Nursing Fundamentals Vol. 1: Chapter 31
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. What would you like to do?
The American College of Sports Medicine (ACSM) recommends what time range of exercise per week to prevent weight gain and chronic illness? how much time do they recommend you spend to achieve weight loss?
150 - 250 minutes
More than 250 minutes a week to achieve significant weight loss: that is, 50 minutes 5 days a week or 40 minutes 6 days a week.
Mobility depends on successful interaction among what 3 systems?
- The skeleton
- The muscles
- The nervous system
When two bones come close together, or _____, a joint is formed. What occurs at the joints?
_____ are immoveable joints, such as the sutures between the cranial bones.
_____ allow for limited movement, like the joints between the vertebrae and pubic bones.
______ are freely moveable because of the amount of space between the articulating bones. What allows this kind of movement?
- Diarthroses (synovial joints)
- Synovial fluid fills diarthroses and the joint surfaces of articulating bones are covered with smooth articular cartilage, which work to prevent friction as the body moves.
What are the 6 types of synovial joints (diarthroses)?
Match the type of diarthrosis to its descriptor:
Ball and Socket
A. An oval shaped bone fits into an elliptical cavity to allow movement in two planes at right angles to each other (i.e. the wrist).
B. A convex surface fits into a cavity, allowing flexion and extension (i.e knee and elbow)
C. Two flat plane surfaces move past each other (i.e intervertebral joints)
D. A rounded head fits into a cup-like structure to allow movement in all planes in addition to rotation (i.e Shoulder and hip)
E. One bone surface is concave in one direction and convex in the other. The other surface has the opposite construction so that the bones fit together. Movement is possible in two planes at right angles to each other. (i.e. carpal, metacarpal joint of the thumb)
F. The joint is formed by a ringlike object that turns on a pivot. Motion is limited to rotation (ie the atlas and axis of the first vertebrae and base of the skull).
- A. Condyloid
- B. Hinge
- C. Gliding
- D. Ball and Socket
- E. Saddle
- F. Pivot
Muscles comprises _______ of body weight.
What are the two points are which muscles attach to bone called? Describe them.
Where does the belly of the muscle lie?
- 1) The point of origin, to the more stationary bone
- 2) The point of insertion, to the more moveable bone.
The belly of the myscle lies between these two points.
A muscle contraction, whether conscious or reflexive, stimulates _____ nerves that convey information where?
- The cerebral cortex and the cerebellum
Tendons connect _____ to _____
Ligaments connect ______ to ______.
- Tendons connect muscles to bone
- Ligaments connect bone to bone (joint to joint)
____ is a term used to describe the way we move our bodies. It includes what four components?
- Body Mechanics
- Body Alignment
- Joint Mobility
____ places the spine in a natural (resting) position, which maintains the ____ natural curves of the spine.
- Body alignment or posture
There are ten common causes of posture problems that often work in combination to create problems. What are they?
- Accidents, Injuries, Falls
- Careless sitting, standing, or sleeping habits
- Excessive weight
- Foot problems or improper shoes
- Negative self image
- Occupational stress
- Poor sleep support
- Poorly designed work place
- Visual difficulties
- Weak muscles or muscle imbalance
Name the four natural curves to the spine
- Cervical (Lordosis)
- Thoracic (Kyphosis)
- Lumbar (Lordosis)
- Sacral (Kyphosis)
- Coccyx (Tailbone)
Where is the line of gravity?
An imaginary vertical line drawn from the top of the head through the center of gravity.
What is the center of gravity?
the point around which mass is distributed. in the human body, it is below the umbilicus at the top of the pelvis.
How should individual components of your body be positioned in order to avoid injury when moving objects?
- Place your center of gravity closest to your base of support (feet)
- Stand with your head erect
- Buttocks pulled in
- Abdominal muscles tight
- Chest high
- Shoulders pulled back
- Feet wide.
How should your posture be when you are standing for long periods of time? Explain why this works.
Use a wide stance with feet apart and one foot forward.
The broader base of support and the lower the center of gravity, the easier it is to maintain balance.
What are the 11 self care tips for maintaining proper posture?
Avoid standing in one position for a lengthy period of time. If you cannot change positions, elevate one foot on a stool or box and alternate foot placement frequently.
Do not lock your knees when standing upright.
Keep your stomach muscles tight to support your back.
Do not bend forward at the waist or neck when you are working in a low position.
When you are seated at your desk, work at a comfortable height.
Do not wear high-heeled or platform shoes for long periods of time.
Do not slump when you sit.
Sit close to your work.
