UNIT 2. ACTIVITY AND EXERCISE -yaya.docx

UNIT 2. ACTIVITY AND EXERCISE ============================= (Promoting physiologic health) ------------------------------ 1. Describe four basic elements of normal movement. 2. Differentiate isotonic, isometric, isokinetic, aerobic, and anaerobic exercise. 3. Identify the effects of exerc...

UNIT 2. ACTIVITY AND EXERCISE ============================= (Promoting physiologic health) ------------------------------ 1. Describe four basic elements of normal movement. 2. Differentiate isotonic, isometric, isokinetic, aerobic, and anaerobic exercise. 3. Identify the effects of exercise and immobility on body systems. 4. Identify factors influencing a person's body alignment and activity. 5. Assess activity-exercise pattern, body alignment, gait, appearance and movement of joints, mobility capabilities and limitations, muscle mass and strength, activity tolerance, and problems related to immobility. 6. Develop nursing diagnoses and outcomes related to activity, exercise, and mobility problems. 7. Apply safe practices when positioning, moving, transferring, and ambulating clients. 8. Differentiate active, passive, and active-assistive range-of-motion (ROM) exercises. 9. Describe client teaching for clients who use mechanical aids for walking. 10. Verbalize and perform the following steps used in: i. Moving a client up in bed. ii. Turning a client to the lateral or prone position in bed. iii. Logrolling a client. iv. Assisting a client to sit on the side of the bed. v. Transferring between bed and chair. vi. Transferring between bed and stretcher. vii. Assisting a client to ambulate. 11. Recognize when it is appropriate to delegate aspects of moving, transferring, and ambulating a client to unlicensed assistive personnel. 12. Demonstrate appropriate documentation and reporting of moving, transferring, and ambulating a client. INTRODUCTION ============ B. NORMAL MOVEMENT =============== 1. Alignment and Posture --------------------- i. Line of gravity ii. Center of gravity iii. Base of support 2. Selected Joint Movement (ADL) - Refer Table 44-2; pg : 1039 -- 1042   3. Nutrition iv. Undernutrition & overnutrition v. Vit. D deficiency 4. Personal values and attitudes vi. Sedentary life style vii. Influence -Family , friends 5. External factors viii. Climate ix. Financial x. Health states 6. Prescribed Limitations xi. RIB xii. CRIB EXERCISE ======== a. Functional strength --ability -- perform work b. Activity tolerance -- ability -- ADL without --adverse effects 7. Type of exercise ---------------- xiii. Isotonic (dynamic) exercises - Muscle shortens --produce muscle contraction and active movement xiv. Isometric (static or setting) exercises - Muscle contraction occurs without moving -- joint - Eg; strengthening abdominal, gluteal, quadriceps muscle. xv. Isokinetic (resistive) exercises - Involve muscle contraction / tension against resistance. 8. Benefits of exercise -------------------- xvi. Musculoskeletal system - Maintain the size, shape, tone and strength (including hear muscle) - Joints lack a discrete blood supply - Maintain bone density & strength xvii. Cardiovascular system - Lowering systolic diastolic blood pressure - Improved oxygen uptake - Improved heart rate variability - Improved circulation - Self-reported stress reduction xviii. Respiratory system - Improving gas exchange - More toxins eliminate - Emotional stable -- increase o2 in brain - Improving stamina n immune function xix. Gastrointestinal system - Improve appetite - Increase gastrointestinal tone - Improve irritable bowel syndrome/digestive disorder xx. Metabolic / endocrine system - Increase production of body heat - Increase waste products n calorie use - Stabilize blood sugar xxi. Urinary system - Efficient blood flow - Body excretes waste more effective - Prevent stasis - Prevent UTI xxii. Immune system - Circulation through lymph node improved - Enhance immunity viii\. Psychoneurologic System - Elevate mood - Relieve stress ix. Cognitive Function - Positive effects decision making, problem solving, planning and paying attention - Improve mood, learning, problem solving and performance individuals x. Spiritual Health - Improve the mind-spirit connection - Improve relationship with God - Improve physical well being  D. EFFECTS OF IMMOBILITY ===================== 9. Musculoskeletal System xxiii. Osteoporosis xxiv. Atrophy xxv. Contracture xxvi. Foot drop xxvii. Ankylosed- joint permenantly immobile 10. Cardiovascular System xxviii. Diminished cardiac reserve xxix. Valsalva maneuver- breathing technique that can be used to unclog ears, restore heart rhythm or diagnose an autonomic nervous system (ANS) xxx. Orthostatic hypotension- a form of low blood pressure that happens when standing after sitting or lying down xxxi. Venous vasodilation and stasis- your veins can\'t send the blood from your legs back to your heart xxxii. Dependent edema- excess fluid influenced by gravity, such as your legs, feet, or arms xxxiii. Thrombus formation -- thrombophlebitis- a condition that causes a blood clot to form and block one or more veins, often in the legs xxxiv. Thrombus- blood clot in vein xxxv. Embolus- a particle or mass that flows through the bloodstream 11. Respiratory system xxxvi. Decreased respiratory movement xxxvii. Pooling of respiratory secretions- infection or aspiration, or by pooling of normal oropharyngeal secretions in a patient who is weak or unable to swallow or cough effectively (for instance in motor neurone disease) or who has a reduced state of consciousness. xxxviii. Atelectasis- the collapse of part or all of a lung xxxix. Hypostatic pneumonia- a slow-developing chronic pulmonary disorder 12. Metabolic System xl. Decreased metabolic rate xli. Negative nitrogen balance xlii. Anorexia xliii. Negative calcium balance 13. Urinary system xliv. Urinary stasis- the stopping of urine. But it doesn\'t always mean you can\'t urinate at all/trouble initiating the flow of urine xlv. Renal calculi- kidney stone xlvi. Urinary retention- you can\'t completely empty your bladder xlvii. "Dribbling" of urine- urine pass out uncontrolly xlviii. Urinary infection xlix. Urinary reflux- condition in which urine flows backward from the bladder to one or both ureters and sometimes to the kidneys 14. Gastrointestinal System l. Constipation- condition in which a person has uncomfortable or infrequent bowel movements 15. Integumentary System li. Reduced skin turgor lii. Skin breakdown 16. Psychoneurologic System liii. Decrease endorphins- helping with stress and anxiety E. NURSING MANAGEMENT ================== 17. Assessing liv. Nursing History ( refer Table assessment Interview) lv. Physical Examination : focusing on activity n exercise patterns. Assessment of body alignment, gait, appearance, movement of joints, capabilities and limitations for movement, muscle mass and muscle strength, activity tolerance and problem related to immobility lvi. Purpose of Body Alignment - Normal developmental variations in posture - Posture n learning needs to maintain good posture - Factors contributing to poor posture, such as fatigue, pain, compression fracture, low self-esteem - Muscle weakness/ other motor impairment - The shoulder n hips are level - The toes point forward - The spine is straight, not curved to the other side lvii. Gait (walk) - The characteristic pattern of a person's walk - To determine mobility - Risk for injury due to falling What need to observe in gait? - Chin is level, gaze is straight ahead sternum is lifted, shoulders are down and back, relaxed away from the ears - Heel strikes the ground before the toe. It is here, where both feet are taking some body weight that the spine is most rotated - Feet are dorsiflexed in the swing phase - Arm opposite the swing through foot moves forward at the same time - Gait is smooth, coordinated, rhythmic, with even weight bone on each foot. Hips gently sway with spinal rotation; the body moves forward smoothly, stopping and starting with ease lviii. What are assessment need to perform in **Appearance and movement of joints?