Posture, Mobility And Ambulation

Posture, mobility and ambulation Ella Yu (VL)

Posture, mobility and ambulation (Kozier, Activity and Exercise )  Describe

four basic elements of normal movement  Differentiate isotonic, isometric, isokinetic, aerobic and anaerobic exercise  Compare the effects of exercise and immobility on body systems  Identify factors influencing a person’s body alignment and activity

Posture, mobility and ambulation  Assess

activity- exercise pattern, alignment, mobility capabilities and limitations, activity tolerance and potential problems related to immobility  Develop nursing diagnoses, outcomes and interventions related to activity, exercise and mobility problems  Use proper body mechanics when positioning, moving, lifting, and ambulating clients

Posture, mobility and ambulation Activity- exercise pattern





1. 2.

Person’s routine of exercise, activity, leisure and recreation Activities of daily living (ADL) The type, the quality and the quantity of the exercise, including sports

Posture, mobility and ambulation  Mobility 



The ability to move freely, easily, rhythmically, and purposefully in the environment Is vital for independence   

Mental well-being Effectiveness of body functioning Self esteem and body image

Normal Movement  Alignment    

and posture

Line of gravity (an imaginary vertical line drawn through the body’s center of gravity) Center of gravity (the point at which all of the body mass is centered) Base of support ( the foundation on which the body rests) Proper alignment minimize the strain on the joints, muscles, tendon and ligament and support the internal organs

Figure 42.38 A, Balance is maintained when the line of gravity falls close to the base of support. B, Balance is precarious when the line of gravity falls at the edge of the base of support. C, Balance cannot be maintained when the line of gravity falls outside the base of support.

Which one is correct posture?

Normal movement 

Joint mobility   



Balance   



Flexor muscles are stronger than the extensor muscles Inactive- the joints are pulled into a flexed (bent) position Range of Motion (ROM)- maximum movement that is possible for that joint Vestibular apparatus Brain stem Proprioception- awareness of the posture, movement and changes in equilibrium and the knowledge of position, weight and the resistance of objects in relation to the body

Coordinated movement   

Cerebral cortex- initiates voluntary motor activity Cerebellum- coordinates the motor activity. When it is injured, movements become clumsy and uncoordinated Basal ganglia- maintain the position

Joint Movements       

Flexion Extension Hyperextension Abduction Adduction Rotation Circumduction (move in a circle)

   

Eversion (laterally) Inversion (medially) Pronation (palm up) Supination (palm down)

Exercise  The

National Institutes of Health (NIH)  Physical activity: bodily movement produced by skeletal muscles that requires energy expenditure and produces progressive health benefits  Exercise: a type of activity defined as a planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness

Types of exercise  Isotonic       

(dynamic) exercises

Muscle shortens to produce muscle contraction and active movement Increase muscle tone, mass and strength Maintain joint flexibility and circulation Increase heart rate and cardiac output Running, walking, swimming ADLs and ROM exercises Isotonic bed exercises- using a trapeze to lift the body off to bed

Exercises  Isometric     

 

(Static or setting) exercises

Change in muscle tension No change in muscle length, muscle or joint movement Exerting pressure against a solid object Cast or traction Extending the legs, tensing the thigh muscles and press the knee against the bed-quadriceps (or quad) set Moderate increase in heart rate and cardiac output No appreciable increase in blood flow

Exercises  Isokinetics   

(resistive) exercises

Muscle contraction or tension against resistance Isotonic or isometric E.g. lifting weights to strength the pectorals (Chest muscle)

Exercises  Aerobic 



 

exercises

The activity during which the amount of oxygen taken in the body is greater than that used to perform the activity Large muscle groups, performed continuously and are rhythmic Walking, jogging, running, swimming, skating Improve cardiovascular conditioning and physical fitness

Measurement of the intensity 1.  

