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- Provide the framework for muscles, tendons, and ligaments.
- Facilitate movement.
- Protect internal organs.
- Store and regulate Calcium.
- Make all blood cells.
- 206 bones in the body.
- Connected to the bones.
- Muscle contraction requires mechanical, chemical and electrical interaction.
- Muscle contraction is initiated when an action potential (electrical charge) moves along a nerve and across the neuromuscular junction.
- Energy for this work comes from the metabolism of food, especially fats and carbs.
- The body only has a certain number of muscle cells.
- The work of the muscle determines the size of the cell within the muscle.
large muscle cells
small muscle cells
Maintaining posture requires
proper alignment of bones, muscles, and joints and a stable center of gravity.
Posture changes with age
In older adults the lumbar spine flattens and the upper spine and head tilt forward.
Equilibrium is provided by
vestiubular apparatus of the ear.
If there is problems with this inner ear client may become:
- have a syncopal episode
- experience vertigo
Body mechanics is
defined as using alignment, posture and balance to coordinate movement.
Proper use of body mechanics promotes:
- Safe musculoskeletal function
- Maintains balance without straining muscles.
Moving a joint or extremity towards the midline of the body.
Moving a joint or extremity away from the midline of the body.
Rotation, Internal is
Turning a joint or extremity on its axis toward the body's midline.
Rotation, external is
Turning a joint or extremity on its axis away from the body's midline.
Decresing the angle between two bones.
Straightening a joint.
Moving a joint past normal extension.
Turning the body or a body part to face up.
Turning the body or body part to face down.
Moving a body part in widening circles.
Turning the feet inward so the toes point towards the midline.
Turning the feet outwards so the toes point away from the midline.
touching the thumb to each finger.
Proper body mechanics includes:
- Using gravity to our advantage in alignment with posture, balance, and movement.
- Keeps the spine in vertical alignment.
- The weight should always be balanced over the center of gravity.
- The greater the support base the better stability.
- Will help keep the client and the nurse safe from injury.
Back injuries are the number one reason for
permanent disability in the nursing profession.
Number one client injury in the healthcare setting is
falls. Costs $461 million annually.
What can we do to prevent injuries?
- Assess the situation before acting.
- Coordination between team members (counting method)
- Have the client assist if possible and explain what is expected of them.
- Use your legs.
- Perform work at the appropriate height.
- Assistive devices ( draw sheets, overhead trapeze, mechanical lifts)
- use lift teams
stengthens muscles, increases endurance, and promotes joint mobility.
Aerobic exercise involves:
- vigorous and continuous muscle movement.
- the heart rate being high which promotes cardiovascular conditioning.
anaerobic exercise occurs when
muscles can't extract oxygen.
marathon runners is an example of
The byproduct of anaerobic exercise is
isotonic exercise is
constant muscle tension
examples of isotonic exercise is
walking, running, and performing ADL's
Isometric exercise is
statice exercise when the client tenses a muscle, holds it stationary while maintaing tension.
Weight lifting is an example of
lack of exercises increases
health risks and problems related to disuse.
Exercise effects the cardiovascular system by
- increased cardiac output.
- improved myocardial contraction.
- decreased resting heart rate
- improved venous return
Exercise effects the respiratory system by:
- Increased respriratory rate and depth, followed by quicker return to resting state.
- Improved alveolar ventilation.
- Decreased work of breathing.
Problems with mobility include:
- congenital (spine bifida, cerebral palsy)
- affective disorders (depression)
- restrictive devices (casts)
- deep vein thrombosis (DVT)
- cerebral vascualr accident (CVA or stroke)
signs and symptoms with altered mobility:
- contractures (shortening of the muscle)
- decreased strength
- decresed muscle tone (flaccidity)
- Increased muscle tone (spasticity)
- lack of coordination
- disuse osteoporosis (bone demineralization)
- weaked immune system (infection)
lack of coordination includes:
ataxia (impaired muscle coordination), tremors, chorea (muscle twitching), waddling gait, hemiplegic gait (one leg paralyzed), festinating gait (walking on toes)
Client safety includes:
- clients have a greater risk for falls if mobility is altered.
- can cause additional trauma (fractures)
- fractured hips is the number one killer of older adults
- fear of repeated falls may cause them to reduce their mobility
- older adults have decreased joint mobility
- activity intolerance
- oxygenation disorders (COPD, asthma)
Impact of immobility on function:
- muscle atrophy and weakness
- contractures and joint pain or foot drop
- increased workload of the heart
- orthostatic hypotension
- thromus formation (DVT) pulmonary embolism (PE)
- constipation & urinary stasis leading to UTI's
- Decreased lung expansion and pneumonia
- sleep disturbances
- anorexia (lack of appetite)
rules of body mechanics
- provide a broad base of support
- work at a comfortable height (raise the bed)
- when lifting, bend your knees and keep your back straight
- keep your load well balanced and close to your body
- roll or push a heavy object. avoid pulling or lifting
principles of body mechanics
- the greater the bse of support the more stable the body
- pelvic tilt before activity helps protect the lower back from strain and injury
- facing the direction of work reduces the chance of injury
- less energy is needed to keep an object moving than to initiate movement
- moving an object on a level surface requires less effort.
- reducing friction between the object moved and the surface on which it is moved requires less energy
- holding an object close to the body requires less energy than holding it further away
- muscle strain can be avoided by using the strong leg muscles when lifting, pushing, or pulling.
- it is crucial for maintaining body alignment and comfort, preventing injury and providing sensory, motor, and cognitive stimulation
- it is important to maintain proper body alignment for the patient at all times, this includes when turning or repositioning
- Our goal is the least possible stress on the client's joints and to prevent shear injuries
- maintain body parts correct alignment so they remain functional and unstressed.
Passive ROM exercises
- perform exercise slowly and gently
- provide support by holding areas proximal and distal to the joint
- repeat each exercise 5 times
- stop or decrease ROM if client complains of discomfort or muscle spasm.
- Perform 1-3 times a day, depending on client's activity tolerance.
bedrest, bed fast, bed bound all mean
an intervention that restricts the client to bed for therapeutic reasons.
impaired physical mobility
a state in which the individual experiences or is at risk of experiencing limitation of physical movement.
- tissues are compressed decreased blood supply to the area therefore decreased oxygen to tissues and cells die
- need to decrease pressure to these points (elbows, coccyx, heels, etc)
subjective data includes
- normal activity pattern
- ability to perform ADL's
- determine any recent changes
- exercise patterns
- determine risks for dysfunction such as medication, eye sigt, obstacles at home, wakers, and hearing
objective data includes
- physical examination of:
- muscle mass
- postural blood pressure
- risk for falls
- activity intolerance
- comfort lever and alignment while lying down
- risk factor- ability to move, paralysis
- level of conciousness
- physical ability/motivation
- prescence of tubes, incisions and equipment
- defining characteristics from the asasessment
- activity intolerance
- impaired physical mobility
- impaired skin integrity
- know expected outcomes - good alignment, increased comfort
- raise bed to comfortable working height
- remove pillows and devices
- obtain extra help if needed
- explain procedure to client and ask them to assist
- wash hands
- provide privacy
- put bed in flat position
- move immoblie client up in bed
- realign patient in correct body allignment
- assess body alignment, comfort
- ongoing assessment of skin condition
- document and photograph all areas of concern
- use of proper body mechanics for you and the client