Immobility, Exercise and Activity

Exercise and Activity

• Immobility is an excessive lack of exercise and activity
• Immobility affect the normal functions of all body systems and the client's mental well-being, potentially causing conditions such as:
  • Constipation
  • Pneumonia
  • Blood clots
  • Pressure sores
  • Social isolation
  • Depression
• Activity and exercise enhance the function of all systems, including mental health:
  • Maintaining elasticity of tissues and joints
  • Increasing muscle strength and endurance
  • Increasing circulation
  • Improving lung expansion and digestion
  • Enhancing mood

Factors Affecting Client Mobility

• Illness, surgery, and injuries
• Aging, bedrest, and pain
• Paralysis and progressive disorders
• It is important to promote exercise and activity in all clients to the greatest extent possible

Bed Rest Orders

• Bed rest is a medical order that requires the client to stay in bed
• It is enforced to:
  • Reduce physical activity
  • Severe arthritis
  • Blood clots
  • Pregnancy complications
  • Promote healing
  • Following surgery
  • Reduce pain
  • Encourage rest
  • In the event of heart failure
  • Regain strength

Types of Bed Rest Orders

• Strict bed rest: everything is done for the client, with no ADLs allowed except using a bedpan or urinal
• Bed rest: allows some ADLs like feeding, oral hygiene, bathing, shaving, and hair care
• Bed rest with commode privileges: allows use of a bedside commode
• Bed rest with bathroom privileges (BRP): allows the client to use the bathroom for elimination needs

Complications of Bed Rest

• Urinary system: urinary tract infections and incontinence
• Gastrointestinal system: constipation
• Neurological system: loss of balance and confusion
• Psychological: social isolation, low self-esteem, depression, anxiety, and fatigue
• Respiratory system: pneumonia and pulmonary embolism
• Cardiovascular system: orthostatic hypotension and blood clots
• Integumentary system: pressure sores

Orthostatic Hypotension

• Orthostatic hypotension involves a drop in blood pressure when a client stands up
• It results in dizziness and weakness, and can lead to fainting

Musculoskeletal Complications

• Contracture: lack of joint mobility caused by abnormal muscle shortening
• Contractures can develop in as little as 48 to 72 hours if muscles/joints are not exercised
• Muscle atrophy: a decrease in muscle size and wasting
• Deconditioning: the loss of muscle size, strength, and function

Preventing Complications

• Encourage clients to move limbs as much as possible
• Communicate regularly with clients
• Socialize with the client
• Address psychological impact by engaging clients in their interests with access to TV, reading, and music
• Ensure good body alignment, assist with ROM exercises, and provide position changes every 2 hours

Preventing Orthostatic Hypotension

• Raise the head of the bed and monitor client for dizziness
• Maintain a fowler's position for short time periods
• Have the client sit on the side of the bed and dangle their feet
• Stay close when helping the client stand
• Use good body mechanics
• Assist the client in sitting or walking, as specified in the care plan
• Report all observations and complaints

Supportive Devices

• Pillows
• Bed can be adjusted with feet up
• Bed boards prevent the mattress from sagging
• Foot boards prevent plantar flexion
• Trochanter rolls prevent hips and legs from external rotation
• Hand rolls or grips prevent contractures of the thumb, fingers & wrist.
• Splints keep the elbows, wrists, thumbs, fingers, ankles, and knees in normal position
• Bed cradles keep the weight of top linens off the feet and toes

Plantar Flexion Contracture

• Tucking in the top bed sheet too tightly can cause plantar flexion contracture

Exercise Benefits

• Exercise helps prevents:
  • Contractures
  • Muscle atrophy
  • Other bed rest complications
• Some exercise occurs with ADLs and when moving in bed without help

Exercise: Trapeze

• Used in rehabilitation facilities with good strength
• Strengthens arm muscles
• Suspended from an over-bed frame
• Clients lift their trunk by grasping the bar with both hands
• Aids in moving and turning in bed

Range of Motion (ROM)

• ROM is moving a joint to the extent possible without causing pain
• ROM exercises involve exercising joints through their complete range
• Active ROM: client performs the exercise independently
• Passive ROM: someone else moves the client's joints
  • Active-assistive ROM: the client performs exercises with some help

ROM Exercises

• Some exercises naturally occur during ADLs like bathing, hair care, eating, reaching, and walking
• Bedrest limits natural ROM
• A care plan will specify which joints to exercise and whether exercises should be active, passive, or active-assistive

