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Activity and Exercise Activity and Exercise

Fundamentals of Nursing Fundamentals of Nursing ReviewReview

MobilityMobility

The ability to move freely, easily, The ability to move freely, easily, rhythmically and purposefullyrhythmically and purposefully

Range of MotionRange of Motion

The ROM of the joint is the maximum The ROM of the joint is the maximum movement that is possible for that movement that is possible for that joint joint

ExerciseExercise

A type of physical activity defined as A type of physical activity defined as a planned, structure and repetitive a planned, structure and repetitive bodily movement done to improve or bodily movement done to improve or maintain one or more components of maintain one or more components of physical fitnessphysical fitness

Types of ExerciseTypes of Exercise

ISOTONICISOTONIC Dynamic exercise in which the Dynamic exercise in which the

muscle shortens to produce muscle shortens to produce contraction and movement contraction and movement

Running, walking, swimming, Running, walking, swimming, cyclingcycling

Types of ExerciseTypes of Exercise

ISOMETRICISOMETRIC Are those in which there is a Are those in which there is a

change in muscle tension but NO change in muscle tension but NO CHANGE in muscle length CHANGE in muscle length

Tensing, extending and pressing Tensing, extending and pressing exercises exercises

Other Types of ExerciseOther Types of Exercise

ISOKINETICISOKINETIC Involves muscle contraction or Involves muscle contraction or

tension against a resistancetension against a resistance

Aerobic exerciseAerobic exercise activity during which the amount of activity during which the amount of

oxygen taken into the body is greater oxygen taken into the body is greater than that used to perform the activity than that used to perform the activity

Benefits of Exercise Benefits of Exercise Increases joint flexibility, tone and ROMIncreases joint flexibility, tone and ROM Bone density is maintained Bone density is maintained Increases cardiac output and perfusionIncreases cardiac output and perfusion Prevents pooling of secretions in the lungsPrevents pooling of secretions in the lungs Improves appetite and facilitate peristalsisImproves appetite and facilitate peristalsis Elevates the metabolic rateElevates the metabolic rate Prevents stasis of urinePrevents stasis of urine Produces a sense of well-being Produces a sense of well-being

IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY

Complications of IMMOBILITYComplications of IMMOBILITY 1. Contractures, atrophy and 1. Contractures, atrophy and

stiffnessstiffness 2. Foot drop2. Foot drop 3. DVT3. DVT 4. Hypostatic pneumonia4. Hypostatic pneumonia 5. Pressure ulcers, skin 5. Pressure ulcers, skin

breakdown, reduced skin turgorbreakdown, reduced skin turgor


Complications of IMMOBILITYComplications of IMMOBILITY 6. muscle atrophy6. muscle atrophy 7. osteoporosis7. osteoporosis 8. dependent edema8. dependent edema 9. urine stasis9. urine stasis 10. constipation10. constipation


ASSESSMENT ASSESSMENT Assess patient’s ability to Assess patient’s ability to

movemove Assess muscle tone, strengthAssess muscle tone, strength Assess joint movement and Assess joint movement and

positioningpositioning

IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITYNursing InterventionsNursing Interventions

1. Position properly to prevent contractures1. Position properly to prevent contractures Place trochanter roll from the iliac crest Place trochanter roll from the iliac crest

to the mid-thigh to prevent EXTERNAL to the mid-thigh to prevent EXTERNAL rotationrotation

Place patient on wheelchair 90 degrees Place patient on wheelchair 90 degrees with the foot resting flat on the floor/foot with the foot resting flat on the floor/foot restrest

Place foot board or high-heeled shoes to Place foot board or high-heeled shoes to prevent foot dropprevent foot drop


2. Maintain muscle strength and 2. Maintain muscle strength and joint mobilityjoint mobility

Perform passive ROMEPerform passive ROME Perform assistive ROMEPerform assistive ROME Perform active ROMEPerform active ROME Move the joints three times TIDMove the joints three times TID


3. Promote independent mobility3. Promote independent mobility Warn patient of the orthostatic Warn patient of the orthostatic

hypotension when suddenly hypotension when suddenly standing uprightstanding upright


4. Assist patient with transfer4. Assist patient with transfer Assess patient’s ability to participateAssess patient’s ability to participate Position yourself in front of the Position yourself in front of the

patientpatient Lock the wheelchair or the bed wheelLock the wheelchair or the bed wheel Use devices such as transfer boards, Use devices such as transfer boards,

sliding boards, trapeze and sheetssliding boards, trapeze and sheets


4. Assist patient with transfer4. Assist patient with transfer In general, In general, the equipments are the equipments are

placed on the side of the placed on the side of the STRONGER , UNAFFECTED body STRONGER , UNAFFECTED body partpart

