Fall 2024 - NURSG200 - Week 7 - Activity (PDF)

Activity Fall 2024 Jinger Roy, DNP, APRN, FNP-C adapted from content by Wolters Kluwer and ATI (copyright 2023 and 2022 respectively) Learning...

Activity Fall 2024 Jinger Roy, DNP, APRN, FNP-C adapted from content by Wolters Kluwer and ATI (copyright 2023 and 2022 respectively) Learning Objectives  Students will be able to:  Describe the role of the skeletal, muscular, and nervous systems in the physiology of movement.  Identify variables that influence body alignment and mobility.  Differentiate isotonic, isometric, and isokinetic exercises.  Describe the effects of exercise and immobility on major body systems.  Assess body alignment, mobility, and activity tolerance, using appropriate interview and assessment skills.  Diagnose actual and potential health problems and needs related to mobility that may be addressed through nursing intervention. Learning Objectives  Students will be able to (cont’d):  Utilize principles of ergonomics when appropriate.  Use safe patient handling and mobility techniques and equipment when positioning, moving, lifting, and ambulating patients.  Develop exercise programs.  Plan, implement, and evaluate nursing care related to select diagnoses/patient problems involving alterations in and related to mobility. Skeletal System  Functions:  Protecting the soft tissues of the body  Maintaining body form and posture  Protecting crucial organs (brain, lungs, heart, spinal cord)  Furnishing surfaces for the attachments of muscles, tendons, and ligaments, which pull on the individual bones to produce movement  Providing storage for minerals and fat  Producing blood cells Freely Movable Joints  Joints, or articulations, are where bone meets bone  Types of synovial joints:  Ball and socket  Condyloid  Gliding  Hinge  Pivot  Saddle Relationship of Skeletal Muscle to Bone Effect of Nervous System on Muscle Contraction  Neurons conduct impulses from one part of the body to another  Afferent neurons from periphery  Response from CNS  Efferent neurons convey response to the skeletal muscles Joint Movements  Abduction  Hyperextension  External rotation  Adduction  Dorsiflexion  Supination  Circumduction  Plantar flexion  Pronation  Flexion  Rotation  Inversion  Extension  Internal rotation  Eversion  Anatomical Yoga! Normal Movement and Alignment  Body alignment or posture  Alignment that permits optimal musculoskeletal balance and operation  Balance  Center of gravity is the point at which the mass is centered  Balance is increased with a wider base of support  Coordination  Ability of muscles to work together for purposeful movement Normal Movement and Alignment  Postural reflexes  Automatic movements that maintain body position and equilibrium  Happen both at rest and with movement  Postural tonus depends on:  Labyrinthine sense  Proprioception  Visual/optic reflexes  Extensor/stretch reflexes Ergonomics  Practice of designing equipment and work tasks to conform to the capability of the worker  When applied to direct patient care: safe patient handling and mobility (SPHM)  Not only performed to keep patients safe, but to also protect our bodies! Ergonomics  Common variables that can lead to injuries (both to nurses and to patients):   Not using assistive devices Uncoordinated lifts appropriately (like lifts or bed  High exertion height)  Repetitive movements or tasks  Awkward or static postures  Standing for long periods of  Manual lifting and transferring without assistive devices time  Transferring/repositioning  Lifting when fatigued or when recovering from injury patients who have cognitive impairments, are dependent/overweight/obese, or are unable/unwilling to participate Postural Misalignments  Lordosis  Kyphosis  Flat back  Sway back  Scoliosis Mobility  Tonus: state of slight contraction that keeps the body aligned/protected  Contractures: state of permanent contracture of a muscle  Activity tolerance: capacity to successfully complete a necessary activity without distress  Activities of daily living (ADLs): basic essential skills that a person does independently each day, usually related to personal care Mobility  Factors influencing mobility:  Developmental considerations  Physical health  Mental health  Lifestyle  Attitude and values  Fatigue and stress  External factors Exercise  Three types by muscle movement:  Isotonic  Isometric  Isokinetic  Types by movement and health benefits:  Aerobic  Stretching (active/passive ROM)  Strength/endurance  ADLs Benefits of Exercise  Cardiovascular:  Increased efficiency of the heart  Decreased HR and BP  Increased blood flow to all body parts  Improved venous return  Increased circulating fibrinolysin  Respiratory:  Improved alveolar ventilation  Decreased work of breathing  Improved diaphragmatic excursion Benefits of Exercise  Musculoskeletal:  Increased muscle efficiency/strength and flexibility  Increased coordination  Reduced bone loss  Increased efficiency of nerve impulse transmission  Metabolism and gastrointestinal:  Increased triglyceride breakdown  Increased gastric motility and appetite  Increased production of body heat  Increased intestinal tone, which improves digestion and elimination  Weight control Benefits of Exercise  Urinary:  Increased blood flow to kidneys  More efficient maintenance of acid-base balance and excretion of wastes  Skin:  Increased circulation and nourishment to skin  Psychosocial:  Increased energy, vitality, general body appearance, self-concept, and well-being  Improved sleep  Increased positive health behaviors Risks of Exercise  Precipitation of cardiac event  Orthopedic discomfort and disability  Other health problems  Depends on weather, temperature, pollution/exposures, environmental safety, etc.  