Activity And Exercise

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  • + mindianderson mindianderson 2 weeks ago
    Could I please get a copy of this slide show sent to my e-mail address? It’s meanderson@covenantretirement.org Thanks! I work at a retirement village and will be doing a presentation soon. Thanks so much!
  • + Angelmarie Angelmarie 9 months ago
    Can you send a copy to my email address? I will make this as one of my reference . I am teaching maternity health.thanks.
  • + joykhim joykhim 10 months ago
    thnk u for this info.. can i have a copy of this presentation?? thnks alot.. my eadd is joy_khim@yahoo.com
  • + guest5eb984 guest5eb984 11 months ago
    hi can i have a copy of your presentation pls..my email add is eyestrain_ajpn@yahoo.com
  • + guest4587cfa guest4587cfa 11 months ago
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  • + guest65dabd4 guest65dabd4 11 months ago
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  • + guest7dacce guest7dacce 2 years ago
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  • + guestb43ced guestb43ced 2 years ago
    hello, i’m interested with your presentation.it’s very useful..can i have a copy of this?i need slide 1 to slide 67..my email is charina_rn@yahoo.com...thanks a lot..good day!
  • + guest2bf57f guest2bf57f 2 years ago
    Hello i found your presentation very helpfull may i have a copy please if possible please send to laine@granitebelthosting.com.

    I am an australian nursing student.
  • + lilibethjl lilibethjl 2 years ago
    hi, can i have a copy please.thanks. my email is lilibethjl@yahoo.com.thanks a lot.

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Activity And Exercise - Presentation Transcript

