Activity & Exercise

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Activity & Exercise
2010-11-07 18:35:30
body alignment isotonic isometric isokinetic exercise nursing

The importance of activity and exercise for our patients.
Show Answers:

  1. What are the four basic elements of normal movement?
    • Body Alignment (posture)
    • Joint Mobility
    • Balance
    • Coordinated Movement
  2. List the 3 different types of exercises.
    • Isotonic
    • Isometric
    • Isokinetic
  3. This exercise is dynamic and it is aerobic.
  4. This exercise is static and involves stretching.
  5. This exercise is resistive and involves strength training.
  6. What are the 3 ways we measure the intensity of an exercise?
    • Target Heart Rate
    • Talk Test
    • Borg scale of perceived exertion (cardiac rehab)
  7. How do we measure our maximum heart rate?
    220 - age = max HR
  8. What kind of exercise is better for frail patients?
  9. This exercise contracts, shortens our muscles, and is active movement.
  10. Aerobic exercise activates what in our bodies?
    Opioid receptors and endorphins are released in our body resulting in a "high."
  11. What has been the Healthy People 2010 objective, and it's been the objective for the past 10 years?
    Moderate physical activity 30min/day
  12. What are the other Healthy People 2010 objectives?
    • Focus on strength, endurance, flexibilty
    • Employer sponsored fitness programs
    • Less chronic back disability
    • Less overweight ppl
  13. Successful aging is based on...
    • continued social connections
    • resiliency-ability to bounce back
    • self-efficacy-belief you can accomplish a task
    • regular physical activity
  14. What is the number one reason women do not exercise?
    Urinary incontinence
  15. Lack of mobility =
  16. The lack of mobility is a result of multiple chronic diseases and injuries, physical function, lack of social support and healthy behaviors, what kind of individual is described here?
    Aging/deconditioned individual
  17. This lack of mobility is often a result of a single event. What kind of individual is described here?
    Younger individual
  18. These days people live longer, but...
    quality of life goes down.
  19. Walking outside, shopping, and doing housework are all examples of...
    Instrumental ADLs
  20. Exercise prevents, reverses or improves health of people with...
    • Cardiovascular disorders
    • Pulmonary dysfunction
    • Aging
    • Depression
    • Diabetes
    • Chronic fatigue syndrome
    • Cancer
    • Arthritis
    • Fibromyalgia
    • Menopause
    • Urinary incontinence
    • HIV/AIDS
  21. Consequences of less exercise means our muscles..
  22. We want Ca⁺ to stay in the bone by doing...
    weight bearing exercises.
  23. What happens when Ca⁺ gets into our blood?
    • Ca⁺ deposits can move to the kidneys= kidney stones
    • Move to the heart = calcification
  24. Which of the following provide the best forms of health promotion and maintenance? Select all that apply.
    a. Immunizations
    b. Healthy Eating
    c. Regular Physical Activity
    d. Annual doctor checkups
    e. Adequate health insurance
    • b. Healthy Eating
    • c. Regular Physical Activity
  25. Mild exercise does what?
    Maintains muscles.
  26. Strenuous exercise does what?
    increases muscle strength
  27. List the benefits of exercise.
    • Affects shape, tone, strength of muscles with mild exercise and increased streuous exercise
