Types of Exercises

Basic Interventions to Maintain Healthy Lifestyle

• The basic interventions includes mobility and exercise, hygiene and comfort, safety, security, and privacy, and psychosocial and spiritual concerns.

Activity and Exercise: Types of exercise

• Isometric exercise refers to strength training where the muscle contracts without changing length, engaging static muscles and producing tension without movement, e.g., plank, wall sit, static squat hold.
• Isotonic exercise involves muscle contraction where the muscle changes length while maintaining constant tension, e.g., push-ups, weightlifting, squats.
• Isokinetic exercise is a strength training type with constant muscle contraction speed and variable resistance, often using machines, e.g., Stationary cycling, treadmill walking/running.
• Aerobic exercise is an activity where the body takes in more oxygen than it uses to perform the activity, using large muscle groups in continuous, rhythmic movements, e.g., swimming, cycling, walking, and rowing.
• Anaerobic exercise occurs when muscles cannot extract enough oxygen from blood, using the anaerobic pathway to provide additional energy for a short time, relying on stored glucose for quick energy, e.g., sprinting, jumping, and heavy weight lifting.

Body Mechanics

• Refers to the proper use of the body to perform tasks efficiently and safely, reducing the risk of injury, especially to the muscles and spine.
• Maintain a stable base of support by keeping feet shoulder-width apart to maintain balance.
• Maintain good body mechanics by bending at the hips and knees when lifting objects to protect the back.
• Support body mechanics by holding objects near the center of gravity.
• Use leg muscles, not the back, when lifting heavy objects.
• Avoid twisting the spine and turn the whole body.
• Body mechanic considerations include pushing rather than pulling.
• To facilitate safe handling of clients, use assistive devices like mechanical lifts, transfer belts, or wheelchairs when needed.
• Proper posture should be maintained by keeping the back straight, shoulders relaxed, and head aligned.
• When lifting a patient, bend at the knees, keep your back straight, and use your legs to lift.
• When transferring a patient from bed to chair, use a gait belt and pivot instead of twisting the body.
• When repositioning a bedridden patient, use a draw sheet and work with a team member to avoid injury.
• Shift weight between feet and use anti-fatigue mats if possible when standing for long hours.

Positioning

• A supine position means lying horizontally with the face and torso facing up.
• Sims' position means lying on the left side with the right knee and thigh drawn up and the left arm along the back.
• A prone position means lying flat with the chest down and the back up
• Dorsal recumbent means lying on the back with the knees flexed and feet flat on the surface.
• Lithotomy position means lying on the back with hips and knees flexed and thighs apart
• Trendelenburg position the body is laid flat on the back on a 15-30 degree incline with the head lower than the feet
• Reverse Trendelenburg's position is where the body is laid flat on the back on a 15-30 degree incline with the head higher than the feet
• Modified Trendelenburg's position is lying supine with the legs elevated at a 20 degree angle
• Knee-chest position in which the patient is resting on the knees and the chest
• When sitting the body is upright supported by the buttock and back

When to Use Specific Positions

• Trendelenburg is used for postural drainage and to promote venous return.
• Lithotomy is used for vaginal and rectal examinations and procedures.
• Knee chest can be used during rectal procedures and examination.
• Dorsal recumbent is used for vaginal examination
• Semi-Fowler's/Fowler's helps clients with breathing difficulty and improves cardiac output.
• Sims (Side-lying) is helpful for clients who have pressure sores on bony prominences of the back and sacrum.
• Supine is for clients on bedrest, post-spinal injury & anesthesia.
• Sitting can be used to assess head, neck, posterior and anterior thorax, and lungs.
• Prone is an alternate position for immobilized patients.

