Chapter 39 - Activity & Exercise PDF

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Chapter 39: Exercise & Activity Why should I promote exercise? • Being sedentary leads to deterioration of health • Inactivity can lead to multiple complications What is Body Mechanics? • An effective way of using your body as a machine • Field of physiology that studies muscular actions & functions of muscle in maintaining posture • Includes knowing actions of various muscle groups What’s the purpose of Body Mechanics? • Makes work easier • Conserves energy • Strengthens muscles • Prevents injury of nurse & client • Helps body be more attractive So, What’s the difference? • Activity is movement • Exercise is movement intended to increase overall body tone, results in fitness The 5 Functions of Bones • Support • Protection • Movement • Mineral storage • Blood formation (hematopoiesis) Joins, Ligaments & Tendons • Connection between two bones is called a joint • Ligaments bind joints and connect bones & cartilage • Tendons connect muscle to bone When in a jam, which superhero would you prefer to see? • Posture refers to the way the body is held • Good posture means good body alignment & foot balance • Body systems work better with good posture

Chapter 39: Exercise & Activity Principles of Body Mechanics • Keep feet apart for wide base of support • Hold objects close to body • Bend at knee instead of at waist • Use pull of gravity if possible • If possible, push, pull or roll objects instead of lifting • Lean toward object when pushing • Lean away from object when pulling • Lower head of bed when moving client up in bed • Face direction of movement • Pivot when turning • Bend knees and keep back straight when lifting, never bend from waist with knees straight • Large muscles tire less quickly than small muscles • Use internal girdle to prevent injury to abdominal wall • Work at comfortable working height • Rest between periods of exertion Cultural Focus • Poor & unemployed may lack access to recreational activities • African Americans & Native Americans have an increased incidence of diabetes type II Disorders effecting Mobility • Bones, Joint & Muscle Disorders – Osteoporosis – Arthritis – Degenerative joint disease • Central Nervous System Disorders – CVA – Head injury • Musculoskeletal Trauma – Fracture – Sprain Be Creative! • Problems with activity & exercise are often prolonged • Use a creative approach • More creative the approach, the more success Exercise • Therapeutic exercise done to prevent or restore loss of function • Passive exercise in which nurse moves client’s body parts • Active exercise is performed by client without assistance Importance of Positioning • Reposition inactive clients every two hours when in bed • When in a chair, shift weight every 20-30 minutes • Promotes circulation, comfort, allows for skin care & provides proper body alignment

Chapter 39: Exercise & Activity Fowler’s • Semi-sitting position • Head of bed elevated - 30⁰Low fowler’s - 45 ⁰Mid fowler’s - 60-90 ⁰High fowler’s also called orthopneic • Facilitates breathing, eating & observing • Elevate knees to relieve lower back strain • Place pillows under head, forearms & at feet Supine • Lying on back • Place pillows under head/shoulder, arms & lower legs • Trochanter rolls to side of hips prevent external rotation • Foot board prevents foot drop Prone • Lying face down on abdomen • Improves oxygenation for clients with ARDS or those mechanically ventilated • Place pillow under abdomen & under feet Lateral • Side lying • Pillows to back, under upper arms & between legs Sims’ • Halfway between side lying lateral & prone • Used for rectal examination & treatment • Knees & thigh near abdomen, arms along back Dorsal Recumbent • Supine with lower extremities flexed, knees bent & legs relaxed Knee Chest • Kneels, weight of body supported by knees & chest, abdomen raised, head turned to side, arms flexed • Head on pillow, chest on bed • Used for gynecological & rectal exams Lithotomy • Supine with hips & knees flexed, thigh abducted & rotated outward Positioning Devices • Foot boards • Trochanter rolls – prevent legs from turning outward, placed next to trochanter (hip) - prevents external rotation of hip - roll should extend from hips to knees - may use rolled bath blanket or towels - fix the roll firmly next to the client • Sandbags – provide firm support & prevent external rotation of extremity - should be positioned to prevent pressure on bony areas - place in a towel or pillowcase to prevent direct contact with skin - keeps moisture from accumulating next to skin • Hand rolls – position the thumb away from the hand slightly