Use a chair that supports your back in a slightly arched position.
Sit with your feet flat on the floor and your knees below your hips.
Sleep on a mattress that is firm but not extremely hard.
Voluntary movment is initiated by the ______; however, the ____ coordinates movements.
- cerebral cortex
What part of the brain largely controls proprioception?
The _____ located deep in the cerebrum, assist with coordination of movement.
Damage to what structures in the brain affect coordination of movement?
- Motor cortex
- Basal Ganglia
_____ is defined as the maximum movement possible at a joint.
ROM: Range of motion
What is AROM?
- Active Range of Motion
- The movement of the joint through the entire ROM by the individual.
Describe the campaign "Handle with care" that was launched in 2004 by the American Nurses Association.
Emphasizes the use of assistive devices to decrease the use of injury and recommends virtually no manual lifting.
Muscle contraction without motion
Isometric training is effective for what? What is it often used for
`Developing total strength of a particular muscle or group of muscles.
It is often used for rehabilitation because the exact area of muscle weakness can be isolated and strengthening can be administered at the proper joint angle.
Patients who are bed bound can use this form of exercise to maintain or regain strength.
Movement of the joint during muscle contraction
A classic example of _____ is weight training with free weights.
Calisthenics, such as chin ups, push ups, and sit ups, all of which use the body weight as a resistance force are considered _______ exercise.
This type of exercise combines the best features of both isometrics and isotonics by providing resistance at a constance, preset speed while the muscle moves through the full ROM.
_____ exercise aquires enerfy from metabolic pathways that use oxygen.
In this type of exercise, the amount of oxyen taken into the body meets or exceeds the amount of oxygen required to perform the activity.
____ exercise uses large muscle groups, can be maintained continuously, and is rhythmic in nature.
Jogging, brisk walking, and cycling are all common forms of what kind of exercise?
____ exercise occurs when the amount of oxygen taken into the body does not met the amount of oxygen required to perform the activity.
Rapid, intense exercise, such as lifting heavy objects, or springing, are examples of this kind of exercise.
When a person is exercising for strength, the goal is to do what?
Increase the amount of resistance with each exercise (lift more weight)
When a person is exercising for endurance, the goal is to do what?
Increase the number of repetitions with each exercise (lift the weight more times)
Fitness and body composition are improved by _____.
What are the components of aerobic conditioning?
The US Department of Health and Human Services recommends ____ hours/minutes per week or more of moderate intensity physical activity coupled with _____.
- 2.5 hours/ 150 minutes per week
- Increasing the activity every day
What is the minimum frequency of exercise recommended by the USDHHS?
3-5 Days per week, although the more often and the longer duration, the better.
The ____ of exercise is the type of activity.
Strong evidence links regular physical activity with what (in regards to disease)? (9)
- A lower risk for:
- early death
- heart disease
- type 2 diabetes
- metabolic syndrome
- colon and breast cancers
What does regular exercise promote in terms of everyday functioning?
- Weight loss
- maintenance of normal weight in combo with diet
- better heart and lung function
- Muscular fitness
- Fall prevention
- Improved memory and mental clarity in older adults
What are the USDHH 2008 guidelines for physical activity for Adults and older adults. (3)
Get at least 150 minutes of moderate intensity or 75 minutes a week of vigorous intensity aerobic physical activity.
Engage in aerobic activity throughout the week in episodes of at least 10 minutes. Longer periods of time provide additional benefits.
Perform moderate to high intensity muscle and bone strengthening activities on 2 or more days per week.
How do you calculate max heart rate?
Max heart rate = 220 -- age
How do you calculate target heart rate?
The THR is calculated as a percentage of the max heart rate. Most persons can exercise at 60-80% of the max heart rate.
Explain what the "talk test"is and how it is used.
The talk test evaluates exercise intensity based on the person's ability to talk while exercising.
Short phrases interspersed with breath or feeling like you can "just respond' is considered an appropriate level of exercise.
If you are too short of breath to answer, the level of intensity is too high.
An ability to carry on a conversation indicates that you are not exercising hard enough.
What is the Borg rate of Perceived Exertion Scale (RPE)?
- The person who is exercising selects the rating based on how difficult the exercise feels at that time. The exerciser selects one of eight categories used to describe the intensity of the activity.
- RPE ratings range from No Exertion At All to Extremely Hard.
- Extremely hard is associated with exercise that corresponds to almost 100% of max heart rate.
- Somewhat Hard corresponds with 75% of max heart rate: this is the level you should encourage for most individuals.