When to Avoid Positions

• Trendelenburg, avoid with increased intracranial pressure, or if hypotension is suspected.
• Knee chest is contraindicated for those with arthritis or other joint deformity.
• Semi-Fowler's/Fowler's is contraindicated post spine surgery patients.
• Sims (Side-lying) is contraindicated with clients post hip replacement, spine, or orthopedic conditions.
• Supine is contraindicated with clients with dyspnea (shortness of breath) or at risk for aspiration.
• When the client is elderly and weak sitting is contraindicated
• When a patient has post abdominal surgery, or respiratory or spinal problems, prone position is contraindicated

Factors Influencing Hygiene: Social Practices

• Social practices impact choice of hygiene products and the frequency of personal care routines from family customs and media.

Factors Influencing Hygiene: Personal Preferences and Body Image

• Personal preferences determine how and when hygiene and grooming care is performed.
• A person's body image impacts hygiene practices

Factors Influencing Hygiene: Socioeconomic Status and Cultural Variables

• Socioeconomic status and cultural variables influence the type and extent of hygiene practices.
• Economic status affects the ability to regularly maintain hygiene.

Common Skin Problems: Abrasions

• Abrasions involve superficial layers of skin scraped or rubbed away, resulting in reddened areas with localized bleeding or serous weeping.
• Wounds should be kept clean and dry due to the risk of infection.
• When providing care to clients, avoid wearing rings or jewelery to prevent causing abrasions.
• Position or lift a client to avoid pulling the client across a bed.

Common Skin Problems: Dry Skin

• Dry skin can appear flaky and rough, and is prone to infection if the skin cracks.
• Using alcohol-free lotions can provide moisture to the skin and prevent cracking
• Limit bathing frequency use nonirritating soap and rinse thoroughly since soap can cause irritation
• Increase patient's fluid intake to prevent dehydration, if their health permits.

Common Skin Problems: Erythema

• Erythema presents as redness associated with conditions like rashes, sun exposure, and elevated body temperature.
• Take care to wash the infected area to remove excess microorganisms.
• Apply antiseptic spray or lotion to prevent itching, promote healing, and prevent skin breakdown.

Common Skin Problems: Hirsutism

• Hirsutism is excessive hair on a person's body and face, particularly in women.
• Remove unwanted hair by using depilatories, shaving, electrolysis, or tweezing.

Bathing

• Bathing removes accumulated oil, perspiration, dead skin cells, and some bacteria, but excessive bathing may cause skin dryness, and bathing stimulates circulation.

Types of Baths

• A complete bed bath is provided for a totally dependent patient in bed.
• A partial bed bath involves bathing only body parts causing discomfort if left unbathed, such as the hands, face, axilla, and perineal area.
• Sponge bath at the sink involves bathing from a bath basin or sink with the patient sitting in a chair, and the nurse helps with hard-to-reach areas.
• Shower involves patient sits or stands under a continuous stream of water and provides more thorough cleaning than a bed bath but can be tiring.

Ear Care

• Cleanse the pinna with a moist wash cloth.
• Visible cerumen can be removed by retracting the ears downward.
• To prevent damage, do not use bobby pins, toothpicks, or cotton-tipped applicators to remove cerumen

Eye Care

• Cleanse the eyes from the inner cantus to the outer cantus. Use a new cotton ball for each wipe.
• When patients are comatose, cover the eyes with sterile moist compresses to prevent dryness and irritation of the cornea.
• Clean eyeglasses with warm water and soap, and dry with soft tissue.
• Clean contact lenses as directed by the manufacturer.
• When removing artificial eyes, use clean gloves and depress the client's lower eyelid.
• Avoid rubbing the eyes to prevent infection and irritation.
• Maintain adequate lighting when reading.
• Avoid regular use of eye drops.

Hygiene: Nursing Interventions for Unconscious Patients

• To ensure safety and prevent complications for unconscious patients, place on the side, where aspiration is avoided.
• Always ensure suction apparatus is accessible.
• Use a padded tongue blade to help open the mouth.
• Ensure to brush teeth using a soft sponge.
• Applying thin layer of petroleum jelly to lips to prevent drying/cracking.

Care of Artificial Dentures

• Wear gloves when handling and cleaning dentures to ensure proper safety.
• When brushing dentures place a washcloth in a basin or bowl to avoid damage if the dentures are dropped.
• Store the dentures in container full of water.

