Question

A client has been bed ridden for several months due to the effects of Alzheimer's Disease. For which musculoskeletal problem is the client at risk? A. Deep vein thrombosis B. Osteoporosis C. Avascular necrosis of hip D. Embolism

Short answer

The client is at risk for B. Osteoporosis due to prolonged inactivity and lack of weight-bearing exercise.

Step-by-step solution

Understanding the Effects of Immobility

Being bedridden can lead to a variety of musculoskeletal problems due to the lack of movement and weight-bearing activity. The musculoskeletal system requires regular activity to maintain bone density and muscle strength.

Analyzing Potential Risks

Each option given is a possible complication from being bedridden. Deep vein thrombosis (A) is a blood clot, usually in the leg, which can happen due to prolonged inactivity. Osteoporosis (B) is the loss of bone density, which can be exacerbated by lack of weight-bearing exercise. Avascular necrosis of the hip (C) involves the loss of blood flow to the femoral head, which can happen due to trauma or long-term steroid use, but is not directly caused by being bedridden. An embolism (D) is a clot that has traveled to another part of the body, which could be related to deep vein thrombosis.

Identifying the Most Likely Risk

Given the client's prolonged bed rest due to Alzheimer's Disease, while deep vein thrombosis is a common occurrence, osteoporosis is the most likely musculoskeletal problem because of the persistent and ongoing lack of weight-bearing activities and exercises which are essential for maintaining bone density.

Key concepts

Osteoporosis

Osteoporosis is a condition characterized by weakened bones due to a decrease in bone density and mass, making them fragile and more prone to fractures. This condition is particularly relevant to individuals who are bedridden for extended periods, like patients with advanced stages of Alzheimer's disease.

The lack of weight-bearing activities can exacerbate bone density loss since our bones require regular mechanical stress to maintain their strength. This stress typically comes from activities such as walking and exercising. Without such stimuli, the bones can lose calcium and other minerals, leading to osteoporosis. One of the keys to preventing or slowing the progress of osteoporosis is engaging in regular physical activity and ensuring an adequate intake of calcium and vitamin D.

To help understand this concept better, it's important to think of bone as a living tissue that is continuously being broken down and rebuilt. For individuals who cannot engage in regular movement, healthcare professionals may look into passive exercises or physiotherapy strategies to help maintain bone health to the extent possible.

Deep Vein Thrombosis

Deep vein thrombosis (DVT), commonly known as a blood clot, typically occurs in the deep veins of the leg. It is a serious condition that can arise due to prolonged periods of immobility, making bedridden individuals particularly susceptible.

The body’s circulatory system relies on movement to help pump blood back up to the heart, especially from the lower extremities. In a bedridden patient, the lack of muscle contractions can lead to stasis, or pooling of blood, increasing the risk for blood clot formation. Symptoms of DVT may include pain, swelling, and redness in the affected leg, though it may also occur without noticeable symptoms.

While not immediately life-threatening, a DVT can lead to complications such as pulmonary embolism if a part of the clot breaks off and travels to the lungs. Preventive measures include regular leg exercises, elevation of the legs, and in some cases, anticoagulant medications, as guided by a healthcare professional.

Avascular Necrosis

Avascular necrosis is a condition where the bone tissue dies due to a lack of blood supply. Although avascular necrosis is not primarily caused by prolonged bed rest, understanding its association with corticosteroid use and joint or bone trauma can offer insight into muscular and bone health management.

The femoral head in the hip is a common site for avascular necrosis. It can lead to joint pain and potentially result in the collapse of the joint surface if the condition progresses untreated. While it is more closely linked to factors such as high-dose steroid therapy and traumatic injury, it serves as a reminder of the intricate balance between bone health and blood supply. While this may not be the primary concern for bedridden patients, strategies to keep the joints healthy can be part of the overall care for individuals dealing with long-term immobility.

Immobility in Alzheimer's Patients

Immobility in Alzheimer’s patients can lead to numerous complications, including those affecting the musculoskeletal system. Alzheimer's disease can cause progressive degeneration of cognitive functions, leading to difficulties in movement and eventually to prolonged periods of immobility.

This lack of movement contributes to the risk of musculoskeletal issues such as muscle atrophy, joint contractures, and pressure ulcers in addition to the aforementioned conditions like osteoporosis and DVT. To mitigate some of these risks, caregivers are encouraged to shift the patient's position regularly, engage in passive range-of-motion exercises, and provide adequate nutrition and hydration.

Considering the overall well-being of Alzheimer's patients is crucial since they may not be able to communicate discomfort or pain effectively. Understanding the increased risk factors associated with immobility can assist caregivers and health professionals in creating comprehensive care plans that address both the physical and mental health needs of these patients.