Mobility, Activity and Exercise in Older Adults

The nurse is assisting an older woman with kyphosis to dress for a holiday social event that will include some ambulatory activities. Which pair of shoes should the nurse encourage the woman to wear? 1. A pair of soft, comfortable slippers that are easy to slip on 2. A pair of bright red heels that match her festive outfit 3. A pair of flat open-heeled shoes with rubber nonslip soles 4. A pair of low-heeled loafers that fit snugly when walking

Answer 4: Older women, particularly those with kyphosis, should be encouraged to wear low heels when walking to provide better balance. Shoes should fit snugly enough that they do not slip off the heel when walking.

The nurse is planning to teach several patients to perform isotonic exercises. Which patient requires special reinforcement of breathing through the mouth to prevent the Valsalva maneuver? 1. 68-Year-old who has cardiac dysthymias that cause syncope 2. 72-Year-old who has Meniere's disease with tinnitus 3. 58-Year-old who has osteopenia and vitamin D deficiency 4. 80-Year-old who has Parkinson disease with tremors

Answer 1: Isometric and isotonic exercises should be used with caution by persons with cardiac problems because these exercises increase stress on the cardiovascular system. These exercises may result in elevation of the blood pressure and use of the Valsalva maneuver, which can slow the heart rate dangerously, even to the point of cardiac arrest in someone with cardiac disease.

What would the nurse suggest to an older adult who independently performs activities of daily living (ADLs) to help conserve energy? 1. Put on clothing while sitting 2. Dress in clothing with smaller buttons 3. Keep shoes laced up as high as possible 4. Wear pajamas during the daytime

Answer 1: Sitting takes less energy than standing up to dress. Small buttons and laced shoes should be avoided and replaced with Velcro fasteners and slip-on shoes. Wearing pajamas all day may conserve energy but is generally not recommend, because a nice appearance and appropriate clothing help to improve self-esteem.

The nurse is instructing the unlicensed assistive personnel to use a gait belt when assisting an older gentleman to ambulate in the hall. What instructions will the nurse give? 1. Use the gait belt to lift the patient to a standing position as needed 2. Use the gait belt to sense changes or problems with balance 3. Apply the patient's trouser belt and ensure that it is secure 4. Apply the belt loosely to prevent discomfort or abrasions to skin

Answer 2: The belt is near the person's center of gravity; thus the caregiver can sense subtle balance changes and anticipate problems. A gait belt is not a lifting device. If the belt is too loose, it may slide up under the rib cage and cause injury. Regular belts on trousers or dresses should only be used as a last resort, because they are usually narrower and may not fasten as securely as a proper gait belt.

The nurse is monitoring the vital signs of an older person who recently started an exercise program as prescribed by the health care provider. What would be considered a normal finding? 1. Orthostatic hypotension with lightheadedness 2. Elevation of temperature that does not respond to rehydration 3. Dyspnea that is temporarily accompanied by cyanosis 4. Elevated pulse that does not immediately return to normal

Answer 4: Tachycardia is a common occurrence when an activity program is started. An elevated pulse in an older adult takes longer to return to its normal rate than it does in a younger person. Orthostatic hypotension is not expected and may pose safety risks to older adults. Dyspnea with cyanosis and elevated temperature are not expected and should be reported to the health care provider.

The nurse is obtaining a health history for a client with osteoporosis. What should the nurse ask the client about? Select all that apply. 1. amount of alcohol consumed daily 2. use of antacids 3. dietary intake of fiber 4. use of Vitamin K supplements 5. intake of fruit juices

Answer: 1, 2, 3, 4 The nurse should ask the client about alcohol use because heavy alcohol use causes fluid excretion resulting in heavy losses of calcium in urine. If the client uses antacids containing aluminum or magnesium, a net loss of calcium can occur. If the client has a high-fiber diet, the fiber can bind up some of the dietary calcium. People with hip fractures have been found to have low vitamin K intakes; vitamin K plays an important role in production of at least one bone protein. Fruit juices do not affect calcium absorption.

A client reports falling in the shower at home about one hour ago. For what should the nurse assess to determine if the client experienced a femoral fracture? Select all that apply. 1. reports of severe pain 2. adduction of the hip 3. internal rotation of the hip 4. inability to move leg 5. left leg shorter in length

Answer: 1, 2, 3, 5 Severe pain, adduction, internal rotation, and the leg appearing shorter than the opposing leg are all signs and symptoms of a femoral fracture. Although the inability to move the leg can be a sign of a fracture, the initial signs and symptoms noted are indications of a femoral fracture.