Maximum heart rate: (220- current age) X 60-85% at least 60% of the maximum heart rate is the recommended intensity

Measurement of the intensity 2. Talk test 

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

Keeps most people at 60% of maximum heart rate or more When exercising, the person should be able to carry on a conversation even with some labored breathing. Exercise intensity should be increased if the person can carry on an unlimited unlabored discussion

Measurement of the intensity of exercise 3. Borg scale of perceived exertion  somewhat hard- 75% of maximum heart rate  Measures “how difficult” the exercise feels to the person in terms of heart and lung exertion

6

Very, very light

14

Somewhat hard (75%)

15

Hard

9

Very light (40%)

10

Fairly light

17

7 8

13

16

11

18

12

19, 20

Very hard Very, very hard (100%)

Exercises  Anaerobic 





exercises

Activity in which cannot draw out enough oxygen from the bloodstream Anaerobic pathways are used to provide additional energy for a short time Endurance training for athletes such as weight lifting and sprinting

Guidelines and minimal requirements for physical activity 

Frequency and duration  

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

Aerobic: cumulative 30 minutes or more daily of “moderately intensity” Stretching: should be added onto that minimum requirement so that all parts of the body are stretched each day Strength training: add onto these minimum requirements so that all muscle groups are addressed at least three times a week, with a day of rest after training

Types and safety 

Please refer to textbook Kozier

Benefits of Exercise  Musculoskeletal    

System

Size, shape and tone, strength of muscle Muscle hypertrophy (enlarge) Increase joint flexibility and range of motion balance between osteoblast (bone -building cells) and osteoclasts (bone-resorption and breakdown cells)

Benefits of Exercise 

Cardiovascular system     

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Increase heart rate Strength of heart muscle contraction Increase cardiac output- 30L/ min Increase blood supply to heart and muscle Level of HDL cholesterol, stress reduction

Respiratory system    

Increase ventilation and oxygen intake (20 times) More toxins are eliminated Emotional stability, problem solving Prevent pooling of the secretions in bronchi and bronchioles

Benefits of Exercise  Metabolic    

System

Increase metabolic rate (20 times) Increase production of body heat and waste products and calorie use Reduce level of serum triglycerides and cholesterol Enhances the effectiveness of the insulin

 Gastrointestinal  

System

Improve appetite Increase peristalsis

Benefits of Exercise  Immune   



Lymph fluid from tissue into lymph capillaries Improve lymph nodes circulation Natural killer cell, circulating T- cell and cytokines function- increase resistance to viral infection, prevent formation of the malignant cells How about strenous exercise?

 Urinary 

system

system

Prevent stasis of urine

Benefits of Exercise  Psychoneurologic    

 

system

Produce a sense of well-being Improve self-concept Enhance the quality of sleep Increase levels of metabolites for neurotransmitters such as norepinephrine and serotonin Exercise releases endogenous opioids and increase level of endorphins Increase oxygen level to brain- euphoria

Benefits of Exercise  Cognitive  



function

Strengthen and build neuronal connections Brain Gym- easy, cross-lateral movement that enhance right and left- brain integration thus improving mood. Learning, problem solving and performance The contralateral movements have been shown to help individual with attention deficit disorder (ADD), Attention deficit/ hyperactivity disorder (ADHD), learning disorders and mood disorders

Benefits of Exercise  Spiritual  



Health

Yoga- style exercise- enhance mind- body spirit The emphasis of breathing- sooth the cardiorespiratory and nervous system Walking a labyrinth (a circular mandala)- induce a meditative state, decrease heart and respiratory rate, lowering blood pressure and decrease chronic pain and insomnia

Walking a labyrinth

Factors affecting body alignment and activity  Growth     

and development

1 to 5 years old- gross and fine motor skills refine 6 to 12 years old- the best Adolescence- awkwardness 20-40years old- pregnancy Older adult- osteoporosis, fracture

Factors affecting body alignment and activity  Physical

health  Mental health  Nutrition  Personal values and attitudes  External factors  Prescribed limitation 

Bed rest

Effects of immobility  Musculoskeletal 

 



System

Disuse osteoporosis- bone demineralize when there is no stress of weight-bearing, bones become spongy and fracture easily Disuse atrophy- muscle decrease in size Contractures- permanent shortening of the muscle leads to joints immobility and deformity Stiffness and pain in joints- ankylosing of the collagen

Effects of immobility  Cardiovascular 





system

Diminshed cardiac reserve- tachycardia with minimal exertion Increase use of valsalva maneuver- holding the breath and straining against a closed glottis, pressure on the large vein and decrease blood flow to heart and coronary vessels Orthostatic (postural) hypotensionvasoconstriction of the lower half of the body