Who should be evaluating before beginning an exercise program? (6)
- Older than 40
- Chronic Health Condition
True or False: Exercise suppresses thirst.
What are the risks associated with exercise?
- Cardiac injury
- Musculoskeletal injury
- Temp Regulation problems
What are the signs and symptoms of heat exhaustion? (7)
- Loss of Concentration
- Abdominal Cramps
____ may occur when a person does not wear proper clothing, or is exposed to cool water for an extended period of time. What are its signs and symptoms (3)?
- Fatigue, Confusion, lack of coordination
Only _____ of young adults get regular physical activity in their spare time.
Only ____ of young adults do strength training at least twice a week.
People with chronic disease may be in _____--- that is, they do not have adequate protein stores available to maintain or repair body tissue. What do they experience as a result?
- Negative nitrogen balance
- Muscle wasting and fatigue --> decreased activity levels
A high stress level can produce ____, but exercise is energizing and can be used to _______.
What environmental factors often affect exercise? (5)
- Neighborhood conditions
- Support systems
What is the most important external factor affecting mobility and activity?
The support system
_____ is the fusion of two or more fingers or toes.
A congenital abnormality of the development of the femur, acetabulum, or both, that shows as hip dislocation.
Developmental dysplasia of the hip
_____ such as club foot (aka ______) occur in about 4% of all newborns. Serial casts or surgery may be used to correct the defect and preserve function.
- Foot deformities
- Talipes Equinovarus
A lateral curvature of the spine. Can result from congenital bone disorders, neuromuscular impairment, or trauma, but approximately 2/3 of cases have no known cause and are termed _____.
- Idiopathic scoliosis
A congenital disorder of bone and connective tissue that is characterized by brittle bones that fracture easily. Infants born with this are often born with fractures and continue to fracture with minimal trauma or even spontaneously. How can you prevent deformities when someone has this disorder?
- Osteogenesis Imperfecta (OI)
- Prompt recognition and treatment of fractures helps prevent deformities
_____, or dwarfism, occurs when the bones_______.
- ossify (harden) prematurely.
A metabolic bone disease in which increased bone loss results in pain, pathological fractures, and deformities. What specific points does this disease usually affect?
- Paget's disease
______and _____ are needed to form and maintain bone. What do deficiencies lead to?
- Vitamin D and Calcium
- Porous Bones
______ is a chronic inlammatory joint disease characterized by stiffening and fusion of the spine and sacroiliac joints. THe inflammation occurs where the ligaments, tendons, and joint capsule insert into the bone.
What are the signs and symptoms of ankylosing spondylitis?
- Low back pain and stiffness
- Decreased ROM of the spine
- Convex lumbar curvature is lost
- Upper spine curve increases, causing kyphosis
____ is a creaking or grating sound with joint motion.
Symptoms of _____ artthritis are aggravated by weight bearing and joint use and are relived by resting the affected joints.
Symptoms of ____ arthritis are most intense when the person arises from bed, and tends to get better as the day goes on.
An inflammatory response to high levels of uric acid.
_____ is a decrease in total bone density, which occurs when osteoclast activity outpaces that of the osteoblasts. The internal structure of the bone diminishes, and the bone collapses in on itself.
After age ____, bone loss begins.
In regards to preventing bone loss, nurses should teach adolescents to eat a diet high in ____ and to do what?
- calcium, fluoride, and other minerals
- start an exercise program they can continue throughout their lives.
The national osteoporosis foundation recommends calcium intake for adults age 50 and older to be ____ mg/day and Vitamin D to be _____ IV/day to prevent ______.
- Ca: 1200 mg/ day
- Vit. D: 800-1,000 IV/day
to prevent bone loss
____ reduces the absorption of alcohol in the intestine.
More than two drinks of alcohol per day has what affect on the bones of the body?
Decreases the matrix of the bone and reduces the body's ability to absorb calcium.
Infection of the bone is referred to as _______. When may it develop? What are treatment options?
- It may develop after bone injury or surgery
- Can be difficult and expensive to treat and leave the patient with permanent disability.
What are the signs and symptoms of a fracture? What about a sprain or strain? How can you tell the difference?
- S&S of a fracture:
- tenderness at the site,
- loss of function,
- deformity of the area,
- swelling of the surrounding tissues.
- S&S of a strain or sprain:
- X ray studies must be used to distinguish between these injuries.
A_____ is a break in the bone. They are classified according to the extent of damage.
A ____ is a stretch injury of a ligament that causes the ligament to tear.
A ___ is an injury to the muscle cause by excessive stress on the muscle.
