Ch. 44 Activity & Exercise

***Thrombophlebitis, 1136

A clot loosely attached to an inflamed vein wall -Monitor for tenderness, redness or discoloration, warmth, and/or swelling in the legs. -Prevention: Compression stockings and anticoagulants such as Coumadin (long term long onset) and heparin (short term fast onset) -Treatment: Clot-dissolving medications -Diagnosis: Ultrasound (doppler), CT scan (for lungs PE)

Crepitation, 1140

A crackling, grating sound produced by bone rubbing against bone

Catabolism, 1137

A process in which complex substances are broken down into simpler substances (e.g., breakdown of tissue)

Dorsal recumbent position, 1150

A supine position with the head and shoulders slightly elevated. (with a pillow)

Functional strength, 1129

Ability of the body to perform work

Anaerobic exercise, 1130

Good to prevent osteoporosis and build strong muscles/bones

Line of gravity, 1123

Imaginary vertical line drawn through an object's center of gravity

Tripod (triangle) position, 1173

position with crutches

Calculi, 1137

renal stones

Urinary stasis, 1137

stagnation of urinary flow

Flaccid, 1134

weak or limp

Active ROM exercises, 1164

Isotonic exercises (same tension) in which the client independently moves each joint in the body through its complete range of movement, maximally stretching all muscle groups within each plane, over the joint.

Verbalize the steps used in: (a) moving a client up in bed (b) turning a client to the lateral or prone position in bed. (c) logrolling a client (d) Assisting a client to sit on the side of the bed. (e) Transferring between bed and chair. (f) Transferring between bed and stretcher. (g) Assisting a client to ambulate.

Logrolling -Place 1-2 pillows between the client's legs to support the upper leg when the client is turned (rationale: This pillow prevents adduction of the upper leg and keeps the legs parallel and aligned.

Prone position, 1150

Lying on abdomen with head turned to side

Vital capacity, 1136

Maximum amount of air that can be exhaled after a maximum inhalation.

Range of motion (ROM), 1124

Maximum degree of movement possible for each joint

Isometric (static or setting) exercise, 1129

Muscle contraction without moving the joint

***Contracture, 1135

Permanent shortening of a muscle ::Causes:: -Brain and nervous system disorders, such as cerebral palsy or stroke -Inherited disorders (such as muscular dystrophy) -Nerve damage -Reduced use (for example, from lack of mobility) -Scarring after traumatic injury or burns ::Home care:: -Doing exercises and stretches -Using braces and splints ::Doctor care:: -Physical therapy, medicines, orthopedic braces, or surgery may be helpful for some types of contractures.

Ankylosed, 1135

Permanently immobile joints

Relaxation response (RR), 1132

Physiologic state achieved through deep relaxation breathing

Activity-exercise pattern, 1123

Refers to a person's pattern of exercise, activity, leisure, and recreation

Embolus, 1136

clot roaming free causing posible obstruction to circulation

Isotonic (dynamic) exercise, 1129

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

Hematemesis

Vomiting blood

Fowler's position, 1149

-Bed at 45-60 degrees, typically at 45 degrees.

High fowler's position, 1149

-Bed-sitting 60-90 degrees

Atrophy, 1135

Wasting away; decrease in size or organ or tissue Treatment: -Exercise such as weight-bearing -Nutrition

Isokinetic (resistive) exercise, 1129

-Increases blood flow in specific muscles -Exercises that provide resistance to movement

Urinary retention, 1137

accumulation of urine in bladder and inability to empty

Aerobic exercise, 1129

any activity during which the body takes in more or an equal amount of oxygen than it expends

Use safe practices when positioning, moving, transferring, and ambulating clients.