Effects of immobility 

Cardiovascular system 

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Venous vasodilation and stasis- poor contractility of the skeletal muscle and incompetent valves Dependent edema- insufficient venous pressure, blood is forced to interstitial spaces (sacrum, heels) Thrombus formation  thrombophlebitis: impaired venous return to the heart, hypercoagulability of the blood and injury to the vessel walls  Embolus: an object move from its place of origin, causing obstruction to circulation

Effects of immobility  Respiratory   



system

Decreased respiratory movement Pooling of respiratory secretions Atelectasis- decreased surfactant and blockage of a bronchiole cause the collapse of a lobe or an entire lung Hypostatic pneumonia

Effects of immobility  Metabolic  

 

system

Decreased metabolic rate Negative nitrogen balance: protein synthesis (anabolism) < protein breakdown (catabolism), increase excretion of nitrogen Anorexia: loss of appetite Negative calcium balance

Effects of immobility  Urinary 

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 

system

Urinary stasis- decrease gravity, decrease in muscle tone Renal calculi- calcium salts precipitate out as crystals to form renal calculi Urinary retention and urinary incontinence Urinary tract infection

Effects of immobility  Gastrointestinal 

Constipation

 Integumentary  

system

system

Reduced skin turgor Skin breakdown

 Psychoneurologic 

system

Decrease self-esteem

Using body mechanics  The

efficient , coordinated and safe use of the body to move objects and carry out the activities of daily living  Lifting  Pulling and pushing  Pivoting- turn without twisting of the spine  Preventing back injury

Positioning of the clients  Fowler’s

position  Orthopneic position  Dorsal recumbent position  Prone position  Lateral position  Sim’s position

Positioning of the clients (please read textbook before the lab.)  Turning

the client in the bed  Logrolling the client 

Why and how we use logrolling?

 Transferring

between bed and chair  Wheelchair safety  Providing passive range of motion exercise

Low-Fowler’s (semi-Fowler’s position)(supported).

•Sitting with an overbed table across the lap •Facilitates respiratory by allowing maximum chest expansion •Helps in inhaling problem/ exhaling problem?

Dorsal recumbent position.

Lateral position (supported).

Sim’s position (supported).

Moving a client up in bed.

Moving a client to a lateral position.

Logrolling

•Turn the clients whose body must at all times be kept in straight alignment (like a log). •E.g. spinal injury •Two nurses/ three nurses •Cervical injury- maintain head and neck alignment

Logrolling

Logrolling

Assisting a client to a sitting position on the edge of the bed.

Assisting a client to a sitting position on the edge of the bed

Controlling Postural Hypotension •Rest with the head of the bed elevated •Be aware the times after the heavy meals or after hypotensive medication •Never bend down quickly •Wear elastic stocking/ rocking chair •Hot bath/ valsalva maneuver •Arise from bed in three stages: •Sit up in bed for 1 minutes •Sit on the side of the bed with the legs dangling for 1 minutes •Stand with holding nonmovable objects for 1 minutes

Supporting a limb above and below the joint for passive exercise.

Passive ROM Exercises •Should be systematic, three repetitions •Twice daily •Use a firm, comfortable grip and good supports of limbs •smoothly., slowly and rhythmically •Avoid fast movement- will cause spasticity and rigidity •Avoid forcing •Firm pressure and stop temporarily if necessary

Assisting the client to ambulate (please read before the lab.) 



To provide a safe condition for the client to walk with whatever support is needed Using mechanical aids for walking    

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Canes Walker Crutches the tripod position: the crutches are placed about 15cm in front of the feet and out laterally about 15 cm, creating a wide base of support Please read the client teaching in using canes, alkers and crutches

The wheelchair is placed parallel to the bed as close to the bed as possible. Note the placement of the nurse’s feet mirrors that of the client’s feet.

Using a transfer (walking) belt.

© Elena Dorfman

Figure 42.67

Lowering a fainting client to the floor.

© Elena Dorfman

The swing-to crutch gait.

The swing-through crutch gait.

The four-point alternate crutch gait.

Teaching: Client Care: Using Crutches

A, standard walker; B, A two-wheeled walker.

©©Elena ElenaDorfman Dorfman

The three-point alternate crutch gait.

The two-point alternate crutch gait.

Teaching: Client Care: Using Walkers

Teaching: Wellness Care: Preventing Back Injuries

Safe Use of Stretchers