Effects of zone 6: Bones, skin, self-concept and Clinical self-esteem


While some patients are required to recover from illness or surgery, long mobility affects the body's systems. This article – the sixth and the last in a series examining the harmful effects of beds on the body and mind – describes the impact of long-term stability and immobility on the bones, skin and skin. the self concept.

Citation: Knight J et al (2019) Effects of rodent 6: bones, skin, self-concept and self-esteem. Nursing Times [online]; 115: 5, 58-61.

Author: John Knight is an associate professor of biomedical science; Yamni Nigam is a professor of biomedical science; both in the College of Health and Human Science, University of Swansea. Aled Jones is a reader of patient safety and quality of healthcare in Cardiff University.

  • This section was subjected to a double peer review
  • Scroll down to read the article or download a PDF that is useful for printing here (if the PDF does not fully download please try again with another browser)
  • Click here to see other articles in this series


Recovery is often necessary for recovery from injury or disease but all major organs and systems of the human body are affected by prolonged immobility. This is the final section in our six-part series on the harmful effects of the trout. It discusses how the hip could affect bones and skin, increasing the risk of using hypercalcaemia, kidney stones, osteoporosis and pressure ulcers. It also examines how a minimum sense of self-esteem could be reduced and the self-concept of patients changed.

Effects on bone

The two main functions of bones are mechanical support for tissues and muscles, and the maintenance of mineral homoeostasis through exercise as a repository of calcium, phosphorus and magnesium salts (VanPutte et al, 2017). In the skeleton, most of the calcium and phosphorus are present in the form of crystals of hydroxyapatite, which affect mechanical stresses on the bone and orientation and orientation (Montague et al, 2005). When there is little force functioning on the body for a long period, the mineral content of bone tissue is greatly reduced, resulting in reduced bone density and strength. One study showed that approximately 1% of bone density in the vertebrate column was lost after one week of movement (LeBlanc et al, 1994).

Bone metabolism

It is a common misconception that bones are static tissues. Actually, the bone, like muscle, is dynamic. Normal bone metabolism (recast) depends on two types of cells: t

  • Osteoblasts – bone forming cells responsible for synthesising new bone tissue;
  • Osteoclasts – bone digestion cells responsible for breaking down (re-absorbing) existing bone tissue.

When the body is standing and practicing regularly, osteoblasts and osteoclasts work at the same rate around; as a result, overall bone density is maintained and the skeleton is in a relative equilibrium position.

Osteoblasts depend on the stress of body weight during normal daily activities to maintain their bone formation rate (Takata and Yasui, 2001). During an immobilisation period, the mechanical skeletal load is reduced and so osteoblast activity reduces, resulting in a reduced bone bone. Meanwhile, osteoclasts keeps their activity and continue to break down bone at a reasonably stable rate; indeed, some studies suggest that reduced skeletal loading can even improve osteoclast activity and, therefore, accelerate the de-centralization of bone (Lau and Guo, 2011; Takata and Yasui, 2001). The end result is a gradual loss of bone density, leaving bones at risk of fracture after small falls, during wheelchair transfers or even during physical therapy.

Bone is classified into two types: t

  • Compact bone (kernel) – dense and strong, this is found mainly in shaft (diaphyses) long bones such as those in the arms and legs;
  • Blind bone (trabecular or spongy) – this is found at the ephemera (enlarged ends, bulbs of long bones) and in the central parts of flat bones like the ribs and the pelvis.

During periods of immobility, compact bone and backbone is lost, although bone loss occurs at a much slower rate than the muscle loses (see section 5). The incredible bone seems particularly at risk of denaturation.

Age can affect the formation and reconstruction of bone: reduced production of sex hormones (see section 4) is reduced bone turnover (total volume of bone reabsorbed and formed over a given period). However, it is surprising, when a recent study that examined bone loss after 16 days of a bedroom showed that it was less in older men (those over 60 years of age) than as who were younger colleagues (Buehlmeier et al, 2017). The reasons for this are not clearly established.

Calcium levels

Within a few days of immobilisation, calcium is lost from bone denaturation bone and, therefore, plasma calcium levels have increased; After five weeks of bedroom there is a measurable increase of up to 50ml on the amount of calcium emitted in the urine (Zerwekh et al, 2007). If denaturation of movement and backbone continues, this increases the risk of renal deposition, leading to the formation of kidney stones (see section 4). Longer bedside periods result in much greater reductions in bone density.