-3 kinds of lifts : ceiling, mobile, and sit-to-stand -Balance depends on 1. Center of gravity 2. Line of gravity 3. Base of support -The closer the line of gravity is to the center of the base of support, the greater the person's stability -Two movements to avoid that cause back injury 1. twisting (rotation) 2. Stooping (leaning over to pick up something) Ambulation -Nurses should encourage ADL's and active ROM exercises

Proprioception, 1124

awareness of posture, movement, and changes in equilibrium

Urinary reflux, 1138

backward flow of urine

Compare and contrast active, passive, and active-assistive range-of-motion exercises

1. Active ROM -Isotonic exercise -Prevents deterioration of joint capsules, ankylosis, and contractures 2. Passive ROM -Stretches all muscle and joints -Does not maintain muscle strength but DOES maintain joint flexibility. 3. Assistive ROM -Patient uses strong limb to assist weak limb in movement People with Passive ROM should have a goal to get to Assistive ROM then finally to Active ROM

Assess activity-exercise pattern, body alignment, gait, appearance and movement of joints, mobility capabilities and limitations, muscle mass and strength, activity tolerance, and problems related to immobility.

1. Activity-Exercise pattern -What type of exercise do you carry out to enhance your physical fitness? -How long and often do you exercise? -Do you think it is beneficial to your health to exercise? 2. Body alignment -The shoulders and hips are level -The toes point forward -The spine is straight, not curved to either side (no slumped posture) causes fatigue quickly 3. Gait -determines risk for injury -two phases (stance & swing) -Stance phase- heel of one foot strikes the ground and carries the weight while the other heel is in the -Swing phase, pushing off the ground going from behind the body to in front of it. -Pace is assessed steps/min(70-100 normal and 40 for older adults). 4. Appearance and movement of joints -Inspection -Palpation -Assessment of active ROM (if not possible, assist with passive ROM) Assess for: -Swelling or redness (injury or inflammation) -Deformity (bony enlargement or contracture) -Palpable tenderness -Muscle size and symmetry of muscles on each side -Crepitation (palpable or audible crackling of joints from repeated trauma over time) -Increased temp over a joint -Degree of joint movement 5. Mobility capabilities and limitations -Presence of orthostatic hypotension before transfers. (assess for any increase in pulse rate, marked fall in blood pressure, dizzyness, light-headedness and dimming of vision) -Rising in bed w/o support 6. Muscle mass and strength -Assess patients ability to move and strength 7. Activity tolerance -Most useful measures in predicting activity tolerance are (a) HR- Strength & Rhythm (b) RR- Depth & Rhythm and (c) Blood Pressure These should be measured *Before activity *During activity *Immediately after activity *Three minutes after activity (resting) ****8. Problems Related to Immobility -Pg. 1142 Table 44-3

Describe four basic elements of normal movement.

1. Alignment & Posture -Line of gravity -Posture -Base of support *Enhances lung expansion, promotes circulation, renal, and gastrointestinal functions. ***2. Joint Mobility -When a person is inactive, the joints are pulled into a flexed (bent) position. Without exercise, the muscles permanently shorten, and the joint becomes fixed in a flexed position (Contracture) 3. Balance -Mechanisms involved in maintaining balance and posture -Labrynth (inner ear) -Vision -Stretch receptors of muscles and tendons (vestibulospinal input) 4. Coordinated Movement -Cerebral cortex- Initiates voluntary motor activity -Cerebellum- Coordinates the motor activities of movement -Basal ganglia- Maintains posture

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

1. Growth and development 2. Nutrition -Vit D deficiency causes bone deformity -Inadequate calcium intake and vit D synthesis increases risk of osteoporosis -Obesity can distort movement and stress joints, affecting posture, balance and joint health 3. Personal values and attitudes -Parents who exercise cause children to exercise -Values influence exercise type -Geographic location and culture may influence type of exercise 4. External Factors -High temp and high humidity discourage activity -lack of money can influence joining a gym -unsafe environment (don't want to go outside) -adolescents choose technology over physical act. 5. Prescribed limitations -Limitation to movement (casts, braces, splints) -Bed red (nurses need to provide therapeutic positioning)

