Chapter 27 Exercise and Activity Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights...

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.

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.Slide

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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

Copyright © 2012 by Mosby, an imprint of lsevier Inc. All rights reserved.

Slide 7

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.

Slide 17

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.

Slide 18

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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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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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.


Slide 22

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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Chapter 27 Exercise and Activity Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights...

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