A high calcium diet does not necessarily improve bone acceptance of minerals; instead, it may add to the already excreted calcium additives in the urine and increase the risk of kidney stones.

In patients with heterosexual calcium (also known as myositis ossificans), soft tissues such as muscles, blood vessel walls and cardiac valves are over-calcium, where it may interfere with joint and / or muscle function, or valve stenosis. cause. This will be deepened by any increase in immobility in calcium excretion.

High levels of calcium plasma (hypercalcaemia) (see section 4) can interfere with synaptic transmission in the nervous system, leading to:

  • Confusion;
  • Pain muscles;
  • Fasciculation (twitching);
  • Nausea, possibly associated with reduced appetite and anorexia.

Bone mass and bone density

Mass loss and bone density can lead to osteoporosis, making bones more vulnerable and breaking. Osteoporosis-related fractures, known as vulnerability fractures, occur after skeletal stress that is not expected to break out, such as falling from a lower or lower height (National Institute for Health and Care Excellence, 2012).

Many factors increase the risk of osteoporosis, including age, smoking, women, poor diet not containing vitamin D and / or calcium, family history of the disease, low body weight (and therefore reduced skeletal load) and reduced mobility (National Osteoporosis Foundation). The long-term bed reduces skeletal load and stress, and refers to demobilization and reduced skeletal mass associated with immobility such as asteoporosis (Lau and Guo, 2011).

When patients with osteoporosis restart weight activities after a bed period, they may experience pain, often in the back. Can:

  • Vertebrate fractures;
  • Bone deformation;
  • Increased muscle tension and / or joint imbalances.

A recent review includes the nature, origin and treatment of osteoporosis related pain (Catalano et al, 2017).

Any patient with pain on re-transfusion needs careful assessment, as the risk of fracture is known to be much higher after long immobilisation. A lost bone mass is not recovered for several weeks after the mass and strength of the muscles returned to normal (Bloomfield, 1997).

Bone marrow

There are two types of bone marrow: t

  • Smear yellow – this is composed mainly of fat tissue (fat) and, among adults, mainly found in the cavity that runs through the shaft of long bones such as the femur and humerus (medieval cavity) ;
  • The red marrow – the major haematopoietic tissue, is responsible for producing erythrocytes (blood red cells), leukocytes (white blood cells) and thrombocytes (platelets). Most of it is found in the canceled bone located in the central part of flat bones such as the pelvis, ribs and vertebrates; the long-leaved limestones have smaller amounts (VanPutte et al, 2017).

Few studies examined the effects of movement on bone marrow. However, it appears that the reduced mechanical stress of bone seen during periods of immobility is associated with an increase in the size of yellow bone marrow (David et al, 2007).

Trudel et al (2009) recommended that the extensive bed of fat tissue deposition in regions containing bones plays a key role in the generation of blood cells. In her study, women who were confined to bed for 60 days showed an increase in fat deposition of about 9% in lumbar vertebrates, and fat levels did not return to ordinary even a year after restoration. Immobility also appeared to promote activity in the red marrow, with increased production of some major leukocytes, including neutrophs and lymphocytes that produce antibodies. The researchers speculated that the increase in fat deposition in bone can stimulate increased red marrow activity.

Effects on the skin

The role of skin includes: t

  • Protecting muscles, bones and basic organs;
  • Regulating body temperature;
  • Increase sensory system.

The soles of the feet are the only part of the skin adapted to carry weight for long periods, where the outer layer (epidermis) contains an additional layer of spongy cells (stratum lucidum). During the beds, the body's weight is on a large area of ​​the skin surface and is always in contact with the bed. Immobility is the most likely factor that an individual would risk changing skin integrity.

Pressure Ulcers


Usually to relieve discomfort, people automatically transfer their weight from pressure areas every few minutes, even during sleep. Patients limited to bed for long periods may not be able to do this because they have lost muscle mass and are not physically strong. Those who have a reduced sensation (for example, patients with sensory neuropathy from diabetes), may not feel the painful stimuli associated with skin damage that would usually affect positioning.

Without regular changes in the position in the bed, the long pressure on the skin puts blood vessels in the dermis, resulting in dermal tissue (necrosis) from dermal layers and blood epidemics. The areas where the skin is stretched over bones are the greatest risk of fracture. Here, the risk of ischaemia is greatest because blood vessels are easily compressed between the bone and hard surface as a bed or chair (Gulanick and Myers, 2007).

