Kozier Ch 44

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  1. 4 Elements of Normal Movement
    • •Body alignment (posture) -
    • Brings body parts into position for
    • –optimal balance
    • –body function
    • Person maintains balance as long as line of gravity passes through center of gravity and base of support

    • •Joint mobility -Skeletal bones articulate at joints & skeletal muscles attach at the bones at the joint
    • •Flexor muscles are stronger than extensors, inactivity causes joints to pull into flexed (bent) position called a contraction
    • Range of motion (ROM): the maximum movement possible for that joint

    • •Balance - Requires input from inner ear, vision, receptors from muscles & tendons
    • •Sense of balance is called equilibrium

    • •Coordinated movement -Balance, smooth, purposeful movements
    • Is the result of proper functioning of:
    • –Cerebral cortex -Initiates voluntary movement

    • –Cerebellum - Coordinates motor activity
    • •Injury to cerebellum result in clumsy/uncoordinated

    –Basal ganglia - Maintains posture
  2. •Proprioception
    • –Awareness of posture, movement, changes in
    • equilibrium

    • –Knowledge of position, weight, resistance of objects
    • in relation to body
  3. Isotonic Exercise
    • •Muscle shortens to produce muscle contraction and active movement
    • –Running, walking, swimming, cycling
    • –In bed: pushing body to sitting position

    •Increase muscle tone, mass, and strength

    •Maintain joint flexibility and circulation

    •HR and CO quicken increase
  4. Isometric Exercise
    • •Muscle contraction without moving the joint (muscle length same)
    • •Involves exerting pressure against a solid object
    • •Strengthens legs for ambulation or muscles in casts or traction
    • •HR and CO increase mildly, no apparent increase in blood flow to other parts of the body
  5. Isokinetic (resistive exercise)
    • •Muscle contraction or tension against resistance
    • •Person moves (isotonic) or tenses (isometric) against
    • resistance
    • –Ex: lifting weights

    •An increase in blood pressure and blood flow to muscles occurs
  6. Aerobic Exercise
    •Amount of oxygen taken in the body is greater than that used to perform the activity

    •Involves big muscles

    •Improve cardiovascular conditioning and physical fitness
  7. Benefits of Exercise - Musculoskeletal
    • –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
  8. Effects of Immobility - Musculoskeletal
    Disuse osteoporosis - loss of bone density

    Disuse atrophy - decrease in size

    Contractures - permanent shortening of the muscle

    Stiffness and pain in the joints

    Ankylosed- permanent immoble joint (collagen - connective tissue in joint stiffens)
  9. Benefits of Exercise - Cardiovascular
    • –Increases HR, strength of contraction, and blood supply to the heart and muscles
    • –Mediates harmful effects of stress
  10. Effects of immobility - Cardiovascular
    • –Diminished cardiac reserve
    • –Increased use of the Valsalva maneuver - holding the breath and straining against a closed glottis–Orthostatic (postural) hypotension - vasoconstriction of lower body (prevents pooling of blood and maintains central blood pressure) becomes dormant so blood pools and bp drops
    • –Venous vasodilation and stasis - blood pools in leg veins and valves that prevent backflow become incompetent
    • –Dependent edema- venous pressure is great enough to force serous fluid out of the blood vessel into the interstitial spaces - causes edema
    • –Thrombus formation - thrombus (clots) is dangerous if it breaks loose - becomes an embolus (object that has moved from place of origin and causes obstriction to circulation somewhere else)
  11. Benefits of Exercise - Respiratory
    • –Increase ventilation and oxygen intake improving gas
    • exchange

    • -Prevents pooling of secretions in the bronchi and
    • bronchioles
  12. Effects of immobility - Respiratory
    –Decreased respiratory movement

    –Pooling of respiratory secretions

    –Atelectasis - collapse of alveoli caused by pooled secretions and decreased production of surfactant to keep alveoli open.

    –Hypostatic pneumonia -pooled secretions are a media for bacterial growth.
  13. Benefits of Exercise - Metabolic/ Endocrine
    Elevates the metabolic rate - increasing the production of body heat and waste products and calorie use.

    Decreases serum triglycerides and cholesterol

    • Stabilizes blood sugar and make cells more
    • responsive to insulin
  14. Effects of immobility - Metabolic/ Endocrine
    –Decreased metabolic rate -

    • –Negative nitrogen balance -depletion
    • of protein stores necessary for building muscle tissue & wound healing

    • –Anorexia - decreased
    • metabolic rate & increased catabolism (protein breakdown)

    • -Negative calcium balance - Absence
    • of weight bearing is a cause of calcium loss from bone
  15. Benefits of Exercise - Gastrointestinal
    –Improves the appetite

    –Increases GI tract tone

    –Facilitates peristalsis
  16. Effects of Immobility - Gastrointestinal
  17. Benefits of Exercise -Urinary
    • –Promotes blood flow to the kidneys causing body
    • wastes to be excreted more effectively

    –Prevents stasis (stagnation) of urine in the bladder
  18. Effects of immobility - Urinary
    –Urinary stasis

    –Renal calculi

    –Urinary retention


    –Urinary infection
  19. Benefits of Exercise - Psychoneurologic
    –Elevates mood

    –Relieves stress and anxiety

    –Improves quality of sleep for most individuals
  20. Effects of immobiltiy - Psychoneurologic
    –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
  21. Benefits of Exercise - Cognitive Function
    • –Positive effects on decision-making and problem
    • solving processes, planning, and paying attention

    • Induces cells in the brain to strengthen and build
    • neuronal connections
  22. Benefits of Exercise & Effects of Immobiltiy - Other
    •May increase spiritual health

    • •Immunity
    • –Mobilizes lymph drainage & fluid into circulation for destruction of pathogens
    • –Increases resistance to viruses

    • Immobility
    • •Immobility causes reduced skin turgor and skin breakdown
  23. Factors affecting body alignment. mobility, and ADL
    •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
  24. Nursing Assessment
    Activity and Exercise
    • •Nursing History
    • •Physical Examination:
    • Body alignment - inspect client while standing - shoulders and hips level? toes point forward? Spine is straight, not curved to either side?

