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
• Elevates the metabolic rate
• Prevents stasis of urine
• Produces a sense of well-being
 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 and sheets
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 the
direction FACING the nurse
 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 Suddarth)
 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 to the
second mark
 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
• Utilize the bridging technique
 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 recommended
 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