Lymph and blood flow may be impaired to cause ischemic lesions (commonly referred to as pressure ulcers), wet ulcers or bed stands. Long periods of pressure on the skin (capillary pressure> 33mmHg) could damage the skin and the underlying tissues as a result of ischaemia (Agrawal and Chauhan, 2012). The higher the bed or mobility period and the greater the pressure applied, the higher the risk of developing a pressure ulcer.

Sites of patients and bodies at risk

Pressure ulcers often occur: t

  • Older patients immobilized;
  • Patients in critical care settings;
  • Patients with spinal cord injury.

Research has shown that blood flow in sacral skin has significantly reduced residents of nursing homes when it is in the supine position and, therefore, increased risk of pressure-ulcer formation (Källman et al, 2016). A large study of 3,233 patients aged 65 years showed:

  • About 6.2% developed ulcers pressure within two days of admission to hospital;
  • The majority of pressure ulcers were assessed as phase 2 (affecting the epidermis and dermal layers of the skin);
  • Oysters were often installed in the sacral area and heels (Baumgarten et al, 2006).

About 95% of the urinators are squeezed on five sites: t

  • Sacrum;
  • Tuberosity unequivocal (sitting bones);
  • Major chains (hip-side bone significance);
  • Heel;
  • Ankle.

In patients with supine, ulcers tend to strain the sacrum and heels; in patients sitting or resilient, they usually develop the abdominal tuberculosis. Figure 1 shows the body locations most at risk of pressure ulcers in the emerging locations, sitting and sitting.

Figure 1 body sites are most at risk from pressure ulcers

Source: Peter Lamb

Risk and prevention factors

In addition to existing age conditions such as diabetes, many of the projected factors for pressure-beard formation can be altered with lifestyle changes. These variable risk factors include: t

  • Increased mobility – identified as the main risk factor for developing pressure ulcers, particularly in those patients who are weak and / or unable to reside regularly (Anders et al, 2010);
  • Poor nutrition;
  • High body mass index;
  • Smoking.

It is best to prevent cure ulcers and this can be achieved by: t

  • Frequent site changes;
  • Terrible skin care;
  • Early assessment of risk factors;
  • Careful continuous observation.

The risk of pressure oils can also be greatly reduced by ensuring that patients who are confined to bed receive sufficient nutrition and remain hydrated; this includes careful monitoring of total calories consumed and macro-nutrient intake and micro-nutrients (Posthauer et al, 2015). Patients should be considered individually according to their needs. A risk assessment for pressure ulcers should investigate a variety of factors – the main ones are listed in Box 1.

Patients who are at risk of developing pressure ulcers require regular turning or repositioning. A trained procedure is a supine patient to put in bed: if it is wrongly called, it can tear and make further healing, and impaired skin over muscles and bones ridges. There are a variety of specialized devices, including modified beds and rolling equipment, which can reduce the risk of skin damage and re-position patients. The devices that can alleviate skin pressure over bones are characterized by air mattresses and specially designed cushions and seating.

Patients should be encouraged to keep mobile whenever possible. It is recognized that the best strategy to prevent pressure ulcers is to get out of bed and mobilize as soon as possible.

Box 1. Risk assessments of pressure laser: what should be considered

  • Reduced mobility
  • Current skin condition
  • History of previous pressure ulcers
  • Reduced sensation (neuropathy) t
  • Nutritional status
  • Cognitive status
  • The patient's ability to reset themselves

Source: National Institute for Health and Care Excellence (2014) t

Effects on self concept

Immobility and the many physiological changes described in this series can affect the self-concept of patients. It is a key concept in psychology is the self; self-concept is described as a stable set of beliefs about human qualities and characteristics (Marks et al, 2018). This involves self-esteem, a sense of self-esteem and an integral part of psychological well-being (Walker et al, 2007). Self-concept and self-esteem are based on an individual's body image, achievement, social functioning and self-identification.

While levels of self-esteem and self-concepts tend to remain constant, events such as sudden or chronic illness can make major changes. A long-term bed, which causes both a decrease in body function and a change of appearance, can re-evaluate patients' self-concept.

Studies of patients admitted to hospital indicated that the body's image during illness was plumme (Fingeret et al, 2014). A hospital can affect: t

  • Achieving the long secure bed is a risk to the perceived achievement of work or recreation. Many people gain a sense of achievement from their positions, interests and activities, which are threatened if they are unable to do them;
  • Social interactions with friends and family are a source of self-confidence and emotional support. A breakdown in this support system can have adverse consequences for the patient's sense of identity and security;
  • The private self-creation creates dependence on others; the loss of independence and the pressure of others can cut the private person.