    • Increases joint flexibility
    • Weight bearing and high impact exercise maintains bone density and strength
    • Decreases the risk and incidence of falls
  28. What are the cardiovascular benefits of exercise?
    • Strengthens heart muscle and blood supply
    • Increased HDL
    • Decreased stress response
    • Increases venous return to heart
  29. What the best types of exercise for cardiovascular benefits?
    • Aerobics
    • Walking fast
    • Yoga
  30. Yoga's benefits include...
    • increases HR
    • increases circulation
    • decreases stress
  31. Cardiovascular benefit of increasing venous return to heart prevents...
    risk for DVT
  32. What are the respiratory benefits of exercise?
    • improved gas exchange
    • increased O₂ to brain
    • prevention of secretion pooling
  33. What are the best types of exercise to get respiratory benefits?
    • LE exercise for people with COPD (ex. walking around)
    • Yoga for ppl with asthma
    • Incentive spirometer in the hospital
  34. Sitting up and standing up tall leads to...
    breathing better and increases O₂
  35. Strong chest muscles means...
    can cough mucus out
  36. What are the GI benefits of exercise?
    • Improved appetite
    • Increased GI tone-increased peristalsis
  37. What happens to the GI motility of someone on bedrest?
    Slows down and less BMs
  38. What are the best types of exercise for GI benefits?
    Working the abdominal muscles – decreases constipation and decreases IBS
  39. What are the metabolic/endocrine benefits of exercise?
    • increased metabolic rate - lasts 20 min after exercise
    • decreased triglycerides
    • decreased cholesterol
    • weight loss
    • stabilized blood sugar & more response to insulin (which then can decrease amt. of insulin)
  40. How much weight loss can decrease one's risk for diabetes?
    5% weight loss which is about 10lbs, which is a 58% overall decrease and 71% in ppl over 60 yrs old
  41. What are the urinary benefits of exercise?
    • increased blood flow
    • prevention of urinary stasis (kidney stones)
  42. What specific exercise for urinary benefits can we do?
    • Kegels
    • 50 kegels/day/ 7 days/wk
  43. Kegels benefit...
    Men at risk for prostate and women at risk for urinary incontinence
  44. How much cardiac output goes to our kidneys?
  45. What are the immune system benefits of exercise?
    • Improved lymph flow
    • Increased T cell function and cytokine production
  46. Moderate exercise benefits the immune system by...
    increases resistance to viral infections and prevents formation of malignant cells
  47. Strenuous exercise affects our immune system by...
    reducing immune function so pts with cancer shouldn't do strenuous exercise.
  48. After vigorous training what should we do?
    Allow our body adequate rest.
  49. What are the psychoneurologic & cognitive benefits to exercise?
    • Improved mood
    • Decreased stress & anxiety
    • Increased endorphins
    • Increased O₂ to brain
    • Improved quality of sleep
    • Better decision making & problem solving
    • Increased attentiveness
    • Purpose in life
    • Spiritual Health
  50. Factors affecting body alignment and exercise in older adults.
    • Decreased muscle mass & tone
    • Decreased bone density, osteoporosis
    • Loss of joint flexibility
  51. Healthy Goal for 2020 involves...
    Schools, physical activity for kids
  52. As adults get older what do they lose?
    Proprial perception/balance
  53. What is the assumption behind the elderly-flexed posture position?
    Assumed to prevent falling
  54. Elderly-flexed posture instead of preventing falling it really leads to...
    • fatigue
    • decreased joint excursion, stride, and speed
    • limits ankle movements
    • poor balance
    • increases risk for falling
  55. List the Giants of Geriatrics.
    • Immobility
    • Instability
    • Incontinence
    • Intellectual Impairment
  56. What factors concerning nutrition affect body alignment and exercise?
    • Undernutrition
    • Overnutrition, Obesity
    • Vitamin D Deficiency
    • Calcium Deficiency
  57. What are the factors concerning personal values & attitudes that affect body alignment & exercise?
    • Family values about exercising
    • Values about personal appearance
    • Motivational status
    • FIT: Frequency, Intensity, Time
    • *professional values– as a nurse if you tell someone to quit smoking, then nurse should be a nonsmoker
  58. What are the external factors affecting body alignment and exercise?
    • Temperatures & humidity (ex. turn on AC and exercise inside during summer)
    • Proper hydration
    • Safe, available locations for exercise
  59. What are the prescribed limitations affecting body alignment and exercise?
    • Immobilized body parts
    • Therapeutic bedrest
  60. What are the hazards of immobility?
    • Affects all body systems
    • Severity depends on duration of inactivity
    • Encourage pt movement
    • Early ambulation after illness and surgery is KEY!