***Effects of Immobility on body systems

1. Musculoskeltal System -Osteoporosis occurs Regardless on calcium intake -Muscles atrophy -Contractures (permanent shortening of muscle) -Stiffness and pain in joints (ankylosed may occur) 2. Cardiovascular System -Imbalance in autonomic nervous system --Causes tachycardia with minimal exertion --Causing reduced coronary blood flow and heart capacity to respond to metabolic demands -Valsalva maneuver -Orthostatic hypotension -Venous vasodilation and stasis --Skeletal muscles don't assist in flow of blood --Veins grow in diameter -Dependent edema --Caused by venous pressure that is sufficiently great. --Serous part of the blood is forced out of blood vessels into interstitial spaces. -Thrombus formation --Impaired venous return to heart 3. Respiratory System -Decreased respiratory movement decreases vital capacity -Pooling of respiratory secretions- usually expelled by changing positions, posture, or coughing. ***-Atelectasis (collapse of entire lung or lobe due to pooling of secretions and decreased amount of surfactant). -Hypostatic pneumonia- pooled secreations provide excellent media for bacterial growth. 4. Metabolic System -Decreased metabolic rate -Negative nitrogen balance muscle breakdown (due to catabolic processes exceeding the anabolic proccess) -Anorexia (reduced caloric intake is a usual response to decreased energy requirements) -Negative calcium balance (weight-bearing is required to replace calcium to bone) 5. Urinary System -Urinary stasis (due to gravity) -Renal calculi (stones) -Urinary retention -Urinary infection (static urine is a good home for bacteria) 6. Gastrointestinal System -Constipation 7. Integumentary System -Reduced skin turgor -Skin breakdown (abnormal blood circulation due to muscle activity) 8. Psychoneurologic System -Lowers self-esteem because of dependence on others

Semi-Fowler's position, 1149

bed at 30 degrees

Dorsal position, 1150

A back-lying position without a pillow

***Orthostatic (postural) hypotension , 1135

Also called postural hypotension Symptoms: -Dizziness -Lightheaded -Faint Can be caused by: -Dehydration (lose blood volume) -Heart problems that lower BP (bradycardia, heart failure, valve problems, heart attack) -Endocrine problems (hypoglycemia, thyroid hormone) -Nervous system disorders (Parkinson's ) -After eating meals TEACHING -Rest with head of bed elevated 8-12 inches -Avoid sudden changes in position (a) sit up in bed for 1 minute (b) sit on the side of bed w/ legs dangling for 1 minute (c) stand with care, holding onto something for 1 minute. -Wear elastic stockings at night to inhibit venous pooling in the legs -Symptoms most severe (a) 30-60 minutes after heavy meal (b) 1-2 hours after antihypertension meds -Get out of hot bath slowly -Use rocking chair to improve circulation -Refrain from strenuous activity resuling in holding breath and bearing down (slows heart rate and lowers BP)

Lordosis, 1139

An exaggerated concavity in the lumbar region of the vertebral column

***Osteoporosis, 1133

Body breaks down bone faster than it can replenish it. *If you have Osteoporosis then walking is best Prevention -Exercise: Upper body: Weight-bearing Legs: walking, jogging, running, stair climbing, skipping rope, skiing

***Describe client teaching for clients who use mechanical aids for walking.

Cane: -Hold cane on stronger side of body Walker: -Move walker 6 in -Move right foot (weight borne by left foot and arms) -Move left foot (weight borne by right foot and arms) Crutches: -Weight should be on be borne by arms not armpits -Erect posture as much as possible -Rubber soles to decrease chances of slipping -Learn tripod position

***Foot drop, 1135 Contracture (wear flattop shoes)

Caused by: -Nerve injury (mostly diabetes) -Muscle or nerve disorders (muscular dystrophy) -Brain and spinal cord disorders. (multiple sclerosis or stroke)

***Thrombus, 1136

Clot attached to a vein wall

Develop nursing diagnoses and outcomes related to activity, exercise, and mobility problems.

