Activity and Exercise Ch 44 Activity, Test Your Knowledge, Review questions & NCLEX from quizlet

4. Which statement from a client with one weak teg regarding use of crutches when using stairs indicates a need for increased teaching. "Going up, the strong leg goes first, then the weaker leg with both crutches." "Going down, the weaker leg goes first with both crutches, then the strong leg." "The weaker leg always goes first with both crutches." "A cane or single crutch may be used instead of both crutches if held on the weaker side."

"The weaker leg always goes first with both crutches."

8. A client weighs 250 pounds and needs to be transferred from the bed to a chair. Which instruction by the nurse to the unlicensed assistive personnel (UAP) is most appropriate? 1. "Using proper body mechanics will prevent you from injuring yourself." 2. "You are physically fit and at lesser risk for injury when transferring the client." 3. "Use the mechanical lift and another person to transfer the client from the bed to the chair." 3. "Use the mechanical lift and another person to transfer the client from the bed to the chair." 4. "Use the back belt to avoid hurting your back."

"Use the mechanical lift and another person to transfer the client from the bed to the chair."

Metabolic System

*Decreased metabolic rate* *Negative nitrogen balance* *Anorexia* *Negative Ca balance*

Respiratory System

*Decreased respiratory movement* ventilation of the lungs is altered. The abd organs push against the diaphragm, restricting lung movement. Muscle atrophy affects the respiratory muscles (no sighs), these changes reduce *vital capacity* the maxim amount of air that can be exhaled after a maximum inhalation. *Pooling of secretions* secretions can not be expelled as well, which leads to pooling, unable to cough (loss of resp muscles) dehydration (mucous becomes thicker), or sedatives (depress cough) Poor Oxygenation and retention of CO2 predisposes a client to resp acidosis *Atelectasis* the collapse of a lube or entire lung. Secretions pool in area of bronchioles and block it, bed rest decreases the amount of surfactant produced, which allows the alveoli to remain open. *Hypostatic pneumonia* pooled secretion are great place for bacteria to grow in, a minor infection can quickly become a severe infection and cause death among weakened, immobile people and heavy smokers.

A nurse educator is teaching basic principles of proper lifting technique to a group of newly hired nurses. Use the ATI Active Learning template to complete this item. Under the section Underlying Principles, list 4 key elements of proper lifting technique.

4 Principles of Lifting 1. Use the major muscle groups to prevent back strain and tighten the abdominal muscles to increase support to the back muscles. 2. Distribute the weight between the large muscles of the arms and legs to decrease the strain on any one muscle group and to avoid strain on the smaller muscles. 3. When lifting an object from the floor, flex the hip, knees & back. Get the object to thigh level, keeping the knees bent and the back straightened. Stand up while holding the object as close as possible to the body, bringing the load to the center of gravity to increase stability and decrease back strain. 4. Use assistive devices whenever possible, and seek assistance whenever it is needed.

A nurse is caring for a client who is on bed rest. Which of the following interventions should the nurse implement to maintain the patency of the client's airway? 1. Encourage isometric exercises. 2. Suction every 8 hours. 3. Give low-dose heparin 4. Promote incentive spirometer use.

4. Promote incentive spirometer use. -- helps keep the airways open and prevents atelectasis.

A nurse educator is teaching a module on proper body mechanics during employee orientation. Which of the following statements by a newly nurse indicates a need for further teaching? A. My line of gravity should fall outside my base of support. B. The lower my center of gravity, the more stability I have. C. To broaden my base of support, I should spread my feet apart. D. When I lift an object, I should hold it as close to my body as possible.

A. My line of gravity should fall outside my base of support. (Not correct, line of gravity will fall with IN base of support )

6. Isotonic (dynamic) exercises: 1. Are those in which there is muscle contraction without moving the joint (muscle length does not change). 2. Involve muscle contraction or tension against resistance; thus, they can be either isotonic or isometric. 3. Are activities during which the amount of oxygen taken in by the body is greater than that used to perform the activity. 4. Are those in which the muscle shortens to produce muscle contraction and active movement.

Are those in which the muscle shortens to produce muscle contraction and active movement.

Isotonic exercises (dynamic)

Are those in which the muscles shortens to produce muscle contractions and active movement. Most physical conditioning exercises-running, walking, swimming, cycling, and other activities are isotonic as are active ROM and ADLs. Examples of isotonic bed exercises are pushing or pulling against a stationary object, using a trapeze to lift the body off the bed, lifting the buttocks off the bed by pushing with the hands against the mattress. These exercises increase muscle tone, mass and strength and maintain flexibly and circulation. During this time, both heart rate and cardiac output quicken to increase blow flow to all parts of the body

Isometric (static or setting)

Are those in which there is muscle contraction without moving the joint- muscle length does not change. These involve exerting pressure against a solid object and are useful for stretching abd, gluteal, and quadriceps muscles used in ambulation, for maintaining strength in immobilized muscles in casts or traction, and for endurance training. An example of this is squeezing a towel or pillow b/w the knees while at the same time tightening the muscles in the front of the thighs by pressing the knees backwards and holding for several seconds. This produces a mild increases in heart rate.

