PBL: Activity and Exercise; Sleep and Rest; FUNDAMENTALS OF NURSING


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PBL: Activity and Exercise; Sleep and Rest; FUNDAMENTALS OF NURSING

  2. 2.  can be described as energetic action or as being in a state of movement.
  3. 3.  Good body mechanics is the efficient, coordinated, and safe use of the body to produce motion and maintain balance during activity.  Three basic elements of body mechanics: BODY ALIGNMENT (POSTURE), BALANCE (STABILITY), and COORDINATED BODY MOVEMENT.
  4. 4.  Body Alignment: the geometric arrangement of body parts in relation to each other.  Balance: a state of equipoise (equilibrium) in which opposing forces counteract each other.  Coordinated Body Movement: Integrated functioning of the musculoskeletal and nervous system as well as joint mobility.
  5. 5.  Joint: functioning unit of the musculoskeletal system.  Bones articulate at the joints  Skeletal muscles attach to two bone at the joint  When a person is inactive, the joints are pulled into a flexed position.  Synovial Joint: freely movable  Range of Motion: maximum movement that is possible for the joint.
  6. 6.  Poor standing and sitting posture, overweight, pregnancy and constant use of high-heeled shoes may produce an exaggerated curvature of the lumbar spine, called lordosis.
  7. 7.  Lifting: When a person lifts or carries an object, the weight of the object becomes part of the person’s body weight.  Pulling and Pushing: When pulling or pushing an object, a person maintains balance with least effort when the base of support is enlarged in the direction in which the movement is to be produced or opposed.  Pivoting: technique in which the body is turned in a way that avoids twisting of the spine.
  8. 8.  Growth and Development  Physical Health  Mental Health  Nutrition  Lifestyle  Personal Values  Fatigue and Stress  External Factors
  9. 9.  Musculoskeletal System ◦ Problem Related to Immobility: Client experience a significant decrease in muscular strength. ◦ Effects of Exercise: Maintenance of muscle strength and tone; efficiency of muscular contraction increases; maintain joint mobility  Cardiovascular System ◦ Problems related to Immobility: Diminished cardiac reserve; Orthostatic hypotension ◦ Effects of Exercise: Heart rate, blood pressure and cardiac output increases;
  10. 10.  Respiratory System ◦ Problems related to Immobility: Decreased respiratory movement; Pooling of respiratory excretions; Atelectasis ◦ Effects of Exercise: Ventilation increases  Metabolic System ◦ Problems related to Immobility: Decreased metabolic rate; Anorexia ◦ Effects of exercise: Metabolic rate elevation;
  11. 11.  Urinary System ◦ Problems related to Immobility: Urinary stasis; Urinary retention; Urinary Infection ◦ Effects of exercise: more efficient blood flow; prevention of stasis.  Gastrointestinal System ◦ Problems related to Immobility: Constipation; decreased peristalsis and colon motility ◦ Effects of exercise: Appetite improvement; increased GI tract tone, improved digestion and elimination
  12. 12.  Integumentary System ◦ Problems related to Immobility: Reduced skin turgor; skin breakdown ◦ Effects of exercise: improved blood circulation (peripheral) and promoted delivery of nutrients and oxygen.  Psychoneurologic System ◦ Problems related to Immobility: Increased dependence; lower self-esteem; Exaggerated emotional reactions; lack of intellectual stimulation ◦ Effects of exercise: improves tolerance to stress; sense of relaxation; improvement of body image; improves sleep
  13. 13.  Nursing History  Physical Examination ◦ Body Alignment  Stance  Sitting Alignment ◦ Gait ◦ Joint Appearance and Movement ◦ Capabilities and Limitations of Movement ◦ Muscle Mass and Strength ◦ Activity Tolerance ◦ Physical Fitness
  14. 14.  NANDA nursing diagnoses that relate to activity/mobility problems include: Activity tolerance, High risk for activity intolerance, Impaired physical mobility, & High risk for disuse symptoms.
  15. 15.  Identifying those clients who need assistance with body alignment and determining the degree of assistance they need.  Sensitive to the client’s need to function as independently as possible yet provide assistance when the client needs it.  Plan to teach clients applicable skills.
