11/23/2010                                                        The gift of exercise                                    ...
11/23/2010                                                      Increases HR,                           ImmobilityIncrease...
11/23/2010Elevates the                 Decreased metabolic           Promotes blood flow         Urinary stasismetabolic r...
11/23/2010Upright                                                       Elevates mood             Decline in moodposition ...
11/23/2010A Basic Need:                                     Body position change                                          ...
11/23/2010Prevent skin breakdown: Bathing Remove excess moisture Use draw sheet to reduce shear Be careful with tape Get h...
11/23/2010Nursing HistoryPhysical Examination: Body alignment Gait                                                ACTIVITY...
11/23/2010                                                                                 Circadian synchronization when ...
11/23/2010                  Awake                                                            Stage I        Stage I       ...
11/23/2010                                                    Stage I NREM:BP falls                                       ...
11/23/2010Sleep 16 to 18 hours a                  Preschool child                                         (3-5 years)day  ...
11/23/2010Illness                                                  HypersomniaEnvironment                                 ...
11/23/2010Helping client to relax                       When does client usually go toTeaching cognitive strategies       ...
11/23/2010  Minimal noise  Comfortable room temperature  Appropriate ventilation  Appropriate lighting                    ...
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53 a focus 10 rest & activity

  1. 1. 11/23/2010 The gift of exercise Physical Activity Produced by muscle contraction that increases energy expenditure Exercise Planned, structured, repetitive Maintain physical fitness Functional Strength Perform work Nursing 53A The consequences of disuse Judy Ontiveros, RN, MSN the state in which an individual is at risk for deterioration of the body systems as the result of prescribed or unavoidable musculoskeletal inactivity 11/23/2010 1 11/23/2010 4Discuss the importance of maintaining Maintain size, shape, Disuse osteoporosis tone, and strength of adequate daily physical activity. muscles (including Disuse atrophyDescribe the consequences of disuse on the the heart muscle) Contractures Nourish joints major body functions. Stiffness and pain in Increase joint the jointsIdentify and explain preventive nursing flexibility, stability, and ROM interventions for the client who is under Maintain bone density temporary or prolonged restriction of and strength physical activity. Gift of Exercise Immobility and Its Effect 11/23/2010 2 11/23/2010 5 Effects of Immobility/Disuse Deterioration of bones, muscles, and jointsExplain the nature of sleep as a formof rest. Atrophy Report the effects of sleep Negative nitrogen balance deprivation. Contractures Sleep as a major part of Foot drop daily rest and the characteristics of Osteoporosis sleepExplain the need for a balancebetween physical activity and rest. 11/23/2010 3 11/23/2010 6 1
  2. 2. 11/23/2010 Increases HR, ImmobilityIncrease ventilation Decreased respiratory strength of Diminished cardiacand oxygen intake movement contraction, and reserveimproving gas Pooling of respiratory blood supply to the Increased use of theexchange secretions heart and muscles Valsalva maneuverPrevents pooling of Mediates harmful Orthostatic hypotension Atelectasissecretions in the effects of stress Venous vasodilation and Hypostatic pneumonia stasisbronchi andbronchioles Dependent edema Thrombus formation Gift of Exercise Immobility and its Effect Gift of Exercise Immobility and its Effect 11/23/2010 7 11/23/2010 10 Metabolic demands of the cell decrease CV workload may increase Difficult to change positions Difficult to perform ADLs Valsalva Maneuver Orthostatic hypotension falls occur Emboli formation DVT Pulmonary Embolism Fatty Embolism – broken bones 11/23/2010 8 11/23/2010 11 red marrow: hematopoietic yellow marrow: fat, in hollow area of long bones, originates from red marrow, converts to yellow by 5 y/o, serves as a last resort for bodys energy requirementsLungs function best when uprightMetabolic need for O2 decreases InactiveBreathing becomes shallow PersonMuscles weakenAbility to cough is compromisedDehydration ActivePneumonia Person 11/23/2010 9 11/23/2010 12 2