Diagnoses -Activity Intolerance : Insufficient physiological psychological energy to endure or complete required or desired daily activities. -Sedentary Lifestyle: Reports a habit of life that is characterized by a low physical activity level. -Risk for Infection if there is stasis of urinary or pulmonary secretions

***Effects of exercise on body systems.

Effects: 1. Musculoskeletal: -Maintained with mild exercise and increased (hypertrophy) with strenuous exercise. -Joints receive nourishment through activity and increases flexibility, stability and ROM -Bone density and Strength is maintained through weight bearing. 2. Cardiovascular: -Prevents stroke and CVD -Increases HR, strength of heart muscle contraction, and the blood supply to the heart due to cardiac output -Aerobic exercise (walking, cycling) is best -Lowers BP -Improved oxygen uptake -Improves circulation -Stress reduction 3. Respiratory: -Improves ventilation -Improves oxygen intake and gas exchange -More toxins removed with deeper breathing -problem solving and emotional stability enhanced due to increased oxygen to the brain. -Prevents pooling secretions into bronchi and bronchioles. Decreases risk for infection -Improves stamina -Improves immunity -COPD patients (walking, treadmill, stair climbing) -Asthma (yogic breathing and posture) 4. Gastrointestinal: -Increases appetite -Increases GI tone, facilitating peristalsis (BM) -rowing, swimming, walking, sit-ups work abd muscles and help with constipation. 5. Metabolic/Endocrine: -increases metabolic rate -During exercise can increase metabolic rate 20x -Stabilizes blood sugar and more responsive to insulin 6. Urinary: -Promotes efficient blood flow, which body excretes wastes more effectively. -Prevents urine stasis and decreases risk for UTIs 7. Immune: -Lymph fluid is more efficiently pumped from tissues -Circulation through lymph nodes and destruction of pathogens and removal of foreign antigens can occur and is improved -Strenuous exercise without rest can reduce immune function 8. Psychoneurologic: -Help with depression (increases levels of metabolites for neurotransmitters such as norepinephrine and serotonin. Exercise releases engogenous opioids, increasing endorphins -Help with anxiety -Improves sleep -Cognitive function- (studying, problem solving) -Spiritual health- Yoga improves mind-body-spirit connection, relationship with God, and physical well-being by establishing balance in the internal and external environment. -Yoga also helps with slowing RR and HR, which is beneficial for those with heart disease.

Hypertrophy, 1131

Enlargement of a muscle or organ

Passive ROM exercises, 1164

Exercise in which another person moves joints of patient in full ROM

Individualized exercise prescriptions, 1134

Exercise program made specific for client

Sims' position, 1150

Side-lying position with lowermost arm behind the body and upper arm at the shoulder and the elbow, with the client's legs flexed in front.

Anabolism, 1137

Simple substances are converted by the body's cells into more complex substances (e.g., building tissue)

Orthopneic position, 1150

Sitting 90 degrees lying over a table

Paresis, 1134

Slight or incomplete paralysis

Bed rest, 1134

Strict confinement to (complete bed rest), or the eclient may be allowed to use bedside commode or have bathroom privileges

***Logrolling, 1156

Technique used to turn a client with back surgery or spinal injury *Clients who have cervical injury, one nurse must maintain the client's head and neck alignment.

Activity tolerance, 1129

The amount of exercise an individual is able to perform

Base of support, 1123

The foundation on which an object rests

Center of gravity, 1123

The point at which all of the mass (weight) of an object is centered.

Basal metabolic rate, 1137

The rate of energy utilization in the body required to maintain essential activities such as breathing.

Valsalva maneuver, 1135

forceful exhalation against a closed glottis, which increases intrathoracic pressure and thus interferes with venous blood return to the heart (Ex,. clients tent to hold breath when moving in a bed. This builds up sufficient pressure on the large veins in the thorax to interfere with the return blood flow to the heart and coronary arteries)