An activity –exercise pattern refers to a persons routine of exercise, activity, leisure, and recreation. It includes:• Activities of daily living (ADL) that require energy expenditure such as hygiene, cooking , shopping, eating , working.• Type, quality, and quantity of exercises, including sports.
• Ligaments; tough fibrous bands that bind joints together & connect bones & cartilages.
• Tendon; strong, flexible, inelastic fibrous band that attach muscle to bone.
Cartilage; nonvascular connective tissue found in the joint s as well as in the nose, ear, thorax, trachea and larynx
Physiology of MovementThe following physiology of movement is:Skeletal system; the bones and cartilage that protect our organ and allow us to move are called skeletal system. The function of this system include: – Maintain body posture by supporting the soft tissue – Protect the delicate structures of the body such as brain, heart and spinal cord – Furnishes surface for attachments of muscles tendons and ligaments – Storage areas of minerals salts and fats. – Produce blood cells
Muscular system; provide functions for the body through• contraction• Motion• Maintenance of posture• Heat production The 3 types of muscles are 1) Skeletal 2) Cardiac 3) Smooth or visceral muscles.Muscles have two different points of attachments:The attachment of a muscle to the more stationary bone is called the Point of Origin.The attachment to the more movable bone is the Point of Insertion
Nervous System; the nerve impulses stimulate muscles to contract.Body Mechanics; is the efficient use of the body as a machine and as a mean of locomotion, correct body mechanics lead to health promotion and illness prevention so the responsibility of the nurse to apply the body mechanics and to teach others .
Types of Joint MovementFlexion: decreases the angle of the joint" bending the elbow"Extension: Increasing the angle of the joint " straightening the arm at the elbow"Hyperextension: further extension or straightening of a joint " bending the head backward"Abduction: movement of the bone away from the midline of the bodyAdduction: movement of the bone toward the midline of the bodyRotation: movement of the bone around its central axis
Circumduction: movement of the distal part of the bone in a circle while the proximal end remains fixed.Eversion: Turning the sole of the foot outward by moving the ankle jointInversion: Turning the sole of the foot inward by moving the ankle joint.Pronation: moving the bones of the forearm so that the palm of the hand faces downward when held in front of the body.Supination: moving the bones of the forearm so that the palm of the hand faces upward when held in front of the body.
ExerciseIs a type of physical activity defined as a planned, structured, and repetitive bodily movement performed to improve or maintain one or more components of physical fitness.
Types of exercise:Exercise can be classified according to the type of muscle contraction to:-Isotonic exercise; in which the muscle shortens to produce muscle contraction and active movement. Example; running, swimming, walking. This increase muscle mass, tone and strength, increase cardiac and respiratory and circulatory functions.
Isometric exercise; in which there is muscle contraction without moving the joint shortening. An example includes squeezing a towel or pillow between the knees. These exercises are useful for strengthening abdominal, quadriceps and gluteal muscles so the nurse encourage both isotonic and isometric exercises for the hospitalized client’s.
Isokinetic exercises; involve muscle contraction with resistance example include rehabilitation exercises for the knee and elbow injuries.
OR exercise can be classified according to the source of energy to:-Aerobic exercise is activity during which the amount of oxygen taken in the body is greater than that used to perform the activity. An example walking, running.
Anaerobic exercise involves activity in which the muscles cannot draw out enough oxygen from the bloodstream, and anaerobic pathways are used to provide additional energy for a short time. An example weight lifting.
Factors affecting body alignment and activity• Growth and development; according to person age the nurse should be familiar with the differences of the neuromuscular development of the client in order to facilitate coping.• Physical health; because any problems in the musculoskeletal or nervous system can have negative influence on the body alignments and movement.• Mental health; bodily processes tend to slow down in depression• Lifestyle variables; such as exercise, food, smoking, occupation, culture.• Attitude and values; such as swim, fitness, many individual values also influence the exercise options people make.
• Fatigue and stress; chronic stress may deplete body energy to the point that fatigue makes even the thought of exercise overwhelming• External factors; environment which influence, humidity, support people, lack of free time, unsafe environment.• Nutrition; both undernutritioin and overnutrition can influence body alignment and mobility.
Effects of exercise on major body system – Musculoskeletal system » Increased muscle efficiency strength and flexibility » Increased coordination, stability, gait and posture » Increased efficiency of nerve impulses transmission » Improve range of motion » Maintained bone density and strength
– Cardiovascular system; » Meet the demands for oxygen » Increase blood flow » Increase efficiency of the heart » Decreased blood pressure » Increased blood flow to all body parts » Improved heart rate, improved circulation, and self – reported stress reduction » Decreased cholesterol level
–Respiratory system; work together with the cardiovascular system »Increase oxygen available to the muscle »Increase depth, rate of gas exchange, rate of CO2 excretion »Improved pulmonary functioning »Decreasing breathing effort and risk of infection.
–GI system; exercises lead to »Increased intestinal tone, facilitating peristalsis »Improve digestion and elimination »Improve the appetite
–Metabolic system; exercise elevates the metabolic rate, thus increasing the production of body heat and waste products and calorie use. »Increased efficiency of metabolic system »Increased efficiency of body temperature regulation »Reduce level of serum triglycerides and cholesterol.
–Urinary system; regular exercise increase blood circulation including improved blood flow to the kidneys which allows the kidneys to maintain the bodys fluid balance and acid-base balance more efficiently and to excrete body waste.
–Skin; regular exercise increase circulation which lead to promote good health–Psychosocial outlook; regular exercise have psychological effects such as increase energy, improve sleep, body image, improve self-concepts and increase positive health behaviors, improve general well being.
Effects of immobility on major body systemMusculoskeletal system• Disuse osteoporosis; demineralization process, known as osteoporosis, the bones become spongy and may gradually deform and fracture easily.