Immune

As resp and mskeletal effort increase with exercise and as gravity is enlisted with postural changes lymph is better pumped from the tissues into lymph caps and vessels throughout the body. The removal of pathogens is improved. Research has shown the benefits on NK, circulating T cell, and cytokine production which increases resistance to viral infections and prevention of malignant cells. Recovery Phase allows a window of reduced immune function, we must have proper rest to allow the body to recover

9- The client is ambulating for the first time after surgery. The client tells the nurse, "I feel faint." Which is the best action by the nurse? 1. Find another nurse for help. 2. Return the client to her room as quickly as possible. 3. Tel! the client to take rapid, shallow breaths. 4. Assist the client to a nearby chair.

Assist the client to a nearby chair.

3. Five minutes after the client's first postoperative exercise, the client's vital signs have not yet returned to baseline. Which is an appropriate nursing diagnosis? 1. Activity Intolerance 2. Risk for Activity Intolerance 3. Impaired Physical Mobility 4. Risk for Disuse Syndrome

Activity Intolerance

9. General guidelines for transfer techniques include all of the following EXCEPT: 1. Obtain essential equipment before starting (e.g., transfer belt, wheelchair), and check its function. 2. Always support or hold equipment rather than the client to ensure safety and dignity. 3. Remove obstacles from the area used for the transfer. 4. Explain the transfer to the nursing personnel who are helping, specify who will give directions (one person needs to be in charge).

Always support or hold equipment rather than the client to ensure safety and dignity.

A nurse is caring for a client receiving enteral tube feedings due to dysphagia. Which of the following bed positions is appropriate for safe care of this client? A. Supine B. Semi-Fowler's C. Semi-Prone D. Trendelenburg

B. Semi-Fowler's -- The client lies supine with the head of the bed elevated approx. 30 degrees. This position is frequently used to prevent regurgitation and aspiration in clients who have difficulty swallowing. This is the safest position for the client receiving a tube feeding.

A nurse is instructing a client who is postoperative about the sequential compression device the provider prescribed. Which of the following client statements should indicate to the nurse that the client understands the teaching. A. This device will keep me from getting sores on my skin. B. This thing will keep the blood pumping through my leg. C. With this thing on my leg muscles wont get weak. D. This device is going to keep my joints in good shape.

B. This thing will keep the blood pumping through my leg. (promotes venous return in the deep veins of the legs and thus helps prevent thrombus formation.

Coordinated movement

Balanced, smooth, purposeful movement is the result of proper functioning of the cerebral cortex, cerebellum, and basil ganglia. The cerebral cortex initiates involuntary movement The cerebellum coordinates ten motor activities of movement The basal ganglia maintain posture The cerebral cortex operates movements not muscles. It will direct the arm to pick up the cup of coffee. The cerebellum which operates below the LOC, blends and coordinates the muscles involves in voluntary movement. It translates the instructions. When a client's cerebellum is injured, movements become clumsy, unsure and uncoordinated.

When assessing activity and exercise patterns, emphasize the following (physical examination)

Body Alignment Gait Appearance and movement of the joints Capabilities and limitations for movement Muscle mass and strength Activity intolerance Problems related to immobility

Four Basic Elements of Normal Movement

Body alignment (posture) Joint mobility (range of motion exercises - active or passive) Balance (how steady you are on your ft?) Coordinated movement

Alignment and Posture

Brings body parts into position that promotes optimal balance and body function Person maintains balance as long as line of gravity passes through center of gravity and base of support

A nurse is completing discharge teaching to a client who has COPD. The client verbalizes understanding of the orthopneic position when he states, "When I have difficulty breathing at night, I will A. lie on my back with my head and shoulders elevated on a pillow. B. lie flat on my stomach with my head to one side. C. sit on the side of my bed and rest my arms over pillows on top of my raised bedside table. D. lie on my side with my weight on my hips and shoulder with my arms flexed in front of me.

C. sit on the side of my bed and rest my arms over pillows on top of my raised bedside table. The client is describing the orthopneic position. This position allows for chest expansion and is especially beneficial to clients who have COPD.

A nurse is caring for a client who is sitting in a chair and asks to return to bed. Which of the following is the priority action for the nurse to take at this time? A. Obtain a walker for the client to use to transfer back to bed. B. Call for additional personnel to assist with the transfer C. Use a transfer belt and assist the client to bed. D. Assess the client's ability to help with the transfer.

D. Assess the client's ability to help with the transfer. The first action the nurse would take using the nursing process is to assess/collect data from the client. The nurse should assess the client's ability to help with the transfers (balance, muscle strength & endurance). Then the nurse can proceed with a safe transfer of the client.

Psychoneurologic System

Decline in production of mood elevating substances, endorphins, people have negative effects. Poor self esteem, anger, depression, aggressiveness can result.

Nurse is reviewing the effects of immobility on various body systems. List at least 2 effects on respiratory system.

Decreased respiratory movement resulting in decreased oxygenation and carbon dioxide exchange Stasis of secretions and decreased and weakened respiratory muscles, resulting in atelectasis and hypo-static pneumonia. Decreased cough response.

1. A nurse is planning a seminar on preventing back injuries. Which of the following statements is correct? 1. When sitting for a period of time, periodically move legs and hips, flex one hip and knee, and rest your foot on an object if possible. 2. When sitting, keep your knees slightly lower than your hips. 3. Use a hard mattress and firm pillow that provide good body support at natural body curvatures. 4. Exercise regularly to maintain overall physical condition and regulate weight; include exercises that strengthen the pelvic, abdominal, and spinal muscles.

Exercise regularly to maintain overall physical condition and regulate weight; include exercises that strengthen the pelvic, abdominal, and spinal muscles.

