Activity and Exercise - Nursing Lecture Notes PDF

Activity and exercise Prepared By Mr. Khaled Metwaly Lecturer-Nursing program  Objectives At the end of this lecture the students will know :  Definition of exercise, Key characteristics of exercise and types of exercise.  Definition and types of physical acti...

Activity and exercise Prepared By Mr. Khaled Metwaly Lecturer-Nursing program  Objectives At the end of this lecture the students will know :  Definition of exercise, Key characteristics of exercise and types of exercise.  Definition and types of physical activity.  Factors affecting patient’s movement.  Barriers to patient’s movement.  Methodes to overcome Barriers of patient’s movement.  Benefits of activity and exercise.  Some common movement disorder and their causes.  Diagnostic test for movement disorder.  Walking assistive device.  Common Patient’s Positions in the hospital.  ROM , definition , types and importance.  The Role of the Nurse in Promoting Physical Activity.  Nursing care plan for immobility  Outlines  Definition, Key characteristics and types of exercise.  Definition and types of physical activity.  Factors affecting patient’s movement.  Barriers to patient’s movement.  Methodes to overcome Barriers of patient’s movement.  Benefits of activity and exercise.  Some common movement disorder and their causes.  Diagnostic test for movement disorder.  Walking assistive device.  Common Patient’s Positions in the hospital.  ROM , definition , types and importance.  The Role of the Nurse in Promoting Physical Activity.  Nursing care plan for immobility   Definition of exercise Exercise is a planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness. It's a subset of physical activity that is specifically designed to achieve a particular objective, such as improving cardiovascular health, increasing muscle strength, or enhancing flexibility. Key Characteristics of Exercise: Planned: Exercise is not spontaneous; it requires intention and forethought. Structured: It involves a specific set of movements or activities performed in a particular order or pattern. Repetitive: Exercise typically involves repeated bouts of physical activity over time to achieve and maintain fitness gains.  Types of exercise Aerobic exercise: This type of exercise increases your heart rate and breathing rate, and helps improve your cardiovascular health. Examples include brisk walking, jogging, swimming, cycling, and dancing. Strength training: This type of exercise helps build and maintain muscle mass, which can help improve your balance, coordination, and bone density. Examples include lifting weights, using resistance bands, and doing bodyweight exercises such as push-ups and squats. Flexibility exercises: This type of exercise helps improve your range of motion and flexibility, which can help reduce your risk of injury and improve your posture. Examples include yoga, Pilates, and stretching. Balance exercises: This type of exercise helps improve your balance and coordination, which can help reduce your risk of falls. Examples include tai chi, yoga, and standing on one leg.  Definition of Physical Activity Physical activity encompasses any bodily movement produced by skeletal muscles that results in energy consuming. It's a broad term that includes activities like walking, gardening, dancing, playing sports, and even fidgeting.  Types of Physical Activity 1.Occupational: Physical activity performed during work, such as manual labor, construction, or farming. 2.Transportation: Physical activity related to commuting, such as walking, cycling, or using public transportation. 3.Household and Gardening: Physical activity performed during household activities , gardening.. 4.Leisure-Time Physical Activity: Physical activity undertaken during free time, such as sports, recreational activities, and hobbies..  Factors Affecting a Patient's Movement 1.Medical Conditions: Neurological Disorders: Conditions like stroke, Parkinson's disease, multiple sclerosis, and spinal cord injuries can significantly affect motor function, coordination, balance, and muscle strength. Musculoskeletal Disorders: Arthritis, osteoporosis, muscle injuries, and joint problems can limit range of motion and cause pain during movement. Cardiovascular Conditions: Heart disease and respiratory problems can reduce endurance and limit the ability to engage in physical activity.  CONT Factors Affecting a Patient's Movement 2.Physical Factors: Age: Aging can lead to natural declines in muscle mass, bone density, and joint flexibility, affecting movement. Weight: Excess weight can put additional stress on joints and muscles, making movement more difficult. Physical Fitness Level: A sedentary lifestyle can lead to muscle weakness and decreased endurance, impacting movement.  CONT.. Factors Affecting a Patient's Movement 3.Environmental Factors: Accessibility: Physical barriers in the environment, such as stairs, and uneven surfaces can limit mobility. Safety: Concerns about falls or other injuries can discourage movement, especially in older adults. Climate: Extreme temperatures or weather conditions can make it difficult to engage in outdoor activities.  