activity and exercise 2010 review

8/6/2019 Activity and Exercise 2010 Review

1/67

Activity and ExerciseActivity and Exercise

Fundamentals of Nursing ReviewFundamentals of Nursing Review


2/67

MobilityMobility

The ability to move freely, easily,The ability to move freely, easily,

rhythmically and purposefullyrhythmically and purposefully


3/67

Range ofMotionRange ofMotion

The ROM of the joint is the maximumThe ROM of the joint is the maximum

movement that is possible for that jointmovement that is possible for that joint


4/67

ExerciseExercise

A type of physical activity defined as aA type of physical activity defined as a

planned, structure and repetitive bodilyplanned, structure and repetitive bodily

movement done to improve or maintainmovement done to improve or maintainone or more components of physicalone or more components of physical

fitnessfitness


5/67

Types of ExerciseTypes of Exercise

ISOTONICISOTONIC

Dynamic exercise in which the muscleDynamic exercise in which the muscle

shortens to produce contraction andshortens to produce contraction and

movementmovement

Running, walking, swimming, cyclingRunning, walking, swimming, cycling


6/67

Types of ExerciseTypes of Exercise

ISOMETRICISOMETRIC

Are those in which there is a change inAre those in which there is a change in

muscle tension but NO CHANGE in musclemuscle tension but NO CHANGE in muscle

lengthlength

Tensing, extending and pressing exercisesTensing, extending and pressing exercises


7/67

Other Types of ExerciseOther Types of Exercise

ISOKINETICISOKINETIC

Involves muscle contraction or tensionInvolves muscle contraction or tension

against a resistanceagainst a resistance

Aerobic exerciseAerobic exercise

activity during which the amount ofactivity during which the amount of

oxygen taken into the body is greater thanoxygen taken into the body is greater than

that used to perform the activitythat used to perform the activity


8/67

Benefits of ExerciseBenefits of Exercise

Increases joint flexibility, tone and ROMIncreases joint flexibility, tone and ROM

Bone density is maintainedBone density is maintained

Increases cardiac output and perfusionIncreases cardiac output and perfusion Prevents pooling of secretions in the lungsPrevents pooling of secretions in the lungs

Improves appetite and facilitate peristalsisImproves appetite and facilitate peristalsis

Elevates the metabolic rateElevates the metabolic rate Prevents stasis of urinePrevents stasis of urine

Produces a sense of wellProduces a sense of well--beingbeing


9/67

IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY

Complications of IMMOBILITYComplications of IMMOBILITY

1. Contractures, atrophy and stiffness1. Contractures, atrophy and stiffness

2. Foot drop2. Foot drop

3. DVT3. DVT

4. Hypostatic pneumonia4. Hypostatic pneumonia

5. Pressure ulcers, skin breakdown,5. Pressure ulcers, skin breakdown,

reduced skin turgorreduced skin turgor


10/67


Complications of IMMOBILITYComplications of IMMOBILITY

6. muscle atrophy6. muscle atrophy

7. osteoporosis7. osteoporosis 8. dependent edema8. dependent edema

9. urine stasis9. urine stasis

10. constipation10. constipation


11/67


ASSESSMENTASSESSMENT

Assess patients ability to moveAssess patients ability to move

Assess muscle tone, strengthAssess muscle tone, strength

Assess joint movement andAssess joint movement and

positioningpositioning


12/67


Nursing InterventionsNursing Interventions1. Position properly to prevent contractures1. Position properly to prevent contractures

Place trochanter roll from the iliac crest toPlace trochanter roll from the iliac crest to

the midthe mid--thigh to prevent EXTERNAL rotationthigh to prevent EXTERNAL rotation

Place patient on wheelchair 90 degrees withPlace patient on wheelchair 90 degrees with

the foot resting flat on the floor/foot restthe foot resting flat on the floor/foot rest

Place foot board or highPlace foot board or high--heeled shoes toheeled shoes toprevent foot dropprevent foot drop


13/67


Nursing InterventionsNursing Interventions2. Maintain muscle strength and joint2. Maintain muscle strength and joint

mobilitymobility

Perform passive ROMEPerform passive ROME Perform assistive ROMEPerform assistive ROME

Perform active ROMEPerform active ROME

Move the joints three times TIDMove the joints three times TID


14/67


Nursing InterventionsNursing Interventions

3. Promote independent mobility3. Promote independent mobility

Warn patient of the orthostaticWarn patient of the orthostatichypotension when suddenlyhypotension when suddenly

standing uprightstanding upright


15/67



4. Assist patient with transfer4. Assist patient with transfer

Assess patients ability to participateAssess patients ability to participate

Position yourself in front of the patientPosition yourself in front of the patient

