ACTIVITY AND EXERCISE

AUGUST 20, 2013 © FUNDAMENTALS OF NURSING 5TH EDITION

can be described as energetic action or as being in a state of movement.

ACTIVITY

Good body mechanics is the efficient, coordinated, and safe use of the body to produce motion and maintain balance during activity.

Three basic elements of body mechanics: BODY ALIGNMENT (POSTURE), BALANCE (STABILITY), and COORDINATED BODY MOVEMENT.

BODY MECHANICS

Body Alignment: the geometric arrangement of body parts in relation to each other.

Balance: a state of equipoise (equilibrium) in which opposing forces counteract each other.

Coordinated Body Movement: Integrated functioning of the musculoskeletal and nervous system as well as joint mobility.

Joint: functioning unit of the musculoskeletal system.

Bones articulate at the joints Skeletal muscles attach to two bone at the

joint When a person is inactive, the joints are

pulled into a flexed position. Synovial Joint: freely movable Range of Motion: maximum movement

that is possible for the joint.

Joint Mobility

Poor standing and sitting posture, overweight, pregnancy and constant use of high-heeled shoes may produce an exaggerated curvature of the lumbar spine, called lordosis.

PREVENTING BACK INJURY

Lifting: When a person lifts or carries an object, the weight of the object becomes part of the person’s body weight.

Pulling and Pushing: When pulling or pushing an object, a person maintains balance with least effort when the base of support is enlarged in the direction in which the movement is to be produced or opposed.

Pivoting: technique in which the body is turned in a way that avoids twisting of the spine.

Growth and Development Physical Health Mental Health Nutrition Lifestyle Personal Values Fatigue and Stress External Factors

Factors Affecting Body Alignment and Mobility

Musculoskeletal System◦ Problem Related to Immobility: Client experience

a significant decrease in muscular strength. ◦ Effects of Exercise: Maintenance of muscle

strength and tone; efficiency of muscular contraction increases; maintain joint mobility

Cardiovascular System◦ Problems related to Immobility: Diminished

cardiac reserve; Orthostatic hypotension◦ Effects of Exercise: Heart rate, blood pressure and

cardiac output increases;

Effects of Immobility and Exercise on Body Systems

Respiratory System◦ Problems related to Immobility: Decreased

respiratory movement; Pooling of respiratory excretions; Atelectasis

◦ Effects of Exercise: Ventilation increases Metabolic System

◦ Problems related to Immobility: Decreased metabolic rate; Anorexia

◦ Effects of exercise: Metabolic rate elevation;

Urinary System◦ Problems related to Immobility: Urinary stasis;

Urinary retention; Urinary Infection◦ Effects of exercise: more efficient blood flow;

prevention of stasis. Gastrointestinal System

◦ Problems related to Immobility: Constipation; decreased peristalsis and colon motility

◦ Effects of exercise: Appetite improvement; increased GI tract tone, improved digestion and elimination

Integumentary System◦Problems related to Immobility: Reduced

skin turgor; skin breakdown◦Effects of exercise: improved blood

circulation (peripheral) and promoted delivery of nutrients and oxygen.

Psychoneurologic System◦Problems related to Immobility: Increased

dependence; lower self-esteem; Exaggerated emotional reactions; lack of intellectual stimulation

◦Effects of exercise: improves tolerance to stress; sense of relaxation; improvement of body image; improves sleep

Nursing History Physical Examination

◦ Body Alignment Stance Sitting Alignment

◦ Gait◦ Joint Appearance and Movement◦ Capabilities and Limitations of Movement◦ Muscle Mass and Strength◦ Activity Tolerance◦ Physical Fitness

ASSESSING

NANDA nursing diagnoses that relate to activity/mobility problems include: Activity tolerance, High risk for activity intolerance, Impaired physical mobility, & High risk for disuse symptoms.

DIAGNOSING

Identifying those clients who need assistance with body alignment and determining the degree of assistance they need.

Sensitive to the client’s need to function as independently as possible yet provide assistance when the client needs it.

Plan to teach clients applicable skills.

PLANNING

Maintaining good posture Positioning Clients

◦ Fowler’s Position◦ Orthopneic Position ◦ Dorsal Recumbent Position◦ Prone Position◦ Lateral Position◦ Sim’s Position

IMPLEMENTING

Moving and Turning Clients in Bed◦ Moving a client up in bed◦ Moving a client to the side of the bed in segments

Transferring Clients◦ Transferring a client between a Bed and a

Wheelchair◦ Transferring a Client between a Bed and a

Stretcher◦ Moving a Client Using a Hydraulic Lift

Exercise◦ Isotonic (dynamic) exercises: muscle tension

is constant and the muscle shortens to produce muscle contraction and movement

◦ Isometric (static or setting) exercises: There is a change in muscle tension but no change in muscle strength.

