kozier - chapter 44-activity & exercise

Kozier & Erb's Fundamentals of Nursing, 8eBerman, Snyder, Kozier, ErbCopyright 2008 by Pearson Education, Inc.

Chapter 44

Activity and Exercise

Copyright 2008 by Pearson Education, Inc.

Question 1

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.


Rationales 1

1. 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.


Question 2

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.


Rationales 2

1. 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).


Question 3

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.”


Rationales 3

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.


Question 4Because the client weighs 250 pounds, the nurse should provide the unlicensed assistive personnel (UAP) with instructions that reflect an awareness of workplace injury. Which of the following is most appropriate?

1. “Using proper body mechanics will prevent you from injuring yourself.”

2. “You are physically fit and at lesser risk for injury when transferring the client.”

3. “Use the mechanical lift and another person to transfer the client from the bed to the chair.”

4. “Use the back belt to avoid hurting your back.”


Rationales 4

1. It is generally accepted that proper body mechanics alone will not prevent injury.

2. Incorrect.3. Correct. It is prudent for nurses to

understand and use proper body mechanics at all times to decrease risk, while keeping in mind the importance of assistive devices and help from other staff. While, many work settings do not yet have “no manual lift” and “no solo lift” policies and resources in place.

4. Incorrect.


Question 5

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.


Rationales 5

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.


Four Basic Elements of Normal Movement

• Body alignment (posture)• Joint mobility• Balance• Coordinated movement


Body Alignment/Posture

• Brings body parts into position that promotes optimal balance and body function

• Person maintains balance as long as line of gravity passes through center of gravity and base of support


Joint Mobility

• ROM is maximum movement possible for joint

• ROM varies and determined by:– Genetic makeup– Developmental patterns– Presence or absence of disease– Physical activity


Elbow Flexion/Extension Animation

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Elbow Pronation/Supination Animation

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Foot Dorsiflexion/Extension Animation

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Ankle Inversion/Eversion Animation

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Hand Opposition Animation

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Humerus Adduction / Abduction Animation

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Humerus Circumduction Animation

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Balance

• Smooth, purposeful movement• Result of proper functioning of:

– Cerebral cortex• Initiates voluntary movement

– Cerebellum• Coordinates motor activity

– Basal ganglia• Maintains posture


Coordinated Movement

• Complex mechanisms• Proprioception

– Awareness of posture, movement, changes in equilibrium

– Knowledge of position, weight, resistance of objects in relation to body


Isotonic (Dynamic) Exercise

• Muscle shortens to produce muscle contraction and active movement

• Increase muscle tone, mass, and strength

• Maintain joint flexibility and circulation

• HR and CO quicken increase


Isometric (Static or Setting) Exercise

• Muscle contraction without moving the joint (muscle length does not change)

• Involve exerting pressure against a solid object

• Produce a mild increase in HR and CO

• No apparent increase in blood flow to other parts of the body


Isokinetic (Resistive) Exercise

• Muscle contraction or tension against resistance

• Can either be isotonic or isometric• Person moves (isotonic) or tenses

(isometric) against resistance• An increase in blood pressure and

blood flow to muscles occurs


Aerobic Exercise

• Activity during which the amount of oxygen taken in the body is greater than that used to perform the activity

• Improve cardiovascular conditioning and physical fitness


Anaerobic Exercise

• Activity in which the muscles cannot draw enough oxygen from the bloodstream

• Anaerobic pathways are used to provide additional energy for a short time

• Used in endurance training for athletes


Effect on Musculoskeletal System

• Exercise– Maintain size, shape,

tone, and strength of muscles (including the heart muscle)

– Nourish joints– Increase joint

flexibility, stability, and ROM

– Maintain bone density and strength

• Immobility– Disuse osteoporosis– Disuse atrophy– Contractures– Stiffness and pain in

