The document discusses various types of exercise and their benefits, as well as factors related to impaired physical mobility such as complications of immobility, nursing assessments, and interventions to address mobility issues. It also covers topics like positioning, pressure ulcers, and wound healing. The main points are that exercise benefits physical fitness, immobility can cause issues like contractures and pneumonia, and nursing focuses on promoting mobility, relieving pressure, improving nutrition, and wound care.

1. Activity and Exercise Fundamentals of Nursing Review Pinoynursing.webkotoh.com

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

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