Activity and Exercise

Fundamentals of Nursing
Review
 Mobility
 The ability to move freely, easily,
rhythmically and purposefully
 Range of Motion
 The ROM of the joint is the maximum
movement that is possible for that
joint
 Exercise
 A type of physical activity defined as
a planned, structure and repetitive
bodily movement done to improve or
maintain one or more components of
physical fitness
 Types of Exercise
 ISOTONIC
 Dynamic exercise in which the
muscle shortens to produce
contraction and movement
 Running, walking, swimming,
cycling
 Types of Exercise
 ISOMETRIC
 Are those in which there is a
change in muscle tension but NO
CHANGE in muscle length
 Tensing, extending and pressing
exercises
 Other Types of Exercise
 ISOKINETIC
 Involves muscle contraction or
tension against a resistance

 Aerobic exercise
 activity during which the amount of
oxygen taken into the body is
greater than that used to perform
the activity
 Benefits of Exercise
 Increases joint flexibility, tone and
ROM
 Bone density is maintained
 Increases cardiac output and
perfusion
 Prevents pooling of secretions in the
lungs
 Improves appetite and facilitate
peristalsis

 IMPAIRED PHYSICAL MOBILITY
Complications of IMMOBILITY
 1. Contractures, atrophy and

stiffness
 2. Foot drop

 3. DVT

 4. Hypostatic pneumonia

 5. Pressure ulcers, skin

breakdown, reduced skin turgor

IMPAIRED PHYSICAL MOBILITY

Complications of IMMOBILITY
 6. muscle atrophy

 7. osteoporosis

 8. dependent edema

 9. urine stasis

 10. constipation
IMPAIRED PHYSICAL MOBILITY

ASSESSMENT
 Assess patient’s ability to

move
 Assess muscle tone, strength

 Assess joint movement and

positioning
 IMPAIRED PHYSICAL MOBILITY
Nursing Interventions
1. Position properly to prevent
contractures
 Place trochanter roll from the iliac

crest to the mid-thigh to prevent

EXTERNAL rotation
 Place patient on wheelchair 90

degrees with the foot resting flat on

the floor/foot rest
 Place foot board or high-heeled

shoes to prevent foot drop

IMPAIRED PHYSICAL MOBILITY
Nursing Interventions
2. Maintain muscle strength and
joint mobility
 Perform passive ROME

 Perform assistive ROME

 Perform active ROME

 Move the joints three times TID

IMPAIRED PHYSICAL MOBILITY
Nursing Interventions

3. Promote independent mobility

 Warn patient of the orthostatic

hypotension when suddenly

standing upright
 IMPAIRED PHYSICAL MOBILITY
Nursing Interventions
4. Assist patient with transfer
 Assess patient’s ability to

participate
 Position yourself in front of the

patient
 Lock the wheelchair or the bed

wheel
 Use devices such as transfer

boards, sliding boards, trapeze

IMPAIRED PHYSICAL MOBILITY
Nursing Interventions
4. Assist patient with transfer
 In general, the equipments are

placed on the side of the

STRONGER , UNAFFECTED body
part
 Nurses assist the patient to

move TOWARDS the stronger

side
 In moving the patient, move to
IMPAIRED PHYSICAL MOBILITY
Nursing Interventions
5. Assist patient to prepare for
ambulation
 Exercise such as quadriceps

setting, gluteal setting and

arm push ups
 Use rubber ball for hand

exercise
 IMPAIRED PHYSICAL
MOBILITY
Nursing Interventions
6. Assist patient in crutch
ambulation
Measure correct crutch length
 LYING DOWN

 Measure from the Anterior

Axillary Fold to the HEEL of the

foot then:
 Add 1 inch (Kozier)

 Add 2 inches (Brunner and

 IMPAIRED PHYSICAL MOBILITY
Nursing Interventions
6. Assist patient in crutch
ambulation
Measure correct crutch length
 STANDING (Kozier)

 Mark a distance of 2 inches to the

side from the tip of the toe (first
mark)
 6 inches is marked (second mark)
ahead from the first
 Measure 2 inches below the axilla
IMPAIRED PHYSICAL MOBILITY
Nursing Interventions
6. Assist patient in crutch
ambulation
 Measure correct crutch length

 STANDING (Kozier)

 Make sure that the shoulder-rest

of the crutch is at least 1- 2

inches below the axilla
IMPAIRED PHYSICAL MOBILITY
Nursing Interventions
6. Assist patient in crutch
ambulation
Measure correct crutch length
 Utilizing the patient’s HEIGHT

 Height MINUS 40 cm or 16 inches

 IMPAIRED PHYSICAL MOBILITY
Nursing Interventions

6. Assist patient in crutch

ambulation
Measure correct crutch
length
 Hand piece should allow 20-

30 degrees elbow flexion

IMPAIRED PHYSICAL MOBILITY
Nursing Interventions
6. Assist patient in crutch GAIT
 A. 4 point gait

 B. three-point gait

 C. two point gait

 D. swing to gait

 E. swing through gait

GAIT
 4-point gait
 Safest gait
 Requires weight bearing on both
legs
 Move RIGHT crutch ahead (6
inches)
 Move LEFT foot forward at the
level of the RIGHT crutch
 Move the LEFT crutch forward
 Move the RIGHT foot forward
 3-point gait
 Requires weight bearing on
the UNAFECTED leg
 Move BOTH crutches and the
WEAKER LEG forward
 Move the STRONGER leg
forward
 2-point gait
 Faster than 4-point
 Requires more balance