  3. 3. 11/23/2010Elevates the Decreased metabolic Promotes blood flow Urinary stasismetabolic rate rate to the kidneys causing Renal calculiDecreases serum Negative nitrogen body wastes to be Urinary retentiontriglycerides and balance excreted more effectively Urinary infectioncholesterol AnorexiaStabilizes blood sugar Prevents stasis Negative calciumand make cells more (stagnation) of urine balanceresponsive to insulin in the bladder Gift of Exercise Immobility and It’s Effects Gift of Exercise Effects of Immobility 11/23/2010 13 11/23/2010 16Improves the appetite ConstipationIncreases GI tracttoneFacilitates peristalsis Gift of Exercise Effect of Immobility 11/23/2010 14 11/23/2010 17Slows Basal Metabolic Rate (BMR)Slows GI motilityDecreases nutrient absorptionPatient Picture: Anorexia Constipation Increase fat and cholesterol storage Negative nitrogen balance 11/23/2010 15 11/23/2010 18 3
  4. 4. 11/23/2010Upright Elevates mood Decline in moodposition elevating substances Relieves stress and Perception of time anxiety intervals deteriorates Improves quality of Problem-solving and sleep for most decision-making abilities may individuals deteriorate Loss of control over Prone Position events can cause anxiety Gift of Exercise Effects of Immobility 11/23/2010 19 11/23/2010 22Immobility Patient can lose interest in life Reduced skin turgor Loneliness and social isolation Prolonged pressure on bony prominences Powerlessness Skin Breakdown pressure ulcer Loss of role Skin damage from Behavior changes shear Sensory deprivation/mental confusion friction Sleep interference maceration infection 11/23/2010 20 11/23/2010 23Exercise Exercise Pumps lymph fluid from tissues Positive effects on decision-making into lymph capillaries and vessels and problem solving processes, Increases circulation through lymph planning, and paying attention nodes Induces cells in the brain to Strenuous exercise may reduce strengthen and build neuronal immune function connections Leaving window of opportunity for infection during recovery phase 11/23/2010 21 11/23/2010 24 4
  5. 5. 11/23/2010A Basic Need: Body position change Proper alignment Physiological effect Stimulate circulation Maximize respirations Safety and survival Prevent skin breakdown Psychosocial effect 11/23/2010 25 11/23/2010 28Mobility Alignment: Essential part of living Support above and below joint Protection from harm Anatomic or functional Meet basic needs Turn q 1 to 2 hours Independence Vs vulnerability / dependency Use positioning aides such as: Mental well-being / effective body functioning Egg crate All body parts function more efficiently Over bed cradles Influences self-esteem and body image Heel protectors Independence/usefulness/ Pain = difficult coping strategies Hand rolls Reaction of others to infirmities 11/23/2010 26 11/23/2010 29Movement fostered to full extent of ability Change body positioning: Satisfying life Active, passive or assistive ROM for all joints Engage in competitions CPM machine for post op orthopedic surgery Fitness patients Create Art Foot boards Isometrics ADL’s OOB 11/23/2010 27 11/23/2010 30 5
  6. 6. 11/23/2010Prevent skin breakdown: Bathing Remove excess moisture Use draw sheet to reduce shear Be careful with tape Get help to move patient 11/23/2010 31 11/23/2010 34 Elevate legs TED hose SEQ Avoid compression of leg vessels Gradual adjustment to vertical Dangle Tilt table 11/23/2010 32 11/23/2010 35 Encourage lung expansion Mobilize secretions Deep breathing 10X q2 hours Drinking lots of fluids to liquefy secretions 2 -3 liters of H2O preferably per day Cough 5 x q 2 hours 11/23/2010 33 11/23/2010 36 6
