Activity and Exercise Fundamentals of Nursing Review

Mobility The ability to move freely, easily, rhythmically and purposefully

The ability to move freely, easily, rhythmically and purposefully

Range of Motion The ROM of the joint is the maximum movement that is possible for that joint

The ROM of the joint is the maximum movement that is possible for that joint

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

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

Types of Exercise ISOTONIC Dynamic exercise in which the muscle shortens to produce contraction and movement Running, walking, swimming, cycling

ISOTONIC

Dynamic exercise in which the muscle shortens to produce contraction and movement

Running, walking, swimming, cycling

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

ISOMETRIC

Are those in which there is a change in muscle tension but NO CHANGE in muscle length

Tensing, extending and pressing exercises

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

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

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

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

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

Complications of IMMOBILITY

1. Contractures, atrophy and stiffness

2. Foot drop

3. DVT

4. Hypostatic pneumonia

5. Pressure ulcers, skin breakdown, reduced skin turgor

IMPAIRED PHYSICAL MOBILITY Complications of IMMOBILITY 6. muscle atrophy 7. osteoporosis 8. dependent edema 9. urine stasis 10. constipation

Complications of IMMOBILITY

6. muscle atrophy

7. osteoporosis

8. dependent edema

9. urine stasis

10. constipation

IMPAIRED PHYSICAL MOBILITY ASSESSMENT Assess patient’s ability to move Assess muscle tone, strength Assess joint movement and positioning

ASSESSMENT

Assess patient’s ability to move

Assess muscle tone, strength

Assess joint movement and positioning

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

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

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

2. Maintain muscle strength and joint mobility

Perform passive ROME

Perform assistive ROME

Perform active ROME

Move the joints three times TID

IMPAIRED PHYSICAL MOBILITY Nursing Interventions 3. Promote independent mobility Warn patient of the orthostatic hypotension when suddenly standing upright

3. Promote independent mobility

Warn patient of the orthostatic hypotension when suddenly standing upright

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

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

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

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

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

5. Assist patient to prepare for ambulation

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

Use rubber ball for hand exercise

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)

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)

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

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

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

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

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

6. Assist patient in crutch ambulation

Measure correct crutch length

Utilizing the patient’s HEIGHT

Height MINUS 40 cm or 16 inches

IMPAIRED PHYSICAL MOBILITY Nursing Interventions 6. Assist patient in crutch ambulation Measure correct crutch length Hand piece should allow 20-30 degrees elbow flexion

6. Assist patient in crutch ambulation

Measure correct crutch length

Hand piece should allow 20-30 degrees elbow flexion

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

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

GAIT

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

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

3-point gait Requires weight bearing on the UNAFECTED leg Move BOTH crutches and the WEAKER LEG forward Move the STRONGER leg forward

Requires weight bearing on the UNAFECTED leg

Move BOTH crutches and the WEAKER LEG forward

Move the STRONGER leg forward

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

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

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)

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)

Swing-through gait Move BOTH crutches together Lift body weight by the arms and swing forward, ahead of the crutches (beyond the level)

Move BOTH crutches together

Lift body weight by the arms and swing forward, ahead of the crutches (beyond the level)

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

6. Assist patient in ambulation with a walker

Correct height of the walker must allow a 20-30 degrees of elbow flexion

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

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

Pressure sores

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

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

Pressure sores

Impaired Skin integrity INITIAL SIGN OF PRESSURE ULCER: ERYTHEMA or redness of the skin that DOES NOT blanch

INITIAL SIGN OF PRESSURE ULCER:

ERYTHEMA or redness of the skin that DOES NOT blanch

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

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

Pressure areas

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

1. Patients with sensory deficits

2. Decreased tissue perfusion

3. Decreased nutritional status

4. Friction and shearing forces

5. Increased moisture and edema

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

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

Nursing Interventions RELIEVE THE PRESSURE Turn and reposition every 1-2 Hours Encourage weight shifting actively, every 15 minutes

RELIEVE THE PRESSURE

Turn and reposition every 1-2 Hours

Encourage weight shifting actively, every 15 minutes

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

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

Nursing Interventions UTILIZE PRESSURE RELIEVING DEVICES Use floatation pads Use air, water or foam mattresses Oscillating and kinetic bed

UTILIZE PRESSURE RELIEVING DEVICES

Use floatation pads

Use air, water or foam mattresses

Oscillating and kinetic bed

Nursing Interventions IMPROVE MOBILITY Active and passive exercises Assistive exercise

IMPROVE MOBILITY

Active and passive exercises

Assistive exercise

Nursing Interventions IMPROVE TISSUE PERFUSION Exercise and repositioning are the most important activities AVOID MASSAGE ON THE REDDENED AREAS

IMPROVE TISSUE PERFUSION

Exercise and repositioning are the most important activities

AVOID MASSAGE ON THE REDDENED AREAS

Nursing Interventions IMPROVE NUTRITIONAL STATUS HIGH protein HIGH vitamin C diet Measure body weight Assess hemoglobin and albumin

IMPROVE NUTRITIONAL STATUS

HIGH protein

HIGH vitamin C diet

Measure body weight

Assess hemoglobin and albumin

Nursing Interventions REDUCE FRICTION AND SHEAR Lift and not drag patient Prevent the presence of wrinkles and creases on bed sheets

REDUCE FRICTION AND SHEAR

Lift and not drag patient

Prevent the presence of wrinkles and creases on bed sheets

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)

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)

Nursing Interventions PROMOTE WOUND HEALING Vitamin C Dictum: Remove the pressure

PROMOTE WOUND HEALING

Vitamin C

Dictum: Remove the pressure

Nursing Interventions PROMOTE WOUND HEALING Stage 1 Remove pressure Reposition Q 2 Never massage the area

PROMOTE WOUND HEALING

Stage 1

Remove pressure

Reposition Q 2

Never massage the area

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

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

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

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

Positioning

Positioning Any position, correct or incorrect, can be harmful if maintained for a prolonged period

Any position, correct or incorrect, can be harmful if maintained for a prolonged period

Positioning Frequent position changes helps to prevent : Muscle discomfort Unnecessary pressure Skin damage Contracture Blood pooling

Frequent position changes helps to prevent :

Muscle discomfort

Unnecessary pressure

Skin damage

Contracture

Blood pooling

Positioning When the client is NOT able to move INDEPENDENTLY, the preferred method is to have two or more people move the patient

When the client is NOT able to move INDEPENDENTLY, the preferred method is to have two or more people move the patient

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

Use of support devices- mattress, pillows, bed boards, foot board

Dry, clean and unwrinkled sheets

24- hour schedule should be posted

Positions

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

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

Fowler’s Position The Sitting position Low Fowler’s Semi-fowler’s Fowler's High Fowler’s

The Sitting position

Low Fowler’s

Semi-fowler’s

Fowler's

High Fowler’s

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

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

Dorsal Recumbent Back-lying position, with head and shoulders SLIGHTLY elevated Provides comfort

Back-lying position, with head and shoulders SLIGHTLY elevated

Provides comfort

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

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

Lateral Side-lying position Good for resting and sleeping because it promotes back alignment Also prevents aspiration

Side-lying position

Good for resting and sleeping because it promotes back alignment

Also prevents aspiration

Sims Semi-prone position Used for unconscious clients as it helps facilitated drainage of secretions

Semi-prone position

Used for unconscious clients as it helps facilitated drainage of secretions

End