Nurses Nurses assist the patient to move assist the patient to move TOWARDS the stronger sideTOWARDS the stronger side

In moving the patient, In moving the patient, move to the move to the direction FACING the nursedirection FACING the nurse


5. Assist patient to prepare for 5. Assist patient to prepare for ambulationambulation

Exercise such as quadriceps Exercise such as quadriceps setting, gluteal setting and setting, gluteal setting and arm push upsarm push ups

Use rubber ball for hand Use rubber ball for hand exerciseexercise

IMPAIRED PHYSICAL IMPAIRED PHYSICAL MOBILITYMOBILITY

Nursing InterventionsNursing Interventions

6. 6. Assist patient in crutch Assist patient in crutch ambulationambulation

Measure correct crutch lengthMeasure correct crutch length LYING DOWNLYING DOWN Measure from the Measure from the Anterior Anterior

Axillary Fold to the HEEL of the Axillary Fold to the HEEL of the foot then:foot then: Add 1 inch (Kozier)Add 1 inch (Kozier) Add 2 inches (Brunner and Add 2 inches (Brunner and

Suddarth)Suddarth)


6. Assist patient in crutch ambulation6. Assist patient in crutch ambulationMeasure correct crutch lengthMeasure correct crutch length STANDING (Kozier)STANDING (Kozier) Mark a distance of 2 inches to the Mark a distance of 2 inches to the

side from the tip of the toe (first side from the tip of the toe (first mark)mark)

6 inches is marked (second mark) 6 inches is marked (second mark) ahead from the firstahead from the first

Measure 2 inches below the axilla Measure 2 inches below the axilla to the second mark to the second mark


6. Assist patient in crutch 6. Assist patient in crutch ambulationambulation

Measure correct crutch lengthMeasure correct crutch length STANDING (Kozier)STANDING (Kozier) Make sure that the shoulder-rest Make sure that the shoulder-rest

of the crutch is at least 1- 2 of the crutch is at least 1- 2 inches below the axillainches below the axilla



Measure correct crutch lengthMeasure correct crutch length Utilizing the patient’s HEIGHTUtilizing the patient’s HEIGHT Height MINUS 40 cm or 16 inchesHeight MINUS 40 cm or 16 inches



Measure correct crutch Measure correct crutch lengthlength

Hand piece should allow 20-Hand piece should allow 20-30 degrees elbow flexion30 degrees elbow flexion


6. Assist patient in crutch GAIT6. Assist patient in crutch GAIT A. 4 point gaitA. 4 point gait B. three-point gaitB. three-point gait C. two point gaitC. two point gait D. swing to gaitD. swing to gait E. swing through gaitE. swing through gait

GAITGAIT

4-point gait4-point gait

Safest gaitSafest gait Requires weight bearing on both legsRequires weight bearing on both legs Move RIGHT crutch ahead (6 inches)Move RIGHT crutch ahead (6 inches) Move LEFT foot forward at the level Move LEFT foot forward at the level

of the RIGHT crutchof the RIGHT crutch Move the LEFT crutch forwardMove the LEFT crutch forward Move the RIGHT foot forwardMove the RIGHT foot forward


Requires weight bearing on Requires weight bearing on the UNAFECTED legthe UNAFECTED leg

Move Move BOTH BOTH crutches and the crutches and the WEAKER LEGWEAKER LEG forward forward

Move the STRONGER leg Move the STRONGER leg forwardforward


FasterFaster than 4-point than 4-point Requires more balanceRequires more balance Partial bearing on BOTH legsPartial bearing on BOTH legs Move the Move the LEFT crutch and RIGHT LEFT crutch and RIGHT

foot FORWARD togetherfoot FORWARD together Move the Move the RIGHT crutch and LEFT RIGHT crutch and LEFT

foot forward togetherfoot forward together

Swing-to gaitSwing-to gait

Usually used by client with Usually used by client with paralysis of both legsparalysis of both legs

Prolonged use results in atrophy Prolonged use results in atrophy of unused muscleof unused muscle

Move Move BOTH crutches togetherBOTH crutches together Lift body weight by the arms and Lift body weight by the arms and

swing to the crutches (at the swing to the crutches (at the level)level)

Swing-through gaitSwing-through gait

Move Move BOTH crutches togetherBOTH crutches together Lift body weight by the arms and Lift body weight by the arms and

swing forward, ahead of the swing forward, ahead of the crutches crutches (beyond the level)(beyond the level)