Lock the wheelchair or the bed wheelLock the wheelchair or the bed wheel

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


16/67



4. Assist patient with transfer4. Assist patient with transfer

In general,In general, the equipments are placedthe equipments are placed

on the side of the STRONGER ,on the side of the STRONGER ,

UNAFFECTED body partUNAFFECTED body part

NursesNurses assist the patient to moveassist the patient to move

TOWARDS the stronger sideTOWARDS the stronger side

In moving the patient,In moving the patient, move to themove to the

direction FACING the nursedirection FACING the nurse


17/67


Nursing InterventionsNursing Interventions5. Assist patient to prepare for5. Assist patient to prepare for

ambulationambulation

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

Use rubber ball for hand exerciseUse rubber ball for hand exercise


18/67



6.6. Assist patient in crutch ambulationAssist patient in crutch ambulation

Measure correct crutch lengthMeasure correct crutch length LYING DOWNLYING DOWN

Measure from theMeasure from theAnterior Axillary FoldAnterior Axillary Fold

to the HEEL

of the foot then:to the HEEL

of the foot then:Add 1 inch (Kozier)Add 1 inch (Kozier)

Add 2 inches (Brunner and Suddarth)Add 2 inches (Brunner and Suddarth)


19/67


Nursing InterventionsNursing Interventions6. Assist patient in crutch ambulation6. Assist patient in crutch ambulation

Measure correct crutch lengthMeasure correct crutch length

STANDING (Kozier)STANDING (Kozier)

Mark a distance of 2 inches to the sideMark a distance of 2 inches to the sidefrom the tip of the toe (first mark)from the tip of the toe (first mark)

6 inches is marked (second mark) ahead6 inches is marked (second mark) aheadfrom the firstfrom the first

Measure 2 inches below the axilla to theMeasure 2 inches below the axilla to thesecond marksecond mark


20/67



6. Assist patient in crutch ambulation6. Assist patient in crutch ambulation


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

crutch is at least 1crutch is at least 1-- 2 inches below the2 inches below the

axillaaxilla


21/67



6. Assist patient in crutch ambulation6. Assist patient in crutch ambulation


Utilizing the patients HEIGHTUtilizing the patients HEIGHT Height MINUS 40 cm or 16 inchesHeight MINUS 40 cm or 16 inches


22/67



6. Assist patient in crutch6. Assist patient in crutch

ambulationambulationMeasure correct crutch lengthMeasure correct crutch length

Hand piece should allow 20Hand piece should allow 20--3030

degrees elbow flexiondegrees elbow flexion


23/67



6. Assist patient in crutch GAIT6. Assist patient in crutch GAIT

A. 4 point gaitA. 4 point gait

B. threeB. three--point gaitpoint gait

C. two point gaitC. two point gait

D. swing to gaitD. swing to gait

E. swing through gaitE. swing through gait


24/67

GAITGAIT


25/67

44--point gaitpoint gait

Safest gaitSafest gait

Requires weight bearing on both legsRequires weight bearing on both legs

Move RIGHT crutch ahead (6 inches)Move RIGHT crutch ahead (6 inches)

Move LEFT foot forward at the level ofMove LEFT foot forward at the level of

the RIGHT crutchthe RIGHT crutch

Move the LEFT crutch forwardMove the LEFT crutch forward

Move the RIGHT foot forwardMove the RIGHT foot forward


26/67


Requires weight bearing on theRequires weight bearing on the

UNAFECTED legUNAFECTED leg

MoveMove BOTHBOTHcrutches and thecrutches and the

WEAKERLEGWEAKERLEGforwardforward

Move the STRONGER leg forwardMove the STRONGER leg forward


27/67


FasterFasterthan 4than 4--pointpoint

Requires more balanceRequires more balance

Partial bearing on BOTH legsPartial bearing on BOTH legsMove theMove the LEFT crutch and RIGHT footLEFT crutch and RIGHT foot

FORWARD togetherFORWARD together

Move theMove the RIGHT crutch andLEFT footRIGHT crutch andLEFT footforward togetherforward together


28/67

SwingSwing--to gaitto gait

Usually used by client with paralysis ofUsually used by client with paralysis of

both legsboth legs

Prolonged use results in atrophy ofProlonged use results in atrophy ofunused muscleunused muscle