CONT.. Factors Affecting a Patient's Movement 4.Psychological Factors: Pain Perception: How a patient perceives pain can influence their willingness to move. Motivation: Lack of motivation or interest in physical activity can hinder movement. Fear of Falling: This can be a significant barrier to movement, especially in older adults. 5.Social Factors: Social Support: Having a support system can encourage physical activity and provide assistance with movement. Access to Resources: Access to healthcare providers, physical therapists, and  Barriers to Patient’s Movement Patients in healthcare settings face numerous barriers to movement, impacting their recovery and overall well-being. These barriers can be categorized as follows: 1.Patient-Related Barriers: Pain: Acute or chronic pain can significantly limit a patient's willingness and ability to move. Fear of Falling: This is particularly prevalent in older adults and can lead to avoidance of movement. Fatigue: Illness and treatments can cause fatigue, reducing a patient's motivation and energy for physical activity. Lack of Motivation: Patients may lack the motivation or understanding of the benefits of early mobility. Cognitive Impairment: Cognitive decline can affect a patient's ability to  Cont.. Barriers to Patient Movement 2.Healthcare Provider-Related Barriers: Time Constraints: Busy schedules and staffing shortages can limit the time available for mobility interventions. Lack of Knowledge or Training: Some healthcare providers may lack the knowledge or training necessary to effectively implement early mobility protocols. Concerns about Patient Safety: Concerns about potential complications, such as falls or hemodynamic instability, can deter providers from encouraging early  Cont.. Barriers to Patient’s Movement 3.Environmental Barriers: Physical Limitations of the Hospital Environment: Limited space, cluttered environments, and lack of appropriate equipment can hinder movement. Lack of Accessibility: Physical barriers such as stairs, narrow hallways, and heavy doors can make it difficult for patients with mobility limitations to navigate the hospital. 4.System-Related Barriers: Lack of Clear Protocols: The absence of clear guidelines and protocols for early mobility can lead to inconsistent implementation. Lack of Interdisciplinary Collaboration: Poor communication and  Methodes for Overcoming Barriers to Patient Movement Pain Management: Effective pain management strategies are essential to reduce pain and encourage movement. Early Mobility Protocols: Implementing standardized early mobility protocols can ensure consistent and timely interventions. Multidisciplinary Collaboration: Fostering collaboration among physicians, nurses, physical therapists, and other healthcare providers can improve the coordination of care and enhance patient outcomes. Methodes for Overcoming Barriers to Patient Movement Patient Education: Educating patients about the benefits of early mobility and addressing their concerns can increase their motivation and participation. Creating a Supportive Environment: Modifying the hospital environment to be more patient-friendly, such as providing wider hallways and accessible equipment, can facilitate movement. Addressing Staff Concerns: Providing adequate training and support to healthcare providers can address their concerns and improve their confidence in implementing early mobility programs.  Benefits of activity and exercise Physical Benefits: Improved Cardiovascular Health: Reduced risk of heart disease, stroke, and high blood pressure: Regular exercise strengthens the heart, improves blood flow, and lowers blood pressure. Increased cardiovascular fitness: Exercise improves the efficiency of the heart and lungs, allowing you to perform physical activities with less effort. Increased Muscle Strength and Endurance: Improved muscle mass and bone density: Strength training helps build and maintain muscle mass, which is crucial for overall health and preventing age-related muscle loss. Enhanced daily functioning: Stronger muscles make everyday activities  Physical Benefits: Weight Management: Calorie burning: Exercise helps burn calories, which can aid in weight loss or weight maintenance. Improved metabolism: Regular physical activity can boost your metabolism, helping your body burn more calories even at rest. Stronger Bones: Reduced risk of osteoporosis: Weight-bearing exercises, such as walking, jogging, and dancing, help strengthen bones and reduce the risk of fractures. Reduced Risk of Chronic Diseases: Type 2 diabetes: Exercise improves insulin sensitivity, helping your body regulate blood sugar levels. Certain types of cancer: Regular physical activity may reduce the risk of Mental Benefits:  Stress Reduction: Exercise can help reduce stress levels by releasing endorphins, natural mood boosters.  Improved Mood: Physical activity can help alleviate symptoms of depression and anxiety.  