  7. 7. 11/23/2010Nursing HistoryPhysical Examination: Body alignment Gait ACTIVITY REST Appearance and movement of joints Capabilities and limitations for movement Muscle mass and strength SLEEP Activity tolerance Problems related to immobility 11/23/2010 37 11/23/2010 40Activity tolerance MobilityBody positioning Respiratory statusBowel elimination Ventilation and gasFall prevention exchangebehavior Self-careImmobility Sleepconsequences both Stress levelphysiological and Weight controlpsychocognitiveJoint movement 11/23/2010 38 11/23/2010 41Plan what to do and how to do it Sleep is altered state of consciousness whereObtain essential equipment before starting perception of and reaction to environmentRemove obstacles decreasedExplain transfer to client and assistive Cyclic nature of sleep thought to bepersonnel controlled by lower part of brain Neurons in reticular formation integrate sensorySupport or hold client rather than equipment information from PNSExplain what client should do Relay to cerebral cortexMake written plan, including client’s RAS involved in sleep-wake cycletolerance 11/23/2010 39 11/23/2010 42 7
  8. 8. 11/23/2010 Circadian synchronization when biological clock coincides with sleep-wake cycle Person awake when body temp highest and asleep when body temp lowest By 3-6 months of age have regular sleep- wake cycle 11/23/2010 43 11/23/2010 46Affect sleep-wake cycle Restores normal levels of activitySerotonin Restores normal balance among parts of the Thought to lessen response to sensory stimulation nervous systemGABA Reticular Thought to shut off activity in neurons of RAS Necessary for protein synthesis ActivatingWakefulness Psychological well-being System RAS – maintains alertness and wakefulness RAS receives visual and sensory input and auditory pain and tactile stimuli Studies support that wakefulness results from neurons in the RAS releasing catecholamines Acetylcholine, dopamine, noradrenalin associated with cerebral cortical arousal 11/23/2010 44 11/23/2010 47 Sleep & Temperature: sleeping warm/hot interferes with insulin & glucocorticoid stabilization, role in weight lossDarkness and preparing for sleep causedecrease in stimulation of RASPineal gland begins to secrete melatonin andperson feels less alertDuring sleep GH secreted and cortisolinhibited 11/23/2010 45 11/23/2010 48 8
  9. 9. 11/23/2010 Awake Stage I Stage I NREM Stage II NREM Stage III NREM Very light sleep and lasts only a Stage IV few minutes NREM Feels drowsy and relaxed Repeat III Eyes roll from side to side Repeat II HR and RR drop slightly Stage V Can be readily awakened and may REM deny sleeping Repeat II 11/23/2010 49 11/23/2010 52Refers to basic organization of sleep Stage IITwo types that alternate in cycles during Light sleep lasts only about 10 to 15sleep minutes NREM REM Body processes continue to slow down Eyes are generally still HR and RR decrease slightly Body temperature falls 44% to 55% of total sleep Requires more intense stimuli to awaken 11/23/2010 50 11/23/2010 53 Stage III and IVOccurs when activity in RAS inhibited Deepest stages of sleep (delta sleep or deepConstitutes 75% - 80% of sleep sleep)Consists of 4 stages HR and RR drop 20% to 30% below waking hours Difficult to arouse Not disturbed by sensory stimuli Skeletal muscles very relaxed Reflexes are diminished Snoring is likely to occur Swallowing and saliva production reduced Essential for restoring energy and releasing important growth hormones 11/23/2010 51 11/23/2010 54 9
  10. 10. 11/23/2010 Stage I NREM:BP falls Light sleep Gradual fall in VS / Few minutes metabolismPulse rate decreasesPeripheral blood vessels dilate Stage II NREM: Body functions slowCO decreases Sound sleep Relaxation progressesSkeletal muscles relax 10 to 20 minutesBMR decreases 10% - 30% Muscles completely Stage III NREM:GH levels peak [kids & *adolescents* need sleep!] 1st stages of deep sleep relaxedIntracranial pressure decreases VS decline / WNL Sleep Cycles Physiological Changes 11/23/2010 55 11/23/2010 58Occurs every 90 minute Stage IV NREM: Body restored / rested VS significant lower than deepest stage of sleep waking hoursLasts 5 to 10 minutes 15 to 30 minutes Sleep walking Enuresis may occurAcetylcholine and dopamineincreaseMost dreams take place Stage V REM: Loss of skeletal muscle tone ANS response of rapidly moving Deep vivid dream eyesBrain is highly active Sleep lasts 20 minutes Fluctuating BP, HR, RR rate and cycles Gastric secretions increaseBrain metabolism increases as much Q 50 to 90 minutes Mental restoration occursas 20% Sleep cycles Physiological changesDistinctive eye movements occur 11/23/2010 56 11/23/2010 59Voluntary muscle tone dramatically Newbornsdecreased ToddlersDeep tendon reflexes absentMay be difficult to arouse or may wake Adolescentsspontaneously PregnancyGastric secretions increase MenopausalHR and RR often are irregular womenRegions of brain associated with learning,thinking, organizing information stimulated Elderly 11/23/2010 57 11/23/2010 60 10