Types of Joint Movement

• Abduction involves moving a body part away from the body's midline
• Adduction involves moving a body part toward the body's midline
• Extension straightens a body part
• Flexion bends a body part
• Hyperextension straightens a body part excessively
• Dorsiflexion bends the toes and foot upwards at the ankle
• Rotation turns a joint
• Internal rotates a joint toward the inside
• External rotation turns a joint toward the outside
• Plantar flexion bends the foot downwards at the ankle
• Pronation describes turning downward
• Supination describes turning upward

Ambulation

• Ambulation is the act of walking
• It can be achieved using a series of steps which involve:
  • Dangling the legs, sitting on the side of the bed
  • Sitting in a bedside chair
  • Walking around the room
  • Walking in the hallway
• Prevent deconditioning: contractures and muscle atrophy must be prevented with proper positioning and exercises during bed rest

Walking Aids

• Walking aids are a device that supports the body
• They are ordered by health professional
• Clients are taught how regulated health professional to use them
• Types of walking aids include:Canes, walkers, crutches, braces
• The type that is ordered is based on the client’s condition, the amount of support needed , and type of disability
• You should know the correct use and reinforce this with the client
• DO NOT adjust

Canes

• Used for weakness on one side of the body
• The four types of canes are: Single-tip or four-point (quad) ones
• Canes help promote balance and support
• Held on the stronger said of the body

Walker

• Is gives more supprt than a cane
• The client will feel more secure than a cane
• Types of Walkers are: Standard Walker, Wheeled Walker.
• Standard: The client has to lifts walker and moves it forward, then walks up to it
• Wheeled: Client pushes ahead and then walks up to it/Has wheels on front, rubber tips on back
• Don’t let clients Lean on, but use table for support
• Key is not to let client lean on walker for supporting when going to sit and stand, should use stable support such as bed or chair

Crutches

• Used if one leg is out of action temporary or permanent
• Axilla crutches are used for temporary weaknesses
• Lofstrand crutches are used for permanent weaknesses
• Crutches should be:
  • Checked for cracks
  • Make sure the client is wearing correct foot wear
  • Make sure the clothes fit well

Braces

• Align weak body part
• Prevent/correct joint problems
• Ankle-foot orthosis (AFO) go in the shoe
• Important to keep clean and dry
• Report redness of discomforts
• Follow care plan

Ambulation

• Assess the amount of help needed
• Will assistance be needed?
• Remove all objects in the way
• Think of where the client can sit if they feel unwell
• Do they have shoes on?
• Are they ready for ambulation?

Ambulation Saftey

• Guide client on weak side
• Stand the side of the client
• Encourage them to look straight and walk
• Support if wheel chair is needed
• Have client seat if dizzyness

Falls

Falls: Before PREVENTION IS KEY! Falls are often devastating events for elderly concussi blood hemorrha difficul a on clots ge recove simple ry fall can from lead to surger death y

• Remove tripping hazards, and tell supervisor, and always be aware of clients

During a Fall

If client begins to fall, DO NOT try to prevent fall: Your first instinct will be to try to catch your client or try to prevent the fall. BUT: Don’t do this. Your responsibility is to get the client to the floor SAFELY, control the direction of the fall and prevent client from hitting head. You can hurt yourself AND cause greater harm to your client: Trying to catch the client results in you twisting awkwardly If you both fall, you could land on your client If you try to catch your client, you are not paying attention to and protecting the head

After a Fall

• do not move the client.
  • Check clients injuries
  • If the client is at home and they can manage to get up offer support
  • Ensure the client is worm
• Document the incident
• What happened?
• Do they tell you they feel anything different

Common symptoms after a Fall

• Inability to move limb
• Are they in pain
• Bleeding
• Snap crackle pop of bones

Tranferring

• Only clients that can fully support themselves
• Position the wheelchair or place where you are going
• Have clear path
• You Must known the clients ability

Stand and pivots

• The client has to be fully able to stand

Seating arrangements

• You must always make note of where they are moving
• You must have the place on the side where they are dangling
• Place on the stronger of the bodie

Tranfer

• Has client wear correct foot wear
• In transferring, the strong side moves first
• Remember: Transferring back to bed has the same rules as
• transferring to chair
• Mechanical lifts are the most effective way to reduce work place injury to caregivers

Tranfer Lifts

• Can not help then selves
• Are too hard for staff
• No lift policy, so no manual labor is needed
• Policy states there can only be two lifts done