Activity And Exercise

Slide 1: Activity and Exercise Fundamentals of Nursing Review

Slide 2: Mobility The ability to move freely, easily,  rhythmically and purposefully

Slide 3: Range of Motion The ROM of the joint is the maximum  movement that is possible for that joint

Slide 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

Slide 5: Types of Exercise ISOTONIC  Dynamic exercise in which the muscle  shortens to produce contraction and movement Running, walking, swimming, cycling 

Slide 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

Slide 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

Slide 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 

Slide 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

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

Slide 11: IMPAIRED PHYSICAL MOBILITY ASSESSMENT  Assess patient’s ability to move  Assess muscle tone, strength  Assess joint movement and positioning

Slide 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

Slide 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

Slide 14: IMPAIRED PHYSICAL MOBILITY Nursing Interventions 3. Promote independent mobility  Warn patient of the orthostatic hypotension when suddenly standing upright

Slide 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

Slide 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

Slide 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

Slide 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)

Slide 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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 24: GAIT

Slide 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 

Slide 26: 3-point gait Requires weight bearing on the  UNAFECTED leg Move BOTH crutches and the  WEAKER LEG forward Move the STRONGER leg forward 

Slide 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

Slide 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)

Slide 29: Swing-through gait Move BOTH crutches together  Lift body weight by the arms and  swing forward, ahead of the crutches (beyond the level)

Slide 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

Slide 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 5th toe

Slide 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

Slide 34: Pressure sores

Slide 35: Impaired Skin integrity INITIAL SIGN OF PRESSURE ULCER: ERYTHEMA or redness of the skin  that DOES NOT blanch

Slide 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

Slide 37: Pressure areas

Slide 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 

Slide 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

Slide 42: Nursing Interventions RELIEVE THE PRESSURE  Turn and reposition every 1-2 Hours Encourage weight shifting actively,  every 15 minutes

Slide 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 

Slide 44: Nursing Interventions UTILIZE PRESSURE RELIEVING DEVICES  Use floatation pads  Use air, water or foam mattresses  Oscillating and kinetic bed

Slide 45: Nursing Interventions IMPROVE MOBILITY  Active and passive exercises  Assistive exercise

Slide 46: Nursing Interventions IMPROVE TISSUE PERFUSION  Exercise and repositioning are the most important activities AVOID MASSAGE ON THE REDDENED  AREAS

Slide 47: Nursing Interventions IMPROVE NUTRITIONAL STATUS  HIGH protein  HIGH vitamin C diet  Measure body weight  Assess hemoglobin and albumin

Slide 48: Nursing Interventions REDUCE FRICTION AND SHEAR  Lift and not drag patient  Prevent the presence of wrinkles and creases on bed sheets

Slide 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)

Slide 50: Nursing Interventions PROMOTE WOUND HEALING  Vitamin C  Dictum: Remove the pressure

Slide 51: Nursing Interventions PROMOTE WOUND HEALING  Stage 1 Remove pressure  Reposition Q 2  Never massage the area 

Slide 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 

Slide 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

Slide 55: Positioning Any position, correct or incorrect, can be  harmful if maintained for a prolonged period

Slide 56: Positioning Frequent position changes helps to  prevent : Muscle discomfort   Unnecessary pressure  Skin damage  Contracture  Blood pooling

Slide 57: Positioning When the client is NOT able to move  INDEPENDENTLY, the preferred method is to have two or more people move the patient

Slide 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 

Slide 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

Slide 61: Fowler’s Position The Sitting position  Low Fowler’s  Semi-fowler’s  Fowler's  High Fowler’s 

Slide 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

Slide 63: Dorsal Recumbent Back-lying position, with head and  shoulders SLIGHTLY elevated Provides comfort 

Slide 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 

Slide 65: Lateral Side-lying position  Good for resting and sleeping because it  promotes back alignment Also prevents aspiration 

Slide 66: Sims Semi-prone position  Used for unconscious clients as it helps  facilitated drainage of secretions