Also depends on age, HX of previous injury, overuse/repetitive motion, obesity, health HX, and technique of movement  EX: heat exhaustion/stroke, exercise-induced asthma, chest pain due to overexertion Effects of Immobility  Cardiovascular:  Increased cardiac workload  Orthostatic hypotension  Venous stasis, with resulting venous thrombosis  Respiratory:  Decrease in depth and rate of respirations  Atelectasis  Poor exchange of CO2/O2, which can cause acid-base imbalances  Decrease of tonus, leading to pressure on the chest wall Effects of Immobility  Musculoskeletal:  Decreased muscle size (atrophy), tone, and strength  Decreased joint mobility and flexibility (contractures)  Bone demineralization  Limited endurance Effects of Immobility  Metabolism and gastrointestinal:  Decreased metabolic rate  Increased catabolism in hypermetabolic states, which results in muscle wasting and negative nitrogen balance  Fluid and electrolyte imbalances leading to acid-base imbalances  Disturbances in appetite, decreased nutrient intake  Poor digestion and utilization of nutrients  Constipation and poor defecation reflexes Effects of Immobility  Urinary:  Urinary stasis and urine alkalinization, leading to risk of UTIs  Incontinence  Decreased fluid intake  Increased risk of renal calculi due to bone demineralization  Skin:  Impaired circulation, leading to skin breakdown and pressure injuries Effects of Immobility  Psychosocial:  Threats to sense of self  Distorted body image  Feelings of worthlessness and diminished self-esteem  Exaggerated emotional responses  Isolation  Disruption of normal sleep-wake patterns Nursing Process  Assessment  History must include info about:  Physical assessment:  Daily activity level  Ease of movement and gait  Endurance  Alignment  Exercise/fitness goals  Joint structure and function, both AROM and PROM  Mobility problems  Muscle mass, tone, and strength  Physical/mental health alterations  Endurance  External factors affecting mobility  Use of assistive devices Nursing Process  Diagnosis / Problem Identification  Decreased activity tolerance  Excessive fatigue burden  Impaired bed/wheelchair/physical mobility  Impaired sitting/standing/transferring/walking ability  Risk for disuse syndrome  Risk for thrombosis  Risk for adult/child pressure injury  Risk for impaired skin integrity Nursing Process  Planning  Outcomes: The patient will…  Identify personal benefits of regular exercise  List support systems that will reinforce exercise efforts  Follow a program of regular physical exercise that improves CV function, endurance, flexibility, and strength  Demonstrate correct body alignment  Demonstrate full range of joint motion  Demonstrate adequate muscle mass, tone, and strength to perform ADLs and/or IADLs  Be free from alterations in skin integrity  Show signs of adequate circulation  Demonstrate correct and safe crutch / cane walking technique  Demonstrate correct wheelchair transfers Nursing Process  Implementation  Interventions should focus on:  Safe walking / transferring / mobility techniques to prevent injury  Maintaining safe/correct posture and alignment  Active or passive range of motion exercises  Maintaining strength and muscle tone/mass  Maintaining self-care behaviors  Safe and correct use of assistive devices  Frequent positioning and padding to prevent skin breakdown  Evaluation Proper Body Mechanics  Use of proper body movement in daily activities to prevent and correct problems associated with posture and enhance coordination and endurance  Lift with your legs, not your back!  Maintain erect posture and use a wide base for balance/stability  Work as closely as possible to an object to be lifted or moved  Face the direction of movement and don’t twist!  Use your body weight for pulling/pushing, rather than the arms  Slide, roll, push, or pull heavy objects, rather than lifting  Break up heavy loads/tasks into smaller ones and take breaks! Proper Body Mechanics  Equipment and assistive devices:  Gait belts for ambulation  Stand-assist and repositioning aids  Lateral-assist devices  Friction-reducing sheets  Transfer chairs  Powered stand-assist and repositioning lifts  Powered full-body lifts Proper Body Mechanics  Positioning patients:  Pillows  Mattresses  Adjustable beds  Trapeze bar  Additional specialty equipment  Bed cradle  Trochanter rolls  Hand-wrist splints or rolls  Turtle transfer device  Compression stockings and sequential compression devices (SCDs) Proper Body Mechanics  Protective positioning:  Fowler’s position  Semi-Fowler’s  Supine or dorsal recumbent  Oblique  Side-lying or lateral  Sims’ position  Prone position Physical Conditioning  Prolonged bed rest is no longer recommended for most disease processes  Early mobility along a continuum helps to prevent detrimental effects, as well as relieving pain and stimulating healing  May need to prepare the patient for mobility:  Quadriceps and gluteal setting drills  Push-ups  Dangling Ambulation  Always assess the need for assistance and for education before attempting  Consider use of gait belt  Clear path for ambulation, non-skid footwear, clear instructions to notify if they feel unsteady or dizzy, clear instructions on how to use ambulation aid  One-nurse support  Two-nurse support  Gradually increase distance as they learn and build their endurance Mechanical Ambulation Aids  Walker  Rubber-tipped  Wheels or slides  Cane  Single-ended (straight or curved handles)  Quad base  Braces  Crutches  Axillary  Forearm References  Assessment Technologies Institute. (2023). Fundamentals for Nursing (Edition 11.0).  Taylor, C. et al. (2022). Taylor’s Fundamentals of Nursing (10th ed.). Wolters Kluwer Health.