Enhanced Cognitive Function: Exercise can improve brain function, memory, and cognitive skills.  Better Sleep Quality: Regular physical activity can improve sleep quality and help you fall asleep more easily. Social Benefits:  Increased Social Interaction: Group exercise classes, team sports, and other social activities can provide opportunities for social interaction and community building.  Sense of Accomplishment: Achieving fitness goals can boost self-esteem and provide a sense of accomplishment.  Some common movement disorders Chorea. Chorea causes brief, irregular, somewhat rapid, involuntary movements that happen over and over. Ataxia. Ataxia affects the part of the brain that controls coordinated movement. Ataxia may cause clumsy movements of the arms and legs, and a loss of balance Dystonia. This condition involves involuntary muscle contractions that cause twisting, irregular postures, or movements that occur again and again. Dystonia may affect the entire body or one part of the body. Tremor. This movement disorder causes rhythmic shaking of parts of the body, such as the hands, head or other body parts. The most common type is essential tremor.  Causes of movement disorder A wide variety of factors can cause movement disorders, including: Genetics. Some types of movement disorders can be caused by an altered gene. The altered gene is passed down from a parent to a child. This is called an inherited condition. Huntington's disease and Wilson's disease are two movement disorders that can be inherited. Medicines. Medicines such as anti-seizure and anti-psychotic medicines can lead to movement disorders. Illegal drugs or large amounts of alcohol. Illegal drugs such as cocaine can cause movement disorders such as chorea. Drinking large amounts of alcohol can cause chorea or ataxia.  Cont.. Causes of movement disorder Not getting enough of certain vitamins. Having low levels of certain vitamins in the body, known as a vitamin deficiency, can cause movement disorders. A deficiency in vitamin B-1, vitamin B-12 or vitamin E can lead to ataxia. Medical conditions. Thyroid conditions, multiple sclerosis, stroke, viral encephalitis and several others can cause movement disorders. Brain tumors also can lead to movement disorders. Head injury. Head trauma from an injury can lead to movement disorders  Diagnostic tests of movement disorder  Blood tests to help diagnose certain kinds of movement disorders or rule out other causes.  Electromyography (EMG) to assess the health of your muscles and the nerves that control them.  Electroencephalogram (EEG) to check the electrical activity of your brain.  Lumbar puncture to analyze your cerebrospinal fluid.  Muscle biopsy to distinguish between nerve and muscle conditions.  Nerve conduction study to measure the flow of electrical current through a nerve before it reaches a muscle.  Walking assistive devices Walking assistive devices are tools that help people with mobility challenges to walk more safely and independently such as  Cane  Walker  Crutches  Gait belt  Common Patient’s Positions in the hospital 1.Supine Position: Patient lies flat on their back with face upward. Used for: Rest, examinations, surgeries on the chest and abdomen. 2.Prone Position: Patient lies on their stomach with face downward. Used for: Surgeries on the back, preventing aspiration, promoting lung drainage. 3.Fowler's Position: Patient is positioned with the head of the bed raised at a 45- degree angle. Used for: Improving breathing, reducing pressure on the sacrum, promoting comfort. 4.Semi-Fowler's Position: Cont Common Patient’s Positions in the hospital 5.Lateral Position: Patient lies on their side. Used for: Preventing pressure ulcers, promoting lung drainage, facilitating access to one side of the body. 6.Sims' Position: Patient lies on their left side with the right knee and thigh flexed. Used for: Rectal examinations, enemas, facilitating childbirth. 7.Trendelenburg Position: Patient is positioned with the head lower than the feet.  Range of motion (ROM) Range of motion (ROM) refers to the extent or limit to which a part of the body can be moved around a joint or a fixed point. Types of ROM: 1.Active Range of Motion (AROM): The patient moves the joint independently, using their own muscles. 2.Passive Range of Motion (PROM): A healthcare professional or caregiver moves the joint for the patient. 3.Active-Assisted Range of Motion (AAROM):  Importance of range of motion exercise Prevents Complications: Regular ROM exercises help prevent complications like contractures, muscle atrophy, and stiffness. Promotes Healing: Improved circulation and reduced stiffness can facilitate healing and recovery. Maintains Function: Maintaining ROM helps patients regain independence in performing activities of daily living. Reduces Pain: In some cases, gentle ROM exercises can help reduce pain and discomfort.  