1

Marija Buttery
Version 4 2012
QuickTime and a
decompressor
are needed to see this picture.
COMPLICATIONS
of
PROLONGED
BED REST
2
Pressure Area Care (PAC)
What are pressure ulcers?

What are pressure sores?

What are decubitis ulcers?

What causes them?

How do we prevent them?
3
Pressure Ulcers
Any lesion caused by unrelieved
pressure resulting in damage of
underlying tissue (AHCPR 1994)
Pressure ulcers can occur anywhere on
the body
Pressure Ulcers, Pressure Sores and
Decubitis Ulcers are all the same thing
4
Pressure ulcer staging
Stage I Persistent redness
Stage II Partial thickness skin loss
Stage III Full thickness skin loss
(subcutaneous)
Stage IV Full thickness loss (to fascia)
5
Pressure Area Care
One of the vital roles of the nurse after
assessment is to prevent damage/illness.
There are a variety of patients who we assess
and determine as being at increased risk of
developing pressure sores.
Implementation of Norton Risk Assessment
scale, Braden Scale, Gosnell Scale (and
possibly others) is meant to reduce
development of new pressure ulcers in high
risk patients

6
Pressure ulcer causes
Prolonged pressure
Duration and intensity
Location
Extended pressure that blocks flow to the
tissue between the source of pressure and
the bone
Shear
Friction
7
Pressure ulcer etiology
Pressure exerted by bony prominences on
the body that stop capillary flow to the
tissues.
Deprives tissues of oxygen and nutrients
causing cell death.
Pressure greater than 32mmHg exerted by
bony prominences disrupts blood flow.

8
Pressure ulcer etiology
Function of both time and pressure
70mmHg pressure for two hours produces
irreversible injury
greater pressure takes less time
lower pressure takes more time
obese may be much lower; emaciated may be
much higher risk
TURNING SCHEDULES MUST BE
INDIVIDUALISED!!!!

9
Pressure Prevention
The main prevention of these ulcers is to stop
the damage before it starts. This includes all
three causes:
pressure
friction
shearing
Management also includes assessment,
monitoring and evaluation of the person as a
whole and improving aspects such as
nutrition
fluid balance
skin integrity
movement/mobility
underlying health conditions
cognitive function
10
Pressure Causing Things
Class discussion

Sheets and blankets
Monitors
Tubing (oxygen, drips and drains etc.)
Clothing (including nappies)


11
WHERE ARE THE POTENTIAL
PRESSURE POINTS?

Positions

Supine

Prone

Lateral

Orthopnoeic
12
MOBILITY
To care for clients who have limited mobility,
the nurse needs to understand the physical
and psychological effects of immobility, the
complications these may lead to and nursing
interventions that can prevent these
complications.
One of the nurses roles is to encourage
mobility, whether that be passive or active.
13
MOBILITY
The provision of various devices may help the
client to be more independent. It may also
assist the nurse in not having to use as much of
their own physical force to ambulate the patient.
Assessment of the patients mobility should be
assessed each time they require assistance,
whether that be in bed or out.
This constant update of information allows for
the nurse to better protect themselves against
injury and be in a better position to provide the
most appropriate assistance to their client.
14
USE OF MOBILITY AIDS
Ensure the equipment is in working
condition
Adjust the aid to the correct height for
the individual
Ensure the patient knows how to use
the walking aid correctly
Maintain a safe environment
Evaluation
15
MOBILITY AND EXERCISE
The musculoskeletal, nervous and
cardiovascular systems combine to allow for
movement.
Exercise can be active or passive.
Active exercise involves voluntary effort.
Passive exercise is movement by another
individual.
16
Why Exercise?
Stimulation
Promote circulation
Muscle tone and strength
Joint mobility
Relaxation - can promote sleep
Combat boredom
Combat stress

17
Complications Of Decreased
Mobility and Bed Rest
Pressure on bony prominences decubitis ulcers
Decreased use of muscles and joints muscle wasting
and contractures
Venous stasis Deep Vein Thrombosis (DVT)
Pulmonary Stasis lung congestion
Urinary Stasis infection or calculi
Decreased intestinal peristalsis constipation
Decreased vasomotor tone hypotension
Decreased independence depression, boredom,
anxiety
Foot drop
18
Thrombosis
Some people are at greater risk of a DVT forming
than others
If a DVT does form it needs to be treated quickly to
prevent the clot from breaking , travelling around the
body causing greater damage such as
Cerebrovascular Accident (CVA)
Myocardial Infarction (MI)
Pulmonary Embolis (PE)
Treatment includes restricting mobility, medication to
reduce blood clotting, and treating the symptoms
19
Sequential Compression Devices (SCD) -
also known as calf stimulators, for
prevention of DVT.

Should be used in conjunction with anti-
embolic stockings
Sequential Calf Compression
20
Relief of Pressure On Feet
Pleat in the sheets/blankets
Bed Cradle - reduces the pressure
on the top of the feet for pain relief
or the prevention of foot drop
(another complication of prolonged
bed rest)
21
The Lungs

Pooling of secretions in the lungs from
prolonged bed rest and lack of movement can
lead to lung damage and pneumonia. Deep
breathing and huffing exercises are needed to
expand the lungs and expectorate the
secretions
22
The Kidneys

Pooling of urine in the urinary bladder
from lying in one position increases the
risks of urinary tract infections
23
Any Questions?