5 activity mobility exercise

FUNDAMENTALS OF NURSING

ACTIVITY, MOBILITY AND EXERCISE

ACTIVITY, MOBILITY AND EXERCISE

1. Body Alignment – geometric arrangement of body parts in relation to each other

Line of gravity Center of gravity Base of support

ACTIVITY, MOBILITY AND EXERCISE

Body Mechanics – efficient, coordinated and safe use of the body to produce motion and maintain balance during activity

Principles:1. Line of gravity passes through the base of

support2. The wider the base of support and the

lower the center of gravity, the greater the stability

3. Objects that are close to center of gravity are moved with least effort

4. The closer the line of gravity to center of base of support, the greater its stability

ACTIVITY, MOBILITY AND EXERCISE

1. Body Alignmenta. Stance – a manner in which a person

standsb. Sitting alignment – popliteal space

from the edge of chair : 1 inch away2. Gait – walk

» Pace – number of steps taken/min: (70 – 100 steps/minute);

elderly (40 steps/min)

ACTIVITY, MOBILITY AND EXERCISE

4. Muscle strength and endurance: Bent – knee sit up Women for 1 minute: 20 – 25/min Men for 2 minutes: 50 – 60/min

5. Joint flexibility Touch toes several times:

1- 3 inches in front of toes

ACTIVITY, MOBILITY AND EXERCISE

Pressure sores – reddened areas, sore, ulcers of skin occurring over bony prominences. Due to interruption of blood circulation to tissue, resulting in localized ischemia

Stages:I – non blanchable erythema of intact skinII – partial thickness skin loss (epidermis

and dermis). III – full thickness skin loss (subcutaneous

tissue); ulcer as deep craterIV – full thickness with extensive

destruction, necrosis (muscle, bone)

Four Stages of Pressure Ulcer Formation

A B

C D

ACTIVITY, MOBILITY AND EXERCISE

Measures to prevent and treat pressure sores:

1. Wrinkle – free bed or egg crate mattress

2. Turn to sides q 15 – 2 hours3. Meticulous hygiene, skin kept

clean and dry4. ROM exercises

ACTIVITY, MOBILITY AND EXERCISE

PROTECTIVE DEVICES:1. Handrolls or rubber balls to prevent clawhand deformity2. Trochanter rolls – hips to upper third of thigh3. Footboard 4. Wedge Pillow

ACTIVITY, MOBILITY AND EXERCISE

TYPES OF EXERCISE: According to type of muscle

contraction:a. Isotonic – (dynamic) change in MUSCLE LENGTH

AND TENSION Ex. walking, running, ADL

ACTIVITY, MOBILITY AND EXERCISE

b. Isometric – (static) change in MUSCLE TENSION

ONLY; alternate tension & relaxation of group of muscles

a. Quadriceps setting – thigh musclesb. Gluteal - buttocksc. Kegel’s – pubococcygeal muscles

ACTIVITY, MOBILITY AND EXERCISE

c. Isokinetic – (resistive) MUSCLE CONTRACTION AND

JOINT MOVEMENT Ex. lifting weights

ACTIVITY, MOBILITY AND EXERCISE

1. Active ROM » done by the client

2. Passive ROM » done by health care provider

3. Active – Resistive » done by client against a weight or force

4. Active – Assistive » done by stronger arm and leg to weaker

arm and leg

ACTIVITY, MOBILITY AND EXERCISE

During ambulation: priority is to prevent what condition?

TRANSFERRING CLIENT FROM BED TO STRETCHER, WHEELCHAIR:

Lock the wheels of bed, stretcher, wheelchair Stretcher and wheelchair parallel to bed

* WHEN ENTERING ELEVATOR, WHICH SHOULD GO FIRST? HEAD OR LOWER

BODY?

ASSISTING CLIENT TO AMBULATE:

Nurse: behind the weaker side of

the client. (moderately weak)

Nurse: behind the stronger side of the client. (very weak)

ACTIVITY, MOBILITY AND EXERCISE

Mechanical Aids for walking:1. Canes: a. Straight leggedb. Tripod or crab canec. Quad Cane• Length should permit the elbow to be

slightly flexed• Distance that the cane should be

positioned (side and front) : 15 CM (6 INCHES)

AMBULATION AIDS:A. CANES:

= on the stronger side of the body.= rubber tips: to prevent slipping.= for maximum support: cane

forward, next affected leg, then stronger leg.

= as pt becomes stronger: move cane and weak leg at the same time.

