Which of the following is a hazard of immobility?

SJH Nursing Officer - 2019

Nursing Foundation

Easy

Appeared in: SJH Nursing Officer - 2019

Explanation

Immobility disrupts the normal balance of bone metabolism. Without the mechanical stress from weight-bearing, bone resorption (breakdown) by osteoclasts increases, while bone formation by osteoblasts slows down.
This imbalance leads to a net loss of bone mass and density, a condition known as disuse osteoporosis.
As bone breaks down, calcium is released into the bloodstream. This not only weakens the bones, making them susceptible to pathological fractures, but can also lead to hypercalcemia (high blood calcium).
The excess calcium is then excreted by the kidneys, increasing the risk for renal calculi (kidney stones).

Option B: Immobility leads to a decrease, not an increase, in vital capacity. Reduced chest wall movement and shallow breathing patterns cause parts of the lungs to be underutilized, leading to atelectasis (alveolar collapse) and reduced overall lung function.
Option C: Immobility causes venous stasis (pooling of blood) and vasodilation in the lower extremities, not vasoconstriction. The lack of skeletal muscle contraction impairs the 'muscle pump' that helps return blood to the heart, increasing the risk of deep vein thrombosis (DVT).
Option D: Immobility leads to a negative nitrogen balance. The body enters a catabolic state, breaking down muscle protein for energy due to decreased metabolic demands and often, reduced appetite. This results in more nitrogen being excreted (from protein breakdown) than is consumed.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Immobility as background academic context rather than a clinical decision trigger.
Nurses play a crucial role in preventing the hazards of immobility through proactive interventions like early ambulation, active and passive range-of-motion exercises, regular repositioning, and encouraging deep breathing.
Recognizing the signs of complications, such as calf tenderness (DVT), decreased breath sounds (atelectasis), or skin redness (pressure injury), is a critical nursing responsibility for patient safety.
What if the patient is on strict bed rest due to a spinal injury? The nurse's focus would shift from ambulation to meticulous in-bed interventions: using a kinetic bed for continuous rotation, performing passive ROM, ensuring adequate hydration and nutrition to combat negative nitrogen balance, and vigilant skin assessment.

How to Approach the Question

First, identify the core concept of the question, which is the 'hazards of immobility'. This is a foundational topic in nursing.
Next, evaluate each option by considering the physiological changes that occur when a person is not moving.
For 'Loss of bone calcium', recall that weight-bearing activity is essential for bone strength. Without it, bones demineralize.
For 'Increased vital capacity', think about how breathing changes when lying down. It becomes more shallow, so vital capacity would decrease, not increase.
For 'Venous vasoconstriction', consider blood flow in the legs. Without muscle movement, blood pools (stasis), which is the opposite of constriction.
For 'A positive nitrogen balance', remember that immobility causes muscle breakdown (catabolism), which leads to a negative, not positive, nitrogen balance. Select the option that correctly identifies a known complication.

Concept Tested & Keywords

QXaFH-OCwAFPLEsSycC83r

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

E6 Nursing Fundamentals Taylor p. 316-318