activity &exercise

Range of Motion, Body Mechanics,

Transfers & Positioning ,

comfort devices

Activity of daily living(ADL) refers activities that require energy expenditure such as hygiene, dressing, cooking, shopping, eating, working, home maintenance.

Mobility refers the ability to move freely , easily, rhythmically and purposefully in the environment.

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Normal movement

Body movement requires coordinated muscle activity and neurologic integration.

It require four basic elements1. Body alignment2. Joint mobility3. Balance4. Coordinated movement

Line of gravity: An imaginary vertical line drawn through the body’s center of gravity.

Center of gravity: the point at which all of the Body’s mass centered.

Base of support: the foundation on which the body rests

Center of gravity

Activity and Exercise

Activity-exercise pattern: Refers to a person’s routine of exercise, activity, leisure and recreation needs for rest and mobility.

Exercise: A type of physical activity involving the muscles performed to maintain or improve physical fitness.

Types of exercise:

Isotonic (dynamic) exercises: Muscle shortens to produce contraction and active

movement .e.g. running, walking, swimming, cycling) * Advantages: 1- Increase muscle tone, mass, strength. 2- Maintain joint flexibility and circulation.

Isometric (static or setting) exercises: There is muscle contraction without moving the joint

* useful for strengthening abdominal, gluteal muscles) * No change in muscle length * No joint movement * Maintaining strength in immobilized muscle

Types of exercise:

Isokinetic (resistive) exercises: It involves muscle contraction or tension against

resistance, can be either isotonic and isometric. These exercises are used in physical conditioning

& are often done to build up certain muscle groups.Aerobic exercises: Activities during which the amount of oxygen taken

in to the body is greater than that used to perform the activity.

GENERAL CONSIDERATIONS FOR PERFORMING PHYSICAL TASKS

Keep the work as close as possible to your body. It puts less of a strain on your back, legs, and arms.

Rock backward or forward on your feet to use your body weight as a pushing or pulling force.

Keep the work at a comfortable height to avoid excessive bending at the waist.

Keep your body in good physical condition to reduce the chance of injury

Range of Motion

ROM is the extent of movement that a joint is normally capable of.

TYPES OF ROM EXERCISES

Passive range-of-motion exercises PROM

Active range-of-motion exercises AROM

Active-Assistive range-of-motion exercises AAROM

Passive ROM

The patient is unable to move independently and someone else manipulates body parts.

Active ROM

The patient moves independently through a full ROM for each joint.

Only active ROM increases muscle tone, mass, strength and improves cardiac and pulmonary functioning

Active-Assistive ROM

The nurse provides minimal support as the patient moves through ROM.

Hand Movements (ROM)

ROM in wrist includes flexion, extension, radial & ulner deviation

ROM in hands include abduction, adduction, flexion, extension, opposition and circumduction of the thumb.

Hip ROM

Hip ROM includes flexion, extension and lateral & external rotation

Adduction & Abduction

Factors That Affect Body Alignment and Mobility

1. Growth & Development---Age of Client2. Nutrition (under nutrition, Over

nutrition)3. Personal values and attitudes

(family ,personal appearance)4. External factors :high temperature and

low humidity 5. Prescribed limitations: Bed rest ,advised for clients to relieve

edema, pain reduce oxygen needs, to promote tissue repair

Effects of immobility

Musculoskeletal system: Disuse osteoporosis: calcium depleted bone

become spongy deform and fracture easily.Disuse atrophy(Decrease in size)Contractures: permanent shortening of the muscleStiffness and pain in the joints :connective tissue

immobile.Cardiovascular system:Diminished cardiac reserveIncreased use of the valsalva maneuverOrthostatic hypotensionVenous vasodilation and stasisDependent edema


Respiratory system:Decreased respiratory movementPooling of respiratory secretionsAtelectasis Hypostatic pneumoniaMetabolic system:Decreased metabolic rateNegative nitrogen balanceAnorexia Negative calcium balance


Urinary system:Urinary stasisRenal calculiUrinary retentionUrinary infectionGastrointestinal systemDecreased peristalsis, constipation


Integumentary systemReduced skin turgorSkin breakdownPsycho neurologic systemLower self esteem(emotional reactions such

as withdrawn, aggressive, regression)FrustrationAnxiety

Body mechanics

Introduction: Some of the most common injuries sustained

by members of the health care team are severe musculoskeletal strains. Many injuries can be avoided by the conscious use of proper body mechanics when performing physical labor.