  61. What are the musculoskeletal changes with immobility?
    • Joint stiffness and pain
    • Atrophy
    • Contractures
    • Disuse osteoporosis
  62. This is caused by decrease in muscle use.
  63. This is permanent flexion and fixation of joint in nonfunctional position.
  64. This is bone demineralization, in which Ca from the bone is released into the blood.
    Disuse Osteoporosis
  65. Patients with neuromuscular problems have an increase in...
    atrophy and contractures
  66. Contractures are found mostly in the...
    legs because they are heavier to move.
  67. What happens to our feet when we are on bedrest for a long time?
    Foot Drop
  68. How can we prevent foot drop in our pts on bedrest?
    Put sneakers on or other devices.
  69. What are some interventions for the musculoskeletal system?
    • Positioning in bed for proper body alignment– use pillows or wedges
    • Ambulate
    • ROM at least 3-4 times/day
    • Incorporate Active ROM in ADLs
    • Physical therapy consult for individualized exercise programs
    • Hand Rolls or hand wrist splints
  70. List some devices used for helping those on bedrest.
    • Trochanter roll
    • ankle/wrist splints
    • footboard
    • loose linens over feet
  71. What are the cardiovascular changes with immobility?
    • Diminished cardiac reserve
    • Orthostatic hypotension (postural hypotension)
    • Venous dilation and stasis, edema
    • Thrombus formation
    • Increased Valsalva maneuver
  72. A resting HR that increases 4-15BPM and there's a decrease in coronary blood flow, this is...
    diminished cardiac reserve
  73. When the systolic BP decreases more than 20mmHg, and HR increases more than 20 BPM, there's dizziness with position change from lying to sitting to standing, this is...
    Orthostatic hypotension
  74. An elderly HR of 120 or higher can lead to...
  75. When a patient is on bedrest the blood is...
    static, there's no circulation, can lead to DVT
  76. How do we lower our risk for DVTs?
    • Early Ambulation
    • Calf pumps, foot circles, hip rotation, knee flexion
    • No crossing legs, sitting long periods, tight clothing
    • Elastic hose (TEDS)
    • Sequential pneumatic compression stockings (FLOTRONS)
    • Avoid pillows under knees or massaging legs
    • Anticoagulation management if ordered like heparin
  77. What are the interventions for cardiovascular changes in immobility?
    • Monitor VS
    • Monitor dependent areas for edema
    • Monitor peripheral body regions for temp changes
    • *Rocking chair increases circulation due to pushing with feet– venous return in legs
  78. What are the respiratory changes with immobility?
    • Decrease lung expansion
    • Decreased ability to cough=pooling of secretions
    • Atelectasis– collapse of alveoli
    • Hypostatic Pneumonia– inflammation of the lung from stasis
  79. What treatments can we use to minimize effects on the respiratory system?
    • Turn C&DB Q2
    • IS
    • Early mobility
    • Unless contraindicated, 200mL/day fluid intake
    • Chest postural drainage and suction
  80. What are the metabolic changes with immobility?
    • ↓BMR
    • ↓insulin production which means ↑blood glucose
    • Anorexia
    • ↑Protein Breakdown & negative nitrogen balance = problems with wound healing/normal tissue growth
