Activity and Exercise

Shurouq Qadose
4/3/2008
Disampaikan oleh:
Prof. Nursalam
An activity exercise pattern refers to a
person's routine of exercise, activity,
leisure, and recreation. It includes:
Activities of daily living (ADL) that
require energy expenditure such as
hygiene, cooking , shopping, eating ,
working.
Type, quality, and quantity of exercises,
including sports.
 Ligaments; tough fibrous bands that bind
joints together & connect bones & cartilages.
 Tendon; strong, flexible, inelastic fibrous band
that attach muscle to bone.
Cartilage; nonvascular connective tissue found
in the joint s as well as in the nose, ear, thorax,
trachea and larynx
 Physiology of Movement
The following physiology of movement is:
Skeletal system; the bones and cartilage that protect our
organ and allow us to move are called skeletal system.
The function of this system include:
Maintain body posture by supporting the soft tissue
Protect the delicate structures of the body such as
brain, heart and spinal cord
Furnishes surface for attachments of muscles
tendons and ligaments
Storage areas of minerals salts and fats.
Produce blood cells
Muscular system; provide functions for the body
through
contraction
Motion
Maintenance of posture
Heat production
The 3 types of muscles are 1) Skeletal 2) Cardiac 3)
Smooth or visceral muscles.
Muscles have two different points of attachments:
The attachment of a muscle to the more stationary
bone is called the Point of Origin.
The attachment to the more movable bone is the
Point of Insertion
Nervous System; the nerve impulses stimulate
muscles to contract.
Body Mechanics; is the efficient use of the body
as a machine and as a mean of locomotion,
correct body mechanics lead to health
promotion and illness prevention so the
responsibility of the nurse to apply the body
mechanics and to teach others .
 Types of Joint Movement
Flexion: decreases the angle of the joint" bending the
elbow"
Extension: Increasing the angle of the joint "
straightening the arm at the elbow"
Hyperextension: further extension or straightening of a
joint " bending the head backward"
Abduction: movement of the bone away from the
midline of the body
Adduction: movement of the bone toward the midline
of the body
Rotation: movement of the bone around its central axis
Circumduction: movement of the distal part of the
bone in a circle while the proximal end remains fixed.
Eversion: Turning the sole of the foot outward by
moving the ankle joint
Inversion: Turning the sole of the foot inward by
moving the ankle joint.
Pronation: moving the bones of the forearm so that the
palm of the hand faces downward when held in front
of the body.
Supination: moving the bones of the forearm so that
the palm of the hand faces upward when held in front
of the body.
Exercise
Is a type of physical activity defined as a
planned, structured, and repetitive bodily
movement performed to improve or maintain
one or more components of physical fitness.
Types of exercise:
Exercise can be classified according to the type of
muscle contraction to:-
Isotonic exercise; in which the muscle shortens to
produce muscle contraction and active movement.
Example; running, swimming, walking. This increase
muscle mass, tone and strength, increase cardiac and
respiratory and circulatory functions.
Isometric exercise; in which there is muscle contraction
without moving the joint shortening. An example
includes squeezing a towel or pillow between the
knees. These exercises are useful for strengthening
abdominal, quadriceps and gluteal muscles so the
nurse encourage both isotonic and isometric exercises
for the hospitalized clients.
Isokinetic exercises; involve muscle contraction with
resistance example include rehabilitation exercises for
the knee and elbow injuries.
OR exercise can be classified according to the
source of energy to:-
Aerobic exercise is activity during which the
amount of oxygen taken in the body is greater
than that used to perform the activity. An
example walking, running.
Anaerobic exercise involves activity in which
the muscles cannot draw out enough oxygen
from the bloodstream, and anaerobic pathways
are used to provide additional energy for a
short time. An example weight lifting.
FACTORS AFFECTING BODY ALIGNMENT AND ACTIVITY