MASS: Quantity of Atoms

VELOCITY: Speed of movement

ACCELERATION: a positive rate of change in velocity

DECELRATION: a negative rate of change in

velocity FORCE: a push or pull

TORQUE: The tendency of force acting at a

perpendicular distance from an axis to rotate a lever system

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BODY MECHANICS

DEFINITION Body mechanics is the utilization of correct

muscles to complete a task safely and efficiently, without undue strain on any muscle or joint.

BODY MECHANICS

Use proper body mechanics in order to avoid the following:

Excessive fatigue. Muscle strains or tears. Skeletal injuries. Injury to the patient. Injury to assisting staff members.

PRINCIPLES OF GOOD BODY MECHANICS

1. Maintain a Stable Center of Gravity. Keep your center of gravity low. Keep your

back straight. Bend at the knees and hips.2. Maintain a Wide Base of Support. This will provide you with maximum stability

while lifting. Keep your feet apart. Place one foot slightly ahead of the other. Flex your knees to absorb jolts.(moving suddenly, violently)

Turn with your feet

Body Alignment

Balance: Keep Your Feet 12” apart

PRINCIPLES OF GOOD BODY MECHANICS contd……..

3. Maintain the Line of Gravity. The line should pass vertically through the

base of support. Keep your back straight. Keep the object being lifted close to your body.

4.Maintain Proper Body Alignment. Tuck in your buttocks. Pull your abdomen in

and up. Keep your back flat. Keep your head up. Keep your chin in. Keep your weight forward and supported on the outside of your feet.

When sitting keep your back straight.

X

http://www.lancs.ac.uk/depts/safety/section.13/images/posture.gif

TECHNIQUES OF BODY MECHANICS

Lifting: Use the stronger leg muscles for lifting. Bend

at the knees and hips; keep your back straight. Lift straight upward, in one smooth motion.

Reaching: Stand directly in front of and close to the object.

Avoid twisting or stretching. Use a stool or ladder for high objects. Maintain a good balance and a firm base of support. Before moving the object, be sure that it is not too large or too heavy.

TECHNIQUES OF BODY MECHANICS

Pivoting Place one foot slightly ahead of the

other. Turn both feet at the same time, pivoting on the heel of one foot and the toe of the other.

Maintain a good center of gravity while holding or carrying the object. Avoid Stooping. Squat (bending at the hips and knees). Avoid stooping (bending at the waist). Use your leg muscles to return to an upright position.

BODY MECHANICS

GENERAL CONSIDERATIONS FOR PERFORMING PHYSICAL TASKS

It is easier to pull, push, or roll an object than it is to lift it.

Movements should be smooth and coordinated rather than jerky.

Less energy or force is required to keep an object moving than it is to start and stop it.

Use the arm and leg muscles as much as possible, the back muscles as little as possible

STEPS INVOLVED IN PROPERLYMOVING AN OBJECT TO A NEW LOCATION

The process of moving (lifting, pivoting, squatting, and carrying) a heavy object.

(The same rules would apply to moving a patient.)

The object will be moved from a waist high area to a lower area five to ten feet away. The procedure will combine all the rules of body mechanics previously discussed.


Identify the object to be moved. Adopt a stable base of support. Your feet are separated. One foot is behind the other. Your back is straight. Grasp the object at its approximate center of

gravity. Pull the object toward your body's center of gravity using your arm and leg muscles


Re-establish your base of support and appropriate body alignment.

Your back is straight. You have a stable base of support.

You are holding the object approximately at waist height and close to your body.

Pivot toward the desired direction of travel. Turn on both feet at the same time. Maintain a stable balance.


Re-establish a stable base of support and appropriate body alignment. Your back is straight. Your feet are apart, one slightly behind the other. The object is at hip level, close to your body Squat and place the object onto the lower area.

Bend at the knees and hips. Maintain a straight back. Maintain a stable

base of support. Use your arm and leg muscles (as needed) for guidance.

