Activity&Exercise

7/29/2019 Activity&Exercise

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Activity and Exercise

Fundamentals of Nursing Review


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Mobility

The ability to move freely, easily,

rhythmically and purposefully


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Range of Motion

The ROM of the joint is the maximum

movement that is possible for that joint


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Exercise

A type of physical activity defined as a

planned, structure and repetitive bodily

movement done to improve or maintain

one or more components of physical

fitness


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Types of Exercise

ISOTONIC

Dynamic exercise in which the muscle

shortens to produce contraction and

movement

Running, walking, swimming, cycling


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Types of Exercise

ISOMETRIC

Are those in which there is a change in

muscle tension but NO CHANGE in muscle

length

Tensing, extending and pressing exercises


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Other Types of Exercise

ISOKINETIC

Involves muscle contraction or tension

against a resistance

Aerobic exercise

activity during which the amount of

oxygen taken into the body is greater than

that used to perform the activity


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Benefits of Exercise

Increases joint flexibility, tone and ROM

Bone density is maintained

Increases cardiac output and perfusion

Prevents pooling of secretions in the lungs

Improves appetite and facilitate peristalsis

Elevates the metabolic rate Prevents stasis of urine

Produces a sense of well-being


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IMPAIRED PHYSICAL MOBILITY

Complications of IMMOBILITY

1. Contractures, atrophy and stiffness

2. Foot drop

3. DVT

4. Hypostatic pneumonia

5. Pressure ulcers, skin breakdown,

reduced skin turgor


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Complications of IMMOBILITY

6. muscle atrophy

7. osteoporosis 8. dependent edema

9. urine stasis

10. constipation


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ASSESSMENT

Assess patients ability to move

Assess muscle tone, strength

Assess joint movement and

positioning


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Nursing Interventions

1. Position properly to prevent contractures

Place trochanter roll from the iliac crest to

the mid-thigh to prevent EXTERNAL rotation Place patient on wheelchair 90 degrees with

the foot resting flat on the floor/foot rest

Place foot board or high-heeled shoes toprevent foot drop


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2. Maintain muscle strength and joint

mobility

Perform passive ROME Perform assistive ROME

Perform active ROME

Move the joints three times TID


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3. Promote independent mobility

Warn patient of the orthostatichypotension when suddenly

standing upright


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4. Assist patient with transfer

Assess patients ability to participate

Position yourself in front of the patient

Lock the wheelchair or the bed wheel

Use devices such as transfer boards,sliding boards, trapeze and sheets


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4. Assist patient with transfer

In general, the equipments are placed

on the side of the STRONGER ,UNAFFECTED body part

Nurses assist the patient to move

TOWARDS the stronger side In moving the patient, move to the

direction FACING the nurse


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5. Assist patient to prepare for

ambulation

Exercise such as quadriceps setting,gluteal setting and arm push ups

Use rubber ball for hand exercise


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6. Assist patient in crutch ambulation

Measure correct crutch length LYING DOWN

Measure from the Anterior Axillary Foldto the HEEL of the foot then:

Add 1 inch (Kozier)

Add 2 inches (Brunner and Suddarth)


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Measure correct crutch length

STANDING (Kozier) Mark a distance of 2 inches to the side

from the tip of the toe (first mark)

6 inches is marked (second mark) aheadfrom the first

Measure 2 inches below the axilla to the

second mark


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STANDING (Kozier) Make sure that the shoulder-rest of the

crutch is at least 1- 2 inches below the

axilla


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Utilizing the patients HEIGHT Height MINUS 40 cm or 16 inches


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6. Assist patient in crutch

ambulationMeasure correct crutch length

Hand piece should allow 20-30

degrees elbow flexion


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6. Assist patient in crutch GAIT

A. 4 point gait

B. three-point gait

C. two point gait

D. swing to gait

E. swing through gait

GAIT


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GAIT


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4-point gait

Safest gait

Requires weight bearing on both legs

Move RIGHT crutch ahead (6 inches)

Move LEFT foot forward at the level of

the RIGHT crutch

Move the LEFT crutch forward

Move the RIGHT foot forward


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3-point gait

Requires weight bearing on theUNAFECTED leg

Move BOTH crutches and theWEAKER LEG forward

Move the STRONGER leg forward


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2-point gait

Faster than 4-point

Requires more balance

Partial bearing on BOTH legsMove the LEFT crutch and RIGHT foot

FORWARD together

Move the RIGHT crutch and LEFT footforward together


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Swing-to gait

Usually used by client with paralysis of

both legs

Prolonged use results in atrophy of

unused muscle

Move BOTH crutches together

Lift body weight by the arms and swingto the crutches (at the level)


