Prolonged immobility is associated with?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021

Explanation

Prolonged immobility disrupts the balance between bone formation and bone breakdown (resorption).
The lack of mechanical stress from weight-bearing activities accelerates bone resorption, causing calcium to be released from the bones into the bloodstream.
This process leads to an elevation in serum calcium levels, a condition known as hypercalcemia.
The kidneys may not be able to filter out the excess calcium, increasing the risk for the formation of renal calculi (kidney stones).

Option A: This is the opposite of what occurs. Immobility leads to an increase in bone resorption as the lack of weight-bearing stress causes bone demineralization.
Option B: The cardiac workload increases, it does not decrease. The heart has to work harder to pump blood due to venous stasis and general deconditioning.
Option D: Prolonged immobility does not typically increase the hematocrit level. It can be associated with a decrease in plasma volume and red blood cell mass, which may lead to a normal or slightly decreased hematocrit.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Systemic effects of prolonged immobility as background academic context rather than a clinical decision trigger.
Nurses are at the forefront of preventing the hazards of immobility. Key interventions include frequent repositioning, encouraging active/passive range-of-motion exercises, and promoting early ambulation.
Monitoring for signs of hypercalcemia (e.g., nausea, vomiting, confusion, lethargy) and renal calculi (e.g., flank pain, hematuria) is a critical nursing assessment for immobile patients.
What if? If the immobile patient also had a history of chronic kidney disease, their risk for severe hypercalcemia would be even higher because their ability to excrete the excess calcium released from bones is already compromised.

How to Approach the Question

First, identify the core concept of the question, which is the physiological effects of 'prolonged immobility'.
Think about the principle of 'use it or lose it' as it applies to the human body.
Consider how lack of weight-bearing affects the skeletal system. Bones require stress to maintain density. Without it, they break down (resorb) and release their primary mineral, calcium, into the blood.
Evaluate each option based on this physiological reasoning:
Does bone breakdown increase or decrease? It increases.
Does the heart work harder or easier when the body is deconditioned? Harder.

Concept Tested & Keywords

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E6 Nursing Fundamentals Taylor p. 316-318

E6 Nursing Fundamentals Potter Perry 12e Part 4 p. 132-134

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