Common Problems of the Mouth

• Plaque refers to an invisible soft film of bacteria, saliva, epithelial cells, and leukocytes adhering to the enamel surface of the teeth.
• Tartar is a visible, hard deposit of plaque and bacteria that forms at the gum lines.
• Halitosis refers to bad breath
• Glossitis refers to inflammation of the tongue.
• Gingivitis refers to inflammation of the gums.
• Stomatitis refers to inflammation and dryness of oral mucosa.
• Cheilosis refers to cracking of the lips.

Hair Shampoo

• Hair shampoo stimulates the circulation of the blood in the scalp through massage.
• Hair shampoo cleans the hair and to improve the client's sense of well-being

Foot Care: Nursing Interventions

• Wash the feet daily, and dry them well, especially the interdigital spaces.
• To moisten the skin and soften calluses, use cream or lotions.
• Use foot powder or deodorant spray to control unpleasant odor.
• Change socks daily.
• Always wear comfortable, well-fitted shoes.
• Do not go barefoot.
• Exercise to improve circulation.
• Avoid crossing legs.

Nail Care: Nursing Interventions

• When attending to nail care, trim nails straight across or follow the contour of the fingers.
• Smooth edges of nails by filing
• When attending to diabetic client, avoid cutting hangnails or cuticles to avoid risk of infection.

Perineal-Genital Care

• Remove secretions and odors.
• Prevent infection.
• Promote comfort.
• Position patients appropriately, use Dorsal recumbent for females and Supine for males.

Safety, Security, and Privacy: Falls

• Falls are the leading cause of injury, especially among older adults to whom patient safety is of top priority.

Factors that Contribute to Falls

• Falls become more common as one ages past 65,
• Falls are common for patients with a history of prior falls.
• Impaired vision or balance can contribute to falls.
• Changes in gait or posture, such as impaired mobility, can be factors.
• Medication regimens and postural hypotension can contribute to falls in patients.
• Confusion, disorientation, and being in an unfamiliar environment can cause falls.

Safety Interventions

• Ensure proper lighting, remove clutter, and secure loose rugs or cords to prevent slips.
• Encourage the use of assistive devices such as walkers, canes, and grab bars in the bathroom.
• Keep the bed in a low position, brakes locked, and side rails up as needed.
• Make sure the call light and personal items are within reach.

Safety Considerations for Infants

• Safety considerations for infants include avoiding behaviors that might harm the infant
• It is imperative to never leave the infant unattended
• It is important to use crib rails
• Monitor settings for objects that are choking hazards
• Use car seats properly
• Rear-facing safety seat placed in the backseat, preferably in the middle, is recommended for infants younger than 1 year and weighing less than 20 lbs, follow manufacturer's recommendations.

Safety Considerations for Toddlers

• Prevent poisoning.
• Be alert to manifestations of child abuse.
• Nearly ½ of all drowning victims are younger than 5 years old.

Safety Considerations for School Aged Children

• Help to avoid potentially dangerous activities
• Teach bicycle and water safety.
• Teach about child abduction
• Wear sear belts
• Teach about internet safety

Safety Considerations for Adolescents

• Teach safe driving skills
• Teach avoidance of tobacco and alcohol
• Teach risk of infection with body piercing
• Teach about internet safety
• 82% of homicide victims between the ages of 10 and 24 are killed with a firearm.

Safety Considerations for Adults

• Remind them of effects of stress on lifestyle and health
• Counsel about unsafe health habits (reliance on drugs and alcohol)
• Counsel about domestic violence

Safety Considerations for Older Adults

• Prevent accidents.
• Orient them to surroundings (avoid falls).
• Schedule eye exams and keep noise at a minimum
• Promote a safe environment at home (avoid fires).
• Use medication trays (avoid poisoning)

Fires

• Nurses are responsible for maintaining a safe environment by identifying risks and implementing fire prevention strategies.
• Emergency preparation should include smoke alarms and fire safety, and maintaining emergency numbers near the telephone.

