Bed rest complication

PRAVINRAJ V MPT SPORTS PHYSIOTHERAPY ANNAMALI UNIVERSITY.

1. BED REST COMPLICATION V PRAVINRAJ MPT SPORTS

2. BED IS BAD

3. IMMOBILITY

4. MOBILITY

5. CAUSES Physical Psychological Environmental

6. PHYSICAL Muscular skeletal disorders Arthritis Osteoporosis Fractures (especially hip and femur) Podiatric problem Others e.g. Paget's disease. Neurological disease Stroke Parkinson disease Others ( cerebellar dysfunction, neuropathies)

7. Cardio vascular disease Congestive heart failure(severe) Coronary heart diseases Peripheral vascular disease Pulmonary disease COPD(severe) Acute and chronic pain Malnutrition Drug side effects( e.g., antipsychotic, vasodilators) Sensory factors impairment of vision

8. PSYCHOLOGICAL Fear (from instability and fear of falling) Depression

9. ENVIRONMENTAL CAUSES Forced immobility( in hospital and nursing home) Inadequate aids for immobility Poor lightening.

10. SKIN Pressure ulcers Immobility threatens healthy skin integrity and can become severe enough to result in pressure ulcers. The first sign is redness that won’t blanch. stage 1 – redness of intact skin. stage 2 – abrasion, crater or blister; ulcer is shallow. stage 3 – damage to subcutaneous tissue, extending down to fascia; deep crater, possibly with drainage. stage 4 – damage to muscle, bone, tendon or joint capsule; small or large surface wound, but with extensive tunneling, and foul smelling discharge.

11. MUSCULOKELETAL Muscle : disuse atrophy “ IF YOU DON’T USE IT, YOU’II LOSE IT,’’ Loss of muscle strength, muscle atrophy (begins after 1 day of immobilization. 1-3%/day muscles may lose half of their bulk after 2 months) Bone : increased bone resorption (osteoporosis) increased risk of the fracture. Dorsal kyphosis . Chronic back pain and 1% loss of vertebral mineral content per week. Hypercalcemia .

12. Joints : Immobilization can induce cartilage degeneration. Contractures (contributing factors include spasticity, improper bed positioning and maintaining the limb in a shortened position) Joint stiffness and pain: if joints are not given adequate full range of motion. The stiffness is due to tightness of the muscles and tissues surrounding the joints.

13. CARDIOVASCULAR Increased heart rate ( 1 beat / minute in every 2 days) Decreased coronary blood flow and decreased O2 available to cardiac muscle. Orthostatic hypotension( 3 weeks of bed rest): due to Excessive pooling of the blood in the lower limb. it may leads to faintness, weakness or dizziness in an attempt to stand. The patient is at high risk for injury due to falls. Decreased circulating blood volume. 20 days of bed rest may lead to a 25% of decreased stroke volume and a 20 % increased in heart rate.

14. Thrombus formation: This is development of clot in a vein due to venous stasis, increased coagulability of blood and damge to the endothelial wall of the vessel. DVT present as groin or calf tenderness, pain, warm and edematous extremities. It poses the danger of throwing off an emboli leading to pulmonary infraction.

15. PULMONARY Decreased strength of respiratory muscles. Its lead to decreased tidal volume, minute volume, respiratory capacity. Increased respiratory rate to compensate for decreased respiratory capacity. Decreased ability to clear secretions (cough reflex). Accumulation of secretion in the lower bronchial tree, which can block airways, cause atelectasis and increase the risk of pneumonia.

16. GASTROINTESTINAL Anorexia Constipation : Weakening of the abdominal wall muscles, leading to difficulty in raising the intra-abdominal pressure sufficiently for defecation. loss of privacy and embarrassment if toilet assistance is needed. bowel irregularity may produce abdominal discomfort, as well as cause loss of appetite.

17. GENITOURINARY Immobility leads to inability to completely empty the bladder, leads to urinary tract infection, renal calculi and bladder calculi formation. Increased post-void residual volume retention. Urinary incontinence – the loss of bladder control.

18. ENDOCRINE Hypercalcemia Decreased parathyroid hormone Increased plasma renin activity Increased aldosterone secretion Altered growth hormone production Altered spermatogenesis and androgen secretion Negative nitrogen balance

19. PSYCHOLOGICAL Increased immobility may result in a loss of independence and can cause the elder client to have a sense of isolation and even depression as they become less able to navigate their world. Behavior disturbances. Anxiety. Sleep disturbances.

20. THANK YOU