• Disuse atrophy; atrophy in muscles losing most of their strength and normal function.• Contractures; when the muscle fibers are not able to shorten and lengthen (permanent shortening of the muscle) forms limiting joint mobility. This process eventually involves the tendons, ligaments, and joint capsules.
Cardiovascular system• Diminished cardiac reserve• Orthostatic hypotension; is a common result of immobilization. The blood pools in the lower extremities, and central blood pressure drops. Cerebral perfusion is seriously compromised, and the person feels dizzy or light headed and may even faint.
• Venous vasodilation and stasis; the skeletal muscles do not contract sufficiently, and the muscles atrophy, so the skeletal muscles can no longer assist in pumping blood back to the heart against gravity. Blood pools in the leg veins, causing vasodilation and engorgement.
• Dependent edema; when the venous pressure is sufficiently great, some of serous part of the blood is forced out of the blood vessel into the interstitial spaces surrounding the blood vessel, causing edema.• Thrombus formation
3. Respiratory system• Decreased respiratory movement; in immobile client, ventilation of the lungs is passively altered. The body presses against the rigid bed and curtails chest movement. The abdominal organs push against the diaphragm, restricting lung movement and making it difficult to expand the lungs fully.
• Pooling of respiratory secretions; secretions of the respiratory tract are normally expelled by changing positions or posture and by coughing. Inactivity allows secretions to pool by gravity, interfering with the normal diffusion of oxygen and carbon dioxide in the alveoli.
• Atelectasis; is the collapse of a lobe or of an entire lung, when ventilation is decreased, pooled secretions may accumulate in a dependent area of a bronchiole and effectively block it. Immobile elderly, postoperative clients are at greatest risk of Atelectasis.
• Pneumonia; pooled secretions provide excellent media for bacterial growth. Under these conditions, a minor upper respiratory infection can evolve rapidly into severe infection of the lower respiratory tract.
Metabolic system• Decreased metabolic rate; in immobile clients, the basal metabolic rate and gastrointestinal motility and secretions of various digestive glands decrease as the energy requirements of the body decrease.• Negative nitrogen balance• Anorexia; loss of appetite occurs because of the decreased metabolic rate and the increased catabolism that accompany immobility.• Negative calcium balance
5. Urinary system• Urinary stasis; in a mobile person, gravity plays an important role in the emptying of the kidneys and the bladder. When the person remains in abed, gravity impedes the emptying of urine from the kidneys and the urinary bladder, so emptying is not as complete and urinary stasis occurs after few days of bed rest.
• Urinary retention, which is accumulation of urine in the bladder, bladder distention, and occasionally urinary incontinence (involuntary urination). The decreased muscle tone of the urinary bladder inhibits its ability to empty completely.• Urinary infection, static urine provides an excellent medium for bacterial growth
6.Gastrointestinal system• Constipation is a frequent problem for immobilized people because of decreased peristalsis and colon motility.
7. Integumentary system• Reduced skin turgor. Skin turgor is an abnormality in the skins ability to change shape and return to normal (elasticity).The skin can atrophy as a result of prolonged immobility.• Skin breakdown. Normal blood circulation relies on muscle activity. Immobility impedes circulation and diminishes the supply of nutrients to specific areas. As a result skin breakdown and formation of pressure ulcers can occur.
8. Psychoneurologic system• Lower the person’s self –esteem• Increased risk of depression• Decreased social interaction
Nursing managementAssessingNursing HistoryPhysical examination• Body Alignment• Appearance and movement of joints• Capabilities and limitation for movement• Muscle mass and strength• Activity tolerance• Problems related to immobility
Nursing DiagnosisNursing diagnoses related to mobility focus primarily on activity and mobility levels, and the psychosocial impact that alterations in mobility can have on a client and theclient’s family. Common NANDA nursing diagnoses related to the physical adaptations or risks resulting from altered mobility include:
• Activity Intolerance related to bed rest and immobility, generalized weakness, sedentary lifestyle, and imbalance between oxygen supply and demand.• Impaired Physical Mobility related to intolerance to activity or decreased strength and endurance, pain, perceptual or cognitive impairment, neuromuscular impairment, musculoskeletal impairment, and depression or severe anxiety.
• Self-Care Deficits related to inability to wash body or body parts, inability to obtain or get to water source, activity intolerance, decreased strength and endurance, pain, and impaired transfer ability• Ineffective Health Maintenance related to lack of or significant alteration in communication skills (written, nonverbal)
• Risk for Falls related to impaired mobility. Alterations in family and social processes may also result from immobility and inactivity. Disruption in activity and mobility leads to impairment of the ability to perform one’s usual social, vocational, educational, and family roles.
There are often changes in the client’s perception of role. Disturbed Body Image and Situational Low Self-Esteem can result from:1. Changes in physical abilities2. Changes in family responsibilities3. Lack of knowledge regarding rehabilitation• Fear (of falling)• Ineffective coping• Low self esteem• Powerlessness•
• Planning• Implementing Nursing strategies to maintain or promote body alignment and mobility involve positioning clients appropriately, moving and turning clients in bed, transferring clients, providing ROM exercises, ambulating clients with or without mechanical aids.•
Techniques to prevent back stress:• Develop a habit of erect posture correct alignment• Use the longest and strongest muscle of the arms and the legs to help provide the power needed in strenuous activities• Use the internal girdle and a long midriff to stabilize the pelvis and to protect the abdominal viscera when stopping, reaching , lifting or pulling
• Use the weight of the body as a force for pulling or pushing by rocking on the feet or leaning forward or backward• Work as closely as possible to an object that is to be lifted or moved.• Flex the knees, put on the internal girdle and come down to an object that is to be lifted.• Spread the feet apart to provide a wider base of support when increased stability of body