An older adult client is admitted post fall with a right hip fracture. The client's family members state that there has been weight loss due to a poor appetite and the client has reported dizziness. Which factors, based on client assessment and history, can cause a risk for impaired skin integrity? Select all that apply. 1. age 2. dizziness 3. right hip fracture 4. confusion 5. poor appetite 6. incontinence

Answer: 1, 2, 3, 5 The client has a risk for impaired skin integrity due to the right hip fracture and dizziness, which will contribute to difficulty with mobility. Having a poor appetite can cause malnutrition which is another risk factor for impaired skin integrity. Age is also a risk factor due to being elderly. There is no evidence of confusion or incontinence with this client although the client will need assistance with elimination needs due to mobility problems.

To ensure safe postoperative care of a client after a total hip arthroplasty, which actions are most appropriate for the nurse to perform? Select all that apply. 1. Limit movements resulting in internal rotation and adduction of the affected hip. 2. Use a pillow under the knees to prevent hip flexion. 3. Reduce extension and hyperextension of the affected hip. 4. Teach the client not to cross the legs. 5. Elevate the client's legs above the level of the heart.

Answer: 1, 4 With a total hip replacement, correct positioning and movement is important to prevent dislocation. Dislocation after hip replacement is minimized when the client avoids movements resulting in internal rotation and adduction of the affected hip. Teaching the client not to cross the legs is important to prevent dislocation. Pillows under the knees may interfere with circulation. Extension and hyperextension should not interfere with hip movement; elevating the legs above the heart level would be incorrect and could result in dislocation.

A nurse is putting groceries in the car when an older adult client falls off of a curb. The nurse assesses the client and has a bystander call for an ambulance. Which assessment findings provide data of a suspected right hip fracture? Select all that apply. 1. The right leg is longer than the left leg. 2. The right leg is shorter than the left leg. 3. The right leg is abducted. 4. The right leg is adducted. 5. The right leg is externally rotated. 6. The right leg is internally rotated.

Answer: 2, 4, 5 A hip fracture is a serious injury, particularly if the client is elderly. Subjective signs of a hip fracture include the inability to move after a fall, pain, and the inability to bear weight and stiffness. Objective signs of a hip fracture include the affected leg is shorter, adducted, and externally rotated.

The nurse is teaching an older adult with a history of severe cardiac problems that the goal is to use exercise to maintain the highest level of function possible. Which directions should be included in the patient education to prevent hypertension or use of the Valsalva maneuver? 1. Breathe through your mouth while exercising. 2. Start slowly, and work up until you feel short of breath. 3. Limit exercises to range of motion and stretching. 4. Perform isotonic and isometric exercise frequently.

Correct answer: 1 Isometric and isotonic exercises should be used with caution by persons with cardiac problems because these exercises increase stress on the cardiovascular system. They may result in elevation of blood pressure and use of the Valsalva maneuver, which can lead to cardiac overload or cardiac arrest. To prevent this problem, older adults should be instructed to breathe through the mouth while exercising.

The patient problem of altered activity tolerance related to oxygenation problems was identified. Which statement made by the patient would indicate to the nurse the need for further teaching? 1. "I'll need to rest if my pulse rate gets too fast." 2. "I need to do my activities quickly to get everything done." 3. "I need to work on strategies that reduce my stress." 4. "I'll use my oxygen so I can breathe easier."

Correct answer: 2 Those who are unable to tolerate low levels of activity need to progress slowly, because progression that is too rapid leads to exhaustion, a feeling of failure, and loss of motivation.

The nurse is caring for an older adult residing in a community-based residential facility. The patient states, "I just don't know what to do except sleep. I worked hard all my life; I never had the time or money to do lots of things." Which nursing intervention is the most appropriate to meet this client's diversional activity needs? 1. Schedule the patient to join a museum trip with the local senior center. 2. Select books and videos from the library to occupy his time. 3. Refer him to occupational therapy for evaluation. 4. Explore the variety of activities that are now available to him.

Correct answer: 4 Older adults should have the right to choose the activities they find most meaningful. Purposeful activity is good for maintaining self-esteem; busywork is not. Nurses can help these individuals maintain active interests by exploring those activities that were enjoyed at an earlier age. The nurse's interest and a little creativity can go a long way toward meeting the social and diversional needs of older adults.

A home health nurse is visiting her patients and evaluating their exercise routines. Which patients meet the current recommendations for physical activity? (Select all that apply.) 1. Tom, a former marathon runner, power walks 30 minutes every weekday. 2. Marge, a retired nurse, swims 25 minutes every day except Sundays and does strength training with weights on Tuesdays and Fridays. 3. Jose lifts weights in his home gym every day and walks to the grocery store twice a week. 4. Yi-Lin plays video fitness 3 times each day, 10 minutes each time, and performs weight lifting 3 times a week.

Correct answers: 2, 4 Older adults without limiting health conditions should participate in 150 minutes of aerobic physical activity each week plus muscle-strengthening activities that work every major muscle group, twice a week. The physical activity can be broken down into small - even 10-minute - sessions. So, in this case, the ladies (Marge and Yi-Lin) have the best physical fitness plans!