Chapter 33: Activity
Mobility and Immobility
-Mobility is freedom and independence in purposeful movement -Immobility is the inability to move freely and independently at will.
Activity
-Regular exercise is necessary for healthy functioning of the body and impacts every major body system. -People who choose inactive lifestyles or who are forced into inactivity by illness or injury place themselves at high risk for serious health problems
Variations of Fowler's position include high-Fowler's and low-Fowler's, or semi-Fowler's position:
-in high-Fowler's position, the head of the bed is elevated 90 degrees and that allows for maximal lung expansion. -In low-Fowler's or semi-Fowler's position, the head of the bed is elevated only 30 degrees. -In Fowler's position, the buttocks bear the main weight of the body. In this position, the heels, sacrum, and scapulae are at risk for skin breakdown and require frequent assessment
Developmental Considerations
A person's age and degree of neuromuscular development influence movements, and reflexes.
Braden Scale
A tool for predicting pressure ulcer risk. Lower the points the higher of risk.
Exercise
Active exertion of muscles involving the contraction and relaxation of muscle groups is termed exercise. It has physiologic and psychological benefits
metabolic processes
Because the resting body requires less energy, the cellular demand for oxygen is decreased, leading to a decreased metabolic rate
PROVIDING ASSISTANCE WITH WALKING
Before getting the patient out of bed, do the following: •Assess the patient's ability to walk and the need for assistance (one nurse or two nurses, walker, cane, walking belt, or crutches). •Explain to the patient exactly what is to be done: transfer technique from bed to erect position, projected distance to be ambulated, assistance available, and the correct manner of using it. Instruct the patient to alert the nurse immediately if feeling dizzy or weak. •Ensure that the patient has a clear path for ambulation. •Provide skid-proof footwear. •Gait belt
Friction-Reducing Sheets
Can be used under patients to prevent skin shearing when moving patients in bed and when assisting with lateral transfers. •Their use reduces friction and the force required to move patients. •However, use of these sheets may require excessive force by the caregiver and exceed the recommended hand force of 35 lb, increasing the risk of musculoskeletal injuries for health care personnel
Daily Activities for Purposeful Exercise
Ex: position the bedside stand so that the patient must use shoulder and arm muscles to reach it, instead of placing it, so that little effort is required to take things from it. •Place the signal cord (call light) so that the patient must move either the arm or shoulder to reach it, as long as it is definitely within reach. • Encourage patients to sit up and reach for the overbed table, to pull it close, and then to push it back in place. In addition, encourage patients to try to carry out self-care activities, including washing their back independently or putting on socks while still in bed.
foam wedges and pillows
Foam wedges and pillows are used primarily to provide support or to elevate a body part. Wedges and pillows of different sizes are useful for different parts.
musculoskeletal system
Immobility (musculoskeletal disuse) leads to decreased muscle size( ATROPHY), tone, and strength; decreased joint mobility and flexibility; bone demineralization; and limited endurance, resulting in problems with ADLs
Proper and Improper Way to Pick up an Object
Left) Correct. A good position for lifting is illustrated. This person is using the long and strong muscles of the arms and legs and holding the object so that the line of gravity falls within the base of support. Incorrect. (Right) This is an incorrect position for lifting because pull is exerted on the back muscles and leaning causes the line of gravity to fall outside the base.
Adjustable Beds
Many different uses; can readjust head and leg positions and easily assist patients in getting out of bed. •Health care workers use the higher bed positions so that they do not strain their backs while providing bed care. •However, a low bed position between treatments decreases the risk of injury if the patient were to fall out of bed.
Gait belt
Put gait belt on while patient is in bed.
Effects of Exercise on Major Body Systems
Regular exercise is necessary for the healthy functioning of the body.
Lateral position
Sims' position. In this position, the patient again lies on the side, but the lower arm is behind the patient and the upper arm is flexed at both the shoulder and the elbow
Stand-Assist and Repositioning Aids
Some patients need minimal assistance to stand up. With an appropriate support to grasp, they can lift themselves. Many types of devices can help a patient to stand. These devices can be freestanding or attached to the bed or wheelchair.
A hand roll holds the hand in functional position.
can be used on an unconscious patient.
Mechanical Lateral-Assist Devices
devices include specialized stretchers and eliminate the need to slide the patient manually. • Some devices are motorized, whereas others use a hand crank. A portion of the device moves from the stretcher to the bed, sliding under the patient, bridging the bed and stretcher •The device is then returned to the stretcher, effectively moving the patient without any pulling by staff members.