  16. 16.  Maintaining good posture  Positioning Clients ◦ Fowler’s Position ◦ Orthopneic Position ◦ Dorsal Recumbent Position ◦ Prone Position ◦ Lateral Position ◦ Sim’s Position
  17. 17.  Moving and Turning Clients in Bed ◦ Moving a client up in bed ◦ Moving a client to the side of the bed in segments  Transferring Clients ◦ Transferring a client between a Bed and a Wheelchair ◦ Transferring a Client between a Bed and a Stretcher ◦ Moving a Client Using a Hydraulic Lift  Exercise ◦ Isotonic (dynamic) exercises: muscle tension is constant and the muscle shortens to produce muscle contraction and movement
  18. 18. ◦ Isometric (static or setting) exercises: There is a change in muscle tension but no change in muscle strength. ◦ Isokinetic (resistive) exercises: involve muscle contraction and joint movement ◦ Aerobic exercise: an activity in which the amount of oxygen taken into the body is greater than or equal to the amount the body requires. (Anaerobic exercise – opposite) ◦ Range of motion:  Active ROM activities  Passive ROM activities  Active-assistive ROM exercises
  19. 19. ◦ Components of Physical Fitness:  Muscle Strength and Endurance  Cardiorespiratory Fitness  Joint Flexibility  Body Composition  Ambulating Clients ◦ Ambulation: act of walking; function that most people take for granted  Preambulatory Exercises  Assisting Clients to Ambulate
  20. 20.  Mechanical Aids in Walking ◦ Canes ◦ Walkers ◦ Crutches
  21. 21.  Collect date relevant to the outcome criteria previously established by asking the client to demonstrate specific exercises, measure muscle size, observe client’s activity tolerance when performing self-care activities, measure vital signs before and after exercise and ambulation.. Etc.
  23. 23.  Implies calmness, relaxation without emotional stress, and freedom from anxiety.  Restores a person’s energy; allowing the individual to resume optimal functioning.
  24. 24.  Considered to be a basic human need  It is a universal process common to all people.  More recently, sleep has come to be considered a state of consciousness in which the individual’s perception and reaction to the environment is decreased.
  25. 25.  Circadian Rhythm ◦ Biorhythms – In humans, these are controlled from within the body and synchronized with environmental factors. ◦ Circadian from circa dies, “about a day” ◦ The person is awake when the physiologic and psychologic rhythms are most active.  Stages of Sleep ◦ Electroencephalogram (EEG) – provides a good a picture of what occurs during sleep.
  26. 26. ◦ Two types of sleep: NREM (Non-REM) sleep and REM (Rapid Eye Movement) sleep ◦ NREM Sleep  Also referred to as slow-wave sleep  Most sleep during a night is NREM sleep.  Deep, restful sleep and brings a decrease in some physiologic functions  Divided into four stages: Stage I (Very light sleep); Stage II (Light sleep); Stage III (Parasympathetic nervous system domination); Stage IV (deep sleep)
  27. 27. ◦ REM Sleep  25% of the sleep of a young adult.  Most dreams take place during the REM sleep.  Brain is highly active (paradoxical sleep)  As the person becomes more rested through the night, the duration of the REM sleep increases  Sleep Cycles ◦ Stage I NREM -> Stage II NREM -> Stage III NREM -> Stage IV NREM -> Stage III -> Stage II -> Stage I REM
  28. 28.  Age  Environment  Fatigue  Lifestyle  Psychologic Stress  Alcohol and Stimulants  Diet  Smoking  Motivation  Illness  Medications
  29. 29.  Primary Sleep Disorders: the person’s problem is the main disorder  Secondary Sleep Disorders: sleep disturbances caused by another clinical disorder  Insomnia: most common sleep disorder; inability to obtain an adequate amount or quality of sleep  Hypersomnia: opposite of insomnia; excessive sleep
  30. 30.  Narcolepsy: sudden wave of overwhelming sleepiness that occurs during the day; “sleep attack”; genetic defect of the CNS in which REM sleep cannot be controlled.  Sleep Apnea: periodic cessation of breathing during sleep ◦ Obstructive Apnea: pharynx or oral cavity blocks the air ◦ Central Apnea: defect in the respiratory center of the brain ◦ Mixed Apnea: combination of Obstructive and Central Apnea
  31. 31.  Parasomnias ◦ Somnambulism (sleepwalking) ◦ Sleeptalking ◦ Nocturnal enuresis (bedwetting) ◦ Nocturnal erections ◦ Bruxism (clenching or grinding of the teeth)  Sleep Deprivations ◦ prolonged sleep disturbances; not a sleep disorder
  32. 32.  Sleep History ◦ Usual sleeping pattern ◦ Bedtime rituals ◦ Use of sleep medications ◦ Sleep environment ◦ Recent changes in sleep patterns or difficulties in sleeping.  Sleep Diary  Physical Examination  Diagnostic Studies ◦ Polysomnography; EEG; Electromyogram (EMG); Electro-oculogram (EOG)
  33. 33.  NANDA nursing diagnosis given to clients with sleeping problems: Sleep pattern disturbance.
  34. 34.  Maintain/develop a sleeping pattern that provides sufficient energy for daily activities.  Interventions include reducing environmental distractions; promoting bedtime rituals; providing comfort measures; scheduling nursing care to provide uninterrupted sleep periods…etc.
  35. 35.  Creating a restful environment  Supporting Bedtime Rituals  Promoting Comfort and Relaxation  Administering Sleep Medications  Client Teaching
  36. 36.  To evaluate whether client outcomes have been achieved, the nurse may observe the duration of the client’s sleep, observe the client’s signs of REM and NREM sleep deprivation, question effectiveness of specific interventions…etc.