The Role of the Nurse in Promoting Physical Activity. Assessment: Assess patient's current activity level, barriers to exercise, and readiness to change. Identify any medical conditions that may limit physical activity. Planning: Develop individualized exercise plans based on patient's needs, preferences, and abilities. Set realistic and achievable goals with the patient. Implementation: Provide education and support to patients about the benefits of exercise and how to incorporate it into their daily lives. Assist patients in overcoming barriers to exercise. Monitor patient progress and make adjustments to the exercise plan as needed. Evaluation: Evaluate the effectiveness of the exercise plan and make necessary  Nursing Care Plan for patient with impaired mobility Assessment Subjective Data: Patient's complaints of weakness, fatigue, dizziness, or pain. Patient's perception of their limitations due to immobility. Patient's and family's understanding of the need for activity.  Objective Data: Musculoskeletal: Decreased muscle strength, decreased range of motion, contractures, muscle atrophy, decreased bone density. Cardiovascular: Decreased cardiac output, orthostatic hypotension, increased risk of thrombus formation. Respiratory: Decreased lung expansion, atelectasis, pneumonia, increased risk of respiratory infections. Integumentary: skin breakdown, dry skin. Gastrointestinal: Constipation, decreased appetite, decreased bowel sounds. Urinary: Urinary stasis, urinary tract infections, incontinence. Psychosocial: Depression, anxiety, social isolation, decreased Nursing Diagnoses Risk for Impaired Skin Integrity related to decreased mobility and pressure. Risk for Impaired Physical Mobility related to decreased muscle strength and endurance. Risk for Constipation related to decreased physical activity and changes in dietary intake. Risk for Disuse Syndrome related to prolonged immobility. Risk for fall and injury related to falls and unsteady gait. Planning Expected Outcomes : Maintain skin integrity free of pressure ulcers. Increase range of motion in affected joints. Prevent complications of immobility, such as deep vein thrombosis (DVT) and pneumonia. Improve bowel function. Maintain adequate hydration and nutrition.. Interventions Preventative Measures: Skin Care: Reposition patient every 1-2 hours. Use pressure-relieving devices (e.g., air mattresses, specialty cushions). Inspect skin for signs of redness or breakdown. Maintain good skin hygiene. Provide adequate nutrition and hydration.  Cardiovascular: Encourage early mobilization as tolerated. Apply graduated compression stockings. Administer anticoagulant therapy as prescribed. Respiratory: Encourage deep breathing and coughing exercises. Use incentive spirometry. Assist with suctioning as needed. Musculoskeletal: Perform range-of-motion exercises. Encourage active and passive exercises. Provide support for weak limbs during movement.  Gastrointestinal: Monitor bowel movements. Encourage adequate fluid intake. Provide high-fiber diet. Administer stool softeners or laxatives as prescribed.  Urinary: Monitor intake and output. Assist with toileting as needed. Encourage adequate fluid intake. Consider use of urinary catheters if necessary. Psychosocial: Provide emotional support and encouragement. Encourage social interaction. Refer to social services or support groups as needed. Evaluation Monitor patient's skin integrity for signs of improvement or deterioration. Assess patient's ability to perform ADLs. Evaluate patient's response to interventions. Reassess and adjust the care plan as needed based on patient's progress. References: American College of Sports Medicine. (2022). ACSM's guidelines for exercise testing and prescription. Wolters Kluwer. American Diabetes Association. (2023). 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Disuse Atrophy Results in Rapid Losses in Skeletal Muscle Mass, Strength, and Power. Journal of the American Medical Directors Association. 2013;14(5):359-368.  Dishman, R. K. (2000). Advances in exercise adherence research. Quest, 52(2), 162-187. Ekelund, U., et al. (2012). Physical activity and health: An epidemiological perspective. International Journal of Epidemiology, 41(4), 991-1007. Ainsworth, B. E., et al. (2011). 2011 Compendium of Physical Activities: A second update of codes and MET values. Medicine & Science 1 in Sports & Exercise, 43(8), 1575-1581. 2 National Institute on Aging. (2023). Physical activity and health. [Online]. Available from: https://www.nia.nih.gov/ National Institutes of Health (NIH): https://www.nia.nih.gov/health/exercise-and-physical-activity American Heart Association (AHA): https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs- for-physical-activity-in-adults Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/physical-activity-basics/guidelines/adults.html Early Mobility in Critically Ill Adults: A Consensus Statement. American College of Chest Physicians. Retrieved from: [invalid URL removed] Kortebein P, et al. Disuse Atrophy Results in Rapid Losses in Skeletal Muscle Mass, Strength, and Power. Journal of the American Medical Directors Association. 2013;14(5):359-368.