mobility, exercise

8/4/2019 Mobility, Exercise

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ACTIVITY, MOBILITY AND EXERCISE

Body Mechanics . Is the efficient, coordinated and safe use of the body to produce motion and maintain

balance during activity.

Principles of Body Mechanics

1. Balance is maintained and muscle strain is avoided as long as the line of gravity passesthrough the base of support.

Start body movement with proper alignment Stand as close as possible to the object to be moved Avoid stretching, reaching and twisting

2. The wider the base of support and the lower the center of gravity, the greater the stability.Before moving objects, put your feet apart, flex the knees, hips and ankles

3. Balance is maintained with minimal effort when the base of support is enlarged in thedirection in which the movement will occur.

When pushing an object, enlarge the base of support by moving the front foot forward When pulling an object, enlarge the base of support by either moving the rear leg back if

facing the object or moving the front foot forward if facing away from the object.

4. Objects that are close to the center of gravity are moved with the least effort. Adjust the working area to waist level and keep the body close to the object.

5. The greater the preparatory isometric tensing, or contraction of muscles before moving anobject, the less the energy required to move it, and the less the likelihood of

musculoskeletal strain and injury.

Before moving objects, contract your gluteal, abdominal, leg, and arm muscles toprepare them for action.

6. The synchronized use of as many large muscle groups as possible during an activity increasesoverall strength and prevents muscle fatigue and injury.

To move objects below your center of gravity, begin with the hip and knees flexed Use the gluteal and leg muscles rather than the sacrospinal muscles of the back to exert

an upward thrust when lifting the weight

Face the direction of the movement to prevent twisting of the spine7. The closer the line of gravity to the center of the base of support the greater the stability

When moving or carrying objects, hold them as close as possible to the center of thegravity

Pull an object toward self whenever possible rather than pushing away8. The greater the friction against the surface beneath an object, the greater the force

required to move the object. Provide a firm, smooth, dry bed foundation before moving the

client in bed.

9. Pulling creates less friction than pushing.10.The heavier an object, the greater the force needed to move an object.


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Encourage the client to assist as much as possible by pushing and pulling themselvesuse arms as levers to increase lifting power.

Use own body weight to counteract the weight of the object Obtain the assistance of other persons or use mechanical device to move objects

that are too heavy

11.Moving an object along a level surface requires less energy that moving an object up aninclined surface or lifting it against the force of gravity.

Pull, push, roll or turn objects instead of lifting them Lower the head of the clients bed before moving the client up to the bed

12.Continuous muscle exertion can result in muscle strain and injury. Alternate rest periodswith periods of muscle use to help prevent fatigue.

Physiologic Responses to Immobility

1. Musculoskeletal Systema. Decrease in muscle strength- Due to unused muscle atrophyb. Muscle atrophy

- Decrease in size of musclesc. Disuse osteoporosis

- The bones become depleted of calciumd. Demineralization

- Calcium is withdrawn from the bones after 48 hours of immobilitye. Fibrosis and ankylosis

- Stiffness and rigidity of joints; excess calcium may deposit in the jointsf. Contracture

- Muscle fibers no longer shorten or lengthen, limiting joint mobility2. Cardiovascular System

a. Use of valsalva maneuver- Holding the breath and straining against a closed glottis, causing increased intrathoracic

pressure, decreasing the return flow of blood to the heart. When the client exhales and

the glottis opens, there is increased volume of blood returning to the heart, increasing

cardiac workload

b. Orthostatic (postural) hypotension- Neurovascular motor reflex is depressed

c. Thrombophlebitis- Due to venous stasis, blood clot forms in the venous wall.

3. Respiratory Systema. Atelectasis

- Pooling of secretions block airways- Decreased amount of surfactant production

b. Hypostatic pneumonia


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- Accumulated secretions enhance bacterial growthc. Respiratory acidosis

- Retention of carbon dioxide due to slow, shallow respiration4. Metabolic and Nutritional Systems

a. Anorexia- Results from decreased metabolic rate, and decreased energy requirements

b. Hypoproteinemia- Due to negative nitrogen balance. Protein catabolism exceeds anabolism. It results to

muscle wasting and weight loss.

c. Hypercalcemia- Greater amounts of calcium are withdrawn from the bones due to absence of weight-

bearing and stress on the musculoskeletal system.

5. Urinary Systema. Urinary stasis

- Horizontal position impedes urine flow by gravity- Poor bladder tone compromises emptying of urine

b. Urinary tract infection- Accumulation of urine in the bladder enhances bacterial growth

c. Renal calculi- The urine becomes alkaline due to urinary stasis, causing calcium salts to precipitate.

d. Incontinence- Poor sphincter control due to increased pressure within the bladder

e. Retention with overflow- Due to bladder distention, involuntary dribbling of urine occurs

f. Urinary reflux- Due to bladder distention. Contaminated urine from the bladder backs up into the renal

pelvis.

6. Fecal Eliminationa. Constipation

- Due to decreased peristalsisb. Flatulence

- Due to decreased peristalsis7. Integumentary System

a. Loss in skin turgor- The skin atrophies due to prolonged immobility

b. Decubitus ulcer- Prolonged immobility impedes circulation to body parts especially in bony prominences

8. Psychosocial Responsesa. Decreased motivationb. Decreased perception of time and spacec. Increased sense of powerlessnessd. Diminished ability to make decisions, concentrate or cope


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e. Inability to sleep

Etiology and Pathogenesis of Pressure Sores

Pressure Sores/ Decubitus Ulcers/Pressure Ulcers/Bedsores or Distortion Sores. Reddened

areas, sore or ulcers of the skin occurring over bony prominences. They are due to interruption

of the blood circulation to the tissue, resulting in a localized ischemia.