Types of Exercises
isotonic, isometric, isokinetic
Mattresses
must be firm but have sufficient "give" to permit proper body alignment, as well as to be comfortable and supportive. Special mattresses, pads are available Ex: patients who are bedridden can use an air mattress to reduce pressure.
Lateral-Assist Devices
reduce patient-surface friction during side-to-side transfers. -Roller boards, slide boards, transfer boards, inflatable mattresses, and friction-reducing lateral-assist devices are examples of these devices, which make transfers safer and more comfortable for the patient.
Mobility
refers to adapting and having self awareness of the environment. Functional musculoskeletal and nervous systems are essential for mobility
dangling
refers to the position in which the person sits on the edge of the bed with legs and feet over the side of the bed. This exercise helps prepare patients for being out of bed.
Active ROM
the patient independently moves joints through their full range of motion (isotonic exercise). In active-assistive exercise, the nurse may provide minimal support
Passive ROM-
the patient is unable to move independently, and the nurse moves each joint through its range of motion
Side-lying position
the patient lies on the side and the main weight of the body is borne by the lateral aspect of the lower scapula and the lateral aspect of the lower ilium
powered full-body lifts
used with patients who cannot bear any weight to move them out of bed, into and out of a chair, and to a commode or stretcher •The device slowly lifts the patient. Some devices can be lowered to the floor to pick up a patient who has fallen. These devices are available on portable bases and ceiling-mounted tracks. The duration of time spent in slings should be limited to reduce risk for pressure injury, especially for vulnerable population
A trapeze attached to the bed of a patient
who has limited use of the lower part of the body helps the patient to move about in bed and strengthens muscles in the upper part of the body
Mental Health
•A person's mental health influences body appearance and movement as much as the person's physical health. •Body processes tend to slow down in depression, and there is a lack of visible energy and enthusiasm. Body posture also may be affected.
Equipment and Assistive Device
•Assessment of the patient, ability to assist and desired movement determines the type of equipment to use. •Gait belts •Stand-assist and repositioning aids •Lateral-assist devices •Friction-reducing sheets •Mechanical lateral-assist devices •Transfer chairs •Powered stand-assist and repositioning lifts •Powered full-body lifts
Braces
•Braces that support weakened leg muscles are available in many variations. Nursing responsibilities include knowing when the brace is to be worn and the correct technique for applying the brace, monitoring to ensure correct use of the brace by the patient, and observing for any untoward problems the brace might cause (e.g., skin irritation). Muscle changes such as those occurring with growth and development or brought about by illness (atrophy) may require the brace to be refitted to maintain its effectiveness.
Canes
•Canes widen a person's base of support, providing improved balance •The cane should fit so that when the patient stands with the cane's tip 4 in (10 cm) to the side of the foot, the cane extends from the floor to the crease in the patient's wrist. The elbow should be flexed 15 degrees when holding the cane. Rubber tips on the cane prevent slipping and accidents. Inspect these regularly to ensure that they are intact. Teach patients to stand erect when walking with a cane and not to lean out over the cane. •Ambulation proceeds in the following fashion: •The patient stands with weight evenly distributed between the feet and the cane. •The cane is held on the patient's stronger side and is advanced one small stride ahead •Supporting weight on the stronger leg and the cane, the patient advances the weaker foot forward, parallel with the cane. •Supporting weight on the weaker leg and the cane,, the patient brings the stronger leg forward to finish the step
transfer chairs
•Chairs that can convert into stretchers are available. •These are useful with patients who have no weight-bearing capacity, cannot follow directions, and/or cannot cooperate. The back of the chair bends back, and the leg supports elevate to form a stretcher configuration, eliminating the need for lifting the patient. Some of these chairs have built-in mechanical aids to perform the patient transfer, as detailed previously
Fatigue and Stress
•Chronic stress may deplete body energy to the point that fatigue makes even the thought of exercise overwhelming. •Regular exercise is energizing and can better equip a person to deal with daily stresses. • Excessive exercise, however, may stress the body and lead to injury as well as to fatigue
Factors Influencing Mobility and alignment
•Developmental considerations •Physical health oMuscular, Skeletal, or Nervous System Problems oProblems Involving Other Body Systems •Mental health •Lifestyle •Attitude and values •Fatigue and stress •External factors
Benefits of Exercise on Gastrointestinal System
•During exercise, blood is shunted away from the stomach and intestines to the exercising muscles. With regular exercise: •Appetite is increased. •Intestinal tone is increased, which improves digestion and elimination. •Weight may be controlled.
nursing history
•During the nursing history, interview patients regarding their daily activity level, endurance, exercise and fitness goals, mobility problems, physical or mental health alterations that affect mobility, and external factors affecting mobility.