Use your leg muscles to resume an upright position

Second session

Positioning

Clients

Positions and Uses

Dorsal (supine): * Place patient on back with head and shoulders are slightly

elevated. * Used for physical assessment , to provide comfort , &

change position.

Positions and Uses

Dorsal recumbent: * Place patient on back, legs flexed and slightly rotated

outward *Used for pelvic examination, female catheterization, perinal

care

Positions and Uses

Semi-fowler’s position: * Sitting position with or without positioning pillow at head

45-60 degree. used for eating and facilitate breathing.

Positions and Uses

High fowler’s position: *Head & trunk are raised 60-90 degrees, used for some

people with heart problems or having difficulty breathing.

Positions and Uses

Prone position: * Lying flat on the abdomen, arm flexed toward head, & head

turned to one side. Useful for some unconscious patients. spinal cord problems

Side-lying Position

Major weight on dependant hip and shoulder.

Use supportive foam blocks or pillows for support

Sims Position

Weight supported by anterior aspects of humerus, clavicle and ileum.

These pressure points are different from other positions, i.e. supine, thereby preserving skin integrity.

Positioning and Ambulating the Adult Patient

One of the basic procedures that nursing personnel perform most frequently is that of changing the patient's position. Any position, even the most comfortable one, will become unbearable after a period of time. Whereas the healthy person has the ability to move at will, the sick person's movements may be limited by disease, injury, or helplessness. It is often the responsibility of the practical nurse to position the patient and change his position frequently. Once the patient is able to ambulate, certain precautions must be taken to ensure the patient's safety.

REASONS FOR CHANGING THE POSITION OF A PATIENT

The following are reasons for changing a patient's position.

To promote comfort and relaxation. To restore body function. Changing positions improves gastrointestinal

function. It also improves respiratory function. Changing positions allows for greater lung

expansion. It relieves pressure on the diaphragm.

REASONS FOR CHANGING THE POSITION OF A PATIENT

To prevent deformities. When one lies in bed for long periods of time, muscles become atonic and atrophy.

Prevention of deformities will allow the patient to ambulate when his activity level is advanced.

To relieve pressure and prevent strain (which lead to the formation of decubiti).

To stimulate circulation. To give treatments (that is), range of motion exercises).

BASIC PRINCIPLES IN POSITIONING OF PATIENTS

Maintain good patient body alignment. . Maintain the patient's safety. Reassure the patient to promote comfort and

cooperation. Properly handle the patient's body to prevent

pain or injury.

BASIC PRINCIPLES IN POSITIONING OF PATIENTS

Keep in mind proper body mechanics for the practical nurse. Obtain assistance, if needed, to move heavy or helpless patients. Follow specific physician's orders. A physician's order, such as one of the following, is needed for the patient to be out of bed. "Up ad lib." "Up as desired." "OOB" (out of bed).

Do not use special devices (that is., splints, traction) unless ordered. Ask if you do not know what is allowed.

TURNING THE ADULT PATIENT

General Principles for Turning the Adult Patient .

Sometimes the physician will specify how often to turn a patient.

A schedule can be set up for turning the adult patient throughout his "awake" hours.

The patient should be rotated through four positions (unless a particular position is contraindicated):

Turning a Patient

Determine what patient can do, find assistance if it is needed.

Position height of bed for nurses’ comfort.Position patient supine on far side of bed.Patient arms across chest, far leg over near

one.Tighten girdles, flex knees.

Positioning/Moving a Client Up in Bed

Allow patient to move himself if he can.

HOB down---don’t move up hill.Position height of bed for nurses’

comfort.Have patient flex knees, chin to chest,

arms folded across chestNurses tightens abdominal girdles,

flex knees.Nurses shift weight, moving patient.Reposition HOB, bed in low position.

Use Mechanical Devises

Lifts will save backs, yours included.

1.PILLOWS:

Used for support to maintain correct body alignment Used under head, arms, legs & along spine or abdomen

Correct positioning reduces strain on muscles & joints

COMFORT DEVICES

COMFORT DEVICES

Support pts back at an angle, so that he may maintain a sitting position Can be adjusted to desired angle

Extra pillows are needed Arms of pt are well supported Used for pts suffering with cardiac & pulmonary distress

PURPOSES To relieve Dyspnea To promote drainage from abdominal cavity To provide a comfortable change of position.

