1-imobilisasi-n-komplikasi(1)

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Immobilization

Dr. Rose Dinda Martini, SpPD

Juni 2012



The Guinness Book of World Records the fastest 100-year-old to run100 meters.



• Immobility

• Instability

• Incontinence (urinary & alvi)

• Intellectual impairment (MCI, Dementia)

• Infection (Pneumonia, etc)

• Impairment of hearing & vision

• Impaction (constipation)

• Isolation (depression)

• Inanition (malnutrition)

• Impecunity (poverty)

• Iatrogenesis

• Insomnia

• Immune deficiency

• Impotence

eriatric iant

Kane, Ouslander Abrass. (from

Solomon 1988), Essentials of

Clinical Geriatrics.2! . ".1#$1!.



!he "ed

#oo$ at a patient lying long in bed% hat a

pathetic picture he ma$es' !he blood clotting inhis veins, the lime draining from his bones, the

scybala stac$ing up in his colon, the flesh rotting

from his seat, the urine lea$ing from his

distended bladder, and the spirit evaporatingfrom his soul%

(% As&er' &e an*ers of Goin* to +ed' +- 19!)



Penyulit Akibat Imobilisasi

eurologi espirasi *ardio+as$ular

Mus$ulo$eletal

astrointestinal

-rologi #ain.#ain

Depresi PneumoniaAtelektasis

D!P"#ipotensi postural

$ema% otot&ontraktur 'steo porosis

&onstipasiInkontinensia

al(i

IS& )atusalurankemi%

*lkus dekubitus#ipoalbuminemia



Ulcus decubitus (pressure ulcer)

Muscle atrophy & joint contracture

Baroreseptor desensitization

Orthostatic hypotension

Atelectasis & Pneumonia

Decrease bone density, ypercalcemia,

Osteoporosis !onstipation

Deep "ein thrombosis & Pulmonary embolism

Complications of immobilization

Resnick NM, Dosa D. Geriatric Medicine. Harrison’s Principles of Internal Medicine. Ed.16. 200! "#$#



+aktor Risiko dan "tioloi

eurologi espirasi *ardio+as$ular

Mus$ulo$eletal

+isual /$sternal #ain.#ain

-Stroke-Parkinson-anuan Serebelum

-PP'& -S&A-/#+-PAD

-'A-'steo porosis

-&atarak -laukoma

-Alat bantuyan tidakadekuat

-Malnutrisi-Depresi-"ek Sampin'bat



Imobiliation

• &eadaan tidak bererak atau tira%

barin selama %ari atau lebi% denan

erak anatomik yan %ilan akibat

peruba%an unsi.



Pasien Imobilisasi



D0/01 P/DI#/*I

"M2 344567736893.89:



tadium ; tadium 3

tadium 7 tadium 8


http://slidepdf.com/reader/full/1-imobilisasi-n-komplikasi1 14/24Dermatologic Therapy, Vol. 19, 2006,



Pre(alensi Imobilisasi di RS*P3/M



)MJ 2004525672-678



!ekanan Daya Rean

esekan &elembaban



<actors !hat !rigger !hrombosis

TRIAD OFVIRCHOW

Stasis of blood

(Immobilization)

Local trauma to t!

"!ss!l #all

(sur$ical)

H%&!rcoa$ulabilit%

(D!'ci!nc% of rot!in C

rot!in S AT III)



0ging process

∀

coagulation factors

• +ein valve rigidity

"lood turbulance

0ccumulation ofcoagulation factors

D+!

Pathophyisiology of D+!

Immobilization

Loss of muscl!contraction

Stasis

H%&o*ia

+ndot!lial d%sfunction

Coa$ulation factors!cr!tion



Emboli Paru



"mboli Parudapat ter9adi di baian mana sa9a pada paru-paru

“Pulmonary Embolism” (PE)

P d $ t *li i



Pende$atan *linis/valuasi *eterangan

0namnesis - i=ayat dan lama disabilitas atau imobilisasi

- *ondisi medis yang merupa$an fa$tor risi$o dan penyebab imobilisasi

- *ondisi pre morbid

- yeri- >bat.obatan yang di$onsumsi

- Du$ungan pramu=erdha

- Intera$si sosial

- <a$tor psi$ologis

- <a$tor ling$ungan

Pemeri$saan <isi$ - tatus $ardiopulmonal

- *ulit- Mus$ulos$eletal? $e$uatan dan tonus otot, ling$up gera$ sendi, lesi dan deformitas

$a$i

- eurologis? $elemahan fo$al, evaluasi persepsi dan sensori$

- astrointestinal

- enitourinarius

tatus <ungsional Pemeri$saan Inde$si 0$tivitas *ehidupan ehari.hari (0*) "arthel

tatus Mental Penapisan dengan Geriatric e"ression Scale (D)

tatus *ognitif Penapisan dengan ini ental State E/amination (MM/), Abbre0iated ental est

(0M!)

!ing$at Mobilitas Mobilitas di tempat tidur, $emampuan transfer, mobilitas di $ursi roda, $eseimbangan

saat dudu$ dan berdiri, cara ber@alan, nyeri saat bergera$

Pemeri$saan

Penun@ang

Penilaian berat ringannya $ondisi medis penyebab imobilisasi (foto lutu, e$o$ardiografi)

dan $ompli$asi a$ibat imobilisasi (pemeri$saan albumin, ele$trolit, glu$osa darah,

hemostasis)



Instabilitas

Jatu% In$ontinensia urin Ineksi

+raktur &esadaran ↓

#ipotermia Imobilisasi

Depresi anuan

*lkus tidur

!rombosis (ena

Pneumonia

IS& De%idrasi konstipasi

Atroi otot

A k ↓ M l i i

SITI SETIATI, Geriatri IP !"#I$%S#P&'C, **+

Asupan cairan ↓

Obat

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