_____ is a disease caused by antibodies to the acetylcholine receptors at the neuromuscular junction.
In terms of mobility, what is/are the goal(s) for patients on bed rest? (8)
- To prevent additional problems caused by immobility, such as:
- Pressure injury
- Joint Contracture
- Muscle Weakness
- Balance problems
- Deep Vein Thrombosis
- Pooling of Secretions
- Orthostatic Hypotension
What general diseases or conditions may affect mobility and activity tolerance?
- Respiratory Disorders
- Circulatory Disorders
- Bed Rest
___ is permanent shortening of the muscle joint caused by the strongest muscles (usually the _____) pulling the joints in their direction. This phenomenon can also lead to what?
- Joint ankylosis (fusion of the joints)
Immobility affects parathyroid function, calcium metabolism, and therefore bone formation. What are the results of changes in these systems?
- Calcium depletion at the joints
- renal calculi (kidney stones) due to increased excretion of calcium.
Immobility decreases the strength of all muscles, including those involved in chest wall expansion, which affects ____. What specific changes happen as a result?
- the depth of respirations decrease
- secretions pool in the airways
- ability to effectively cough and expectorate diminishes as muscle tone of the abdomen and chest decrease
Changes in the respiratory system associated with immobility and weakening of the chest and abdominal muscles can lead to what dysfunctions and diseases?
Pooled secretions and reduced ability to cough block air passages and alveoli, and decrease oxygen and carbon dioxide exchange, leading to atelectasis or pneumonia.
____ is the collapse of the air sacs.
True or False: Even a sedentary lifestyle affects the capacity to increase ventilation in response to exercise.
Immobility____ the workload of the heart and promotes venous _____.
When you are active, the skeletal muscles in the legs help do what (in terms of heart function)?
pump blood back to the heart.
To compensate for immobility, heart rate and stroke volume ______ to maintain blood pressure: but with immobility, cardiac reserves are lessened. What does this mean?
- The heart is less able to respond to demands above baseline. Without muscle activity, the force of gravity causes blood to pool in the periphery, which leads to edema.
- Fluid in the tissue is more prone to pressure injury
What is Virchow's Triad?
- A trilogy of symptoms associated with a greater change of thrombus formation, such as deep vein thrombosis (DVT)
- Activation of clotting
- Vessel injury
In addition to venous pooling, immobility leads to _____ and ____ of the small vessels in the legs. What happens to coagulation factors when this occurs?
- there is decreased clearance of coagulation factors, which causes blood to clot faster.
Why is a person on prolonged bed rest more likely to experience orthostatic hypotension?
Prolonged bed rest inactivates the baroreceptors involved with constriction and dilation of the blood vessels. As a result, when a person who has been immobilized changes position, he is less able to maintain his blood pressure.
Inactivity increases the level of _____ and decreases the level of ____, which also decreases the body's energy reserves.
- serum lactic acid
- adenisine triphosphate (ATP)
What does the body do in response to increase level of serum lactic acid and decreased ATP caused by inactivity?
- Metabolic rate drops
- Protein and glycogen synthesis decrease
- Fat stores increase
- Together, these effects cause glucose intolerance and reduced muscle mass.
Immobility can be a stressor in itself. Describe physiologically why this is true.
- Immobility triggers the release of:
- epinephrine and norepinephrine,
- thyroid hormones
- adrenocorticotropic hormone (ACTH) from the pituitary gland
- Aldosterone from the kidneys
- These are the same changes that occur during the stress response.
What are the effects of immobility on the integument? How could you, as a nurse, prevent this?
- External pressure from lying in one position compresses the capillaries in the skin, obstructing skin circulation
- Lack of skin circulation causes tissue ischemia and possible necrosis.
- Frequent turning (every 2 hours)
- skin care to prevent pressure ulcers from forming
Immobility ____ peristalsis. What does this directly lead to?
- difficulty evacuating stool from the rectum
- In extreme circumstances, a paralytic ileus (cessation of peristalsis) may occur.
What effects does diminished peristalsis have on appetite?
Appetite diminishes and food is also digested slowly
What effect does immobility have on the genitourinary system?
- Drainage of urine from the renal pelvis and bladder is inhibited, resulting in stagnant urine.
- Stagnant urine is an ideal environment for infection and kidney stone formation.
Immobility triggers a _____ in calcium levels, which has what effect?
- contributes to kidney stone formation
Immobility leads to diminished muscle tone, which leads to a decrease in bladder tone. Thus, immobile patients have difficulty doing what?
Voiding in a bedpan or urinal
What would you like to do?
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