This six part series examined the harmful effects of long stability and immobility in the functioning of major organs and body systems, as well as the mental well-being of patients. Most research shows that patients should remain as active and mobile as possible, while in hospital (even when they are limited to bed) and when they return home. Patients who can do a mild exercise regularly should do so, as it has been proven to reverse or prevent many of the harmful effects of long insufficiency. discussed in this series, and recovery.

Key points

  • Mobility can lead to reduced bone mass and bone density, bone detonation and bone loss.
  • Patients limited to bed have a higher risk of kidney stones and use osteoporosis
  • Patient pressure may be prolonged pressure on skin over visible bones
  • Pressure ulcers can be prevented by site changes, skin care, risk factor assessment and observation
  • Bedrest changes the function and appearance of the body, so it affects the self-concept of patients


Agrawal K, Chauhan N (2012) Pressure Ulcers: back to the basics. Indian Journal of Plastic Surgery; 45: 2, 244-254.

Anders J et al (2010) Ulces decubitus: pathophysics and primary prevention. Deutsches Ärzteblatt International; 107: 21, 371-381.

Baumgarten M et al (2006) Ulcers strain among elderly patients early in the hospital. Journal of Gerontology. Series A, Biological Sciences and Medical Sciences; 61: 7, 749-754.

Bloomfield SA (1997) Changes in musculoskeletal structure and function with long bed rest. Medicine and Science in Sport and Exercise; 29: 2, 197-206.

Buehlmeier J et al (2017) Bone metabolism markers during 14 days of bed rest in young and old men. Journal of Musculoskeletal and Neuronal Interactions; 17: 1, 399-408.

Catalano A et al (2017) Pain in Osteoporosis: from the pathology to the therapeutic approach. Drugs and Aging; 34: 10, 755-765.

David V et al (2007) Mechanical loading down-control gamma receiferator-activated receptor is in bone marrow stromal cells and prefers osteoblastogenesis at the cost of adipogenesis. Endocrinology; 148: 5, 2553-2562.

Fingeret MC et al (2014) Difficulties in managing the body images of adult cancer patients: lessons from available research. Cancer; 120: 5, 633-641.

M Gulanick, JL Myers (2007) Nursing Care Plans: Nursing Diagnosis and Mediation. St. Louis, MO: Mosby.

Källman U et al (2016) Hip blood responses in nursing home residents during one hour bed rest. Microcirculation; 23: 7, 530-539.

Lau RY, Guo X (2011) Review of current osteoporosis research: with a special focus on bone loss use. Journal of Osteoporosis; 2011: 293808.

LeBlanc AD et al (1994) Variations in the cross section of an interphabetic disc with rest and bed space. Spine; 19: 7, 812-817.

Marks DF et al (2018) Health Psychology: Theory, Research and Exercise. London: Sage.

Montague SE et al (2005) Physiology for Nursing Practice. London: Bailièrre Tindall.

National Institute for Health and Care Excellence (2014) Pressure Ulcers: Prevention and Management.

National Institute for Health and Care Excellence (2012) Osteoporosis: Assessing the Broken Broken Risk.

Posthauer ME et al (2015) The role of nutrition for pressure ulcer management: National Advisory Panel for Ulcer Pressure, European Advisory Panel on Pressure Ulcer, and white paper of the Pacific Pressure Alliance. Advances in Skin Care and Wound; 28: 4, 175-188.

Takata S, Yasui N (2001) Do not use osteoporosis. Journal of Medical Investigation; 48: 3-4, 147-156.

Trudel G et al (2009) Continued fatigue fat accumulation after 60 days of bed rest 1 year after resume activities as well as hemopoietic stimulation: Space Women's International Simulation study for Women. Journal of Applied Physiology; 107: 2, 540-548.

VanPutte CL et al (2017) Seeley Anatomy and Physiology. New York, NY: McGraw-Hill Education.

Walker J et al (2007) Psychology of nurses and care professions. Maidenhead: Open University Press.

Zerwekh JE et al (2007) Reduction in the risk of renal stone through potassium-magnesium citrate during 5 weeks of bed rest. Urology Journal; 177: 6, 2179-2184.

Leave a comment

Send a Comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.