IMPAIRED PHYSICAL IMPAIRED PHYSICAL MOBILITYMOBILITY

Nursing InterventionsNursing Interventions6. Assist patient in ambulation with 6. Assist patient in ambulation with

a walkera walker Correct height of the walker must Correct height of the walker must

allow a 20-30 degrees of elbow allow a 20-30 degrees of elbow flexionflexion


6. Assist patient in ambulation with a 6. Assist patient in ambulation with a canecane

Correct cane measurement: Correct cane measurement: With elbow flexion of 30 With elbow flexion of 30

degrees, measure the length degrees, measure the length from the HAND to 6 inches from the HAND to 6 inches lateral to the tip of the 5lateral to the tip of the 5thth toe toe

Impaired Skin integrityImpaired Skin integrity

Pressure ulcersPressure ulcers Are localized areas of dead Are localized areas of dead

soft tissue that occurs when soft tissue that occurs when pressure applied to the skin pressure applied to the skin overtime is more than 32 overtime is more than 32 mmHg leading to tissue mmHg leading to tissue damagedamage

Pressure soresPressure sores


INITIAL SIGN OF PRESSURE INITIAL SIGN OF PRESSURE ULCER:ULCER:

ERYTHEMA or redness of the ERYTHEMA or redness of the skin that DOES NOT blanchskin that DOES NOT blanch


Weight bearing Bony prominencesWeight bearing Bony prominences 1. Sacrum and cocygeal area1. Sacrum and cocygeal area 2. Ischial tuberosity2. Ischial tuberosity 3. Greater trochanter3. Greater trochanter 4. Heel and malleolus4. Heel and malleolus 5. Tibia and fibula5. Tibia and fibula 6. Scapula and elbow6. Scapula and elbow

Pressure areasPressure areas

Risk Factors for pressure ulcersRisk Factors for pressure ulcers

1. Patients with sensory 1. Patients with sensory deficitsdeficits

2. Decreased tissue perfusion2. Decreased tissue perfusion 3. Decreased nutritional status3. Decreased nutritional status 4. Friction and shearing forces4. Friction and shearing forces 5. Increased moisture and 5. Increased moisture and

edemaedema

Pressure ulcer stagesPressure ulcer stages

Stage 1- non-blanchable ErythemaStage 1- non-blanchable Erythema

Stage 2- skin breakdown in dermisStage 2- skin breakdown in dermis

Stage 3- ulceration extends to the Stage 3- ulceration extends to the subcutaneous tissuesubcutaneous tissue

Stage 4- ulcers involve the muscle and Stage 4- ulcers involve the muscle and bonebone


RELIEVE THE PRESSURERELIEVE THE PRESSURE Turn and reposition every 1-2 Turn and reposition every 1-2

HoursHours

Encourage weight shifting Encourage weight shifting actively, every 15 minutesactively, every 15 minutes


POSITION PATIENT PROPERLYPOSITION PATIENT PROPERLY Follow the recommended sequenceFollow the recommended sequence LateralLateral prone prone supine supine lateral lateral

Position patient with the bed Position patient with the bed elevated at NO MORE THAN 30 elevated at NO MORE THAN 30 degreesdegrees

Utilize the bridging techniqueUtilize the bridging technique


UTILIZE PRESSURE RELIEVING UTILIZE PRESSURE RELIEVING DEVICESDEVICES

Use floatation padsUse floatation pads Use air, water or foam Use air, water or foam

mattressesmattresses Oscillating and kinetic bedOscillating and kinetic bed


IMPROVE MOBILITYIMPROVE MOBILITY Active and passive exercisesActive and passive exercises Assistive exercise Assistive exercise


IMPROVE TISSUE PERFUSIONIMPROVE TISSUE PERFUSION Exercise and repositioning are Exercise and repositioning are

the most important activitiesthe most important activities

AVOID MASSAGE ON THE AVOID MASSAGE ON THE REDDENED AREASREDDENED AREAS


IMPROVE NUTRITIONAL STATUSIMPROVE NUTRITIONAL STATUS HIGH proteinHIGH protein HIGH vitamin C dietHIGH vitamin C diet Measure body weightMeasure body weight Assess hemoglobin and albuminAssess hemoglobin and albumin