MoveMove BOTH crutches togetherBOTH crutches together

L

ift body weight by the arms and swingL

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


29/67

SwingSwing--through gaitthrough gait

MoveMove BOTH crutches togetherBOTH crutches together

Lift body weight by the arms and swingLift body weight by the arms and swing

forward, ahead of the crutchesforward, ahead of the crutches (beyond(beyondthe level)the level)


30/67



6. Assist patient in ambulation with a walker6. Assist patient in ambulation with a walker

Correct height of the walker must allow aCorrect height of the walker must allow a

2020--30 degrees of elbow flexion30 degrees of elbow flexion


31/67



6. Assist patient in ambulation with a cane6. Assist patient in ambulation with a cane

Correct cane measurement:Correct cane measurement:

With elbow flexion of 30 degrees,With elbow flexion of 30 degrees,

measure the length from the HAND to 6measure the length from the HAND to 6

inches lateral to the tip of the 5inches lateral to the tip of the 5thth toetoe


32/67


33/67

Impaired Skin integrityImpaired Skin integrity

Pressure ulcersPressure ulcers

Are localized areas of dead softAre localized areas of dead soft

tissue that occurs when pressuretissue that occurs when pressureapplied to the skin overtime is moreapplied to the skin overtime is more

than 32 mmHg leading to tissuethan 32 mmHg leading to tissue

damagedamage


34/67

Pressure soresPressure sores


35/67


INITIAL SIGN OF PRESSURE ULCER:INITIAL SIGN OF PRESSURE ULCER:

ERYTHEMA or redness of the skinERYTHEMA or redness of the skin

that DOES NOT blanchthat DOES NOT blanch


36/67


Weight bearing Bony prominencesWeight bearing Bony prominences

1. Sacrum and cocygeal area1. Sacrum and cocygeal area

2. Ischial tuberosity2. Ischial tuberosity 3. Greater trochanter3. Greater trochanter

4. Heel and malleolus4. Heel and malleolus

5. Tibia and fibula5. Tibia and fibula 6. Scapula and elbow6. Scapula and elbow


37/67

Pressure areasPressure areas


38/67

Risk Factors for pressure ulcersRisk Factors for pressure ulcers

1. Patients with sensory deficits1. Patients with sensory deficits

2. Decreased tissue perfusion2. Decreased tissue perfusion

3. Decreased nutritional status3. Decreased nutritional status 4. Friction and shearing forces4. Friction and shearing forces

5. Increased moisture and edema5. Increased moisture and edema


39/67

Pressure ulcer stagesPressure ulcer stages

Stage 1Stage 1-- nonnon--blanchable Erythemablanchable Erythema

Stage 2Stage 2-- skin breakdown in dermisskin breakdown in dermis

Stage 3Stage 3-- ulceration extends to theulceration extends to the

subcutaneous tissuesubcutaneous tissue

Stage 4Stage 4-- ulcers involve the muscle and boneulcers involve the muscle and bone


40/67


41/67


42/67


RELIEVE THE PRESSURERELIEVE THE PRESSURE

Turn and reposition every 1Turn and reposition every 1--2 Hours2 Hours

Encourage weight shifting actively,Encourage weight shifting actively,

every 15 minutesevery 15 minutes


43/67


POSITION PATIENT PROPERLYPOSITION PATIENT PROPERLY

Follow the recommended sequenceFollow the recommended sequence

LateralLateral proneprone supinesupine laterallateral

Position patient with the bed elevatedPosition patient with the bed elevated

at NO MORE THAN 30 degreesat NO MORE THAN 30 degrees Utilize the bridging techniqueUtilize the bridging technique


44/67


UTILIZE PRESSURE RELIEVINGUTILIZE PRESSURE RELIEVING

DEVICESDEVICES

Use floatation padsUse floatation pads Use air, water or foam mattressesUse air, water or foam mattresses

Oscillating and kinetic bedOscillating and kinetic bed


45/67


IMPROVE MOBILITYIMPROVE MOBILITY

Active and passive exercisesActive and passive exercises

Assistive exerciseAssistive exercise


46/67


IMPROVE TISSUE PERFUSIONIMPROVE TISSUE PERFUSION

Exercise and repositioning are theExercise and repositioning are the

most important activitiesmost important activities

AVOID MASSAGE ON THE REDDENEDAVOID MASSAGE ON THE REDDENED

AREASAREAS


47/67


IMPROVE NUTRITIONAL STATUSIMPROVE NUTRITIONAL STATUS

HIGH proteinHIGH protein

HIGH vitamin C dietHIGH vitamin C diet Measure body weightMeasure body weight

Assess hemoglobin and albuminAssess hemoglobin and albumin


48/67


REDUCE FRICTION AND SHEARREDUCE FRICTION AND SHEAR

Lift and not drag patientLift and not drag patient

Prevent the presence of wrinkles andPrevent the presence of wrinkles andcreases on bed sheetscreases on bed sheets


