Exercise and Mobility Quiz

Activity and Exercise

• Activity and exercise are crucial for patient well-being, impacting recovery and overall health.
• Defining exercise involves planned, structured, repetitive bodily movements to improve or maintain physical fitness.
• Key characteristics of exercise include planning, structure, and repetition.
• Exercise subtypes include aerobic, strength training, flexibility, and balance exercises.
• Aerobic exercises elevate heart rate and breathing, improving cardiovascular health.
• Strength training builds and maintains muscle mass, improving balance and bone density.
• Flexibility exercises enhance range of motion and posture, reducing injury risk.
• Balance exercises improve balance and coordination, reducing fall risk.
• Physical activity is a broad term encompassing any bodily movement that consumes energy.
• Physical activity includes various activities like walking, gardening, dancing, sports, and fidgeting.
• Types of physical activity include occupational (work-related), transportation (commuting), household and gardening, and leisure-time activities.
• Factors affecting a patient's movement can be categorized into medical, physical, environmental and psychological and social.

Factors Affecting Patient Movement

• Medical Conditions:
• Neurological disorders (e.g., stroke, Parkinson's, multiple sclerosis) affect motor function, coordination, balance, and muscle strength.
• Musculoskeletal disorders (e.g., arthritis, osteoporosis, muscle/joint injuries) limit range of motion and cause pain.
• Cardiovascular conditions (e.g., heart disease, respiratory problems) reduce endurance and limit physical activity.
• Chronic pain discourages movement.
• Physical Factors:
• Age-related declines in muscle mass, bone density, and joint flexibility impact movement.
• Excess weight puts additional stress on joints and muscles.
• Physical fitness level affects endurance and muscle strength, affecting movement.
• Environmental Factors:
• Accessibility barriers (e.g., stairs, uneven surfaces) limit mobility.
• Safety concerns about falls or injuries discourage movement, especially in older adults.
• Climate extremes limit outdoor activities.
• Psychological and Social Factors:
• Pain perception influences willingness to move.
• Lack of motivation limits physical activity participation.
• Fear of falling hinders movement, especially in older adults.
• Social support encourages physical activity and provides assistance.
• Access to resources (healthcare providers, physical therapists) facilitates movement.

Barriers to Patient Movement

• Patient-Related Barriers:
• Pain (acute or chronic) significantly limits movement willingness and ability.
• Fear of falling discourages movement, especially in older adults.
• Fatigue reduces motivation and energy for physical activity.
• Lack of motivation and understanding the benefits of early mobility.
• Cognitive impairment affects the ability to participate.
• Healthcare Provider-Related Barriers:
• Time constraints due to busy schedules and staffing shortages limit interventions.
• Lack of knowledge or training regarding mobility protocols.
• Concerns about patient safety (falls or hemodynamic instability) discourage early interventions.
• Environmental Barriers:
• Limited space, cluttered environments, and lack of suitable equipment hinder movement.
• Lack of accessibility (stairs, narrow hallways) and heavy doors make navigation challenging.
• System-Related Barriers:
• Lack of clear protocols for early mobility can lead to inconsistent implementation.
• Lack of interdisciplinary collaboration hinders consistent interventions.

Methods for Overcoming Barriers

• Effective pain management strategies reduce pain and encourage movement.
• Implementing standardized early mobility protocols ensures consistent interventions.
• Fostering collaboration among healthcare providers (physicians, nurses, therapists) improves care coordination and enhances outcomes.
• Educating patients about early mobility benefits, addressing concerns, and creating a supportive environment increase patient participation.
• Providing adequate training and support to healthcare providers boosts their confidence in implementing programs.

Benefits of Activity and Exercise

• Physical Benefits:
• Improved cardiovascular health (reduced heart disease, stroke, and high blood pressure risks).
• Increased cardiovascular fitness improves heart and lung efficiency.
• Increased muscle strength and endurance, improving muscle mass and bone density.
• Enhanced daily functioning due to stronger muscles.
• Weight management by burning calories.
• Improved metabolism.
• Reduced risk of osteoporosis (weight-bearing exercises) and chronic diseases (e.g., type 2 diabetes).
• Reduced certain cancer risks.
• Mental Benefits:
• Reduced stress levels through endorphin release.
• Improved mood and alleviated depression and anxiety symptoms through physical activity.
• Enhanced cognitive function (brain function, memory, and cognitive skills).
• Improved sleep quality.
• Social Benefits:
• Increased social interaction through group exercise classes and sports.
• Increased sense of accomplishment with achieving fitness goals, boosting self-esteem.

Movement Disorders

• Chorea: Involuntary, brief, irregular, somewhat rapid movements.
• Ataxia: Affects the brain's coordinated movement control, causing clumsy movements and balance loss to the arms and legs.
• Dystonia: Involves involuntary muscle contractions causing twisting, irregular postures, or repetitive movements.
• Tremor: Rhythmic shaking of body parts (essential tremor is the most common type).
• Common movement disorder causes include genetics, medications, illegal drugs, or large amounts of alcohol.
• Less frequent causes are not getting enough of certain vitamins or medical conditions such as thyroid conditions, multiple sclerosis, strokes, viral encephalitis, or brain tumors.
• Head injury can lead to movement disorders.