  1. Activity and Exercise Fundamentals of Nursing Review
  2. Mobility
    • The ability to move freely, easily, rhythmically and purposefully
  3. Range of Motion
    • The ROM of the joint is the maximum movement that is possible for that joint
  4. Exercise
    • A type of physical activity defined as a planned, structure and repetitive bodily movement done to improve or maintain one or more components of physical fitness
  5. Types of Exercise
    • ISOTONIC
      • Dynamic exercise in which the muscle shortens to produce contraction and movement
      • Running, walking, swimming, cycling
  6. Types of Exercise
    • ISOMETRIC
      • Are those in which there is a change in muscle tension but NO CHANGE in muscle length
      • Tensing, extending and pressing exercises
  7. Other Types of Exercise
    • ISOKINETIC
      • Involves muscle contraction or tension against a resistance
    • Aerobic exercise
      • activity during which the amount of oxygen taken into the body is greater than that used to perform the activity
  8. Benefits of Exercise
    • Increases joint flexibility, tone and ROM
    • Bone density is maintained
    • Increases cardiac output and perfusion
    • Prevents pooling of secretions in the lungs
    • Improves appetite and facilitate peristalsis
    • Elevates the metabolic rate
    • Prevents stasis of urine
    • Produces a sense of well-being
  9. IMPAIRED PHYSICAL MOBILITY
    • Complications of IMMOBILITY
    • 1. Contractures, atrophy and stiffness
    • 2. Foot drop
    • 3. DVT
    • 4. Hypostatic pneumonia
    • 5. Pressure ulcers, skin breakdown, reduced skin turgor
  10. IMPAIRED PHYSICAL MOBILITY
    • Complications of IMMOBILITY
    • 6. muscle atrophy
    • 7. osteoporosis
    • 8. dependent edema
    • 9. urine stasis
    • 10. constipation
  11. IMPAIRED PHYSICAL MOBILITY
    • ASSESSMENT
    • Assess patient’s ability to move
    • Assess muscle tone, strength
    • Assess joint movement and positioning
  12. IMPAIRED PHYSICAL MOBILITY Nursing Interventions
    • 1. Position properly to prevent contractures
    • Place trochanter roll from the iliac crest to the mid-thigh to prevent EXTERNAL rotation
    • Place patient on wheelchair 90 degrees with the foot resting flat on the floor/foot rest
    • Place foot board or high-heeled shoes to prevent foot drop
  13. IMPAIRED PHYSICAL MOBILITY Nursing Interventions
    • 2. Maintain muscle strength and joint mobility
    • Perform passive ROME
    • Perform assistive ROME
    • Perform active ROME
    • Move the joints three times TID
  14. IMPAIRED PHYSICAL MOBILITY Nursing Interventions
    • 3. Promote independent mobility
    • Warn patient of the orthostatic hypotension when suddenly standing upright
  15. IMPAIRED PHYSICAL MOBILITY Nursing Interventions
    • 4. Assist patient with transfer
    • Assess patient’s ability to participate
    • Position yourself in front of the patient
    • Lock the wheelchair or the bed wheel
    • Use devices such as transfer boards, sliding boards, trapeze and sheets
  16. IMPAIRED PHYSICAL MOBILITY Nursing Interventions
    • 4. Assist patient with transfer
    • In general, the equipments are placed on the side of the STRONGER , UNAFFECTED body part
    • Nurses assist the patient to move TOWARDS the stronger side
    • In moving the patient, move to the direction FACING the nurse
  17. IMPAIRED PHYSICAL MOBILITY Nursing Interventions
    • 5. Assist patient to prepare for ambulation
    • Exercise such as quadriceps setting, gluteal setting and arm push ups
    • Use rubber ball for hand exercise
  18. IMPAIRED PHYSICAL MOBILITY Nursing Interventions
    • 6. Assist patient in crutch ambulation
    • Measure correct crutch length
    • LYING DOWN
    • Measure from the Anterior Axillary Fold to the HEEL of the foot then:
      • Add 1 inch (Kozier)
      • Add 2 inches (Brunner and Suddarth)
  19. IMPAIRED PHYSICAL MOBILITY Nursing Interventions
    • 6. Assist patient in crutch ambulation
    • Measure correct crutch length
    • STANDING (Kozier)
    • Mark a distance of 2 inches to the side from the tip of the toe (first mark)
    • 6 inches is marked (second mark) ahead from the first
    • Measure 2 inches below the axilla to the second mark
  20. IMPAIRED PHYSICAL MOBILITY Nursing Interventions
    • 6. Assist patient in crutch ambulation
    • Measure correct crutch length
    • STANDING (Kozier)
    • Make sure that the shoulder-rest of the crutch is at least 1- 2 inches below the axilla
  21. IMPAIRED PHYSICAL MOBILITY Nursing Interventions
    • 6. Assist patient in crutch ambulation
    • Measure correct crutch length
    • Utilizing the patient’s HEIGHT
    • Height MINUS 40 cm or 16 inches
  22. IMPAIRED PHYSICAL MOBILITY Nursing Interventions
    • 6. Assist patient in crutch ambulation
    • Measure correct crutch length
    • Hand piece should allow 20-30 degrees elbow flexion
  23. IMPAIRED PHYSICAL MOBILITY Nursing Interventions
    • 6. Assist patient in crutch GAIT
    • A. 4 point gait
    • B. three-point gait
    • C. two point gait
    • D. swing to gait
    • E. swing through gait
  24. GAIT
  25. 4-point gait
    • Safest gait
    • Requires weight bearing on both legs
    • Move RIGHT crutch ahead (6 inches)
    • Move LEFT foot forward at the level of the RIGHT crutch
    • Move the LEFT crutch forward
    • Move the RIGHT foot forward
  26. 3-point gait
    • Requires weight bearing on the UNAFECTED leg
    • Move BOTH crutches and the WEAKER LEG forward
    • Move the STRONGER leg forward
  27. 2-point gait
    • Faster than 4-point
    • Requires more balance
    • Partial bearing on BOTH legs
    • Move the LEFT crutch and RIGHT foot FORWARD together
    • Move the RIGHT crutch and LEFT foot forward together
  28. Swing-to gait
    • Usually used by client with paralysis of both legs
    • Prolonged use results in atrophy of unused muscle