Ensuring Safe Patient Handling and Movement Pt 2.
•Explain to the patient what you plan to do. Then use what abilities the patient has to assist you. This technique often decreases the effort required and the possibility of injury to you. •If the patient is in pain, administer the prescribed analgesic sufficiently in advance of the transfer to allow the patient to participate in the move more comfortably. •Elevate the bed as necessary so that you are working at a height that is comfortable and safe for you. •Lock the wheels of the bed, wheelchair, or stretcher so that they do not slide while you are moving the patient. •Be sure the patient is in good body alignment while being moved and lifted to protect the patient from strain and muscle injury. •Support the patient's body properly. Avoid grabbing and holding an extremity by its muscles. •Avoid friction on the patient's skin during moving. •Use friction-reducing devices whenever possible, especially during lateral transfers. Ex. Sliding board- reduces friction decreases workload to move the patient. •Move your body and the patient in a smooth, rhythmic motion. Jerky movements tend to put extra strain on muscles and joints and are uncomfortable for the patient. •Use mechanical devices such as lifts, slides, transfer chairs, or gait belts for moving patients. Be sure that you understand how the device operates and that the patient is properly secured and informed of what will occur. •Ensure that the equipment used meets weight requirements. Bariatric patients (BMI >50) require bariatric transfer aids and equipment. Bariatric transfer aids and equipment are designed to be used with people who are obese.
Safe Handling of Patients with Dementia
•Face the patient when speaking. •Use clear, short sentences. •Call patient by name. •Use calm, reassuring tone of voice. •Offer simple, step-by-step instructions. •Repeat verbal cues and prompts as necessary; this is helpful when thought processes are delayed. •Determine if the patient experiencing dementia has receptive aphasia. This inability to understand what is being said results in noncompliance with verbal instructions. •Phrase instructions positively. For example, remind the patient to "Stand up" until the chair is correctly positioned, instead of saying "Don't sit down." The patient may not register the "Don't" and will try to sit too early. Positive instructions are more likely to result in successful maneuvers. •Ask one question at a time, allow the patient to answer, and repeat the question if necessary. •Allow the patient to focus on the task; avoid correcting the process of the action unless it would be dangerous to the patient not to do so. •Identify the patient's established patterns of behavior, customs, traits, and everyday habits and try to incorporate these habits into desired activities. For instance, a patient with dementia may resist or become frightened when a morning shower is attempted if the patient was accustomed to evening baths. Another patient may have difficulty getting out of bed in the morning for the simple reason that he is being asked to get out on what he considers the wrong side of the bed.
Nursing process-Outcome Identification (what is the goal) and Planning
•For Patients at high risk for specific mobility problems the expected outcomes patient will be: •Demonstrate correct body alignment whenever observed (alignment) •Demonstrate full range of joint motion (joint mobility) •Demonstrate adequate muscle mass, tone, and strength to perform functional ADLs (muscle mass, tone, strength) •Patients who are immobile require outcomes directed toward preventing complications related to inactivity and its effects on the body systems. For example, the patient will: •Be free from alterations in skin integrity •Show signs of adequate venous return •Be free of contractures -Outcome: goal what is the patient going to do by when.
crutches
•Forearm crutches are used for patients requiring long-term support for ambulation Axillary crutches are used to provide support for patients who have temporary restrictions on ambulation. These crutches •Remind the patient that the support of body weight should come primarily on the hands and arms while using the crutches, not in the axillary areas where pressure may damage nerves and cut off circulation. Also, the crutches should not be forced into the axillae each time the body moves forward.
types of positions
•Fowler's position •Protective supine position •Protective side-lying or lateral position •Protective Sims' position •Protective prone position
Turning the Patient in Bed
•Frequently, a patient cannot turn in bed without assistance. Nurses need to use their knowledge of correct alignment to turn the patient from the back onto the side, from the back onto the abdomen, and from the abdomen onto the back. •If the patient is unable to assist with movement, a full-body sling and two or more caregivers are required. •When turning the patient, the bed should be at the height of the caregivers' elbows to ensure a comfortable working height.