Anaerobic exercise

Involves activity in which the muscles cannot draw out enough O2 form the bloodstream, and anaerobic pathways are used to provide additional energy for a short time. This type of exercise is used in endurance training for athletes such as weight lifting and sprinting

Types of Exercise

Involves the active contraction and relaxation of muscles. Exercise can be classified according to the type of muscle contraction: Isotonic Isometric Isokinetic Or the source of energy: Aerobic Anaerobic

Exercise

Is a type of physical activity defined as a planned, structured, and repetitive bodily movement performed to improve health and maintain fitness to achieve an optimal state of health. People partake in exercise to decrease risk factors for cardiovascular disease and to increase their health and well being. *Functional strength* a goal of exercise, and it is the ability of the body to perform work. *Activity intolerance* the type and amount of exercise or ADLs that a person can perform without adverse effects.

Aerobic excercise

Is activity during which the amounts of O2 taken into the body is greater than that used to perform the activity. It uses large muscle groups that move repetitively. Aerobic exercise improves cardiovascular conditioning and physical fitness.

7. A nurse is evaluating a nursing student's understanding of positioning clients. Which of the following state- ments indicates a need for further teaching? 1. Positioning a client in good body alignment and changing the position regularly (every 3 hours) and sys- thematically are essential aspects of nursing practice. 2. Any position, correct or incorrect, can be detrimental if maintained for a prolonged period. 3. For all clients, it is important to assess the skin and provide skin care before and after a position change. 4. Frequent change of position helps to prevent muscle discomfort, undue pressure resulting in pressure ul- cers, damage to superficial nerves and blood vessels, and contractures.

Positioning a client in good body alignment and changing the position regularly (every 3 hours) and sys- thematically are essential aspects of nursing practice.

Mobility problems as the etiology

Problems w/ mobility affect other areas of human functioning and indicate other diagnoses Examples in which Impaired Physical Mobility is the etiology: -Fear -Ineffective Coping -Situational Low Self-Esteem -Powerlessness -Risk for Falls

Body Alignment

assessment of the body alignment includes an inspection of the client while the client stands, the purpose is to identify: -Normal developmental variations in posture -Posture and learning needs to maintain good posture -Factors contributing to poor posture, such as fatigue, pain, compression fractures, or low self esteem -Muscle weakness or other motor impairments. When assessing alignment, the nurse inspects form lateral, anterior, and posterior perspectives. The nurse should observe whether: -The shoulders and hips are level -The toes are pointed forward -The spine is straight, not curved to either side (44-40A) The *slumped* posture is the most commonly observed. Neck is flexed, abd protrudes, pelvis is thrust forward to create *lordosis* (an exaggerated anterior/inward curvature of the lumbar spine) and the knees are hyperexteneded. (low back pain is common) 44-40B

Isokinetic (resistive )

involve muscle contraction or tension against resistance. During this exercise, the person tenses (isometric) against resistance. Special machines provide the resistance. These are used in physical conditioning and are done to build up certain muscles. And increase of blood flow AND blood pressure occurs during this type of training.

Growth and Development

pg 1132

Nutrition

undernutrition and overnutrition can influence the body alignment and mobility. Poorly nourished- causes muscles weakness and fatigue, Vit D deficiency causes bone deformity during growth, low Ca and Vit D synthesis and intake can cause osteoporosis Obesity- can distort movement and stress joints, affecting balance and posture

Alignment and Posture

Proper body alignment and posture bring body parts into position in a manner that promotes optimal balance and maximal body function whether the client is standing, sitting, or lying down. A person maintains balance as long as the *line of gravity* (an imaginary verticals line drawn through the body's center of gravity) passes through the *center of gravity* (the point at which all of the body's mass is centered) and the *base of support* (the foundation on which the body rests) see pg 1124 fig 44-1 When the body is properly aligned, Stress on joints, muscles, tendons or ligaments is minimized and internal structures and organs are supported. Proper alignment enhances lung expansion, and promotes efficient circulatory, renal, and GI functions. This is a criteria for assessing general health. A person's posture reflects mood, self-esteem, and personality of a person. The *extensor muscles* carry the major load as they keep the body upright

10. Which of the following actions is appropriate for the nurse assisting a client with crutches? 1. The client lies in a prone position and the nurse measures from the anterior fold of the axilla to the heel of the foot and adds 2.5 cm (1 in.)- 2. The client stands erect and positions the crutch. The nurse makes sure the shoulder rest of the crutch is at least three fingerwidths, that is, 2.5 to 5 cm (1 to 2 in.), below the axilla. 3. The client stands upright and supports the body weight by the axilla nurse measures the angle of elbow flexion. It should be about 10°.

The client stands erect and positions the crutch. The nurse makes sure the shoulder rest of the crutch is at least three fingerwidths, that is, 2.5 to 5 cm (1 to 2 in.), below the axilla.

Examples of overall goals for clients w/ actual or potential problems related to mobility or activity follow

The client will have: -Increased tolerance for physical activity -Restored or improved capability to ambulate and/or participate in ADLs -Absence of injury from falling or improper use of body mechanics -Enhanced physical fitness -Absence of any complications associated with immobility -Improved social, emotional, and intellectual well being

GI

Improves the appetite and increases GI tract tone, facilitating Peristalsis. Activities such as rowing, swimming, walking, and sit ups, work the abd muscles and can help alleviate constipation. Has shown to improve IBS and other digestive disorders

Mobilty

The ability to move freely, easily, rhythmically, and purposefully in the environment, is an essential part of living. People must protect themselves from trauma AND to meet their basic needs. Mobility is vital to independence; a fully immobilized person is as vulnerable and dependent as an infant.

