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Geriatric Giant
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
Solomon
The Bed
Look at a patient lying long in bed. What a
pathetic picture he makes! The blood clotting in
his veins, the lime draining from his bones, the
scybala stacking up in his colon, the flesh rotting
from his seat, the urine leaking from his
distended bladder, and the spirit evaporating
from his soul.
(R Asher: The Dangers of Going to Bed: BMJ 1947)
Respirasi
Kardio
Vaskular
Muskulo
Skeletal
Gastro
intestinal
Urologi
Depresi
Pneumonia
Atelektasis
DVT
PE
Hipotensi
postural
Lemah otot
Kontraktur
Osteo
porosis
Konstipasi ISK
Inkontinensia Batu
alvi
saluran
kemih
Lain-Lain
Ulkus dekubitus
Hipoalbuminemia
Complications of immobilization
Ulcus decubitus (pressure ulcer)
Muscle atrophy & joint contracture
Baroreseptor desensitization
Orthostatic hypotension
Atelectasis & Pneumonia
Decrease bone density, Hypercalcemia, Osteoporosis
Constipation
Deep vein thrombosis & Pulmonary embolism
Resnick NM, Dosa D. Geriatric Medicine. Harrisons
Principles of Internal Medicine. Ed.16. 2005: 43-53
Respirasi
-PPOK
-Stroke
-Parkinson
-Gangguan
Serebelum
Kardio
Vaskular
Muskulo
Skeletal
Visual
Eksternal Lain-Lain
-SKA
-CHF
-PAD
-OA
-Osteo
porosis
-Katarak
-Alat
-Glaukoma bantu
yang tidak
adekuat
-Malnutrisi
-Depresi
-Efek Samping
Obat
Imobilization
Keadaan tidak bergerak atau tirah
baring selama 3 hari atau lebih dengan
gerak anatomik yang hilang akibat
perubahan fungsi.
Pasien Imobilisasi
DAERAH PREDILEKSI
BMJ 2006;332;472-475
KLASIFIKASI
Stadium 1 Stadium 2
Stadium 3 Stadium 4
PATOFISIOLOGI
BMJ 2006;332;472-475
PATOGENESIS
Tekanan
Gesekan
Daya Regang
Kelembaban
DVT and PE
vessel wall
(Immobilization)
(surgical)
TRIAD OF
VIRCHOW
Hypercoagulability
(Deficiency of Protein C,
Protein S, AT III)
Pathophyisiology of DVT
Aging process
coagulation factors
Vein valve rigidity
Blood turbulance
Accumulation of
coagulation factors
Immobilization
Loss of muscle
contraction
Stasis
Hypoxia
DVT
Endothelial dysfunction
Coagulation factor
secretion
Emboli Paru
Emboli Paru
dapat terjadi di bagian mana saja pada paru-paru
Pendekatan Klinis
Evaluasi
Anamnesis
Keterangan
Riwayat dan lama disabilitas atau imobilisasi
Kondisi medis yang merupakan faktor risiko dan penyebab imobilisasi
Kondisi pre morbid
Nyeri
Obat-obatan yang dikonsumsi
Dukungan pramuwerdha
Interaksi sosial
Faktor psikologis
Faktor lingkungan
Pemeriksaan Fisik
Status kardiopulmonal
Kulit
Muskuloskeletal: kekuatan dan tonus otot, lingkup gerak sendi, lesi dan deformitas
kaki
Neurologis: kelemahan fokal, evaluasi persepsi dan sensorik
Gastrointestinal
Genitourinarius
Status Fungsional
Status Mental
Status Kognitif
Tingkat Mobilitas
Pemeriksaan
Penunjang
Penilaian berat ringannya kondisi medis penyebab imobilisasi (foto lutu, ekokardiografi)
dan komplikasi akibat imobilisasi (pemeriksaan albumin, elektrolit, glukosa darah,
hemostasis)
Instabilitas
Jatuh
Obat
Inkontinensia urin
Fraktur
Hipotermia
Infeksi
Kesadaran
Imobilisasi
Ulkus
Trombosis vena
Pneumonia
ISK
Atrofi otot
Asupan
cairan
Asupan makanan
Depresi
Gangguan
tidur
Dehidrasi
konstipasi
Malnutrisi