Equipment and Assistive Devices
•Gait Belts •A gait belt is a device used for transferring patients and assisting with ambulation .The belt, which often has handles, is placed around the patient's waist and secured by Velcro fasteners. •The gait belt is used to help the patient stand and provides stabilization during pivoting. •Gait belts also allow the nurse to assist in ambulating patients who have leg strength, can cooperate, and require minimal assistance. • Do not use gait belts on patients with abdominal or thoracic incisions
Physical Assessment for Mobility
•General ease of movement and gait •Alignment •Joint structure and function, ROM •Muscle mass, tone, and strength •Endurance •Use of assistive devices
Moving a patient up in bed
•If the patient is fully able to assist in moving up in the bed, allow the patient to complete the movement independently, with safe supervision. •The patient assists movement either by pushing with the feet flat against the bed or by using an overbed trapeze. •If only partially able, encourage the patient to assist using a repositioning aid or cues. If the patient is less than 200 lb, use a friction-reducing device and two to three caregivers. • If the patient is over 200 lb, use a friction-reducing device and at least three caregivers. -If the patient is not able to assist, use a full-body sling lift and two or more caregivers. Friction-reducing sheets or other devices should be used to minimize shearing forces and work effort
Moving a Patient from Bed to Stretcher
•If the patient is fully able to assist in the transfer, allow the patient to complete the movement independently, with supervision. •If the patient is partially able or not able to assist at all and weighs less than 200 lb, use a friction-reducing device and/or a lateral-transfer board. •If the patient is partially able or not able to assist at all and weighs more than 200 lb, a ceiling lift with supine sling, a mechanical lateral-transfer device or air-assisted device, and three caregivers are required. If the patient is unconscious or weakened, additional nurses are needed to support the extremities and the head.
gastrointestinal system
•Immobility leads to disturbances in appetite, decreased food intake, altered protein metabolism, and poor digestion and utilization of food. • If people increase food intake while decreasing energy expenditure, weight gain will result. • Normal muscular activity in the GI tract also slows down in an immobile person, which often results in constipation, poor defecation reflexes, and an inability to expel feces and gas adequately.
Nursing process- Implementing
•Implementing- The use of ergonomics, safe patient handling and movement strategies •Application of Ergonomics to Prevent Injury •Ergonomics includes proper body movement in daily activities, the prevention and correction of problems associated with posture, and the enhancement of coordination and endurance. Musculoskeletal disorders plague the nursing profess.
Benefits of Exercise to Respiratory System
•Improved alveolar ventilation •Decreased work of breathing •Improved diaphragmatic excursion
Skin
•In patients who are immobile, especially those who are older or debilitated, the impaired circulation that accompanies immobility may result in serious skin breakdown. •Prolonged pressure over bony prominences produces areas of breakdown, leading to pressure injuries
Supine or Dorsal Recumbent Position
•In the supine position, the patient lies flat on the back with the head and shoulders slightly elevated with a pillow unless contraindicated, such as spinal anesthesia or surgery on the spinal vertebrae.
Benefits of Exercise on Skin
•Increased circulation resulting from regular exercise nourishes the skin. Regular exercise aids in promoting the overall general health of the skin
Benefits of Exercise to Cardiovascular System
•Increased efficiency of the heart •Decreased heart rate and blood pressure •Increased blood flow to all body parts •Improved venous return •Increased circulating fibrinolysin (substance that breaks up small clots)
Benefits of Exercise to Musculoskeletal System
•Increased muscle efficiency (strength) and flexibility •Increased coordination •Reduced bone loss •Increased efficiency of nerve impulse transmission •Regular exercise is also believed to slow the effects of aging. For example, exercise has been shown to help prevent osteoporosis (the process of bone demineralization) associated with aging. •Exercise has also been associated with minimizing bone loss during chemotherapy
Intermittent pneumatic compression
•Intermittent pneumatic compression devices may be used in conjunction with graduated compression stockings or alone. • They are composed of an air pump, connecting tubes, and extremity sleeves that apply intermittent or sequential pressure to the legs to enhance blood flow and venous return, stimulating the normal muscle-pumping action in the legs. •They require a prescriber's order and are often prescribed for high-risk surgical patients, those with decreased mobility or chronic venous disease, and patients at risk for deep vein disorders
Compression stockings--general nursing guidelines:
•Measure the patient's legs to determine the proper size of stocking. An improperly fitting stocking is uncomfortable and ineffective and possibly even harmful •Assess the skin condition and neurovascular status of the legs. Report abnormalities before continuing with the application of the stockings. •Be prepared to apply the stockings in the morning before the patient is out of bed and while the patient is supine. If the patient is sitting or has been up and about, have the patient lie down with legs and feet elevated for at least 15 minutes before applying the stockings. Otherwise, the leg vessels are congested with blood, reducing the effectiveness of the stockings. •Do not massage the legs. If a clot is present, it may break away from the vessel wall and circulate in the bloodstream. •Check the legs regularly for redness, blistering, swelling, and pain. Some recommend checking the legs at least once every 8 hours; others recommend twice a day. Remove the stockings completely once a day to bathe the legs and feet. •Launder the stockings as necessary, but at least every 3 days. Always remove graduated compression stockings during morning care and inspect the legs. Then reapply the stockings before the patient is out of bed
Diagnosing-
•Nursing diagnoses specifically addressing problems of mobility include: •Activity Intolerance related to fatigue, generalized weakness, and exertional discomfort (problem focused diagnosis) •Impaired Transfer Mobility related to pain and musculoskeletal impairment (problem focused diagnosis) •Risk for Injury related to altered sensation, unsteady gait, and confusion (risk diagnosis)
Logrolling a patient
•Patient's legs are stretched, the head is held to immobilize the neck, arms are at the sides, patient is rolled to the desired direction without twisting or bending the body.