    • Move BOTH crutches together
    • Lift body weight by the arms and swing to the crutches (at the level)
  29. Swing-through gait
    • Move BOTH crutches together
    • Lift body weight by the arms and swing forward, ahead of the crutches (beyond the level)
  30. IMPAIRED PHYSICAL MOBILITY Nursing Interventions
    • 6. Assist patient in ambulation with a walker
    • Correct height of the walker must allow a 20-30 degrees of elbow flexion
  31. IMPAIRED PHYSICAL MOBILITY Nursing Interventions
    • 6. Assist patient in ambulation with a cane
    • Correct cane measurement:
    • With elbow flexion of 30 degrees, measure the length from the HAND to 6 inches lateral to the tip of the 5 th toe
  32. Pressure sores
  33. Impaired Skin integrity
    • Pressure ulcers
    • Are localized areas of dead soft tissue that occurs when pressure applied to the skin overtime is more than 32 mmHg leading to tissue damage
  34. Pressure sores
  35. Impaired Skin integrity
    • INITIAL SIGN OF PRESSURE ULCER:
    • ERYTHEMA or redness of the skin that DOES NOT blanch
  36. Impaired Skin integrity
    • Weight bearing Bony prominences
    • 1. Sacrum and cocygeal area
    • 2. Ischial tuberosity
    • 3. Greater trochanter
    • 4. Heel and malleolus
    • 5. Tibia and fibula
    • 6. Scapula and elbow
  37. Pressure areas
  38. Risk Factors for pressure ulcers
    • 1. Patients with sensory deficits
    • 2. Decreased tissue perfusion
    • 3. Decreased nutritional status
    • 4. Friction and shearing forces
    • 5. Increased moisture and edema
  39. Pressure ulcer stages
    • Stage 1- non-blanchable Erythema
    • Stage 2- skin breakdown in dermis
    • Stage 3- ulceration extends to the subcutaneous tissue
    • Stage 4- ulcers involve the muscle and bone
  40.  
  41.  
  42. Nursing Interventions
    • RELIEVE THE PRESSURE
    • Turn and reposition every 1-2 Hours
    • Encourage weight shifting actively, every 15 minutes
  43. Nursing Interventions
    • POSITION PATIENT PROPERLY
    • Follow the recommended sequence
    • Lateral  prone  supine  lateral
    • Position patient with the bed elevated at NO MORE THAN 30 degrees
    • Utilize the bridging technique
  44. Nursing Interventions
    • UTILIZE PRESSURE RELIEVING DEVICES
    • Use floatation pads
    • Use air, water or foam mattresses
    • Oscillating and kinetic bed
  45. Nursing Interventions
    • IMPROVE MOBILITY
    • Active and passive exercises
    • Assistive exercise
  46. Nursing Interventions
    • IMPROVE TISSUE PERFUSION
    • Exercise and repositioning are the most important activities
    • AVOID MASSAGE ON THE REDDENED AREAS
  47. Nursing Interventions
    • IMPROVE NUTRITIONAL STATUS
    • HIGH protein
    • HIGH vitamin C diet
    • Measure body weight
    • Assess hemoglobin and albumin
  48. Nursing Interventions
    • REDUCE FRICTION AND SHEAR
    • Lift and not drag patient
    • Prevent the presence of wrinkles and creases on bed sheets
  49. Nursing Interventions
    • REDUCE IRRITATING MOISTURE
    • Adhere to a meticulous skin care
    • Promptly clean and dry the soiled areas
    • Use mild soap and water
    • Pat dry and not rub
    • Lotion may be applied
    • AVOID powders (cause dryness)
  50. Nursing Interventions
    • PROMOTE WOUND HEALING
    • Vitamin C
    • Dictum: Remove the pressure
  51. Nursing Interventions
    • PROMOTE WOUND HEALING
    • Stage 1
    • Remove pressure
    • Reposition Q 2
    • Never massage the area
  52. Nursing Interventions
    • PROMOTE WOUND HEALING
    • Stage 2
    • Clean with sterile SALINE only
    • Antiseptic solutions may damage healthy regenerating tissue and delay healing
    • Wet saline dressings are helpful
  53. Nursing Interventions
    • PROMOTE WOUND HEALING
    • Stage 3 and 4
    • Necrotic tissues are debrided
    • Administer analgesics before cleansing
    • Do a mechanical flushing with saline solution
    • Topical ointments may be applied UNTIL granulation tissue appears then only saline irrigation is recommended
  54. Positioning
  55. Positioning
    • Any position, correct or incorrect, can be harmful if maintained for a prolonged period
  56. Positioning
    • Frequent position changes helps to prevent :
      • Muscle discomfort
      • Unnecessary pressure
      • Skin damage
      • Contracture
      • Blood pooling
  57. Positioning
    • When the client is NOT able to move INDEPENDENTLY, the preferred method is to have two or more people move the patient
  58. Requisites of proper positioning
    • Use of support devices- mattress, pillows, bed boards, foot board
    • Dry, clean and unwrinkled sheets
    • 24- hour schedule should be posted
  59. Positions
  60. Fowler’s Position
    • The Sitting position
    • The position of choice for people who have difficulty breathing and for some people with hear problems
    • This allows greater chest expansion and lung ventilation
  61. Fowler’s Position
    • The Sitting position
    • Low Fowler’s
    • Semi-fowler’s
    • Fowler's
    • High Fowler’s
  62. Orthopneic position
    • The client sits in chair or bed, with an overbed table
    • Allows maximum chest expansion
    • Client can press the lower chest against the bed further facilitating ventilation
  63. Dorsal Recumbent
    • Back-lying position, with head and shoulders SLIGHTLY elevated
    • Provides comfort
  64. Prone
    • The client lies on the abdomen with the head usually turned to one side
    • Allows full extension of the hips to prevent flexion contractures
    • Promotes drainage from the mouth
  65. Lateral
    • Side-lying position
    • Good for resting and sleeping because it promotes back alignment
    • Also prevents aspiration
  66. Sims
    • Semi-prone position
    • Used for unconscious clients as it helps facilitated drainage of secretions
  67. End

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