This document discusses common physiologic disabilities and interventions. It identifies five major problems as pain, stiffness, decreased muscle strength, loss of dexterity, and loss of locomotor ability. Complications of immobility can impact the cardiovascular, respiratory, skin, gastrointestinal, musculoskeletal, urinary, and neurological systems. Common interventions include rest, assistive devices, heat/cold therapy, traction, bracing, positioning, exercise, medications, nutrition management, and surgery. The goal is to preserve function, prevent deformity, correct existing deformities, and help patients compensate and adapt.

1. Physiologic Disabilities
Common Problems
&
Interventions

2. COMMON PROBLEMS

3. Five major problems :
1. PAIN
2. STIFFNESS
3. DECREASE IN MUSCLE
STRENGTH
4. LOSS OF DEXTERITY
5. LOSS OF LOCOMOTOR
ABILITY

4. PAIN
 Pain is the priority problem.

5. STIFFNESS
 Decreased flexibility
 Can be a result of pain, or of
disuse or it can be a result of
pathophysiologic changes

6. DECREASE IN MUSCLE
STRENGTH
 a primary problems, as with
some myopathic and
neuropathic disorders, or it
can result from prolonged
bed rest or immobility

7. LOSS OF
DEXTERITY
 skilful use of hands or body

8. LOSS OF LOCOMOTOR
ABILITY
 Temporary or complete loss
of the ability to move freely
from one place to another or
care for one’s self.

9. System Involved:
Complications of
Immobility

10. CARDIOVASCULAR
Mechanism:
Failure of vessels in legs to
assume or maintain a state of
vasoconstriction, resulting in
pooling of venous blood.

11. Potential Complication:
Deep vein thrombosis (DVT)
Pulmonary embolism (PE)
Increase work load on heart
Diminished cardiac output
Decreased ability to adapt to
erect posture

12. RESPIRATORY
Mechanism:
Decrease movement
Decrease stimulus to cough
Decrease depth of ventilation

13. Potential Complication:
Pooling of secretions in
bronchi, bronchioles
Hypostatic pneumonia

14. SKIN
Mechanism:
Pressure or shearing forces
(two or more tissue layers
sliding on each other or tissue
sliding on another surface)
disrupting or decreasing
circulation to an area.

15. Potential Complication:
Skin breakdown
(abrasion or decubitus
ulcer)

16. GASTROINTESTINA
L
Mechanism:
Decrease bowel mobility
Change in dietary habits
Disadvantageous
positioning for defecation

17. Potential Complication:
Constipation
Impaction

18. MUSCULOSKELETAL
MUSCLES
Mechanism:
Disuse
Potential Complication:
Atrophy
Weakness

19. JOINTS
Mechanism:
Limited motion leads to
muscle, tendon shortening
Potential Complication:
Contracture
Fibrosis or bony ankylosis
around joints

20. BONES
Mechanism:
Disruption of balance of
osteoblastic/osteoclstic
activity with destruction of
bone matrix and release of
calcium.
Potential Complication:
Osteoporosis

21. URINARY
Mechanism:
Increase urinary pH, increased
citric acid
Poor bladder emptying
Potential Complication:
Renal stones
Urinary stasis

22. NEUROLOGIC
Mechanism:
Loss of normal stimuli
Potential Complication:
Confusion
Restlessness
Forgetfulness

23. COMMON
INTERVENTIONS

24. Common interventions:
1. Rest, activity, joint protection,
energy conservation
2. Assistive, supportive, and
safety devices
3. Application of heat and cold
4. Traction
5. Splinting and bracing

25. 6. Positioning and transfer
7. Exercise
8. Medications
9. Surgical interventions

26.  Rest, activity, joint
protection, energy
conservation
REST
 A therapeutic measure used in
many inflammatory and traumatic
conditions of the musculoskeletal
system.
 However, too much rest can at
times be as detrimental as too
much activity.

27. Two Forms of Rest:
1. Absolute rest or no activity.
2. Partial rest or limited
activity.

28. Nurse’s responsibility in helping
the patient rest:
 Help patient understand the
meaning of “rest” as it applies
to him or her.
 Take over functions for the
patient that would require use
of body part beyond limits
prescribed.

29.  Teach the patient how to
effectively use body parts
not required to rest.
 Gradually return functions
to the patient when rest is
no longer required.

30. ACTIVITY
 Activity, particularly in chronic
conditions, must be balanced with
adequate rest.
 Individuals who have pain with
certain activities or increase pain
and stiffness following certain
activities must learn to recognize
their tolerances and adapt their
ADL accordingly.

31. • Nurses can help patients
determine their activity needs
in the following ways:
Teach the patient the
advantages of continuing, but
modifying, activity
Help the patient identify his
or her own activity tolerances

32. Help the patient work out an
activity schedule
approximating rest/activity
requirements at home.
Help the patient work through
concerns about not being able
to perform all activities he or
she believes are necessary or
desired.

33. Joint Protection & Energy
Conservation
 Individual with joint involvement
and /or activity intolerances can
learn to protect their joints and
themselves from overuse, misuse,
and stress by becoming aware of
and practicing joint protection and
energy conservation techniques.