Cardiovascular System

*Diminished cardiac reserve* decreased mobility creates an imbalance in the ANS resulting in a preponderance of sympathetic activity over cholinergic activity that increase heart rate. *Increased use of the Valsalva maneuver* refers to holding the breath and straining against a closed glottis. Clients ten to hold their breath when moving up in bed or sitting on a bed pan. This builds up pressure on the lg veins in the thorax to interfere w/ the return of blood flow to the heart and coronary arteries. When person exhales, the pressure is suddenly released and a surge of blood flows to the heart, cardiac arrhythmias can result *Orthostatic Hypotension* common with immobilization. Normally, the SNS causes vasoconstriction in the blood vessels in the lower half of the body when a person changes from a horizontal position to a vertical position. This prevents pooling of blood in the LEs and maintains effective central BP flow to the heart and brain. Immobility causes this to become dormant, the reconstricting mechanism fails, the blood pools in the LEs and central blood pressure drops causing the person to faint or feel dizzy. This is usually followed by an increase in heart rate, the body is trying to protect the brain from the decreased blood supply *Venous vasodilation and stasis* the tiny valves in the leg veins aid in venous return to the heart by preventing backward flow of blood and pooling. In an immobile person, the skeletal muscles do not contract sufficiently and the muscles atrophy. They can no longer assist in pumping blood back to the heart, blood pools causing vasodilator and engorgement. This is known as *incompetent valves* the valves can't prevent backflow and pooling. *Dependent edema* venous pressure is do great, the serious part of the blood is forced out of the blood vessel and into the interstitial spaces surrounding the blood vessels, causing edema. Edema further impedes venous return *Thrombus formation* 3 factors predispose someone to this. *Thrombophlebitis* is a clot that is loosely attached to an inflamed vein wall *Thrombus* (clot) is dangerous if it breaks free form the vein and enters general circulation (embolus). This can block circulation and cause an infarcted area (dead)

Musculoskeletal System

*Disuse Osteoporosis* bones dimineralize w/o weight bearing activity, depleted mostly of Ca. The bones become spongy and break easier *Disuse atrophy* ( decrease in size) happens when muscles are unused. (LTC) *Contractures* (shortening of the muscle) when muscle fibers are unable to shorten and lengthen, this happens. This process involves ligaments, tendons and joints. A *foot drop* occurs when a stronger muscle dominates the opposite muscle *Stiffness and pain in the joints* w/o movement, the collagen fibers (CT) at the joint become *ankylosed* (permanently immobile). Joints also become stiff due to Ca deposits in the joints

Integumentary System

*Reduced skin Turgor* the skin can atrophy after prolonged immobilization *Skin breakdown* normal blood circulation relies on muscle activity, immobility affects this and diminishes the supply of nutrients to area, skin breaks down and pressure ulcers form.

Intensity of Exercise can be measured in 3 ways

*Target heart rate* *Talk test* *Borg scale of perceived exertion* See pg 1130

Urinary System

*Urinary stasis* gravity plays an important role in the emptying of the kidneys and bladder. When clients remain in an horizontal position, gravity impeded the emptying of urine form the kidneys and urinary bladder. Emptying is not as complete, and *urinary stasis* (stoppage or slowdown of flow) occurs after a few days of bed rest. *Renal calculi* urine becomes more alkaline and Ca salts precipitate out of as crystals to form calculi (stones). Also being in the horizontal position, the renal pelvis becomes filled w/ stagnant alkaline urine and stones can form. (In a mobile person, Ca in the urine remains dissolved and the citric acid are balanced) *Urinary retention* suffer form accumulation of urine in the bladder, bladder distention, and urinary incontinence. The decreases muscle tone if the urinary bladder inhibits the ability to completely empty. *Urinary infection* static urine is a great place for bacterial growth which causes infection. The normal flushing action is diminished. Most common is E. coli. Can also result form poor peri care

Prolonged Immobility Diagnoses

-Ineffective Airway Clearance -Risk for infections -Risk for Injury -Risk for Disturbed Sleep Pattern -Risk for Situational Low Self-Esteem

Activity tolerance

-heart rate, strength and rhythm -respiratory rate, depth and rhythm -blood pressure This data should be assessed at the following time: -before the activity starts (baseline data) client is at rest -during activity -immediately after the activity stops -3 mins after the activity has stopped and the client has rested See when activity should be stopped immediately

Problems related to Immobility

-the nurse should use the assessment methods of inspection, palpations, and auscultation. -check lab tests -take measurements such as body weight, fluid intake, fluid output. It is very important to obtain baseline data assessment right after the client becomes immobile, this serves as the standard against which all data collected throughout the immobilization is compared. Nurses must prevent the complications of immobility and identify clients at risk: -poorly nourished -have decreased sensitivity to pain, temp, or pressure -have existing cardiovascular, pulm, or neuromuscular problems -have altered LOC

Pschyoneurologic

A strong body of evidence supports the role of exercise in elevating mood and relieving stress and anxiety and relieves symptoms of depression. The mechanism of action is: Exercise increases the levels of metabolites for NTs such as serotonin and norepinephrine, releases endogenous opioids thus increasing the level of endorphins , increased levels of O2 to the brain induced euphoria and can improve the quality of sleep. *Relaxation of Response* by eliciting this response, ex is beneficial counteracting some of the harmful effects of stress on the body and mind.

