Rahadi Arie Hartoko

2018
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 PHYSIOLOGIC ALTERATIONS OF BEDREST

1. STASIS Physiologic alteration Pathologic Compl.

Urine stagnation Bladder distension

Increase Calcium in urine Stone formation
Decreased fecal excretion Constipation / obstipation
Venous pooling DVT  Pulmonary embolism
Decreased movement of Pneumonia
Pulmonary secretions
Joint contracture
Decreased movement of
ligaments and joint fluid

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2. ATROPHY Physiologic Complication

Decreased bone anabolism Osteoporosis

Decreased muscle use Muscle weakness
Decreased sensory stimuli Incoordination
Decreased vasoconstriction Hypotension
Decreased Heart Size Decreased endurance
Decreased Emotional Stimuli Dependency

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CARDIOVASCULAR SYSTEM :

1. HEART

2. BLOOD VESSELS ( TONE )

3. FLUID BALANCE

4. VENOUS TROMBOSIS

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DECREASED HEART SIZE

stroke volume

heart rate

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HEART RATE :
Rises 0.5 hbm / day

STROKE VOLUME :
decrease 15% within 2 weeks

DECREASED BLOOD VESSEL TONE

decrease venous return
blood pressure
(orthostatic)

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FLUID BALANCE :

SHIFT 700 cc to thorax

CARDIAC OUTPUT increased 25%

Gradual diuresis  protein loss

Decreased plasma volume by 10 – 15%  HCT increased

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3. PRESSURE Physiologic Complication

Impaired Circulation to skin Decubitus Ulceration

Impaired conduction of nerve Nerve palsy
Impaired Emotional Control
Anxiety and Hostility

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STASIS – ATROPHY – PRESSURE = SAP

SAP (noun) : slang for stupid or foolish

SAP (verb) : to weaken or destroy by

degrees

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 THE PATHOPHYSIOLOGY OF
IMMOBILIZATION
REST IS GOOD, ESPECIALLY AFTER AN INJURY / DISEASE
BUT PROLONGED REST IS NOT GOOD AT ALL

“BEFORE THEY ADVICE REST, LET EVERY

DOCTOR ASK THEMSELVES WHETHER
THEIR PRESCRIPTION IS REALLY
NECESSARY, AND IF IT IS, HOW LITTLE
WILL SUFFICE”

Prof. W. Melville Arnott

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Key points

 Physiopathological mechanisms are time

dependent
 Involves various physiological systems
 Care must be provided by multiprofessional
team
 Essential interventions: early mobilization,
change pos 2-3 h, facilitationg awakeness,
promote weaning from mechanical
ventilation
 Dietary intake of EAA
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 ACUTE STAGE
FOOT BOARD

TROCHANTER ROLL

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 HAND ROLL

RESTING SPLINT

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RISK FACTORS FOR DVT :
Increasing age Obesity
Prolonged immobilization
Stroke
Previous VTE
Cancer and its Treatment
Major surgery
Respiratory failure
Trauma, esp. fractures of
pelvis, hip, leg
Varicose vein
CHD and MI
Inflammatory Bowel Dis.
Nephrotic Syndrome
Pregnancy, OC, HRT
Inherited conditions
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CLINICAL SYMPTOMS :

TENDERNESS
PAIN  Homan’s test +
SWELLING
DISCOLORATION or REDNESS

……..however, this is highly non specific..

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REHABILITATION MEDICINE MANAGEMENT :

Most important is PREVENTION of DVT

1. Early mobilization : begins on the first day

after the operation ; ambulation is allowed on
the second / third day
2. Mechanical prophylaxis :
a. LE elevation and Ankle pumping
b. Gradient elastic stocking
c. External pneumatic compression
d. Intermittent leg compression
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