  81. Exercise increases our
    BMR=Basal Metabolic Rate
  82. What are the treatments for metabolic changes?
    • Dietician consult
    • Exercise/PT
    • TPN (Total Parenteral Nutrition) if ordered
    • Manage diabetes
  83. How does exercise and PT treatment help with metabolic changes?
    Utilizes the glucose and decreases protein breakdown
  84. What Renal System changes take place with immobility?
    • Urinary stasis
    • Renal Calculi
    • Urinary retention
    • UTI
  85. Recumbent position slows downward flow of urine, this is known as...
    Urinary stasis
  86. Ca⁺ loss from bones causes hypercalcemia= precipitation and calculi formation in kidneys. What is this called?
    Renal Calculi
  87. Urinary retention happens with...
    overflow incontinence
  88. Where does the blood flow once it's pumped from the heart? What is it's first stop?
  89. How do we minimize renal changes?
    • Increase fluid intake and monitor I&O
    • Cranberries and Blueberries (research unconclusive)
    • Positoning for bladder emptying
    • Monitor s/s UTI or kidney stones
  90. What are the GI changes with immobility?
    • Anorexia
    • Constipation
  91. Within constipation what else happens?
    • Decreases peristalsis 2〫to hypercalcemia
    • Decrease intake of fiber
    • Abnormal positioning of bedpan
    • Valsalva maneuver
  92. When we are not actively using our muscles in our abdomen then...
    ↓motility = constipation
  93. How do we minimize GI changes?
    • Monitor bowel sounds and BMs
    • Adequate fiber
    • Adequate fluid intake
    • Positioning for elimination
    • Stool softeners, laxatives, enemas if ordered
  94. What are the integumentary changes with immobility?
    • Risk for pressure ulcer
    • Prolonged pressure = ischemia, greater risk of skin breakdown
  95. Risk of pressure ulcer 2〫
    • Risk for incontinence
    • ↓activity
    • ↓muscle tone for movement
    • ↓protein in diet
    • ↑friction and sheer
    • ↓turgor (elasticity)
  96. What can actually stimulate circulation in our head?
    Brushing our hair
  97. What are interventions for integumentary changes?
    • Frequent position changes
    • Pressure reducing devices
    • Maintain skin clean and dry
  98. What qualifies as frequent position changes?
    • As needed and Q2H in bed
    • Limit OOB chair to 1HR or less
  99. What are some pressure reducing devices?
    • Air mattress
    • Chair pads
  100. What are the psychological changes in immobility?
    • Depression
    • Changes in sleep-wake cycle
    • Impaired coping
    • Inability to concentrate will affect problem solving and memory
  101. What are psychological interventions?
    • Cluster nursing and medical interventions to assure adequate sleep
    • Clocks and calendars
    • Newspapers and tv
    • Conversation
    • Watch for behavioral changes
    • Communication with pt's family (about pt's behavior)
  102. For activity/exercise problems what do we assess for?
    History: ADLs, activity tolerance, exercise, environmental factors, health problems

    • Physical Exam:
    • Body alignment/posture while standing
    • Gait and pace with/without assistive device
    • Joint appearance and ROM
    • Capabilities & limitations for movement
    • Activity tolerance
  103. COPD/cardiac pts cannot do ADLs quickly so we need to provide...
    rest periods
  104. What are some nursing Dx?
    • Activity intolerance
    • Impaired physical mobility
    • Sedentary lifestyle
    • Risk for disuse syndrome
  105. What are some planning & interventions?
    • Safe positioning, moving, lifting, ambulating pts
    • Body Mechanics– RN and pt
    • ROM–(see pg 1108-1111 Kozier)
    • Nurses assist and teach
  106. What are the interventions for Dx: Activity Intolerance?
    • Check HR, RR, BP
    • Before activity, baseline data
    • During activity
    • Immediately after activity stops
    • Five minutes/rest
  107. What are s/s of activity intolerance?
    • sudden facial pallor
    • dizziness
    • weakness
    • change in LOC
    • increased HR and RR
    • Weakening of HR
    • Change in rhythm of HR or RR
    • dyspnea
    • SOB
    • Chest pain
    • diastolic BP change of 10mmHg or more
  108. Respiratory therapy lets the case manager know if...
    • pt needs O₂ @home
    • they monitor O₂ sat during activity
  109. When ambulating pts we need to...
    • use good body mechanics, hydraulic lifts if needed
    • Preambulation: quadriceps femoris exercises (isometric)
    • Gait Belts
    • Canes
    • Walkers