Growth and development; according to person age

the nurse should be familiar with the differences of
the neuromuscular development of the client in order
to facilitate coping.
Physical health; because any problems in the
musculoskeletal or nervous system can have negative
influence on the body alignments and movement.
Mental health; bodily processes tend to slow down
in depression
Lifestyle variables; such as exercise, food, smoking,
occupation, culture.
Attitude and values; such as swim, fitness, many
individual values also influence the exercise options
people make.
 Fatigue and stress; chronic stress may deplete
body energy to the point that fatigue makes
even the thought of exercise overwhelming
External factors; environment which
influence, humidity, support people, lack of
free time, unsafe environment.
Nutrition; both undernutritioin and
overnutrition can influence body alignment
and mobility.
Effects of exercise on major body system
Musculoskeletal system
Increased muscle efficiency' strength
and flexibility
Increased coordination, stability, gait
and posture
Increased efficiency of nerve impulses
transmission
Improve range of motion
Maintained bone density and strength
Cardiovascular system;
Meet the demands for oxygen
Increase blood flow
Increase efficiency of the heart
Decreased blood pressure
Increased blood flow to all body parts
Improved heart rate, improved
circulation, and self reported stress
reduction
Decreased cholesterol level
Respiratory system; work together
with the cardiovascular system
Increase oxygen available to the
muscle
Increase depth, rate of gas
exchange, rate of CO2 excretion
Improved pulmonary functioning
Decreasing breathing effort and risk
of infection.
GI system; exercises lead to
Increased intestinal tone, facilitating
peristalsis
Improve digestion and elimination
Improve the appetite
Metabolic system; exercise elevates
the metabolic rate, thus increasing the
production of body heat and waste
products and calorie use.
Increased efficiency of metabolic
system
Increased efficiency of body
temperature regulation
Reduce level of serum triglycerides
and cholesterol.
Urinary system; regular exercise
increase blood circulation including
improved blood flow to the kidneys
which allows the kidneys to maintain
the body's fluid balance and acid-base
balance more efficiently and to excrete
body waste.
Skin; regular exercise increase
circulation which lead to promote good
health