PHYSICAL CONDITIONING TO PREPARE FOR AMBULATION
•Patients who are not confined to bed for long periods, who sleep well, and who experience possibly short periods of rest during the day may not require special considerations for increased physical activity in preparation for ambulation. •Certain exercises that strengthen the overall efficiency of the musculoskeletal system can be done in bed. Check for physical activity restrictions or other contraindications before beginning any exercises.
Risks Related to Exercise
•Personal harm can include cardiovascular events, muscle injuries, or falling. •Precipitation of a Cardiac •Orthopedic Discomfort and Disability •Other Health Problems
It is carried out as follows:
•Place the patient in the sitting position in bed for a few minutes. This will accustom the patient to this position and help prevent feelings of faintness. •Place the bed in the low position or have a footstool handy, on which the patient can rest the feet while dangling. •Move the patient toward the side of the bed near you so that you do not stretch and strain while turning the patient. •Pivot the patient a quarter of a turn by supporting the shoulders and legs. Swing the patient's legs over the side of the bed. The patient may place hands on your shoulders. •Rest the patient's feet on the floor or on a footstool. This gives a sense of security and lessens the likelihood that the patient will slide off the bed. •Have the patient move the feet using an up-and-down, marching motion. This promotes circulation in the legs. •Assess for lightheadedness or other signs of orthostatic hypotension (dizziness, nausea, tachycardia, or pallor). •Remain with the patient and be ready to place the patient back to a lying position if feeling faint, to prevent falling out of bed.
Positioning Patients
•Positioning that maintains correct body alignment and facilitates physiologic functioning contributes to the patient's psychological and physical well-being. Many devices can help maintain proper body alignment and muscle tonus while the patient is in bed and can alleviate discomfort or pressure on various parts of the body. •Pillows •Mattresses •Adjustable beds •Bed side rails •Trapeze bar •Additional equipment
Moving a Patient from Bed to Chair
•Preliminary assessment of vital signs provides baseline data; subsequent recordings determine the effect of this activity on the patient. •Patients who are unable to bear partial weight or full weight or who are uncooperative should be transferred using a full-body sling lift with two caregivers. •When moving the patient, if the patient becomes lightheaded, weak, and unsteady, lower the patient back to bed.
Physical Health
•Problems in the musculoskeletal or nervous systems can have a negative influence on body alignment and movement. •Illness or trauma involving other body systems may interfere with movement because of either the underlying pathology or the treatment regimen •Inflammation, degeneration, and trauma can all interfere with joint mobility.
•Quadriceps and Gluteal Setting Drills (Sets)
•Quadriceps drills are an isometric exercise. One of the most important muscle groups used in walking is the quadriceps femoris. This muscle group helps extend the leg and flex the thigh. To help reduce weakness and make first attempts at walking easier, encourage bedridden patients to contract this muscle group frequently The muscles in the buttocks can be exercised in the same way by pinching the buttocks together and then relaxing them. This is called gluteal setting. Tightening and holding the abdominal muscles for 6 seconds and then relaxing them also strengthens this muscle group to facilitate walking.
Promoting Exercise
•Regular physical activity can improve the health and quality of life of people of all ages and helps prevent certain chronic diseases such as hypertension, type 2 diabetes, and cardiovascular disease. •Physical activity guidelines for older adults who are fit and have no chronic conditions are the same as for all adults. Older adults should be as physically active as their abilities and conditions allow.