Preventing Home Fires

• Teach fire safety.
• Keep emergency numbers near the telephone, or stored for speed dialing
• Make sure smoke alarms are operable and appropriately located
• Teach to change batteries in smoke alarms annually on a special day
• Participate in a family fire drill
• Make sure fire extinguishers are available and in working order

Fire Safety Protocols: RACE

• Rescue: Move patients from immediate danger
• Alarm: Activate the fire alarm system
• Contain: Close doors to prevent fire spread
• Extinguish or Evacuate: Use fire extinguishers if safe or evacuate the area

Use of Fire Extinguishers: PASS

• Twist the pin
• Pull the pin.
• Aim the nozzle
• Squeeze the handle
• Sweep at the base of the fire.

Safety, Security, and Privacy: Seizure Precautions

• A seizure is a sudden, uncontrolled electrical disturbance in the brain that can cause changes in behavior, movement, feelings, or level of consciousness.

Safety During Ongoing Seizure

• Call for help or activate the Rapid Response Team if needed.
• Note the time when the seizure starts.
• status epilepticus is defined as a seizure lasting longer than 5 minutes, requires immediate intervention to prevent brain damage.
• Lower the patient to a flat surface or bed if not already lying down.
• Turn the patient on their side to prevent aspiration.
• Loosen clothing around the neck.
• Remove nearby objects to avoid injury.
• Do NOT restrain the patient or force them to stop moving.
• Place a soft item like a folded towel or pillow under the head
• Do not put anything in the mouth (no spoon, no fingers, no water).
• Do not give food, drink, or medications orally during the seizure
• Do not leave the patient alone.

Safety, Security, and Privacy: Restraints

• Restraints are any devices or interventions used to limit a person's movement or restrict their freedom of movement, typically for medical, safety, or behavioral reasons.
• Check client's circulation frequently.
• Check every 15 minutes and release every 2 hours to toilet and check for skin integrity.
• Do not tie restraints in a complete knot.
• Do not tie to side rails (tie to bed frame).
• Informed consent from the patient or legal guardian is required unless the patient is unconscious or incapacitated.
• Restraints should only be used as a last resort after less restrictive methods have been tried.
• Proper documentation is necessary for legal and ethical purposes Restraints should be used for the shortest time possible and only when absolutely necessary to ensure patient safety or prevent harm.

Psychosocial and Spiritual Concerns: Coping, Grieving, and Death

• Loss is the experience of having something important taken away or no longer available.
• Bereavement is the period of time after a person has lost someone significant, especially due to death, encompassing emotional, physical, and psychological reactions to this loss.
• Grief involves emotional suffering and sadness experienced as a result of bereavement or loss, manifesting in forms like sadness, anger, guilt, and confusion.
• Mourning is the external expression of grief, influenced by cultural, social, or religious practices.

Stages of Death & Dying (Kubler Ross)

• Denial: The individual refuses to accept the reality of the situation, feeling numb or in shock.
• Anger: The individual becomes frustrated, especially at proximate individuals or the situation, and may feel resentful.
• Bargaining: The individual tries to make deals or bargains in hopes of reversing or postponing the death.
• Depression: The individual despairs at the recognition of their mortality, often withdrawing and feeling helpless.
• Acceptance: The individual comes to terms with their impending death and reaches a sense of peace.

Crisis Intervention

• A crisis refers to a situation or event that causes significant distress or disruption, often overwhelming an individual's ability to cope with or resolve it.
• Normal coping mechanisms may no longer be effective, requiring intervention or support.

Types of Crisis

• Maturational crisis occurs as individuals face developmental milestones or life transitions that challenge their emotional, psychological, or social well-being, and is expected and predictable, e.g., marriage, death due to old age, parenthood, retirement.
• Situational crisis is triggered by an unexpected, traumatic event or life change that disrupts an individual's sense of security and normal functioning, e.g., job loss, unwanted pregnancy, divorce/annulment.
• Adventitious crisis are rare and unexpected events that occur outside the individual's control, e.g., Terrorist Attacks, Mass Casualties (typhoon, earthquake), Pandemics.