the joints


Effects on the Cardiovascular System

• Exercise– Increases HR,

strength of contraction, and blood supply to the heart and muscles

– Mediates harmful effects of stress

• Immobility – Diminished cardiac

reserve– Increased use of the

Valsalva maneuver– Orthostatic

hypotension– Venous vasodilation

and stasis– Dependent edema– Thrombus formation


Leg Veins

Active Person

Inactive Person


Effect on the Respiratory System

• Exercise– Increase ventilation

and oxygen intake improving gas exchange

– Prevents pooling of secretions in the bronchi and bronchioles

• Immobility– Decreased

respiratory movement

– Pooling of respiratory secretions

– Atelectasis– Hypostatic

pneumonia


Pooling of Secretions:Immobile Person


Effects on the Metabolic/Endocrine System

• Exercise– Elevates the

metabolic rate– Decreases serum

triglycerides and cholesterol

– Stabilizes blood sugar and make cells more responsive to insulin

• Immobility– Decreased

metabolic rate– Negative nitrogen

balance– Anorexia– Negative calcium

balance


Effects on the GI System

• Exercise– Improves the

appetite – Increases GI tract

tone– Facilitates

peristalsis

• Immobility– Constipation


Effect on the Urinary System

• Exercise – Promotes blood flow

to the kidneys causing body wastes to be excreted more effectively

– Prevents stasis (stagnation) of urine in the bladder

• Immobility– Urinary stasis– Renal calculi– Urinary retention– Urinary infection


Pooling of Urine


Effect on the Immune System

• Exercise – Pumps lymph fluid from tissues into

lymph capillaries and vessels– Increases circulation through lymph

nodes– Strenuous exercise may reduce immune

function• Leaving window of opportunity for infection

during recovery phase


Effect on the Psychoneurologic System

• Exercise – Elevates mood– Relieves stress and

anxiety – Improves quality of

sleep for most individuals

• Immobility – Decline in mood

elevating substances– Perception of time

intervals deteriorates– Problem-solving and

decision-making abilities may deteriorate

– Loss of control over events can cause anxiety


Effect on Cognitive Function

• Exercise – Positive effects on decision-making and

problem solving processes, planning, and paying attention

– Induces cells in the brain to strengthen and build neuronal connections


Other Effects of Exercise and Immobility

• Evidence that certain types of exercise increase spiritual health

• Immobility causes reduced skin turgor and skin breakdown


Factors Affecting Body Alignment, Mobility, and DAL

• Growth and development• Nutrition, personal values and

attitudes• External factors

– i.e., Temperature, humidity, availability of recreational facilities, safety of the neighborhood

• Prescribed limitations– i.e., Casts, braces, traction, activity

restrictions including bed rest


Factors Affecting Body Alignment, Mobility, and Daily

Activity Level


Assessment of Activity and Exercise

• Nursing History • Physical Examination:

– Body alignment– Gait– Appearance and movement of joints– Capabilities and limitations for movement– Muscle mass and strength– Activity tolerance– Problems related to immobility


NANDA Nursing Diagnoses

• For activity and exercise problems– Activity Intolerance– Risk for Activity Intolerance– Impaired Physical Mobility– Sedentary Lifestyle– Risk for Disuse Syndrome



• The mobility problem becomes the etiology:– Fear (of falling)– Ineffective Coping– Low Self-Esteem– Powerlessness– Risk for Falls– Self-Care Deficit



• Prolonged immobility: – Ineffective Airway Clearance – Risk for Infection– Risk for Injury– Risk for Disturbed Sleep Pattern– Risk for Situational Low Self-Esteem


Examples of Desired Outcomes(NOC Labels)

• Activity tolerance• Body positioning• Bowel elimination• Fall prevention

behavior• Immobility

consequences both physiological and psychocognitive

• Joint movement

• Mobility• Respiratory status• Ventilation and gas

exchange• Self-care• Sleep• Stress level• Weight control


Overall Goals for Problems Related to Mobility or Activity

• Increased tolerance for physical activity• Restored or improved capability to

ambulate and/or participate in ADLs• Absence of injury from falling or improper

use of body mechanics• Enhanced physical fitness• Absence of any complications associated

with immobility• Improved social, emotional, and

intellectual well-being


Safe Practice for Positioning, Moving, Lifting, Ambulating

Clients• Correct body mechanics required for

nurse to prevent injury • Correct body alignment for the client

also so that undue stress is not placed on the musculoskeletal system


General Guidelines for Moving and Lifting

• Before moving, assess • If indicated, use pain relief modalities • Prepare any needed assistive devices • Plan around encumbrances • Be alert to the effects of any

medications • Obtain required assistance • Explain the procedure to the client


General Guidelines for Transferring a Client

• Plan what to do and how to do it• Obtain essential equipment before starting• Remove obstacles• Explain transfer to client and assistive

personnel• Support or hold client rather than equipment• Explain what client should do• Make written plan, including client’s

tolerance


Safe Practice for Positioning, Moving, Lifting, Ambulating

Clients


General Guidelines for Ambulating

• Assess the amount of assistance the client will require

• Assess for signs and symptoms of orthostatic hypotension

• Prepare client for ambulation• Apply transfer or walking belt• Physically support client• Obtain assistance to follow with wheelchair

or assist with physical support• Teach client to correctly use mechanical aids


Question 1

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.