◦ Isokinetic (resistive) exercises: involve muscle contraction and joint movement

◦ Aerobic exercise: an activity in which the amount of oxygen taken into the body is greater than or equal to the amount the body requires. (Anaerobic exercise – opposite)

◦ Range of motion: Active ROM activities Passive ROM activities Active-assistive ROM exercises

◦ Components of Physical Fitness: Muscle Strength and Endurance Cardiorespiratory Fitness Joint Flexibility Body Composition

Ambulating Clients◦ Ambulation: act of walking; function that most

people take for granted Preambulatory Exercises Assisting Clients to Ambulate

Mechanical Aids in Walking◦ Canes◦ Walkers◦ Crutches

Collect date relevant to the outcome criteria previously established by asking the client to demonstrate specific exercises, measure muscle size, observe client’s activity tolerance when performing self-care activities, measure vital signs before and after exercise and ambulation.. Etc.

EVALUATING

REST AND SLEEP AUGUST 20, 2013

© FUNDAMENTALS OF NURSING 5TH EDITION

Implies calmness, relaxation without emotional stress, and freedom from anxiety.

Restores a person’s energy; allowing the individual to resume optimal functioning.

REST

Considered to be a basic human need It is a universal process common to all

people. More recently, sleep has come to be

considered a state of consciousness in which the individual’s perception and reaction to the environment is decreased.

SLEEP

Circadian Rhythm◦ Biorhythms – In humans, these are controlled

from within the body and synchronized with environmental factors.

◦ Circadian from circa dies, “about a day”◦ The person is awake when the physiologic and

psychologic rhythms are most active. Stages of Sleep

◦ Electroencephalogram (EEG) – provides a good a picture of what occurs during sleep.

PHYSIOLOGY OF SLEEP

◦ Two types of sleep: NREM (Non-REM) sleep and REM (Rapid Eye Movement) sleep

◦ NREM Sleep Also referred to as slow-wave sleep Most sleep during a night is NREM sleep. Deep, restful sleep and brings a decrease in some

physiologic functions Divided into four stages: Stage I (Very light sleep);

Stage II (Light sleep); Stage III (Parasympathetic nervous system domination); Stage IV (deep sleep)

◦ REM Sleep 25% of the sleep of a young adult. Most dreams take place during the REM sleep. Brain is highly active (paradoxical sleep) As the person becomes more rested through the

night, the duration of the REM sleep increases Sleep Cycles

◦ Stage I NREM -> Stage II NREM -> Stage III NREM -> Stage IV NREM -> Stage III -> Stage II -> Stage I

REM

Age Environment Fatigue Lifestyle Psychologic Stress Alcohol and Stimulants Diet Smoking Motivation Illness Medications

Factors Affecting Sleep

Primary Sleep Disorders: the person’s problem is the main disorder

Secondary Sleep Disorders: sleep disturbances caused by another clinical disorder

Insomnia: most common sleep disorder; inability to obtain an adequate amount or quality of sleep

Hypersomnia: opposite of insomnia; excessive sleep

COMMON SLEEP DISORDERS

Narcolepsy: sudden wave of overwhelming sleepiness that occurs during the day; “sleep attack”; genetic defect of the CNS in which REM sleep cannot be controlled.

Sleep Apnea: periodic cessation of breathing during sleep◦ Obstructive Apnea: pharynx or oral cavity

blocks the air◦ Central Apnea: defect in the respiratory center

of the brain◦ Mixed Apnea: combination of Obstructive and

Central Apnea

Parasomnias◦ Somnambulism (sleepwalking)◦ Sleeptalking◦ Nocturnal enuresis (bedwetting)◦ Nocturnal erections◦ Bruxism (clenching or grinding of the teeth)

Sleep Deprivations ◦ prolonged sleep disturbances; not a sleep

disorder

Sleep History◦ Usual sleeping pattern◦ Bedtime rituals ◦ Use of sleep medications◦ Sleep environment◦ Recent changes in sleep patterns or difficulties in

sleeping. Sleep Diary Physical Examination Diagnostic Studies

◦ Polysomnography; EEG; Electromyogram (EMG); Electro-oculogram (EOG)

ASSSESSING

NANDA nursing diagnosis given to clients with sleeping problems: Sleep pattern disturbance.

DIAGNOSING

Maintain/develop a sleeping pattern that provides sufficient energy for daily activities.

Interventions include reducing environmental distractions; promoting bedtime rituals; providing comfort measures; scheduling nursing care to provide uninterrupted sleep periods…etc.

PLANNING

Creating a restful environment Supporting Bedtime Rituals Promoting Comfort and Relaxation Administering Sleep Medications Client Teaching

IMPLEMENTING

To evaluate whether client outcomes have been achieved, the nurse may observe the duration of the client’s sleep, observe the client’s signs of REM and NREM sleep deprivation, question effectiveness of specific interventions…etc.

EVALUATING