  11. 11. 11/23/2010Sleep 16 to 18 hours a Preschool child (3-5 years)day requires 11 to 13Periods of 1 to 3 hours hours of sleepspent awake Sleep needs fluctuate in relation to activityEnter REM sleep and growth spurtsimmediately School-age child50% NREM and 50% (aged 5 to 12)REM needs 10-11 hours ofSleep cycle ~ 50 sleep Most receive lessminutes 11/23/2010 61 11/23/2010 64 Awaken every 3 to 4 Require 9-10 hours hours, eat, and then go of sleep each night back to sleep Few actually get Periods of wakefulness that much sleep gradually increase Circadian rhythms By 6 months, most tend to shift infants sleep through the night and establish a Tendency to stay pattern up later and wake Establish a pattern of later daytime naps 11/23/2010 62 11/23/2010 65 Adults12 to 14 hours are 7-9 hours of sleeprecommended Individual variationsMost still need anafternoon nap EldersNighttime fears Tendency toward earlier bedtime andand nightmares wake timesare also common May show an increase in disturbed sleep Need to sleep does not decrease with age circadian rhythm variations - 24.2 hour cycle 11/23/2010 63 11/23/2010 66 11
  12. 12. 11/23/2010Illness HypersomniaEnvironment Sufficient sleep at night but cannot stay awakeLifestyle during dayEmotional stress Caused by medial or psychological disordersStimulants and alcohol NarcolepsyDiet Caused by lack of hypocretin in CNS that regulates sleepSmoking Clients have sleep attacksMotivation Sleep at night usually begins with sleep-onsetMedications REM period Insufficient sleep 11/23/2010 67 11/23/2010 70Insomnia Sleep apneaExcessive daytime sleepiness Frequent short breathing pauses during night More than 5 apneic episodes > 10 sec/hrParasomnias considered abnormal Symptoms include snoring frequent awakenings difficulty falling asleep morning headaches memory and cognitive problems irritability Types include obstructive, central, mixed 11/23/2010 68 11/23/2010 71 Signs: reddened uvula, irritation caused by breathing with open mouth CPAPDifficulty falling asleep Behavior that may interfere with or occurWaking up frequently during sleepDifficulty staying asleep Arousal disorders i.e., Sleepwalking, sleep terrorsDaytime sleepiness Sleep-wake transition disordersDifficulty concentrating i.e., Sleep talkingIrritability Associated with REM sleepRisk factors i.e., NightmaresOlder age OthersFemale i.e., Bruxism 11/23/2010 69 11/23/2010 72 12
  13. 13. 11/23/2010Helping client to relax When does client usually go toTeaching cognitive strategies sleep?Administering medicationsPreparing the environment for sleep Bedtime rituals?Promoting dietary changes Does client snore?Scheduling night time care Can client stay away during day?Managing DisordersManaging symptomatology that disturbs sleep Taking any prescribed or OTCManaging bedtime agitation medications? 11/23/2010 73 11/23/2010 76Reducing environmental distractions Rarely yields information unless client has obstructive sleep apneaPromoting bedtime rituals Enlarged and reddened uvula and softProviding comfort measures palateScheduling nursing care to promote Enlarged adenoids and tonsilsuninterrupted sleep (children)Teaching stress reduction, relaxation Obesity (adults)techniques or good sleep hygiene Neck circumference > 17.5 inches (men) Deviated septum (occasionally) 11/23/2010 74 11/23/2010 77Experience sleepiness and fatigue Altering or eliminating routines can affectduring day sleep AdultsAttention and concentration deficits Listening to musicReduced vigilance ReadingDistractibility Soothing bathReduced motivation PrayingFatigue, malaise, diplopia, dry Childrenmouth Need to be socialized into presleep routine Usually preceded by hygienic ritual 11/23/2010 75 11/23/2010 78 13
  14. 14. 11/23/2010 Minimal noise Comfortable room temperature Appropriate ventilation Appropriate lighting 11/23/2010 79• Maintain (or develop) a sleeping pattern that provides sufficient energy for daily activities• Enhance feeling of well being• Improve the quality and quantity of the client’s sleep 11/23/2010 80 Sedative-hypnotics (induce sleep) Anti-anxiety or tranquilizers Be aware of actions, effects, risks of specific medications 11/23/2010 81 14