    • –Gait - chin level, sternum lifted, shoulders down and back, heel strikes ground before the toe, feet are dorsiflexed
    • Appearance and movement of joints
    • –Capabilities and limitations for movement
    • –Muscle mass and strength
    • –Activity tolerance
    • -Problems related to immobility
  25. NANDA Diagnoses for Activity and Exercise
    • •For activity and exercise problems
    • –Activity Intolerance -inadequate physical or psychological energy to perform daily activities
    • 1- Walking with little effort to 4. Dyspnea & fatigue at rest
    • Most useful measure in predicting activity tolerance are BP, HR, (rhythm), RR. Obtain before and after. Should return to baseline within 5 minutes after activity.

    • Risk for Activity Intolerance
    • –Impaired Physical Mobility
    • Impaired physical mobility is limitation in independent, purposeful physical movement of the body or of one or more extremities.
    • Impaired bed mobility
    • Impaired walking
    • Impaired w/c mobility
    • Impaired transfer ability

    • –Sedentary Lifestyle
    • --Risk for Disuse Syndrome - risk of deterioration of body systems.
    • •The mobility problem can become 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
  26. Goals for Problems related to Mobility or Activity
    Positioning, transferring & ambulating clients are almost always independent nursing functions.

    • Examples of overall goals for clients with actual or potential problems related to mobility or activity include:
    • •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
  27. Body Mechanics
    efficient, coordinated, and safe yse of the body to move objects and carry out ADL

    • •Proper alignment - center of gravity, line of gravity, and base of support - line of gravity should be near center of base of support for best balance
    • •Wide base of support - feet apart
    • •Avoid bending and twisting
    • Squat to lift- lift with thighs, not back
    • •Keep objects close when lifting - center of balance
    • •Raise beds
    • •Pull rather than push
    • •Push rather than lift
    • •Get help
  28. Body alignment
    client must maintain body alignment so that undue stress is not placed on the musculoskeletal system

    • -postion should be changes every 2 hours
    • -bad should be clean and dry
    • -avaid placing one body part directly on top of another
    • -plan a systematic 24-hour schedule for position changes
  29. Guidelines for moving and lifting
    • Before moving, assess the degree of exertion permitted, the client’s physical abilities (e.g., muscle
    • strength, presence of paralysis) and ability to assist with the move, ability to understand instructions, degree of comfort or discomfort when moving, client’s weight, presence of orthostatic hypotension (particularly important when client will be
    • standing), and your own strength and ability to move the client.
    • If indicated, use pain relief modalities
    • •Prepare any needed assistive devices
    • •Plan around encumbrances (IV or heavy cast)
    • •Be alert to the effects of any medications
    • •Obtain required assistance
    • Explain the procedure to the client

    • Procedure
    • 1. Provide privacy.
    • 2. Perform hand hygiene.
    • 3. Raise the height of the bed to bring the client close to your center of gravity.
    • 4. Lock the wheels on the bed, and raise the rail on the side of the bed opposite you to ensure client safety.
  30. Client positions for correct body alignment
    • •Fowlers- semi-sitting (low, semi, high)
    • •Orthopneic
    • •Dorsal recumbent
    • •Lateral
    • •Prone
    • Sims
  31. Fowler's Position
    semisitting - head and trunk are 45 to 60 degrees

    Low fowler's (semi-fowlers) - head and trunk raised 15 to 45 degrees

    High fowler's - head and trunk raised 60 to 90 degrees

    • Fowlers postion for people who have difficulty breathing or heart problems
    • -gravity pulls diaphram down & allows greater chest expansion and lung ventilation
  32. Orthopneic position
    client sits in bed or on edge of bed with overbed tray across lap. Pillow are placed on table and patient leans forward on pillows.

    • -good for clients with COPD
    • -for clients that have trouble exhaling they can press lower chest against table
  33. Dorsal Recumbent Position
    clients head and shoulders are slightly elevated on a small pillow

    supine - flat - head and shoulders not elevated

    dorsal recumbant is used to provide comfort and facilitate healing following certain surgeries or anesthetics
  34. Prone Position
    client lies on abdomin with the head turned to one side

    • -only postion that fully extends hip and knee joints
    • -should only bed used for short periods
    • - must make sure back is correctly aligned
    • -not good for clietns with spinal abnormalities or trouble breathing
  35. Lateral position
    lies on side of body with top hip and knee flexed to produce stability

    • -promotes good back alignment
    • -helps relieve pressure on the sacrum
  36. Sims position
    semiprine - halfway between the lateral and prone positions

    -used for unconcuois clients, paralized clients, clients receiving enemas or undergoing perineal treatments

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  37. Guideines 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
  38. Guideliens 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
Card Set
Kozier Ch 44
Notes from powerpoint on Ch 44 Activity and Exercise
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