well welcome to this video the subject
we're looking at today uh is the
complications of
immobility now Mobility is the ability
to move around freely and at will so
immobility is any interference with the
ability to move around freely and at
will and it's important to realize that
immobility can refer to all of the body
whole body immobility or it can refer to
part of the body part of the body body
immobility but before we actually start
looking at the the content uh there's
one thing I want to point out about
nursing and that is that a lot of good
nursing is
invisible you can't actually see it
because a patient comes into Hospital
maybe has an
operation gets better goes home and
everything's okay there's no
complications and what the nurses have
been doing very often is not obvious but
in fact the nurses have been been doing
a lot of things that have been
preventing
complications so nurses need to know in
detail about all the complications that
can occur to their patients and what
we're looking at today is really
complications the complications of
immobility so nurses need to know about
these complications and because nurses
know about them they account for them
and because the nurses account for them
these complications hopefully never
occur and if the complications never
occur it means the patients never even
know never even knew that these
complications existed they remain in
Blissful ignorance of these
complications so very often it looks
like nurses have not been doing very
much but in actual fact by interventions
they've been preventing these
complications
occurring not very good for the ego of
nurses but it's an important point that
a lot of good nursing is invisible
because we're preventing these things
happening so hazards of immobility let's
start off by looking at some possible
causes of immobility Fairly briefly
we're not going to do this in detail but
causes of immobility
first what causes
immobility well this is any condition
any condition at all where the traumatic
or pathological in which movement is
restricted so movement might be
restricted in a simple case of something
having a fractured arm and a cast on it
to being completely ComEd and utterly
immobile in every
way so as we said whole body immobility
or part body immobility whether caused
by disease or whether caused by
trauma so for example devices can cause
immobility we used to keep patients on
traction for huge periods of time we
tend not to do that very very much these
days we tend to use external fixations
for fractures but you know various
devices um ventilators things like that
can restrict patient
movement now another cause of immobility
is
um impairment of neuromuscular
function whenever the nervous system or
the muscles are not working properly
there's going to be
immobility for example if the spinal
trauma and there's a transverse uh
transverse damage to the spinal cord
then no no impulses from the top of the
spinal cord can get to the bottom so the
lower part of the body can be
immobilized this can also happen in a
number of disease processes such as
guong Barry syndrome or muscular
distrophy or my Mia gravis or motor
neuron disease many diseases can affect
the nervous system and the musculature
therefore movement is not going to be
possible so devices neuromuscular
function
and voluntary immobility imposed bed
rest but not very often used these
days now if you go back to say the 1920s
1930s bed rest was imposed for virtually
every
condition but then they found out uh in
the second world war when soldiers were
often severely injured but they were
rehabilitated fairly quickly and not
left lying around for weeks and months
that they actually got better much
quickly much more quickly so starting
from after the second world war patients
were remobilized for shorter periods of
time and they found out that that
improved the prognosis that they
actually got better quickly if the
patients were not
immobilized so changing from bed rest
being the treatment for almost
everything now bed rest is the treatment
for some things but not very many now
the emphasis is very much on early
Rehabilitation early mobilization
even after someone's had say a myio
myocardial infarction then mobilization
tends to occur fairly early we'll sit
them out of bed the day after and start
mobilizing maybe the day after that so
um mobilization is measured in day
remobilization is measured in days not
weeks and months we do still arrest some
conditions for example spinal injuries
conditions where there's inflammation or
acute illness of course the patient
needs to rest but very often early
mobilization is is is the order of
treatment and we do this to prevent the
complications of immobility for example
after surgery I mean basically we get
the patients up as early as we can as
early as they can tolerated because it
gets them moving around and it makes
these complications less likely to occur
so I think to try and condense what I've
said the rule of thumb is only keep
patients immobilized if you've got a
good rationale for doing so that might
be a a fairly good rule of thumb so
voluntary
immobilization you use if there's a
reason to for example if there's an
inflammatory condition or the patient's
acutely ill or you have another good
rationale for doing so of course part
body immobilization might occur to allow
a fracture or a tendon to
heal but normally mobilization is the is
the treatment of
choice and finally psychiatric causes
people may become immobile because
they're uh in a depressive stuper or
they're too depressed to to get out of
bed or in simple schizophrenia where
they don't have the motivation or the
valtion to get out of bed or in other
rare conditions such as catatonic
schizophrenia which is characterized by
periods of
immobility so various causes of
immobility