Psychosocial outlook; regular exercise

have psychological effects such as
increase energy, improve sleep, body
image, improve self-concepts and
increase positive health behaviors,
improve general well being.
 Effects of immobility on major body system
Musculoskeletal system
Disuse osteoporosis; demineralization
process, known as osteoporosis, the bones
become spongy and may gradually deform and
fracture easily.
 Disuse atrophy; atrophy in muscles losing
most of their strength and normal function.
Contractures; when the muscle fibers are not
able to shorten and lengthen (permanent
shortening of the muscle) forms limiting joint
mobility. This process eventually involves the
tendons, ligaments, and joint capsules.
Cardiovascular system
Diminished cardiac reserve
Orthostatic hypotension; is a common result
of immobilization. The blood pools in the
lower extremities, and central blood pressure
drops. Cerebral perfusion is seriously
compromised, and the person feels dizzy or
light headed and may even faint.
 Venous vasodilation and stasis; the skeletal
muscles do not contract sufficiently, and the
muscles atrophy, so the skeletal muscles can
no longer assist in pumping blood back to the
heart against gravity. Blood pools in the leg
veins, causing vasodilation and engorgement.
 Dependent edema; when the venous pressure
is sufficiently great, some of serous part of the
blood is forced out of the blood vessel into the
interstitial spaces surrounding the blood vessel,
causing edema.
Thrombus formation
3. Respiratory system
Decreased respiratory movement; in immobile
client, ventilation of the lungs is passively
altered. The body presses against the rigid bed
and curtails chest movement. The abdominal
organs push against the diaphragm, restricting
lung movement and making it difficult to
expand the lungs fully.
 Pooling of respiratory secretions; secretions of
the respiratory tract are normally expelled by
changing positions or posture and by
coughing. Inactivity allows secretions to pool
by gravity, interfering with the normal
diffusion of oxygen and carbon dioxide in the
alveoli.
 Atelectasis; is the collapse of a lobe or of an
entire lung, when ventilation is decreased,
pooled secretions may accumulate in a
dependent area of a bronchiole and effectively
block it. Immobile elderly, postoperative
clients are at greatest risk of Atelectasis.
 Pneumonia; pooled secretions provide
excellent media for bacterial growth. Under
these conditions, a minor upper respiratory
infection can evolve rapidly into severe
infection of the lower respiratory tract.
 Metabolic system
Decreased metabolic rate; in immobile clients,
the basal metabolic rate and gastrointestinal
motility and secretions of various digestive
glands decrease as the energy requirements of
the body decrease.
Negative nitrogen balance
Anorexia; loss of appetite occurs because of
the decreased metabolic rate and the increased
catabolism that accompany immobility.
Negative calcium balance
5. Urinary system
Urinary stasis; in a mobile person, gravity plays an
important role in the emptying of the kidneys and the
bladder. When the person remains in abed, gravity
impedes the emptying of urine from the kidneys and
the urinary bladder, so emptying is not as complete
and urinary stasis occurs after few days of bed rest.
 Urinary retention, which is accumulation of
urine in the bladder, bladder distention, and
occasionally urinary incontinence (involuntary
urination). The decreased muscle tone of the
urinary bladder inhibits its ability to empty
completely.
Urinary infection, static urine provides an
excellent medium for bacterial growth
6.Gastrointestinal system
Constipation is a frequent problem for
immobilized people because of decreased
peristalsis and colon motility.
7. Integumentary system
Reduced skin turgor. Skin turgor is an
abnormality in the skin's ability to change
shape and return to normal (elasticity).
The skin can atrophy as a result of prolonged
immobility.
Skin breakdown. Normal blood circulation
relies on muscle activity. Immobility impedes
circulation and diminishes the supply of
nutrients to specific areas. As a result skin
breakdown and formation of pressure ulcers
can occur.
8. Psychoneurologic system
Lower the persons self esteem
Increased risk of depression
Decreased social interaction
NURSING MANAGEMENT
Assessing
Nursing History
Physical examination
Body Alignment
Appearance and movement of joints
Capabilities and limitation for movement
Muscle mass and strength
Activity tolerance
Problems related to immobility
Nursing Diagnosis
Nursing diagnoses related to mobility focus
primarily on activity and mobility levels, and
the psychosocial impact that alterations in
mobility can have on a client and the clients
family. Common NANDA nursing diagnoses
related to the physical adaptations or risks
resulting from altered mobility include:
 Activity Intolerance related to bed rest and
immobility, generalized weakness, sedentary
lifestyle, and imbalance between oxygen
supply and demand.
Impaired Physical Mobility related to
intolerance to activity or decreased strength
and endurance, pain, perceptual or cognitive
impairment, neuromuscular impairment,
musculoskeletal impairment, and depression or
severe anxiety.
 Self-Care Deficits related to inability to wash
body or body parts, inability to obtain or get to
water source, activity intolerance, decreased
strength and endurance, pain, and impaired
transfer ability
Ineffective Health Maintenance related to lack
of or significant alteration in communication
skills (written, nonverbal)
 Risk for Falls related to impaired mobility.
Alterations in family and social processes may
also result from immobility and inactivity.
Disruption in activity and mobility leads to
impairment of the ability to perform ones
usual social, vocational, educational, and
family roles.
There are often changes in the clients perception
of role. Disturbed Body Image and Situational
Low Self-Esteem can result from:
1. Changes in physical abilities
2. Changes in family responsibilities
3. Lack of knowledge regarding rehabilitation
Fear (of falling)
Ineffective coping
Low self esteem
Powerlessness

 Planning
Implementing
Nursing strategies to maintain or promote body
alignment and mobility involve positioning
clients appropriately, moving and turning
clients in bed, transferring clients, providing
ROM exercises, ambulating clients with or
without mechanical aids.

Techniques to prevent back stress:

Develop a habit of erect posture correct
alignment
Use the longest and strongest muscle of the
arms and the legs to help provide the power
needed in strenuous activities
Use the internal girdle and a long midriff to
stabilize the pelvis and to protect the
abdominal viscera when stopping, reaching ,
lifting or pulling
 Use the weight of the body as a force for
pulling or pushing by rocking on the feet or
leaning forward or backward
Work as closely as possible to an object that is
to be lifted or moved.
Flex the knees, put on the internal girdle and
come down to an object that is to be lifted.
Spread the feet apart to provide a wider base
of support when increased stability of body