REDUCE FRICTION AND SHEARREDUCE FRICTION AND SHEAR Lift and not drag patientLift and not drag patient Prevent the presence of wrinkles and Prevent the presence of wrinkles and

creases on bed sheetscreases on bed sheets


REDUCE IRRITATING MOISTUREREDUCE IRRITATING MOISTURE Adhere to a meticulous skin careAdhere to a meticulous skin care Promptly clean and dry the soiled areasPromptly clean and dry the soiled areas Use mild soap and waterUse mild soap and water Pat dry and not rubPat dry and not rub Lotion may be appliedLotion may be applied AVOID powders (cause dryness)AVOID powders (cause dryness)


PROMOTE WOUND HEALINGPROMOTE WOUND HEALING Vitamin CVitamin C Dictum: Remove the pressureDictum: Remove the pressure


PROMOTE WOUND HEALINGPROMOTE WOUND HEALING Stage 1Stage 1

Remove pressureRemove pressure Reposition Q 2Reposition Q 2 Never massage the areaNever massage the area


PROMOTE WOUND HEALINGPROMOTE WOUND HEALING Stage 2Stage 2

Clean with sterile SALINE onlyClean with sterile SALINE only Antiseptic solutions may damage Antiseptic solutions may damage

healthy regenerating tissue and healthy regenerating tissue and delay healingdelay healing

Wet saline dressings are helpfulWet saline dressings are helpful


PROMOTE WOUND HEALINGPROMOTE WOUND HEALING Stage 3 and 4Stage 3 and 4

Necrotic tissues are debridedNecrotic tissues are debrided Administer analgesics before cleansingAdminister analgesics before cleansing Do a mechanical flushing with saline Do a mechanical flushing with saline

solutionsolution Topical ointments may be applied UNTIL Topical ointments may be applied UNTIL

granulation tissue appears then only granulation tissue appears then only saline irrigation is recommendedsaline irrigation is recommended

Positioning Positioning

Any position, Any position, correct or incorrect, correct or incorrect, can can be harmful if maintained for a be harmful if maintained for a prolonged periodprolonged period

Positioning Positioning

Frequent position changes helps Frequent position changes helps to prevent :to prevent : Muscle discomfortMuscle discomfort Unnecessary pressureUnnecessary pressure Skin damageSkin damage Contracture Contracture Blood poolingBlood pooling

PositioningPositioning

When the client is NOT able to move When the client is NOT able to move INDEPENDENTLY, the preferred INDEPENDENTLY, the preferred method is to have two or more method is to have two or more people move the patientpeople move the patient

Requisites of proper Requisites of proper positioningpositioning

Use of support devices- mattress, Use of support devices- mattress, pillows, bed boards, foot boardpillows, bed boards, foot board

Dry, clean and unwrinkled sheetsDry, clean and unwrinkled sheets 24- hour schedule should be posted 24- hour schedule should be posted

Fowler’s PositionFowler’s Position

The Sitting positionThe Sitting position The position of choice for people who The position of choice for people who

have difficulty breathing and for have difficulty breathing and for some people with hear problemssome people with hear problems

This allows greater chest expansion This allows greater chest expansion and lung ventilation and lung ventilation

Fowler’s PositionFowler’s Position

The Sitting positionThe Sitting position Low Fowler’sLow Fowler’s Semi-fowler’sSemi-fowler’s Fowler'sFowler's High Fowler’sHigh Fowler’s

Orthopneic position Orthopneic position

The client sits in chair or bed, with an The client sits in chair or bed, with an overbed table overbed table

Allows maximum chest expansionAllows maximum chest expansion Client can press the lower chest Client can press the lower chest

against the bed further facilitating against the bed further facilitating ventilation ventilation

Dorsal RecumbentDorsal Recumbent

Back-lying position, with head and Back-lying position, with head and shoulders SLIGHTLY elevatedshoulders SLIGHTLY elevated

Provides comfort Provides comfort

Prone Prone

The client lies on the abdomen with The client lies on the abdomen with the head usually turned to one side the head usually turned to one side

Allows full extension of the hips to Allows full extension of the hips to prevent flexion contractures prevent flexion contractures

Promotes drainage from the mouth Promotes drainage from the mouth

Lateral Lateral

Side-lying positionSide-lying position Good for resting and sleeping Good for resting and sleeping

because it promotes back alignment because it promotes back alignment Also prevents aspiration Also prevents aspiration

Sims Sims

Semi-prone position Semi-prone position Used for unconscious clients as it Used for unconscious clients as it

helps facilitated drainage of helps facilitated drainage of secretions secretions

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Documents

impaired physical mobilitycomplications

lift body weight

foot forward

skin breakdown

fowlers position

assist patient

elbow flexion

point gait