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Swing-through gait

Move BOTH crutches together

Lift body weight by the arms and swing

forward, ahead of the crutches (beyondthe level)


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6. Assist patient in ambulation with a walker

Correct height of the walker must allow a

20-30 degrees of elbow flexion


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6. Assist patient in ambulation with a cane

Correct cane measurement:

With elbow flexion of 30 degrees,measure the length from the HAND to 6inches lateral to the tip of the 5th toe


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Impaired Skin integrity

Pressure ulcers

Are localized areas of dead soft

tissue that occurs when pressureapplied to the skin overtime is more

than 32 mmHg leading to tissue

damage

P


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Pressure sores


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INITIAL SIGN OF PRESSURE ULCER:

ERYTHEMA or redness of the skinthat DOES NOT blanch


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Weight bearing Bony prominences

1. Sacrum and cocygeal area

2. Ischial tuberosity 3. Greater trochanter

4. Heel and malleolus

5. Tibia and fibula 6. Scapula and elbow


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Pressure areas


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Risk Factors for pressure ulcers

1. Patients with sensory deficits

2. Decreased tissue perfusion

3. Decreased nutritional status 4. Friction and shearing forces

5. Increased moisture and edema


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Pressure ulcer stages

Stage 1- non-blanchable Erythema

Stage 2- skin breakdown in dermis

Stage 3- ulceration extends to thesubcutaneous tissue

Stage 4- ulcers involve the muscle and bone


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RELIEVE THE PRESSURE

Turn and reposition every 1-2 Hours

Encourage weight shifting actively,

every 15 minutes


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POSITION PATIENT PROPERLY

Follow the recommended sequence

Lateral

prone

supine

lateral

Position patient with the bed elevated

at NO MORE THAN 30 degrees Utilize the bridging technique


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UTILIZE PRESSURE RELIEVING

DEVICES

Use floatation pads

Use air, water or foam mattresses

Oscillating and kinetic bed


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IMPROVE MOBILITY

Active and passive exercises

Assistive exercise


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IMPROVE TISSUE PERFUSION

Exercise and repositioning are the

most important activities

AVOID MASSAGE ON THE REDDENED

AREAS


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IMPROVE NUTRITIONAL STATUS

HIGH protein

HIGH vitamin C diet

Measure body weight

Assess hemoglobin and albumin


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REDUCE FRICTION AND SHEAR

Lift and not drag patient

Prevent the presence of wrinkles and

creases on bed sheets


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REDUCE IRRITATING MOISTURE

Adhere to a meticulous skin care

Promptly clean and dry the soiled areas

Use mild soap and water

Pat dry and not rub

Lotion may be applied AVOID powders (cause dryness)


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PROMOTE WOUND HEALING

Vitamin C

Dictum: Remove the pressure


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Stage 1

Remove pressure

Reposition Q 2

Never massage the area


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Stage 2

Clean with sterile SALINE only

Antiseptic solutions may damagehealthy regenerating tissue and delay

healing Wet saline dressings are helpful


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Stage 3 and 4

Necrotic tissues are debrided

Administer analgesics before cleansing

Do a mechanical flushing with saline

solution Topical ointments may be applied UNTIL

granulation tissue appears then only salineirrigation is recommended


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Positioning

Any position, correct or incorrect, can be

harmful if maintained for a prolonged

period


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Positioning

Frequent position changes helps to

prevent :

Muscle discomfort Unnecessary pressure

Skin damage

Contracture Blood pooling


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Positioning

When the client is NOT able to move

INDEPENDENTLY, the preferred method

is to have two or more people move the

patient


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Requisites of proper positioning

Use of support devices- mattress, pillows,

bed boards, foot board

Dry, clean and unwrinkled sheets

24- hour schedule should be posted


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Fowlers Position

The Sitting position

The position of choice for people who

have difficulty breathing and for some

people with hear problems

This allows greater chest expansion and

lung ventilation


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Fowlers Position

The Sitting position

Low Fowlers

Semi-fowlers

Fowler's

High Fowlers


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Orthopneic position

The client sits in chair or bed, with an

overbed table

Allows maximum chest expansion

Client can press the lower chest against

the bed further facilitating ventilation


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Dorsal Recumbent

Back-lying position, with head and

shoulders SLIGHTLY elevated

Provides comfort


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Prone

The client lies on the abdomen with the

head usually turned to one side

Allows full extension of the hips to prevent

flexion contractures

Promotes drainage from the mouth


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Lateral

Side-lying position

Good for resting and sleeping because it

promotes back alignment

Also prevents aspiration


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Sims

Semi-prone position

Used for unconscious clients as it helps

facilitated drainage of secretions


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Activity&Exercise

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