Normal movement

And stability are the result of an intact musculoskeletal system, an intact nervous system, and intact inner ear structures responsible for equilibrium. It involves 4 basic elements: Body alignment (posture) Joint mobility Balance Coordinated movement

A nurse is caring for a client who has been sitting in a chair for 3 hours. Which of the following problems is the client at risk for developing? 1. Stasis of secretions 2. Muscle atrophy 3. Pressure ulcer 4. Fecal impaction

Correct -- 3 - Pressure ulcer Incorrect 1. Stasis of secretions -Sitting in a chair will help prevent stasis of secretions 2. Muscle atrophy - is a complication for a client on prolonged bed rest, not just sitting in a chair. 4. Fecal impaction - complication for a client on prolonged bed rest not just sitting in a chair for brief time.

A nurse is caring for a client who is post-operative. Which of the following nursing interventions reduce the risk of thrombus development.? (Select ALL that apply) 1. Instruct the client not to use the Valsalva maneuver. 2. Apply elastic stockings. 3. Review laboratory values for total protein level. 4. Place pillows under the client's knee's and lower extremities. 5. Assist the client to change position often.

Correct -->2. Apply elastic stockings.(promotes venous return and prevents thrombus formation) Correct --> 5. Assist the client to change position often. (prevents venous stasis) Wrong 1. Instruct the client not to use the Valsalva maneuver. (increases workload of heart, but it does not affect peripheral circulation) Wrong3. Review laboratory values for total protein level. (important for evaluating his ability to heal and prevent skin breakdown) Wrong4. Place pillows under the client's knee's and lower extremities. (further impairs circulation to lower extremities.)

Performance of activities of daily living (ADLs) and active range of motion (ROM) exercises can be accomplished simultaneously as illustrated by which of the following? Select all that apply. Elbow flexion with eating and bathing. Elbow extension with shaving and eating. Wrist hyperextension with writing. Thumb ROM with eating and writing. Hip flexion with walking.

Correct Answers: Elbow flexion with eating and bathing. Thumb ROM with eating and writing. Hip flexion with walking. Rationale: Eating and bathing will flex the elbow joint, and grasping and manipulating utensils to eat and write will take the thumb through its normal ROM. Walking flexes the hip. Shaving and eating require elbow flexion, not extension (option 2). Writing brings the fingers toward the inner aspect of the forearm, thus flexing the wrist joint (option 3). Cognitive Level: Applying. Client Need: Health Promotion and Maintenance. Nursing Process: Implementation.

To promote the safe use of a cane for a client who is recovering from a minor musculoskeletal injury of the lower left extremity, which of the following instructions should the nurse provide? (Select ALL that apply) 1 - Hold the cane on the right side. 2. Keep two points of support on the floor. 3. Place the cane 15 inches in front of the feet before advancing. 4. After advancing the cane, move the weaker leg forward. 5. Advance the stronger leg so that it aligns evenly with the cane.

Correct: 1 - Hold the cane on the right side. (hold cane on the uninjured side to provide support for injured leg) 2. Keep two points of support on the floor. (for stability) 4. After advancing the cane, move the weaker leg forward. (cane, weaker leg then stronger leg) Wrong: 3. Place the cane 15 inches in front of the feet before advancing. (s/b 6-10 inches) 5. Advance the stronger leg so that it aligns evenly with the cane. ( should advance the stronger leg past the cane)

A nurse manager is reviewing guidelines to prevent injury with staff nurses. Which of the following should the nurse manager include in the teaching? (Select ALL that apply) A. Request assistance when repositioning a client. B. Avoid twisting the spine or bending at the waist. C. Keep the knees slightly lower than the hips when sitting for long periods of time. D. Use smooth movements when lifting and moving clients. E. Take a break from repetitive movements every 2 - 3 hours to flex and stretch joints and muscles.

Correct: A. Request assistance when repositioning a client. B. Avoid twisting the spine or bending at the waist. D. Use smooth movements when lifting and moving clients. Incorrect: C. Keep the knees slightly lower than the hips when sitting for long periods of time. Should be knees HIGHER in order to decrease strain on the lower back. E. Take a break from repetitive movements every 2 - 3 hours to flex and stretch joints and muscles. Nurses should take a break every 15-20 min

7. Performance of activities of daily living (ADLs) and active range- of-motion (ROM) exercises can be accomplished simultaneously as illustrated by which of the following? Select all that apply. 1. Elbow flexion with eating and bathing 2. Elbow extension with shaving 3. Wrist hyperextension with writing 4. Thumb ROM with eating and writing 5. Hip flexion with walking

Elbow flexion with eating and bathing Thumb ROM with eating and writing Hip flexion with walking

Metabolic/Endocrine System

Elevates the m rate, thus increasing the production of body heat and waste products and calorie use. During exercise, the m rate can increase as much as 20 times the normal rate. This elevation lasts long after exercise is completed, it increases the use of triglycerides and fatty acids, resulting in reduced levels of serum triglycerides, AIC levels, and cholesterol. Weight loss and ex stabilize blood sugar and make cells more responsive to insulin *

4. Which of the following actions is appropriate for the nurse performing active ROM exercises? 1. Perform each ROM exercise as taught to the point of slight resistance, but not beyond, and never to the point of discomfort. 2. Perform the movements systematically, using a different sequence during each session. 3. Perform each exercise five times. 4. Perform each series of exercises three times daily.

Perform each ROM exercise as taught to the point of slight resistance, but not beyond, and never to the point of discomfort.

