A nurse is collecting data from a client who has had paraplegia for several years. Which of the following physiologic changes due to immobility should the nurse consider when evaluating this client's overall status? (Select all that apply.)

Choice A rationale Immobility generally leads to a decreased metabolic rate due to the reduced expenditure of energy for physical activity and muscle contraction. This lowered metabolic demand results in an overall reduction in oxygen consumption and nutrient utilization, often contributing to a negative nitrogen balance and weight loss, but it is not a direct increase. Choice B rationale Immobility significantly impairs the skeletal muscle pump mechanism, which normally assists venous return in the lower extremities. This failure results in venous pooling, or stasis, increasing hydrostatic pressure within the capillaries. This stasis elevates the risk for thrombus formation, commonly referred to as deep vein thrombosis (DVT), a potentially fatal complication. Choice C rationale Prolonged immobility, particularly in a supine position, hinders the complete emptying of the bladder due to the lack of gravity and ineffective detrusor muscle function. This leads to urinary stasis, where residual urine harbors bacteria, significantly increasing the risk of urinary tract infections (UTIs) and the potential for renal calculi formation due to calcium reabsorption. Choice D rationale Immobility, especially in a supine position, restricts the chest wall's excursion and the functional capacity of the diaphragm and intercostal muscles. This leads to decreased depth of respirations, or hypoventilation, which causes the pooling of secretions in the dependent lung fields and elevates the risk for atelectasis and pneumonia. Choice E rationale The absence of weight-bearing and regular muscle contraction stimuli due to immobility results in a rapid breakdown of muscle protein, exceeding the rate of synthesis. This physiological response causes muscle atrophy, characterized by a reduction in muscle mass and strength, leading to significant weakness and functional decline over time. 80mm.5pt.