Helping Patients Ambulate
•Routine activity and mobilization of patients is an important activity and is appropriate for most patient populations. It reduces hospital length of stay, shortens the duration of mechanical ventilation, and improves muscle strength and functional independence •Physical conditioning to prepare for ambulation •Quadriceps and Gluteal Setting Drills •Pushups •Dangling •Providing assistance with walking.
Ensuring Safe Patient Handling and Movement
•SAFE PATIENT TRANSFER-Follow these recommended guidelines when moving and lifting patients: •Assess the patient. Know the patient's medical diagnosis, capabilities, and any movement not allowed. Apply braces or any device the patient wears before helping from bed. •Assess the patient's ability to assist with the planned movement. • Encourage patients to assist in their own transfers. Encouraging patients to perform tasks that are within their capabilities promotes independence. •Assess the patient's ability to understand instructions and cooperate with the staff to achieve the movement. •During any patient-transferring task, if any caregiver is required to lift more than 35 lb of a patient's weight, consider the patient to be fully dependent and use assistive devices for the transfer. •Ensure that enough staff are available and present to safely move the patient. •Assess the area for clutter, accessibility to the patient, and availability of devices. • Remove any obstacles that may make moving and lifting inconvenient. •Decide which equipment to use. •Plan carefully what you will do before moving or lifting a patient. Assess the mobility of attached equipment. You may injure the patient or yourself if you have not planned well. If necessary, enlist the support of another caregiver. This reduces the strain on everyone involved. Communicate the plan with staff and the patient to ensure coordinated movement.
Proving assistance with walking pt. 2
•Should a patient faint or begin to fall while walking, stand with feet apart to create a wide base of support and rock the pelvis out on the side facing the patient. • With arms under the patient's axillae and encircling the patient and supporting the patient's body against the nurse's, gently slide the patient down to the floor, carefully protecting the patient's head •When two nurses are assisting a patient who starts to fall or faint, they both should use one hand to grasp the gait belt to support the patient and grasp the patient's hand or wrist with their other hand. After they have steadied the patient, they can slowly lower the patient to a chair or the floor
Protective Positioning
•Teach patient-Correct positioning techniques •The need to change positions frequently, at least every 2 hours •The importance of using the time allotted to position changes to exercise the extremities and to assess and massage pressure areas (reddened areas should not be massaged) •When the patient is unable to change position independently, use a turn schedule, posted at the bedside to assist with and document the rotation of positions
basic guidelines to follow when helping to put the patient's joints through range of motion
•Teach the patient what exercise is being undertaken, why, and how it will be done. A show-and-tell technique is often helpful. •Avoid overexertion and continuing exercises to the point that the patient develops fatigue. The exercises are not meant to exhaust or tax the patient. It may be necessary to delay certain exercises until the patient's condition allows. •Avoid neck hyperextension and attempts to achieve full range of motion in all joints with older adults. These movements may prove painful. Encourage adequate range of motion in those joints necessary to perform ADLs. •Start gradually and work slowly. All movements should be smooth and rhythmic. Irregular and jerky movements are uncomfortable for patients. •Move each joint until there is resistance but not pain. Report uncomfortable reactions and stop exercises until further instructions are obtained.
Application of Ergonomics to Prevent Injury
•Techniques to prevent back stress : •Develop a habit of erect posture (correct alignment). When sitting, use the chair back to support the whole spine, keeping shoulders back but relaxed. Balance the head over the shoulders, avoid leaning forward, and hold in the stomach muscles. •Use the longest and the strongest muscles 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 stooping, reaching, lifting, or pulling.
Benefits of Exercise on Metabolic Processes
•The metabolic rate increases during excercise . With regular exercise, the efficiency of metabolism and body temperature regulation is increased. Other benefits of exercise on the metabolic processes include: •Increased triglyceride breakdown •Increased gastric motility •Increased production of body heat
pushups
•The muscles of the arms and shoulders may also need strengthening before the patient is ready to be out of bed. They are part of the preparation for patients who must learn to walk on crutches.
cardiovascular system
•The primary and serious effects of immobility on the cardiovascular system include increased cardiac workload, orthostatic hypotension, and venous stasis, with resulting venous thrombosis. Immobility results in an increased workload for the heart.
