Let’s Get Moving!
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Transcript of Let’s Get Moving!
Lisa B. Flatt, RN, MSN, CHPN
Let’s Get Moving!
The Cornerstones of Nursing CareMaintaining mobilitySupporting increased mobility
Priniciples of body alignmentBody mechanicsRange of Motion (ROM)PositioningTransfer
Mobility PrinciplesBody alignment – ideal body position,
proper anatomical positionPositioning changes depending on
how/what you are doingIdeal position:
Centered cranium (midline shoulders, facing forward)
Arms hanging at sides palms midline and fingers slightly bent
Weight is mostly on hips, knees not locked, feet slightly apart and pointed forward
Body MechanicsProtection of MS system
Nursing Care Plan & Implications
Weight to center of gravity
Lift with legsStraight back
Implementation: instruct patient and family about body mechanics and safe patient handling
Evaluation: return demonstration and verbalization of techniques; injury free
ROM – part of every joint, nose to toes!Active ROM: patient does selfActive-assisted ROM: patient does with
assistancePassive ROM: caregiver does all the work
Influencing factors on Activity & MobilityAge & developmental
levelPreferences & patternsInitial physical conditionCulture/spiritual/
religiousSocioeconomicEnvironmentalPsychological –
depressionObesityNutritional statusFinancesHousing (stairs)
Cardiovascular statusEducational levelCongenital or acquired
postural anomaliesVitamin D deficienciesMS disordersRespiratory statusCV statusChronic IllnessClimateAltitudeOccupation
Nursing ImplicationsContracture prevention - ___ROM,
positioning_______Nursing responsibility- _teaching, turning_____Positioning - ___reduce pressure, promote
health____Importance of alignment - ___decrease injury___Transferring - __safety, prevent injury_____Exercise - ____promotes health____Bedrest - ___evil or good depending___Immobility issues - _contractures, pneumonia,
pressure sores, UTI, weakness, nerve damage_
The Evils of Bedrest! Encourage ROM and bed activity Systems affected
Respiratory ___lung expansion decreases; fluids pool; decreased tolerance__
MS __decreased strength, muscle wasting, contractures, loss of mobility_
Cardiac __arrhythmias, decreased tone, fluids pooling, not increasing heart rate_
Vital signs ___depressed__Appetite __decreases__GU__UTI, incontinence____GI_incontinence, constipation____Psychosocial – depression and isolation
Diseases & Nursing ConsiderationsOsteoporosis – primarily effects___women___ who are
of __asian, caucasian__descent ___thin____small boned?Television and obesity ___more tv = less exercise =
fatter__Athletics – social outlet – teamwork with peers –
increase muscle massOlder adults – kyphosis, gait changes, muscle tone,
joint mobilityChronic illnessesSmoking/dipping/chewingSedentary lifestylePsychological benefits of exerciseNutritional status
Disturbed…. Oh yeah.. Immobility CV__diminshed cardiac reserve and muscle tone______Repiratory __decreases amt of air take in, lung
compliance, decreased air exchange__Orthostatic hypotension___shift in position causes bp
changes/ lowering_Metabolism ___slows way down…….._Pressure Ulcers__bad__Venous __stasis, stasis ulcers, blood pools, mottling,
dvt__GI _constipation, decreased motility___GU__UTI, incontinence, decrease urination_Skin _____poor, tenting__________________Thrombophlebitis ___bid bad risk_________
Psychological HopelessnessHelplessSensory deprivationSleep issuesAttention-seekingPowerlessnessDevelopmental
Nursing InterventionsExercisesPositioningSupportive devicesTransfer techniquesPrevention programsAssistive devicesAlternative and complementary treatmentsActive and passive ROMQuadriceps-settingWeights
The lay of the land - positioningFowlers – HOB 45*-90*Semi-fowlers – HOB 15*-45*High-fowlers- HOB- 90*Orthopneic – like high-fowlers with arms
over table (ie)Dorsal recumbent – lying on back,
shoulders slightly elevatedProne – lying flat on back Sims’ (semi-prone) – between lateral and
prone (ie enema assume the position)
Are you there for me? Support! Pillows, mattresses, bed boards, chair beds, foot boots,
footboards, trochanter rolls, sand bags, handrails, restraints Safe transfer techniques: elevate bed, get help Mechanical aids & Safety: lifts, slider sheets, chair riser,
trapeze Wheelchairs – brakes, foot pads Crutches (117)
4 point gait – safest, one crutch, one foot, one crutch opposite foot 3 point gait – both crutches and weaker leg first 2 point gait – opposite crutch and leg Swing through gait – crutches then body swings through Swing to gait – body and then crutches
Canes – various kinds, depends on what is needed Transfer belts Bedside rails Trapeze Lifts
Sample of Nursing Care Plan (120) Assessment: SOB, Dyspenic when climbing stairs, Unemployed, Diagnosis: Activity intolerance R/T sedentary lifestyle manifested by SOB on
exertion. Plan:
Pt will verbalize the need to incorporate exercise into daily activity. Find Pt’s activity preference
Implementation: Pt will work with PT three times/wk. Nursing staff will also walk pt twice per
day working towards ambulating 100ft. Will educate pt on benefits of exercising. Administer Resp. Tx prior to ambulation
Evaluation: Pt ambulated twice per day with stand by assist up to 150ft. Verbalizes education of benefits in exercising. RT gave Tx’s prior to ambulation.
Exercise – a dirty word?Aerobic – using air- hehe - burning caloriesWeight – what we have Resistive (isokinetic)- pushing againstIsotonic – muscles movesIsometric – muscle tensesTarget heart rate – 60-85% of maximumMaximum heart rate – 220-ageTalk test – carry on a conversation without labored
breathingBorg’s scale is- perception of exertion or how difficult
the exercise feels related to heart and lung exertion
Complementary therapyChiropracticAcupunctureAcupressureTherapeutic touchMassageReflexology