REMEMBER: COALC = CANE, OPPOSITE, AFFECTED, LEG

WALKERS:= for maximum support: move walker, then right, then left

leg.= one leg is weaker: move

walker and the weak leg, then stronger leg.

REMEMBER: WWW.LEG MOVE WALKER WITH WEAKER LEG

ACTIVITY, MOBILITY AND EXERCISE

2. Walker Move the walker ahead about 15 cm (6

inches) For maximum support;

a. right foot up to the walker, then left foot up to the right foot

If one leg is weaker:a. move walker and weak leg ahead together about 15 cm (6 in), then move the stronger leg

ACTIVITY, MOBILITY AND EXERCISE

3. Crutches: Methods of measuring crutch length:1. Supine: anterior fold of axilla to

heel of foot + 2.5 cm (1 in)2. Standing: position the crutch:

shoulder rest of the crutch is 1 – 2 inches below the axilla

» Angle of elbow flexion = 30 degrees

CRUTCHES

CRUTCHESCorrect fit:= STAND STRAIGHT, ARMPIT TO FLOOR= DEDUCT 5 CM/ 2 INCHES OR 3 FINGERS= HANDGRIP: SLIGHTLY ABOVE WRIST

LEVEL= ELBOW 30 DEGREES FLEXION= IF pt in supine, measure from axillary fold

to heel of foot = ADD 1 inch

4 point gait= the safest, very slow.= client can bear weight on both legs.= tripod, R crutch, L foot, L crutch, L foot.

 3 point gait

= pt bears entire weight on the unaffected leg.

= tripod, both crutches with bad leg, good leg. 2 point gait

= requires partial weight bearing on both legs.

= L crutch with R foot, L foot with R crutch. 

DIFFERENCE:SWING TO AND SWING

THROUGH

Swing to= with paralysis of legs and

hips.= swing to the crutches

 Swing through

= swing beyond the crutches.

ACTIVITY, MOBILITY AND EXERCISE

Going up and down stairs:

“Good leg goes to heaven”“Bad leg goes to hell”

ACTIVITY, MOBILITY AND EXERCISE

Practice test

To best prevent a pressure (decubitus) ulcer in an older adult, the nurse should provide:

    A. an air mattress     B. a daily bed bathC. a high-protein dietD. an indwelling urinary

catheter

16. TEST-TAKING TIP The word “best” in the stem sets priority.

A. An air mattress distributes body weight over a larger surface and reduces pressure over bony prominences.

B. Although bathing removes secretions and promotes clean skin, it can be drying, which can compromise skin integrity.

C. Protein does not prevent pressure (decubitus) ulcers. Protein is the body’s only source of nitrogen and is essential for building, repairing, or replacing body tissue.

D. An indwelling urinary catheter should never be used to prevent a pressure (decubitus) ulcer; however, a catheter may be used to prevent contamination of a pressure (decubitus) ulcer after it is present.

To safely transfer a patient with one-sided weakness (hemiparesis) to a chair, the nurse should:

     A. pivot the patient on the unaffected

leg     B. stand next to the patient’s

affected side

     C. stand next to the patient’s strong side

     D.  keep the patient’s feet together

19. TEST-TAKING TIP The words “one-sided weakness” are a clue in the stern. Option A is unique because it does not use the possessive form of the word ‘‘patient’’ (“patient’s”). Options B and C are opposites.

A. Pivoting avoids unnecessary movement by transferring the patient to the chair while supporting body weight on the unaffected leg.

B. When transferring this patient, the nurse should stand in front of, not next to, the patient.

C. Same as B.

D. Keeping the patient’s feet together narrows the base of support and decreases the patient’s stability.

To increase stability during client transfer, the nurse increases the base of support by performing which of the following?

1. Leaning slightly backward.2. Spacing the feet farther apart.3. Tensing the abdominal

muscles.4. Bending the knees.

Rationale1. Leaning backward actually decreases

balance.2. Correct. A key word in the question is

“base,” and the feet provide this foundation.

3. Tensing abdominal muscles alone does not affect the base of support.

4. Bending the knees does not affect the base of support.

Five minutes after the client’s first postoperative exercise, the client’s vital signs have not yet returned to baseline. An appropriate nursing diagnosis might be:

1. Activity Intolerance.2. Risk for Activity Intolerance.3. Impaired Physical Mobility.4. Risk for Disuse Syndrome.

Rationale1. Correct. Vital signs that do not return to

baseline 5 minutes after exercising indicate intolerance of exercise at that time.

