coli causes the most infections.

-Gastrointestinal System
-Constipation is a frequent problem b/c of decreased perstalsis and colon motility. Repeated postponement eventually suppresses the urge and weakens the defecation reflex. Some excessively use the Valsalva manuever and this effort increases the intra-abdominal and intrathoracic pressures and places undue stress on the heart and circulatory system.

-Integumentary System
- Reduced skin turgor: skin can atrophy. Shifts in body fluids between the fluid compartments can affect the consistency and health of the dermis and subq tissues, eventually causing a gradual loss of skin elasticity.
-skin breakdown: normal blood circulation relies on muscle activity. skin breakdown and pressure ulcers can occur.

-Psysconeurologic System
-Immobility can lower self-esteem. Frustration and decreased self esteem can provoke emotional reactions. Persons perception of time intervals deteriorates as a result of lack of intellectual stimulation and the stress of the illness and immobility. Immobility can impair social and motor development of young children.