Diagnostic Tests for Movement Disorders

• Blood tests help diagnose specific movement disorders or rule out other causes.
• Electromyography (EMG) assesses muscle and nerve health to measure the electrical activity of the muscles and nerves.
• Electroencephalogram (EEG) checks electrical activity of the brain.
• Lumbar puncture analyzes cerebrospinal fluid.
• Muscle biopsy helps distinguish nerve and muscle conditions.
• Nerve conduction studies measure electrical current through nerves and to muscles.

Walking Assistive Devices

• Tools that help people with mobility challenges walk safely and independently.
• Examples include canes, walkers, crutches, and gait belts.

Common Patient Positions in the Hospital

• Supine: Lying flat on the back (for rest, examinations, surgeries on chest and abdomen).
• Prone: Lying face down on the stomach (for back surgeries, preventing aspiration, promoting lung drainage).
• Fowler's: Head of the bed raised 45 degrees (for improved breathing, reducing pressure on the sacrum, promoting comfort).
• Semi-Fowler's: Head of the bed raised 30-45 degrees, a midway position.
• Lateral: Lying on the side (for preventing pressure ulcers, promoting lung drainage, and facilitating access to one side of the body).
• Sims': Lying on the left side with the right knee and thigh flexed (for rectal examinations, enemas, and facilitating childbirth).
• Trendelenburg: Head lower than the feet (for specific medical procedures).

Range of Motion (ROM)

• Active ROM: The patient independently moves a joint using their muscles.
• Passive ROM: A healthcare professional or caregiver moves the joint for the patient.
• Active-Assisted ROM: The patient initiates movement but requires minimal assistance.

Importance of ROM Exercises

• Prevent complications (contractures, muscle atrophy, stiffness).
• Promote healing by improving circulation and reducing stiffness.
• Maintain function (independence in daily activities).
• Reduce pain and discomfort.

The Role of the Nurse in Promoting Physical Activity

• Assess patients' activity level, barriers to exercise, and readiness to change.
• Identify any medical conditions that limit physical activity.
• Develop personalized exercise plans based on needs, preferences, and abilities.
• Set realistic and achievable goals with patients.
• Provide education and support about benefits of exercise and how to incorporate it daily.
• Help patients overcome barriers to exercise.
• Monitor patient progress and adjust the exercise plan.
• Evaluate the effectiveness of the exercise plan.

Nursing Care Plan for Impaired Mobility

• Assessment (Subjective Data):

• Patient complaints (weakness, fatigue, dizziness, pain).

• Patient's perception of limitations due to immobility.

• Patient's and family's understanding of the need for activity.

• Assessment (Objective Data):

• Muscle strength and range of motion

• Cardiovascular status (cardiac output, hypotension)

• Respiratory status (lung expansion, atelectasis, pneumonia)

• Integumentary status (skin breakdown, dry skin)

• Gastrointestinal status (bowel sounds, constipation, decreased appetite)

• Urinary status (urinary stasis, urinary tract infections, incontinence)

• Psychosocial status (depression, anxiety, social isolation)

• Nursing Diagnoses:

• Risk for impaired skin integrity.

• Risk for impaired physical mobility.

• Risk for constipation.

• Risk for disuse syndrome.

• Risk for falls.

Expected Outcomes

• Maintain skin integrity, free of pressure ulcers.
• Increase range of motion in affected joints.
• Prevent immobility complications (deep vein thrombosis, pneumonia).
• Improve bowel function.
• Maintain adequate hydration and nutrition.

Interventions

• Skin care: Reposition patients every 1-2 hours, use pressure-relieving devices, inspect skin for redness/breakdown, maintain good hygiene, provide adequate nutrition and hydration.
• Cardiovascular: Encourage early mobilization, apply compression stockings, administer anticoagulants as prescribed.
• Respiratory: Encourage deep breathing and coughing exercises, use incentive spirometry, and assist with suctioning as needed.
• Musculoskeletal: Perform ROM exercises, encourage active and passive exercises, and provide support for weak limbs.
• Gastrointestinal: Monitor bowel movements, encourage adequate fluid intake, provide a high-fiber diet, administer stool softeners or laxatives as prescribed.
• Urinary: Monitor intake and output, assist with toileting, encourage fluids, consider urinary catheters as necessary.
• Psychosocial: Provide emotional support, encouragement, and facilitate social interaction, and refer to resources as needed.

Evaluation

• Monitor patient's skin integrity for any improvement or deterioration.
• Assess the patient's ability to perform activities of daily living (ADLs).
• Evaluate patients' response to nursing interventions and adjust care as needed based on progress.