Activity And Exercise

Chapter 36 and 46 Activity and Exercise Mobility and Immobility Mosby items and derived items © 2005 by Mosby, Inc.

Body Mechanics, Exercise, and Activity • • • • •

Body alignment Body balance Coordinated body movement Friction Exercise and activity – Isotonic, isometric, resistive isometric exercises Mosby items and derived items © 2005 by Mosby, Inc.

Regulation of Movement • Skeletal muscle – Bones – Joints – Ligaments, tendons, cartilage

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Regulation of Movement (cont'd) • Skeletal muscle – Movement – Posture – Groups • Synergistic • Antigravity

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Regulation of Movement (cont'd) • Nervous system – Movement – Posture – Proprioception – Balance

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Principles of Body Mechanics • Pathological influences – Congenital defects – Disorders of bones, joints, and muscles – Musculoskeletal trauma

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Behavioral Aspects • Support by significant others, health care team • Knowledge of exercise and activity • Readiness to change behavior • Program customized to meet personalized needs

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Culture • Box 36—4 p. 936

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Environmental Issues • Worksite • Schools • Community

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Psychosocial Issues • Cultural and ethnic influences • Family and social support

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Effects of Exercise • P. 939 box 36—5 • Recommendation: P. 945 box 36--9

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Box 36—11 p. 947

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Assessment • Body alignment and posture – Standing – Sitting – Recumbent position

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Assessment (cont'd) • Body alignment and posture (cont'd) – Mobility • Range of motion • Gait • Exercise – Activity tolerance

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Nursing Diagnoses • • • • •

Activity intolerance Disturbed body image Risk for injury Impaired physical mobility Acute/Chronic pain

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THINK PROACTIVE: Risk for Disuse Syndrome

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Planning • Goals and outcomes – Examples • Participates in prescribed activity • Expresses understanding of balancing rest and activity – Setting priorities – Continuity of care

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Implementation • Health promotion: exercise programs • Nursing safety – Body mechanics – Lifting techniques

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Knees flexed

Good posture

Wide base of support Hips flexed Using large muscles Do not arch your back See page 946 table 36-1 - body mechanics for the health care worker Mosby items and derived items © 2005 by Mosby, Inc.

Implementation (cont'd) • Acute care – Muscle strengthening, isometric exercise – Joint mobility: ROM, CPM machines

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Implementation (cont'd) • Ambulation – Nurse assistance – Assistive devices • Walkers • Canes • Crutches

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Implementation (cont'd) • Restoration of activity – Coronary heart disease – Hypertension – COPD – Diabetes mellitus

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Evaluation • Activity tolerance • Mobility, balance • Client expectations

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EFFECTS OF IMMOBILITY • Assignment: 8 groups; present to the class effect of immobility on the assigned body system & nursing interventions to minimize negative effects

– – – – – – – –

Musculoskeletal Cardiovascular Respiratory Metabolic Urinary GI Integumentary Psychoneurolgic

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Practice • • • • • •

Ambulating a client Walking with walker Walking with crutches Transfer bed-chair PROM Positioning Mosby items and derived items © 2005 by Mosby, Inc.

Mobility • Physiology and principles of body mechanics – Alignment: posture – Balance – Gravity and friction

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Regulation of Movement • • • • • •

Bones Joints Ligaments Tendons Cartilage Skeletal muscle Mosby items and derived items © 2005 by Mosby, Inc.

Muscle Movement and Posture • Musculskeletal function • Nervous system

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Pathological Influences on Mobility • • • •

Postural abnormalities Impaired muscle development CNS damage Musculoskeletal trauma

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Systemic Effects of Immobility • • • • • •

Metabolic Respiratory Cardiovascular Musculoskeletal Urinary and bowel elimination Integumentary

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Psychosocial and Developmental Effects • • • •

Infants, toddlers, preschoolers Adolescents Adults Older adults

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Assessment • • • • •

Mobility Range of motion (ROM) Gait Exercise and activity tolerance Body alignment: standing, sitting, lying

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Physiological Assessment • Metabolic: anthropometric measurements, wound healing • Respiratory system: ventilatory status, breath sounds • Cardiovascular system: BP, pulse, peripheral circulation, signs of DVT

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Physiological Assessment (cont'd) • Musculoskeletal: ROM; muscle strength, tone, and mass • Integumentary: color, integrity, turgor • Elimination: I&O

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Psychosocial Assessment • Reactions to immobility • Developmental stages • Client expectations

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Nursing Diagnoses • • • • • •

Activity intolerance Ineffective breathing pattern Risk for disuse syndrome Impaired physical mobility Impaired skin integrity Social isolation Mosby items and derived items © 2005 by Mosby, Inc.

Planning • Goals and outcomes – Client’s skin remains dry and intact

• Setting priorities • Continuity of care

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Implementation: Health Promotion • Lifting techniques • Exercise

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Prevention of the Hazards of Immobility • Metabolic – Nutritional needs: protein, calories, vitamins (B and C)

• Respiratory system – Promotion of chest and lung expansion – Removal of secretions – Maintenance of patent airway Mosby items and derived items © 2005 by Mosby, Inc.

Prevention of the Hazards of Immobility (cont'd) • Cardiovascular system – Reducing orthostatic hypotension – Reducing cardiac workload: discourage Valsalva maneuver – Preventing thrombus formation: medications, exercise, fluids, TED stockings, pneumatic compression, positioning Mosby items and derived items © 2005 by Mosby, Inc.

Prevention of the Hazards of Immobility (cont'd) • Musculoskeletal system – ROM – Isometric exercise

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Prevention of the Hazards of Immobility (cont'd) • Integumentary system – Turning every 1 to 2 hours – Hygienic care – Protection: preventive aids

• Elimination – Hydration – I&O – Nutritional intake: fiber Mosby items and derived items © 2005 by Mosby, Inc.

Prevention of the Hazards of Immobility (cont'd) • Psychosocial – Orientation – Communication – Client participation

• Developmental – Age-appropriate activities

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Prevention of the Hazards of Immobility (cont'd) • Positioning – Supports: footboards, trochanter rolls, hand rolls, and splints – Trapeze bar – Bed positions: Fowler’s, supine, prone, side-lying, Sims’

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Transfer Techniques • In bed • Bed to chair • Bed to stretcher

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Implementation: Restorative Care • • • •

Instrumental activities of daily living Physical and occupational therapy Exercises—ROM Ambulation: canes, walkers, crutches

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Evaluation • Client care • Client expectations

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