Fowler's position
•The semi-sitting position, or Fowler's position, calls for the head of the bed to be elevated 45 to 60 degrees. This position is often used to promote cardiac and respiratory functioning because abdominal organs drop in this position, providing maximal space in the thoracic cavity. This is also the position of choice for eating, conversation, and urinary and intestinal elimination.
Additional Equipment
•The use of a foot support, such as a foot board, foot boot, or high-top sneakers, helps avoid foot drop. •If top bedding must be kept off the patient's lower extremities, a device called a cradle is used. A cradle is usually a metal frame that supports the bed linens away from the patient while providing privacy and warmth. •Trochanter rolls are used to support the hips and legs so that the femurs do not rotate outward. •If a patient is paralyzed or unconscious, hand-wrist splints or hand rolls may be necessary to provide a means for keeping the thumb in the correct position. •Side rails can assist the patient in rolling from one side to the other or to sitting up without calling for assistance.
Variables Leading to Back Injury in Health Care Workers/nurses
•Uncoordinated lifts •Manual lifting and transferring of patients without assistive devices •Lifting when fatigued or after recent back injury recovery •Repetitive movements such as lifting, transferring, and repositioning patients •Standing for long periods of time •Transferring patients •Repetitive tasks •Transferring/repositioning uncooperative or confused patients
Assisting with range of motion exercises
•Unless contraindicated, encourage active, active-assistive, or passive range-of-motion exercises regularly and include them in the patient's care plan.
urinary system
•Urinary stasis favors the growth of bacteria that, when present in sufficient quantities, may cause urinary tract infections. Poor perineal hygiene, incontinence, decreased fluid intake, or an indwelling urinary catheter can increase the risk for urinary tract infection in an immobile patient. •Immobility also predisposes the patient to renal calculi, or kidney stones, which are a consequence of high levels of urinary calcium; urinary retention and incontinence resulting from decreased bladder muscle tone; the formation of alkaline urine, which facilitates growth of urinary bacteria; and decreased urine volume.
Mechanical Aids for Walking
•Various devices can assist a patient with walking. •Walker •Cane •Braces •Crutches
Using Graduated Compression Stockings and Pneumatic Compression Devices
•Venous stasis and the development of venous thrombosis are potential complications of immobility. •Graduated compression stockings and pneumatic compression devices are passive interventions prescribed to aid in the prevention of these complications. •By applying pressure, graduated compression stockings increase the velocity of blood flow in the superficial and deep veins and improve venous valve function in the legs, promoting venous return to the heart. By preventing pooling of the blood, clot formation is less likely. •An order is required from the patient's health care provider for their use.
•Instruct a patient using a walker to do the following:
•Wear nonskid shoes or slippers. •When rising from a seated position, use the chair arms for support. Once standing, place one hand at a time on the walker and move forward into it. •Begin by pushing the walker forward, keeping the back upright. Place one leg inside the walker, keeping the walker in place. Then, step forward with the remaining leg into the walker, keeping the walker still. Repeat the process by moving the walker forward again. •Caution the patient to avoid pushing the walker out too far in front and leaning over it. Patients should always step into the walker, rather than walking behind it, staying upright as they move. •Never attempt to use a walker on stairs.
External Factors
•Weather exerts the greatest influence over outside exercise. A brisk, clear day is invigorating and invites increased activity. However, high humidity, very hot and very cold temperatures, rain, and snow discourage outdoor exercise. • Sufficient financial resources for gym memberships, access to exercise equipment, safe outdoor parks and sports areas, the availability of malls for early morning walkers, support people, and occupational or insurance rewards for exercise can all encourage regular exercise. •Discouraging factors include lack of free time, insufficient financial resources for equipment purchase or gym membership, air pollution, unsafe neighborhoods, and lack of support and reinforcement.
respiratory system
•When areas of lung tissue are not used over time, atelectasis (incomplete expansion or collapse of lung tissue) may occur. Immobility results in a poor exchange of carbon dioxide and oxygen •When a person is immobile, the movement of secretions in the respiratory tract is decreased, causing secretions to pool and leading to respiratory congestion. These conditions predispose the person to respiratory tract infections. Hypostatic pneumonia is a type of pneumonia that results from inactivity and immobility
Evaluating
•When evaluating the effectiveness of a care plan designed to help patients enhance, maintain, or regain mobility and fitness goals, use each nurse-patient interaction to evaluate the patient in the following respects: •General ease of movement and gait •Body alignment •Joint structure and function •Muscle mass, tone, and strength •Endurance
Lifestyle
•Whether a person chooses an active or sedentary lifestyle is dependent on many variables, including occupation, leisure activity preferences, and cultural influences. •Many occupations are sedentary (e.g., computer technician). •Culture and biological sex may also play a role, encouraging or discouraging exercise.
