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Chapter 27Exercise and Activity
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Exercise and Activity
Being active is important for physical and mental well-being.
Illness, surgery, injury, pain, and aging cause weakness and some activity limits.
Inactivity, whether mild or severe, affects: Every body system Mental well-being
Deconditioning is the loss of muscle strength from inactivity.
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Exercise and Activity (cont’d) Nurses use the nursing process to promote exercise and activity in all persons to the extent possible. CNA’s help promote well being by assisting patients to activities of their choice (requirement of OBRA)
To help promote exercise and activity, you need to understand: Bedrest How to prevent complications from
bedrest How to help with exercise
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Bedrest Generally, bedrest is ordered to:
Reduce physical activity. Reduce pain. Encourage rest. Regain strength. Promote healing.
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Bedrest These types of bedrest are common:
Strict bedrest-everything is done for the person-no ADL’s allowed
Bedrest with some ADL allowed-feeding, oral hygiene etc.
Bedrest with commode privileges-can use the commode for elimination
Bedrest with bathroom privileges (bedrest with BRP)-person can go to bathroom for elimination
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Bedrest (cont’d) Complications from bedrest include:
Pressure ulcers
Constipation and fecal impaction
Urinary tract infections and renal calculi (kidney stones)
Blood clots (thrombi)
Pneumonia (inflammation and infection of the lung)
Contractures-lack of joint mobility caused by abnormal shortening of the muscle
Atrophy-decrease in size of wasting of muscle tissue
Orthostatic hypotension (postural hypotension)
Syncope (fainting)Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.Slide
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Bedrest (cont’d)
Good nursing care prevents complications from bedrest.
Important measures included in the care plan include
Good alignment
Range-of-motion exercises
Frequent position changes
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Supportive Devices Supportive devices are often used.
Bed-boards-prevents mattress from sagging
Foot-boards-prevents footdrop
Trochanter rolls-prevents external rotation of legs and hips
Hip abduction wedges-keeps hips abducted (apart)
Hand rolls or hand grips-prevents contractures of thumb, fingers and wrist
Splints-keeps joints in normal position
Bed Cradles-keeps linen off feetCopyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.Slide
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bedboard
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footboard
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Trochanter roll
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Hip abduction wedge
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Hand grip
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Splint
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Bed cradle
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Bedrest (cont’d) Exercise helps prevent:
Contractures
Muscle atrophy
Other complications from bedrest
Some exercise occurs:
With ADL
When turning and moving in bed without help
A trapeze is used:
For exercises to strengthen arm muscles
To move up and turn in bed
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Range-of-Motion Exercises Range-of-motion exercises (ROM) involve
moving the joints through their complete range of motion. They are usually done at least 2 times a day. Active ROM exercises are done by the person.
Passive ROM exercises—someone moves the joints through their range of motion.
Active-assistive ROM exercises—the person does the exercises with some help.
Persons on bedrest need more frequent ROM exercises; so do those who cannot walk, turn, or transfer themselves because of illness or injury.
Exercise the joints delegated to you, move slowly and support the joints. Stop for pain! Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Ambulation (Walking) After bedrest, activity increases slowly and in
steps.
First, the person sits on the side of the bed (dangles).
Sitting in a bedside chair follows.
Next, the person walks in the room and then in the hallway.
Regular walking helps prevent deconditioning.
Use a gait (transfer) belt if the person is weak or unsteady-remember to walk to the side and slightly behind the person!
The person also uses hand rails along the wall.
Always check for orthostatic hypotension.Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Orthostatic hypotension
Definition: abnormally low (hypo) blood pressure when the person suddenly stands up
Same as postural hypotension Patient will complain of dizziness and
seeing spots in front of eyes Syncope (fainting) is a common
occurrence and is dangerous to patients
Key to prevention is slow position changes!
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Ambulation (Walking) (cont’d)
Walking aids support the body. The need may be temporary or
permanent. The type ordered depends on the:
Person’s condition Amount of support needed Type of disability
Crutches are used when the person cannot use one leg or when one or both legs need to gain strength.
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Ambulation (Walking) (cont’d)
The person on crutches is at risk for falls. Follow these safety measures: Check the crutch tips. Check crutches for flaws. Tighten all bolts. Make sure the person wears street
shoes with flat, non-skid soles. Make sure clothes fit well. Practice safety rules to prevent falls. Keep crutches within the person’s
reach. Know which crutch gait the person
uses.
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Ambulation (Walking) (cont’d)
Canes are used for weakness on one side of the body. They help provide balance and
support. Single-tip and four-point (quad) canes
are common. A cane is held on the strong side of the
body.
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Walking with a cane Walking with a cane. A, The cane is moved
forward about 6 to 10 inches. B, The leg opposite the cane (weak leg) is brought forward even with the cane. C, The leg on the cane side (strong side) is moved ahead of the cane and the weak leg.
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Walkers
A walker gives more support than a cane. Wheeled walkers are common. Baskets, pouches, and trays
attach to the walker. Some have seats so the patient
can rest
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Ambulation (Walking) (cont’d) Braces support weak body parts.
They also prevent or correct deformities or prevent joint movement.
A brace is applied over the ankle, knee, or back.
An ankle-foot orthosis (AFO) is placed in the shoe.
You need to:
Keep skin and bony points under braces clean and dry.
Report redness or signs of skin breakdown at once.
Report complaints of pain or discomfort.
The care plan tells you when to apply and remove a brace.
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Braces
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