2. This is a real problem, not “at risk for.”

3. There is no evidence that the client requires assistance (impaired mobility).

4. There is no evidence that this client is immobile (disuse syndrome)

Which of the following statements from a client with one weak leg regarding use of crutches when using stairs indicates a need for increased teaching?

1. “Going up, the strong leg goes first, then the weaker leg with both crutches.”

2. “Going down, the weaker leg goes first with both crutches, then the strong leg.”

3. “The weaker leg always goes first with both crutches.”

4. “A cane or single crutch may be used instead of both crutches if held on the weaker side.”

Rationale

1. This is correct.

2. This is correct.

3. Correct. Although the crutches (or cane) are always used along with the weaker leg, the weaker leg should go down the stairs first. The stronger leg can support the body as the weaker leg moves forward. All of the other statements are correct.

4. This is correct.

The client is ambulating for the first time after surgery. The client tells the nurse, “I feel faint.” The best action by the nurse includes which of the following?

1. Find another nurse for help.2. Return the client to her room as

quickly as possible.3. Tell the client to take rapid,

shallow breaths.4. Assist the client to a nearby chair.

Rationale

1. Leaving the client creates unsafe conditions as the client may faint before being able to return to her room.

2. The client may faint before being able to return to her room.

3. Rapid, shallow breathing (hyperventilation) may increase the dizziness.

4. Correct. Placing the client in a safe position is the best maneuver.

What should the nurse do when assisting a blind patient to walk?

      A. Walk in front while the patient uses the corridor handrail

      B. Stand behind the patient and provide verbal directions

      C. Walk on the side while holding the

patient’s elbow      D. Instruct the patient to hold

onto the nurse’s arm

TEST-TAKING TIP Options A and B are opposites.

A. Corridor rails are not continuous, and standing in front does not position the nurse in a way that will protect the patient; this method does not inspire confidence.

B. The patient cannot see and should not lead.C. Walking on the side while holding the patient’s

elbow is one method used to assist a patient who has a mobility, not visual, deficit.

D. Instructing the blind patient to hold onto the nurse’s arm allows the nurse to guide and the patient to follow; it supports the patient’s comfort and promotes confidence.

A patient with the highest risk of developing a pressure (decubitus) ulcer is the patient who:

    A. uses a reclining wheelchair       B. uses crutches to ambulateC. is ambulatory but is confusedD. is on bed rest but able to move

TEST-TAKING TIP The word “highest” is the key word in the stem that sets a priority. The word “risk” is a clue in the stem. Option A is unique because it is the only option that does not mention that the patient is able to move independently.

A. A patient using a reclining wheelchair would have minimal lower- or upper-body control. A reclining position places excessive pressure on the sacral area.

B. As long as a person can move, positioning can be changed to relieve pressure.

C. Same as B.

D. Same as B.

What should the nurse do to best prevent a patient from developing contractures?

     A. Support the patient’s joint with

pillows     B. Transfer the patient to a chair

twice a day     C. Turn and reposition the

patient every 2 hours     D. Teach the patient to perform

active ROM exercise

29. TEST-TAKING TIP The word best is the key word in the stem that sets a priority.

A. Although supporting joints contributes to maintaining functional alignment, which can help prevent contractures, it is not the best intervention.

B. Although movement of joints experienced during activity will contribute to preventing contractures, it will not move all joints through their full range; also, prolonged sitting can cause flexion contractures of the hips and knees.

C. Turning and repositioning a patient every 2 hours will reduce pressure, not prevent contractures.

D. Range-of-motion exercises maximally stretch all muscle groups; this prevents shortening of muscles, which can result in contractures.

A patient who had a brain attack (stroke, cerebrovascular accident) 3 days earlier has left-sided hemiparesis. When dressing the patient, the nurse should plan to:

     A. put the patient’s left sleeve on first     B. encourage the patient to dress

independently     C. instruct the patient to wear clothes

with zippers     D. tell the patient to get clothes with

buttons in the front

TEST-TAKING TIP The phrase “3 days earlier” is a significant clue in the stem. Options C and D are equally plausible. Options B, C, and D are similar because they contain the verbs “encourage,” “instruct” and “tell,” which all require verbal interaction with the patient. Option A is unique because it is the only option in which the nurse is actually dressing the patient and that uses the possessive form of the word “patient” (“patient’s”). Option B denies the patient’s need for assistance during the acute phase of this illness.-

A. Affected joints should be dressed first to avoid unnecessary strain; the unaffected side generally has greater joint range.

B. It is unreasonable to expect self-sufficiency during the acute phase.

C. These are difficult to close with one hand. Velcro closures maybe more appropriate.

D. Same as C.