49/67


50/67


PROMOTE WOUND HEALINGPROMOTE WOUND HEALING

Vitamin CVitamin C

Dictum: Remove the pressureDictum: Remove the pressure


51/67



Stage 1Stage 1

Remove pressureRemove pressure

Reposition Q 2Reposition Q 2

Never massage the areaNever massage the area


52/67



Stage 2Stage 2

Clean with sterile SALINE onlyClean with sterile SALINE only

Antiseptic solutions may damageAntiseptic solutions may damagehealthy regenerating tissue and delayhealthy regenerating tissue and delay

healinghealing Wet saline dressings are helpfulWet saline dressings are helpful


53/67



Stage 3 and 4Stage 3 and 4

Necrotic tissues are debridedNecrotic tissues are debrided

Administer analgesics before cleansingAdminister analgesics before cleansing

Do a mechanical flushing with salineDo a mechanical flushing with saline

solutionsolution Topical ointments may be applied UNTILTopical ointments may be applied UNTIL

granulation tissue appears then only salinegranulation tissue appears then only salineirrigation is recommendedirrigation is recommended


54/67


55/67

PositioningPositioning

Any position,Any position, correct or incorrect,correct or incorrect, can becan be

harmful if maintained for a prolongedharmful if maintained for a prolonged

periodperiod


56/67


Frequent position changes helps toFrequent position changes helps to

prevent :prevent :

Muscle discomfortMuscle discomfortUnnecessary pressureUnnecessary pressure

Skin damageSkin damage

ContractureContractureBlood poolingBlood pooling


57/67


When the client is NOT able to moveWhen the client is NOT able to move

INDEPENDENTLY, the preferred methodINDEPENDENTLY, the preferred method

is to have two or more people move theis to have two or more people move the

patientpatient


58/67

Requisites of proper positioningRequisites of proper positioning

Use of support devicesUse of support devices-- mattress, pillows,mattress, pillows,

bed boards, foot boardbed boards, foot board

Dry, clean and unwrinkled sheetsDry, clean and unwrinkled sheets

2424-- hour schedule should be postedhour schedule should be posted


59/67


60/67

Fowlers PositionFowlers Position

The Sitting positionThe Sitting position

The position of choice for people whoThe position of choice for people who

have difficulty breathing and for somehave difficulty breathing and for some

people with hear problemspeople with hear problems

This allows greater chest expansion andThis allows greater chest expansion and

lung ventilationlung ventilation


61/67

Fowlers PositionFowlers Position

The Sitting positionThe Sitting position

Low FowlersLow Fowlers

SemiSemi--fowlersfowlers Fowler'sFowler's

High FowlersHigh Fowlers


62/67

Orthopneic positionOrthopneic position

The client sits in chair or bed, with anThe client sits in chair or bed, with an

overbed tableoverbed table

Allows maximum chest expansionAllows maximum chest expansion

Client can press the lower chest againstClient can press the lower chest against

the bed further facilitating ventilationthe bed further facilitating ventilation


63/67

Dorsal RecumbentDorsal Recumbent

BackBack--lying position, with head andlying position, with head and

shoulders SLIGHTLY elevatedshoulders SLIGHTLY elevated

Provides comfortProvides comfort


64/67

ProneProne

The client lies on the abdomen with theThe client lies on the abdomen with the

head usually turned to one sidehead usually turned to one side

Allows full extension of the hips to preventAllows full extension of the hips to prevent

flexion contracturesflexion contractures

Promotes drainage from the mouthPromotes drainage from the mouth


65/67

LateralLateral

SideSide--lying positionlying position

Good for resting and sleeping because itGood for resting and sleeping because it

promotes back alignmentpromotes back alignment

Also prevents aspirationAlso prevents aspiration


66/67

SimsSims

SemiSemi--prone positionprone position

Used for unconscious clients as it helpsUsed for unconscious clients as it helps

facilitated drainage of secretionsfacilitated drainage of secretions


67/67

activity and exercise 2010 review

Documents