Application of Ergonomics to Prevent Injury
•Work as closely as possible to an object that is to be lifted or moved. This brings the body's center of gravity close to that of the object being moved, permitting most of the burden to be borne by the leg and arm muscles, rather than the back. . •Face the direction of your movement. Avoid twisting your body. •Use the weight of the body as a force for pulling or pushing, by rocking on the feet or leaning forward or backward. This reduces the amount of strain placed on the arms and the back. •Slide, roll, push, or pull an object, rather than lift it, to reduce the energy needed to lift the weight against the pull of gravity. •Use the weight of the body to push an object by falling or rocking forward and to pull an object by falling or rocking backward. •Push rather than pull equipment when possible. Keep arms close to your body and push with your whole body, not just your arms. •Begin activities by broadening your base of support. Spread the feet to shoulder width. •Make sure that the surface is dry and smooth when moving an object to decrease the effects of friction •Flex the knees, put on the internal girdle, and come down close to an object that is to be lifted. •Break up heavy loads into smaller loads. Take breaks from lifting or moving to relax and recover.
Trapeze Bar
•handgrip suspended from a frame near the head of the bed. • A patient can grasp the bar with one or both hands and raise one's trunk from the bed. •The trapeze makes moving and turning considerably easier for many patients and facilitates transfers into and out of bed. •It can also be used when a patient needs to perform exercises that strengthen some muscles of the upper extremities (e.g., biceps).
Isometric exercise:
•involves muscle contraction without shortening (i.e., there is no movement or only a minimum shortening of muscle fibers). Examples include contractions of the quadriceps and gluteal muscles, such as what occurs when holding a Yoga pose. •Potential benefits are increased muscle mass, tone, and strength; increased circulation to the exercised body part; and increased osteoblastic activity. •Nurses should encourage both isotonic and isometric exercises for hospitalized patients with limited mobility. isolates a specific muscle or muscle group and exercises it by holding the muscle steady and maintaining tension.
Isokinetic exercise
•involves muscle contractions with resistance. The resistance is provided at a constant rate by an external device, which has a capacity for variable resistance. Examples include rehabilitative exercises for knee and elbow injuries and lifting weights. •A continuous passive motion (CPM) device used postoperatively after joint surgery (knee replacement, anterior cruciate ligament [ACL] repair) performs these same type exercises passively for the patient.
Isotonic:
•involves muscle shortening and active movement. Examples include carrying out ADLs, independently performing range-of-motion exercises, and swimming, walking, jogging, and bicycling. • Potential benefits include increased muscle mass, tone, and strength; improved joint mobility; increased cardiac and respiratory function; increased circulation; and increased osteoblastic or bone-building activity. •These benefits do not occur when the nurse or family member performs passive range-of-motion exercises for a patient because the patient's muscles do not exert effort.
Walker
•is a lightweight metal frame with four legs •When the patient stands between the back legs of the walker with arms relaxed at the side, the top of the walker should line up with the crease on the inside of the patient's wrist. • When the patient's hands are placed on the grips, elbows should be flexed about 30 degrees •The walker's rubber tips should be intact to prevent slipping. •patients lift the walker without wheels ahead of themselves and step into it.
Caution is necessary when
•performing range-of-motion exercises with patients who are unresponsive because these patients are unable to report complaints of pain. •Return the joint to a neutral position, that is, its normal position of alignment, when finishing each exercise. •Keep friction at a minimum when moving extremities to avoid injuring the skin. •Use range-of-motion exercises twice a day, and do the exercises regularly to build up muscle and joint capabilities. Perform each exercise two to five times. It is possible to perform many of the exercises when the patient is being bathed as part of that procedure. Encourage routine tasks such as eating, dressing, self-bathing, and writing to help to put certain joints through range of motion. •Expect the patient's respiratory and heart rate to increase during exercise. These rates should return to usual resting levels within 3 minutes. If they do not, the exercises are probably too strenuous for the patient. •Use passive exercises as necessary, but encourage active exercises of the same kind when the patient is able to do so independently. Exercises should continue at home after a period of hospitalization, as necessary.
Prone Position
•the person lies on the abdomen with the head turned to the side. •The position is thus contraindicated for people with spinal problems.
Attitude and Values
•values learned early may be internalized for a lifetime.