34. Techniques:
 Avoid positions of possible
joint deformity
 Avoid holding muscles or
joints in one position for a
long time

35.  Use the strongest joints for all
activities
 Use joints in their best
position, maintaining good
standing and sitting posture
 Conserve energy

36. Nursing Intervention:
 Teach the patient to recognize
the symptoms of overactivity.
 Teach the patient appropriate
energy conservation and joint
protection techniques.
 Encourage the patient to use
those techniques in ADL.

37. Assistive, supportive, and
safety devices
Assistive devices
 Viable for individuals who
have impairement of upper
and/or lower extremity
function.

38. Some assistive devices for persons with
motor impairments:

40. Supportive devices
 Ambulatory aids
 Usually recommended for
persons who cannot bear
weight on one or more
joints of the lower
extremities

41. •Some considerations
regarding choice of device
include:
Axillary crutches
Walkers
Canes

42. Safety devices
 Enhance function and
prevent accidents when
normal function,
balance, or dexterity are
compromised.

43. Application of heat and
cold
Heat
 Used for relieving stiffness
and relaxing muscles and
for analgesic effect and
sedative effect.

44.  Heat may be applied in a
variety of ways:
Dry heat
Moist heat

45. Cold
 Helpful in reducing or
preventing swelling,
reducing pain, and
relieving stiffness

46. Heat and cold should be
applied with caution to any
individual with decreased
sensation, because that
person will not be able to
determine if damage is
occurring.

47.  Nursing intervention with
heat and cold include:
Helping patient determine
which type of application
works best
Instructing patient about
safety precautions to be
observed with that method

48. Instructing patient about
timely application of heat
and cold depending on
patient’s particular needs.
Assisting the patient with
application.

49. Traction
 Used to help reduce contractures
or to relieve pain in the presence
of muscle spasm.
 It can be applied intermittently or
constantly and usually in the form
of skin traction, that is Buck’s
extension, Russell traction, or
pelvic traction.

50. Splinting and bracing
 Purposes:
 Stabilize or support a joint
 Protect a joint or body part from external
trauma
 Mechanically correct dysfunction such
as footdrop by supporting the joint in its
functional position
 Assist patients to exercise specific joints

51.  When patients need to use
braces or splints, nurses need to:
Inspect patient’s skin after the
orthosis has been applied for a
short time to be certain it has
caused no skin irritation
Notify orthotist if adjustments in
the orthosis need to be madee to
make it more comfortable or
relieve chafing

52. Instruct the patient in the
proper appllication and
care of th eorthosis
Assist the patient to make
the psychologic adjustment
to wearing the orthosis

53. •Types of splints and braces and
their function:
 Spring-loaded braces
 Oppose the action of unparalyzed
muscles and act as partial functional
substitutes for paralyzed muscles
 Resting splints
 Maintain a limb or joint in a functional
position while permitting the muscles
around the joint to relax

54. Functional splints
 Maintain the joint or limb in a
usable position to enable the
body part to be used correctly
Dynamic splints
 Permit assisted exercise to
joints, particularly following
surgery to finger joints

55. Positioning and transfer

56. Exercise
 Exercise is a prescribed form
of activity designed to
accomplish the following:
Preserve joint mobility
Maintain muscle tone
Strengthen selected muscle
groups

57. Medications
 antiinflammatory analgesics
Teach patients the expected
effects of the drugs
How to use them appropriately
How to recognize side effects
or toxic effects.

58. Use of narcotic analgesics in
chronic inflammatory
musculoskeletal conditions is
generally contraindicated.

59. Promoting nutrition
 important for individuals with musculoskeletal
problems for anyone else
 Patient should pay particular attention to
avoiding weight gain
 For many individuals with mobility problems,
however, the problem of weight and mobility
becomes a vicious circle.
 This cycle can be broken only by weight loss
through a properly supervised reduction diet.

60. Nurses can help in the following
ways:
 Teach patient the importance of a well-
balanced diet
 Teach patients the importance of restricting
weight gain
 Encourage patients to select food wisely
 Encourage the patient family to bring home
cooked food if the patient is not eating
hospital food particularly following surgery
when the patient needs to maintain a positive
nitrogen balance

61. Surgical interventions
Indication period:
 Two categories:
 Those who have suffered trauma such
as a fracture
 Those who require an elective
orthopaedic procedure for correction of
deformity, relief of pain, or restoration of
musculoskeletal function .

62. •Four major objectives of
orthopaedic treatment:
1. Restoration or maintenance of function
of a body part
2. Prevention of deformity
3. Correction of deformity if it already
exists
4. Development of the patient’s powers of
compensation and adaptation if loss of
function or permanent deformity is not
preventable

63.  It is important that those
caring for the patient know
and understand what the
expected outcomes are so
that care may be adapted to
achieving them.

64. Types of surgery:
 Arthrotomy
=opening of a joint
• Arthroplasty
=reconstruction of a joint

65.  Synovectomy
=removal of part or all of
the synovial membrane
• Osteotomy
=cutting a bone to change
its alignment

66.  Arthrodesis
=causing the bones of a joint to
grow together by removing
articular hyaline cartilage,
introducing bone grafts, and
stabilizing with external fixation
• Tendon transplants
=moving a tendon from its
usual position