 Partial bearing on BOTH legs

 Move the LEFT crutch and RIGHT

foot FORWARD together

 Move the RIGHT crutch and LEFT

foot forward together

 Swing-to gait
 Usually used by client with
paralysis of both legs
 Prolonged use results in atrophy
of unused muscle
 Move BOTH crutches together
 Lift body weight by the arms and
swing to the crutches (at the
level)
 Swing-through gait
 Move BOTH crutches together
 Lift body weight by the arms and
swing forward, ahead of the
crutches (beyond the level)
 IMPAIRED PHYSICAL
MOBILITY
Nursing Interventions
6. Assist patient in ambulation with
a walker
 Correct height of the walker must

allow a 20-30 degrees of elbow

flexion
IMPAIRED PHYSICAL MOBILITY
Nursing Interventions
6. Assist patient in ambulation with a
cane
 Correct cane measurement:

 With elbow flexion of 30

degrees, measure the length
from the HAND to 6 inches
lateral to the tip of the 5th toe
 Impaired Skin integrity

Pressure ulcers
 Are localized areas of dead

soft tissue that occurs when

pressure applied to the skin
overtime is more than 32
mmHg leading to tissue
damage
Pressure sores
 Impaired Skin integrity

INITIAL SIGN OF PRESSURE

ULCER:

 ERYTHEMA or redness of the

skin that DOES NOT blanch
 Impaired Skin integrity

Weight bearing Bony

prominences
 1. Sacrum and cocygeal area

 2. Ischial tuberosity

 3. Greater trochanter

 4. Heel and malleolus

 5. Tibia and fibula

 6. Scapula and elbow

Pressure areas
Risk Factors for pressure ulcers

 1. Patients with sensory

deficits
 2. Decreased tissue perfusion

 3. Decreased nutritional status

 4. Friction and shearing forces

 5. Increased moisture and

edema
 Pressure ulcer stages
 Stage 1- non-blanchable Erythema

 Stage 2- skin breakdown in dermis

 Stage 3- ulceration extends to the

subcutaneous tissue

 Stage 4- ulcers involve the muscle

and bone
 Nursing Interventions

RELIEVE THE PRESSURE

 Turn and reposition every 1-2

Hours

 Encourage weight shifting

actively, every 15 minutes
 Nursing Interventions

POSITION PATIENT PROPERLY

 Follow the recommended

sequence
 Lateral prone supine

lateral

 Position patient with the bed

elevated at NO MORE THAN 30
degrees
 Nursing Interventions

UTILIZE PRESSURE RELIEVING

DEVICES
 Use floatation pads

 Use air, water or foam

mattresses
 Oscillating and kinetic bed
 Nursing Interventions

IMPROVE MOBILITY
 Active and passive exercises

 Assistive exercise
 Nursing Interventions

IMPROVE TISSUE PERFUSION

 Exercise and repositioning are

the most important activities

 AVOID MASSAGE ON THE

REDDENED AREAS
 Nursing Interventions

IMPROVE NUTRITIONAL STATUS

 HIGH protein

 HIGH vitamin C diet

 Measure body weight

 Assess hemoglobin and albumin

 Nursing Interventions

REDUCE FRICTION AND SHEAR

 Lift and not drag patient

 Prevent the presence of wrinkles and

creases on bed sheets

 Nursing Interventions

REDUCE IRRITATING MOISTURE

 Adhere to a meticulous skin care

 Promptly clean and dry the soiled

areas
 Use mild soap and water

 Pat dry and not rub

 Lotion may be applied

 AVOID powders (cause dryness)

 Nursing Interventions

PROMOTE WOUND HEALING

 Vitamin C

 Dictum: Remove the pressure

 Nursing Interventions

PROMOTE WOUND HEALING

 Stage 1

 Remove pressure
 Reposition Q 2
 Never massage the area
 Nursing Interventions
PROMOTE WOUND HEALING
 Stage 2

 Clean with sterile SALINE only

 Antiseptic solutions may damage
healthy regenerating tissue and
delay healing
 Wet saline dressings are helpful
 Nursing Interventions
PROMOTE WOUND HEALING
 Stage 3 and 4

 Necrotic tissues are debrided

 Administer analgesics before
cleansing
 Do a mechanical flushing with saline
solution
 Topical ointments may be applied
UNTIL granulation tissue appears
then only saline irrigation is
 Positioning
 Any position, correct or incorrect, can
be harmful if maintained for a
prolonged period
 Positioning
 Frequent position changes helps
to prevent :
 Muscle discomfort
 Unnecessary pressure

 Skin damage

 Contracture

 Blood pooling
 Positioning
 When the client is NOT able to move
INDEPENDENTLY, the preferred
method is to have two or more
people move the patient
 Requisites of proper
positioning
 Use of support devices- mattress,
pillows, bed boards, foot board
 Dry, clean and unwrinkled sheets
 24- hour schedule should be posted
 Fowler’s Position
 The Sitting position
 The position of choice for people who
have difficulty breathing and for
some people with hear problems
 This allows greater chest expansion
and lung ventilation
 Fowler’s Position
 The Sitting position
 Low Fowler’s
 Semi-fowler’s
 Fowler's
 High Fowler’s
 Orthopneic position
 The client sits in chair or bed, with an
overbed table
 Allows maximum chest expansion
 Client can press the lower chest
against the bed further facilitating
ventilation
 Dorsal Recumbent
 Back-lying position, with head and
shoulders SLIGHTLY elevated
 Provides comfort
 Prone
 The client lies on the abdomen with
the head usually turned to one side
 Allows full extension of the hips to
prevent flexion contractures
 Promotes drainage from the mouth
 Lateral
 Side-lying position
 Good for resting and sleeping
because it promotes back alignment
 Also prevents aspiration
 Sims
 Semi-prone position
 Used for unconscious clients as it
helps facilitated drainage of
secretions