Personal Values and Attitudes

Family influence plays a big role whether a person exercises or not. (intrinsic) People who value their appearance are more likely to exercise Values, geographical location, and motivation play a role. An *individualized exercise prescription* that tailor exercise mode and dose will cause greater adherence to a program.

Cardiovascular

Important for the prevention of stroke and cardiovascular disease. Adequate exercise increases hart rate, strength of the muscle contraction, and blood supply to the heart. It also mediates the harmful effects of stress.

Identify the factors influencing a person's body alignment and activity

Growth and development Nutrition Personal values and attitudes External Factors Prescribed Limations

External Factors

High temps can discourage activity Availability of recreational facilities, lack of money, neighborhood safety, can all discourage activity. Adolescents especially may spend more time in front of TV or computer than engaging in physical activities.

8. Fowler's position is a bed position: 1. In which the head and trunk are raised 45° to 60°. 2. In which the client's head and shoulders are slightly elevated on a small pillow. 3. In which the client lies on the abdomen with the head turned to one side. 4. In which the person lies on one side of the body. Flexing the top hip and knee and placing this leg in front of the body creates a wider, triangular base of support and achieves greater stability.

In which the head and trunk are raised 45° to 60°.

Appearance of Movement and Joints

Includes inspection, palpation, assessment and ROM -any joint swelling or redness, indicates inflammation -any deformity- contracture, bony enlargement -muscle development associated with each joint and the relative size and symmetry -any reported or palpable tenderness -Crepitation- palpable or audible crackling or grating sensation produced by joint movement -increased temp over the joint -degree of joint movement

2. Isotonic exercises such as walking are intended to achieve which of the following? Select all that apply. 1. Increase muscle tone and improve circulation. 2. Increase blood pressure. 3. Increase muscle mass and strength. 4. Decrease heart rate and cardiac output. 5. Maintain joint range of motion.

Increase muscle tone and improve circulation Increase muscle mass and strength. Maintain joint range of motion.

Gait (walk)

Is assessed to determine the client's mobility and risk for injury. 2 normal phases of gait are *stance* and *swing* When one leg is in swing phase, the other is in stance phase. In the stance phase, the heel of one foot strikes the ground and the biddy weigh is spread over the ball of the foothill the other heel pushes off and leaves the ground. In the swing phase, the leg from behind moves in front of the body. The nurse assesses gait when client walks into the room or asks them to walk a short distance. They will observe the following: -Chin is level, gaze is straight, sternum is lifetime and shoulders are down and back, relaxed away from the ears -Heel strikes the ground before the toe, it is here where both feet are taking some body weight, that the spine is most rotated. -Feet are dorisflexed in the swing position -Arm opposite the swing -through foot moves forward at the same time -Gait is smooth, coordinated and rhythmic *Pace* number of steps taken per min. Normal is 70-100 steps per minute. (Older-40)

Joint mobility

Joints are the functional units of the musculoskeletal system. The bones of the skeleton articulate joints. These muscles are categorized according to the type of joint movement they produce on contraction. Muscles are called flexors, extensors, internal rotators. When a person is inactive, the joints are pulled into a *flexed* (bent) position. If this tendency is not counteracted with exercise, the muscles permanently shorten and the joints become fixed in the flexed position which is a *contracture* Types of joint movements are on pg 1124 *ROM* of a joint is the maximum movement that is possible for that joint. pg 1125 44-2

Prescribed Limitations

Limitations to movement may be medically prescribed for health problems. To promote healing, braces, casts, splints are used. Bed rest- to limit activity and to prevent further complications and to improve the clients outcomes. *there is a rarely a need for complete bed rest

2 During discharge planning, the nurse is evaluating the client's understanding of wheelchair safety. Which of the following statements indicates a need for further teaching? 1. Always lock the brakes on both wheels of the wheelchair when the client transfers in or out of it. 2. Lower the footplates before transferring the client into the wheelchair. 3. Lower the footplates after the transfer, and place the client's feet on them. 4. Ensure the client is positioned well back in the seat of the wheelchair.

Lower the footplates before transferring the client into the wheelchair.

3. A nurse is evaluating a nursing student's understanding of stretcher safety. Which of the following statements demonstrates a need for further teaching? 1. Never leave a client unattended on a stretcher unless the wheels are locked and the side rails are raised on both sides and/or the safety straps are securely fastened across the client. 2. Always push a stretcher from the end where the client's head is positioned. This position protects the cli- ent's head in the event of a collision. 3. Maneuver the stretcher when entering the elevator so that the client's feet go in first. 4. Fasten safety straps across the client on a stretcher, and raise the side rails.

Maneuver the stretcher when entering the elevator so that the client's feet go in first.

Develop nursing diagnosis and outcomes related to activity, exercise, and mobility problems

Mobility problems can be the diagnostic label or the etiology -Activity Intolerance (Four levels can be used)-insufficient physiological or psychological energy to endure or complete required or desired daily activities -Risk for Activity Intolerance -Impaired Physical Mobility -Impaired Bed Mobility -Impaired Transfer Ability -Impaired Walking -Impaired Wheelchair Mobility -Sedentary Lifestyle -Risk for Disuse Syndrome

Benefits of exercise on body systems

Musculoskeletal Cardiovascular Respiratory GI Metabolic/Endocrine Urinary Immune Psychoneurologic Cognitive Function Spiritual Health

Muscle mass and strength

Nurse must assess the client's strength and ability to move -provide appropriate assistance to lower risk of strain or injury -assessment of upper body strength esp for people that use aids such as walkers, canes, etc

Nurse is reviewing the effects of immobility on various body systems. List at least 2 effects on cardiovascular system.