** - Any joint swelling/redness, indicate injury/inflammation - Any deformity: bone enlargement/contracture/symmetry - The muscle development with each joint relative size n symmetry muscle of each side body - Any reported/palpable tenderness - Crepitation: palpable/audible crackle/grating sensation of joint motion -- trauma - Increased temp over the joint - Degree of joint movement. Ask pt to show which part (table 44-2, 4 gmbr kt ats tdi) lix. Capabilities and limitation for movement (what u need to obtain?) - How the client's illness influences the ability to move n whether the client's health contraindicates any exertion/position/movement lx. Muscle and strength -- in lower and upper extremities lxi. Activity tolerance (which condition can be apply?) - Who have cardiovascular/respiratory disability - Completely immobilize for prolonged period - Decrease muscle mass/ musculoskeletal disorder - Experience inadequate sleep/pain/depressed/anxious/unmotivated 18. Diagnosis? lxii. Activity Intolerance 19. Objective / Goal lxiii. According diagnosis (jwpn kt gmbr ats) 20. Implementing i. Using Body Mechanics - Efficient, coordinated and safe use of the body to carry objects - Principle; - Widening the base of support by spreading the feet farther apart - Lowering the center of gravity, bringing it closer to the base of support - By flexing the hips and knees until a squatting position is achieved a. Lifting b. Pulling & pushing c. Pivoting -- berputar but kaki d. Preventing Back Injury  ii. Positioning clients (what are the 7 principles that need to apply to ensure client comfort n safety?) - Make sure the mattress is firm, enough to fill in and support body curve -- ripple mattress - Ensure the bed is clean n dry - Place support devices according clients position -- pillow, rolled sheets, towel, blanket - Avoid placing 1 body part to another body part -- to prevent pressure - Avoid friction n shearing iv. Position (state the indication/purpose of each position) a\) **Fowler's Position** **Fowler's (45°-60°)** **Semi-Fowler's known low-fowler's (30°-45°)**: to reduce lower back pain, administer drugs and prevent aspiration during tube feeding **High-Fowler's (60°-90**°): postoperatively after abdominal or lung surgery to allow dependent drainage, for feeding and feeding tube insertion, as well as for taking upright X-rays at the bedside b\) **Orthopneic Position**: to help decrease the breathing effort of individuals experiencing dyspnea or shortness of breath c\) **Dorsal Recumbent position** **Supine** - lying flat : during anesthesia, after surgery **Recumbent** -- pakai bantal : physical examination d\) **Prone Position** : spine and neck surgeries, neurosurgery, colorectal surgeries, vascular surgeries, and tendon repairs e\) **Lateral Position** : back surgeries, lower extremity surgeries, thoracic surgeries, Ear Nose Throat (ENT) surgeries, and kidney surgeries. f\) **Sims' Position** : rectal examination, treatments, enemas, and examining women for vaginal wall prolapse v. Moving n turning clients in bed (List the action n rationales applicable to move n lift a client)  **Skills** 1. **Moving a client up in bed**  2. **Turning a client to the lateral or prone position in bed**  3. **Logrolling a client**  4. **Assisting a client to sit on the of the bed**  vi. **Transferring client** - Assistance in transferring between bed and chair or wheelchair, between wheelchair and toilet, and between bed and stretcher. - Guidelines for transfer technique: (list the guidelines) - Practice guideline - Wheelchair safety - Stretchers  **Skills** - Transferring between bed n chair/chair to bed - Transferring between bed n stretcher   vii. **Providing ROM exercise** a\) Active ROM exercises - Isotonic exercises -- client moves each joint -- body through its complete range of movement, maximally stretching all muscle groups within each plane over the joint. b\) Passive ROM exercises - Another person moves each -- client's joints through its complete range of movement, maximally stretching all muscle groups within each plane over each joint.  viii. **Ambulating clients** Ambulation - walking a\) Preambulatory Exercises - To strengthens the muscle :quadriceps femoris, which extends the knee and flexes the thigh b\) Assisting Clients to Ambulate  ix. **Using mechanical aids for walking** a\) Canes i\. Standard straight --legged cane ii\. Tripod cane iii\. Quad cane b\) Walkers  Standard walker  Two-wheeled walker c\) Crutches