Causes of Pressure Sores

1. Pressure. Is the perpendicular force exerted on the skin by gravity.2. Friction. Is a force acting parallel to the skin.3. Shearing Force. Is a combination of friction and pressure.Risk Factors in the Formation of Pressure Sores

1. Immobility and inactivity. Produce pressure to body parts which impede circulation.2. Inadequate nutrition. Causes weight loss, muscle atrophy and loss of subcutaneous tissue.3. Hypoproteinemia. Predisposes the client to edema. Edema decreases elasticity, resilience,

and vitality of skin thus, more prone to injury. Edema causes circulatory impairment.

4. Excessive body heat. Increases metabolic rate, thus, increases the oxygen requirements ofthe cell. Oxygen becomes deficient.

5. Fecal and urinary incontinence. Moisture causes maceration of ski n, and the epidermis iseroded.

6. Decreased mental status. The client is unable to recognize the discomfort of pressure.7. Diminished sensation. The client is unable to perceive pressure.Stages of Pressure Sore Formation

Stage I. Non blanchable erythema of intact skin.

Stage II. Partial-thickness skin loss involving epidermis and/or dermis. The ulcer is

superficial and presents clinically as an abrasion, blister or shallow crater.

Stage III. Full-thickness skin loss involving damage or necrosis of subcutaneous tissue that

may extend down to, but not through underlying fascia. The ulcer presents

clinically as a deep crater.

Stage IV. Full-thickness skin loss with extensive destruction, tissue necrosis or damage to

muscle, bone or supporting structures such as tendon or joint capsule.


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Preventing and Treating Pressure Sores

1. Prevention. Provide smooth, firm wrinkle-free foundation on which the client can lie. Use foam, rubber pads, artificial sheepskins, egg crate or flotation mattress under

pressure areas. Apply thin layer of cornstarch to the bed sheet or wheelchair seat cover. Reduce shearing force by elevating head of bed of bedfast clients no more than 30

degree angle.

Ongoing assessment of early signs and symptoms of pressure sores. Change position of bedfast clients every 15 mins to 2 hours. Meticulous hygiene. Keep skin clean and dry. Apply powder to tissues with limited blood flow. Avoid massaging bony prominences with soap when bathing the client. Use superfatted soaps and oils. Massage pressure areas gently. Apply cream or lotion on dry skin. Client teaching on prevention of pressure sores.

Treatment

Clean pressure sore daily, preferably in a whirlpool bath. Clean and dress the sore using surgical asepsis. If the pressure sore is not infected, cover it with an occlusive dressing and leave the

wound undisturbed for few days. If the pressure sore is infected, obtain a sample of drainage for c & s. Reposition the client every 2 hours Apply a small amount of cornstarch to bedsheet. Keep head of bed flat or elevated at a maximum of 30 degree angle Use a special mattress or pad. Teach the client to move. Encourage ambulation or sitting in a wheelchair. Provide ROM exercises.

Nursing Interventions to Promote Activity and Exercise

1. ADL (Activities of Daily Living)2. Protective Positions

a. Supine- Back lying position; head and shoulders not elevated


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b. Fowlers1. Low /semi-Fowlers- Head of bed is elevated 15 to 45 degrees2. High Fowlers- Head of bed is elevated 90 degrees

c. Lateral/Side-Lying/Sims- Body is turned to the side

d. Dorsal Recumbent- Supine with the knees flexed.

e. Prone- Abdomen-lying position; head turned to one side.

f. Knee- chest/Genupectoral- The trunk is perpendicular to the legs.

g. Modified Trendelenburg- Supine, with the lower extremities elevated at 45 degrees

Exercises

Purposes

a. To maintain good body alignmentb. To improve muscle strength and endurancec. To improve muscle toned. To improve circulatione. To relieve muscle spasmf. To relieve paing. To prevent or correct contracture deformitiesh. To promote sense of well-being

Types of Exercises

a. Active ROM. Done by the client.b. Passive ROM. Done for the client.c. Active Resistive ROM. Done by the client against a weight or force.d. Active Assistive ROM. Done by the stronger arm and leg to the weaker arm and leg.e. Isotonic. Involves changes in muscle length and tension.f.

Isometric.- Involves change in muscle tension only. (alternate tension and relaxation of group of

muscles) e.g. quadriceps setting, gluteal setting, Kegels exercises

Transport of Client

a. Bed to wheelchair- Position wheelchair parallel to bed


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b. Bed to stretcher- Place the stretcher parallel to the bed- Lo ck the wheels of the bed and stretcher- Push the stretcher from the end where the clients head is positioned- When entering the elevator, maneuver the stretcher so that the clients head goes in

first

Assisting Client in Ambulation

purposes

a. To increase muscle strength and joint mobilityb. To prevent some potential problems of immobilityc. To increase the clients sense of independence and self-esteem

- Ambulate the client gradually to prevent orthostatic hypotension- If orthostatic hypotension or extreme weakness occurs, assist the client quickly in a

sitting position and lower the head between the knees. Lowering the head facilitates

blood flow to the brain.

- Ensure safety of the client during ambulation.

mobility, exercise

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