Orthostatic hypotension Less fluid volume in the circulatory system Stasis of blood in the legs Diminished autonomic response Decreased cardiac output leading to poor cardiac effectiveness, which results in increased cardiac workload Increased oxygenation requirement Increased risk of thrombus development

Assessing problems of immobility

Table 44-3, pg 1142

Joint Mobility

ROM (range of motion) is maximum movement possible for joint ROM varies and determined by: Genetic makeup Developmental patterns Presence or absence of disease Physical activity

10. The nurse is performing an assessment of an immobilized client. Which assessment causes the nurse to take action? 1. Heart rate 86 beats/min 2. Reddened area on sacrum 3. Nonproductive cough 4. Urine output of 50 mL/h

Reddened area on sacrum

Activity - exercise pattern

Refers to a person's routine of exercise, activity, leisure, and recreation. It includes the ADLs that require energy such as hygiene, dressing, cooking, shopping, eating, etc

Cognitive

Research supports exercise has positive effects on cognitive functioning in particular decision-making, and problem solving, planning and paying attention. Physical exertion induces cells in the brain to strengthen and build neuronal connections. Elder adults have denser brains then inactive elder adults. Brain Gym-cross lateral movements that enhance right and left brain integration, thus improving mood, learning, problem solving, and performance in persons of all ages.

1- To increase stability during client transfer, the nurse increases the base of support by performing which action? 1. Leaning slightly backward 2. Spacing the feet farther apart 3. Tensing the abdominal muscles 4. Bending the knees

Spacing the feet farther apart

Balance

The mechanisms involved in maintaining balance and posture involve informational inputs from the *labyrinth* (inner ear) , from *vision* (vestibule-ocular input), and from *stretch receptors* of muscles and tendons (vestibulospinal input). Mechanisms of the *equilibrium* (sense of balance) those receptors (hair like cells) in the semicircular canals and vestibule, called the vestibular apparatus, send signals to the brain that imitate reflexes needed to make required changes in position. When the head moves, fluid within the vestibule and semicircular canals stimulates the sensory hair cells sensory hair cells. The info goes right to the reflex centers in brainstem to allow for fast reflexive responses to body imbalance. *Proprioception* describes awareness of posture, movement, and changes in equilibrium, and the knowledge of position, weight, and resistance of objects in relation to the body.

Capabilities and limitations for movement

The nurse needs to obtain data that indicates hindrances or restrictions to the client's movement -how the client's illness influenced the ability to move and whether the client's health contraindicated any exertion, position, or movement -encumbrances to movement (cast or IV) -mental alertness and ability to follow directions- check client's meds to see if they are hindering their ability to walk -balance and coordination -presence of Orthostatic hypotension before transfers, assess for increase pr, dizziness, light-headedness -degree of comfort-people with pain, won't want to move -vision-is it adequate to prevent falls

Musculoskeletal

The size, shape, tone, and strength of a muscle (including the heart) are maintained with mild exercise and strenuous exercise. Muscles hypertrophy (enlarge) and the efficiency of the muscle contraction increases. (arm muscles of a carpenter) Joints lack blood supply so through activity the joints receive nourishment. Excessive also improves ROM and increase joint flexibility, Studies have shown that this helps with fall risks, depression, frailty in older adults. Bone density is maintained through weight bearing.

6. When assessing a client's gait, which does the nurse look for and encourage? 1. The spine rotates, initiating locomotion. 2. Gaze is slightly downward. 3. Toes strike the ground before the heel. 4. Arm on the same side as the swing-through foot moves for- ward at the same time.

The spine rotates, initiating locomotion.

5. During discharge planning, the nurse is teaching the client how to control postural hypotension. Which of the following statements is correct? 1. Bend down all the way to the floor and stand up quickly after stooping. 2. Wear elastic stockings day and night to inhibit venous pooling in the legs. 3. Use a rocking chair to improve circulation in the lower extremities. 4. Get out of a hot bath very quickly, because high temperatures can lead to venous pooling.

Use a rocking chair to improve circulation in the lower extremities.

5. A nurse is teaching a client about active range-of-motion (ROM) exercises. The nurse then watches the client demonstrate these principles. The nurse would evaluate that teaching was success- ful when the client does which of the following? 1. Exercises past the point of resistance. 2. Performs each exercise one time. 3. Performs each series of exercises once a day. 4. Uses the same sequence during each exercise session.

Uses the same sequence during each exercise session.

Respiratory

Ventilation (air circulating into and out of the lungs) and O2 intake increase during exercise, thereby improving gas exchange. Toxins are eliminated with deep breathing, help with stress, and problem solving and emotional stability are enhanced due to increase O2 to the brain. It also prevents the pooling of secretions, decreasing risk of infection, improves circulation of lymph, helps with asthma.

Urinary system

With adequate blood flow, which promotes efficient blood flow*, the body excreted wastes better. Stasis can be prevented which decreased risk of UTIs

Spiritual Healt

Yoga-style exercise improves the mind-body-spirit connection, relationship with God, and physical well-being by establishing balance in the internal and external environments. The emphasis on breathing in is thought to soothe the nervous and cardiorespiratory systems, promoting relaxation and preparedness for a contemplative experience. Mantra or prayer while sitting quietly and relaxing your muscles can cause a relaxation response resulting in a decrease in heart and respiratory rate.