Chapter 39: Exercise & Activity - may use a rolled face cloth or ball in hand to prevent contractures - keep fingers slightly neutral • Splints & footboard - footboard is placed upright at the foot of mattress - prevents foot drop & contractures of feet or plantar flexion of the feet - may also use ankle high tennis shoes to prevent foot-drop • Trapeze bar – bars used to assist client to move up in bed • Side rails – assist client in turning • Bed boards • Wedge pillows What’s a draw sheet? • Sheet used to turn client • Prevents friction when repositioning client • Should extend from shoulder to thighs • Roll sheet closely to client’s body • Keep sheet free of wrinkles Techniques to Remember • Lift client twice • Assess client’s ability to assist • Reason for moving client • Explain procedure to client • Raise side rails on opposite side of you • Raise bed to comfortable working height • Arrange equipment so that it doesn’t interfere What’s a Hoyer lift? • Hydraulic lift used to lift clients • Place wide part of sling under knees, narrow part under shoulders • Place hooks away from client • Lock bed wheels • Check body alignment When performing skills… • Protect drains & tubes • Protect paralyzed or weak extremity • Use foot boards to prevent foot drop • Keep foot dorsi-flexed to prevent foot drop Shearing Force • When body weight presses body mass into mattress as client slides down in bed • Separates layers of skin when pulled in opposite directions Valsalva Maneuver • Forceful expiration with mouth and nose closed causing an increase in intra thoracic pressure • Ask client to breathe out as they push up to avoid Valsalva’s maneuver • Adjustable bed allows client to get in & out of bed from low position without straining Elevating the Head of the Bed • Allows client to observe • Facilitates breathing

Chapter 39: Exercise & Activity • Promotes gravity • Prepares client for standing Assisting the Client to Walk • Remove obstacles • Dangle on side of bed first - For clients that have been in bed for long periods - Allows blood pressure to stabilize - Avoids postural hypotension, dizziness or fainting • Nonskid shoes or socks • Well-fitting shoes • Use assistive devices as needed Assistive Devices • Tilt table • Parallel bars • Gait belt • Cane • Walker • Crutches Health Benefits of Physical Exercise • Improved cardio & respiratory function • Overall reduction of blood pressure at rest • Increased physical endurance • Increased lean mass & weight loss • Decreased blood glucose & blood lipids • Increased physical appearance • Increased bone density • Regular bowel habits • Improved sleep pattern • Reduced tension & depression Isotonic Exercise • Involves movement & work • Rhythmic body movement at slow speed • Doesn’t interfere with breathing • Should be able to talk comfortably Isometric Exercise • Muscles tightened & contracted then relaxed without movement • Usually sitting or standing in place • Tend to increase muscle tone, mass & strength • Do not improve cardio or respiratory functioning Exercise… • Tone: ability to respond when stimulated • Strength: power to perform • Therapeutic exercises: done to prevent or restore loss of function • Passive exercise: nurse moves client’s body part • Active exercise: performed by client without assistance

Chapter 39: Exercise & Activity Range of Motion • Form of passive exercise performed • Moving joints through usual direction of movement until resistance is met • Done to assess, maintain joint flexibility • Prevents contractures • Stretches joints before strenuous activity

Muscles Groups • Quadriceps & gluteal settings – Includes vastus intermedius, vastus medialis, vastus lateralis & rectus femoris • Gluteal setting – Tighten buttocks, hold for count of five, relax – Repeat two or three times every hour • Upper arm strengthening

Chapter 39: Exercise & Activity

Fowler’s

Supine

Prone

Lateral

Chapter 39: Exercise & Activity

Sims’

Dorsal Recumbent

Knee Chest

Chapter 39: Exercise & Activity

Lithotomy...