2.BACK REST

Comfort device contd……

3.BED CRADLEIs a frame used to hold thebed linen from touching the pt •Used to prevent pressure from the weight of linen •Used to allow air to circulate around lower limbs •Cradle is often a semicircular frame of metal May be made of wood or bamboo It may be made into a rectangular shape.


4.CARDIAC TABLE /ORTHOPNEIC/BED TABLE:

Usually for pts who are propped up in a sitting position for change of position Bed table placed in front with a pillow on it, pt can lean forward & take rest

Table without pillow is used for writing & meals

Used for pts with cardiac conditions & asthma Makes it possible to use accessory muscles of respiration

Position sh0ud be changed to relieve fatigue & prevent embolism .


5.MATTRESSES 2 types One that fits on bed frame. Ex: standard bed mattress Mattresses that fit on standard bed mattress. Ex: egg crate mattress

6.BED BOARDS Boards are usually made of wood & are

placed under the mattress to provide support

7.CHAIR BEDS Beds can be placed into the position of chair for

pts who cannot move from the bed but require a sitting position


8.TRAPEZE BAR Bar is suspended from

an overhead frame that extends from the foot to head of bed Pt can grasp the bar to raise the trunk off the bed surface or to move up in bed

9.FOOTBOARD Device that is placed

towards the foot of pts bed to serve as support for his feet Some fit onto the sides of bed frame & rest on the mattress at any point along the bed Usually made up of wood/plastic/heavy canvas


10.FRACTURE BOARD: Is a support that is placed under pts mattress

to give added rigidity to the mattress Usually made of wood/canvas & is constructed to fit the standard hospital bed

11.BALKAN FRAME : Frame made of wood or metal that extends

lengthwise above the bed & is supported at either ends by a pole Trapeze may be attached to the frame just above pt’s head as an aid to the pt in lifting himself up in bed


12.BRADFORD FRAME: Is a canvas stretcher like device that is

supported by blocks on the foundation of bed Used to immobilize pts who have injured spines. canvas is divided into 3 parts so that small center portion can be removed to insert a bedpan

13.TROCHANTER ROLLSPrevent external rotation of legs when pt is in

supine position A cotton bath blanket/sheet is folded lengthwise to width extending from greater trochanter of femur to lower border of popliteal space Blanket is placed under the buttocks & rolled away from the pt until thigh is in neutral position with patella

TROCHANTER ROLLS


Provide support & shape to body contours

Immobilize extremities & maintain specific body alignment They are filled plastic bags that can be shaped to body contours Can be used in place of, or in addition to trochanter rolls

14.SANDBAGS:

Comfort device contd

15.HAND ROLLS

Maintain thumb in slightly adducted & in opposition to fingers Maintain fingers in slightly flexed position Can be made by folding a washcloth in half, rolling in lengthwise & securing roll with tape. Roll is placed against palmar surface of hand


16.HAND-WRIST SPLINTSIndividually molded for

the patient to maintain proper alignment of the thumb in slight adduction & wrist in slight dorsiflexion These splints should be used for the patient whom the splint was made.

17.SIDE RAILS• Are bars positioned along the sides of the length of the bed •Ensure pt’s safety & are useful for increasing mobility• Provide assistance in rolling from side to side or sitting up in bed

Comfort device contd…..

18.WEDGE/ABDUCTOR PILLOW

Is a triangular

shaped pillow made of heavy foam Used to maintain legs in abduction following total hip replacement surgery

WEDGE/ABDUCTOR PILLOW

Nursing Diagnoses

Activity Intolerance

Impaired Physical Mobility

Risk of Disuse Syndrome

Self-Care Deficits

Altered Health Maintenance

Risks for Falls

Planning and Outcome Identification

Bed Rest

Restorative Nursing Care (Changing position)

Health Promotion and Fitness

Assisting with Ambulation

Assistive Devices-Canes -Crutches -Walkers

activity &exercise

Health & Medicine

performing

proper body

foot slightly

lower area

nurses comfort

body alignment

promote comfort

leg muscles