Which statement from a client with one weak leg regarding use of crutches when using stairs indicates a need for increased teaching? "Going up, the strong leg goes first, then the weaker leg with both crutches." "Going down, the weaker leg goes first with both crutches, then the strong leg." "The weaker leg always goes first with both crutches." "A cane or single crutch may be used instead of both crutches if held on the weaker side."

Your Answer: "The weaker leg always goes first with both crutches." Rationale: Although the crutches (or cane) are always used along with the weaker leg, the weaker leg should go down the stairs first. The stronger leg can support the body as the weaker leg moves forward. All of the other statements are correct. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Evaluation.

A client weighs 250 pounds and needs to be transferred from the bed to a chair. Which instruction by the nurse to the unlicensed assistive personnel (UAP) is most appropriate? "Using proper body mechanics will prevent you from injuring yourself." "You are physically fit and at lesser risk for injury when transferring the client." "Use the mechanical lift and another person to transfer the client from the bed to the chair." "Use the back belt to avoid hurting your back."

Your Answer: "Use the mechanical lift and another person to transfer the client from the bed to the chair." Rationale: It is prudent for nurses to understand and use proper body mechanics at all times to decrease risk, while keeping in mind the importance of assistive devices and help from other staff. While it is generally accepted that proper body mechanics alone will not prevent injury, many work settings do not yet have "no manual lift" and "no solo lift" policies and resources in place. Cognitive Level: Analyzing. Client Need: Safe, Effective Care Environment. Nursing Process: Implementation.

Five minutes after the client's first postoperative exercise, the client's vital signs have not yet returned to baseline. Which is an appropriate nursing diagnosis? Activity Intolerance. Risk for Activity Intolerance. Impaired Physical Mobility. Risk for Disuse Syndrome.

Your Answer: Activity Intolerance. Rationale: Vital signs that do not return to baseline 5 minutes after exercising indicate intolerance of exercise at that time. This is a real problem, not "at risk for," as in option 2. There is no evidence that the client requires assistance (impaired mobility, option 3), or is immobile (disuse syndrome, option 4). Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Diagnosis.

The client is ambulating for the first time after surgery. The client tells the nurse, "I feel faint." Which is the best action by the nurse? Find another nurse for help. Return the client to her room as quickly as possible. Tell the client to take rapid, shallow breaths. Assist the client to a nearby chair.

Your Answer: Assist the client to a nearby chair. Rationale: Placing the client in a safe position is the best maneuver. Leaving the client creates unsafe conditions because the client may faint before being able to return to her room (options 1 and 2). Rapid, shallow breathing (hyperventilation) may increase the dizziness (option 3). Cognitive Level: Applying. Client Need: Safe, Effective Care Environment. Nursing Process: Implementation.

The nurse is performing an assessment of an immobilized client. Which assessment causes the nurse to take action? Heart rate 86 Reddened area on sacrum Nonproductive cough Urine output of 50 mL/hour

Your Answer: Reddened area on sacrum Rationale: The reddened area of the skin can lead to skin breakdown. The other options are within normal limits. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment.

To increase stability during client transfer, the nurse increases the base of support by performing which action? Leaning slightly backward. Spacing the feet farther apart. Tensing the abdominal muscles. Bending the knees.

Your Answer: Spacing the feet farther apart. Rationale: A key word in the question is base, and the feet provide this foundation. Leaning backward actually decreases balance (option 1), and tensing abdominal muscles alone (option 3) or bending the knees (option 4) does not affect the base of support. Cognitive Level: Applying. Client Need: Health Promotion and Maintenance. Nursing Process: Implementation.

When assessing a client's gait, which does the nurse look for and encourage? The spine rotates, initiating locomotion. Gaze is slightly downward. Toes strike the ground before the heel. Arm on the same side as the swing-through foot moves forward at the same time.

Your Answer: The spine rotates, initiating locomotion. Rationale: Normal gait involves a level gaze, an initial rotation beginning in the spine, heel strike with follow-through to the toes, and opposite arm and leg swinging forward. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment.

A nurse is teaching a client about active range-of-motion (ROM) exercises. The nurse then watches the client demonstrate these principles. The nurse would evaluate that teaching was successful when the client does which of the following? Exercises past the point of resistance. Performs each exercise one time. Performs each series of exercises once a day. Uses the same sequence during each exercise session.

Your Answer: Uses the same sequence during each exercise session. Rationale: When the client performs the movements systematically, using the same sequence during each session, the nurse can evaluate that the teaching was understood and is successful. When performing active ROM the client should exercise to the point of slight resistance, but never past that point of resistance in order to prevent further injury (option 1). The client should perform each exercise at least three times, not just once (option 2). The client should perform each series of exercises twice daily, not just once per day (option 3). Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Evaluation.

Isotonic exercises such as walking are intended to achieve which of the following? Select all that apply. Increase muscle tone and improve circulation. Increase blood pressure. Increase muscle mass and strength. Decrease heart rate and cardiac output. Maintain joint range of motion.

Your Answers: Increase muscle tone and improve circulation. Increase muscle mass and strength. Maintain joint range of motion. Rationale: Isotonic exercise increases muscle tone, mass, and strength, maintains joint flexibility, and improves circulation. During isotonic exercise, both heart rate and cardiac output quicken to increase blood flow to all parts of the body (option 4). Little or no change in blood pressure occurs (option 2). Cognitive Level: Remembering. Client Need: Physiological Integrity. Nursing Process: Planning.