Chapter 39: Activity and Exercise

Antagonistic muscles

Cause movement at the joint

Synovial Joints

"true joints," freely movable and the most mobile, numerous, and anatomically complex; examples of synovial joints include: elbow joint, hip joint, etc.

The nurse is attempting to start an exercise program in a local community as a health promotion project. In explaining the purpose of the project, the nurse explains to community leaders that a. A sedentary lifestyle contributes to the development of health-related problems. b. The recommended frequency of workouts should be twice a day. c. An exercise prescription should incorporate aerobic exercise only. d. The purpose of weight training is to bulk up muscles.

ANS: A A sedentary lifestyle contributes to the development of health-related problems. A holistic approach is taken to develop overall fitness and includes warm-ups, aerobic exercise, resistance training, weight training, and so forth. The recommended frequency of aerobic exercise is 3 to 5 times per week or every other day for approximately 30 minutes. Cross-training is recommended for the patient who prefers to exercise every day. Some patients use weight training to bulk up their muscles. However, the purposes of weight training from a health perspective are to develop tone and strength and to simulate and maintain healthy bone

The nurse is preparing to reposition a patient. Before doing so, the nurse must a. Assess the weight to be lifted and the assistance needed. b. Attempt to manually lift the patient alone before asking for assistance. c. Attempt a manual lift only when lifting most or all of the patient's weight. d. Not use the agency lift team if a mechanical lift is available

ANS: A Before lifting, assess the weight to be lifted and determine the assistance needed and the resources available. Manual lifting is the last resort, and it is used when the task at hand does not involve lifting most or all of the patient's weight. Use safe patient handling equipment in conjunction with agency lift teams to reduce the risk of injury to the patient and members of the health care team.

Isotonic, isometric, and resistive isometric are three categories of exercise. They are classified according to the type of muscle contraction involved. Of the following exercises, which are considered isotonic? a. Bicycling, swimming, walking, jogging, dancing b. Tightening or tensing of muscles without moving body parts c. Push-ups, hip lifting, pushing feet against a footboard on the bed d. Quadriceps set exercises and contraction of the gluteal muscles

ANS: A Examples of isotonic exercises are walking, swimming, dance aerobics, jogging, bicycling, and moving arms and legs with light resistance. Isometric exercises involve tightening or tensing of muscles without moving body parts. Examples include quadriceps set exercises and contraction of the gluteal muscles. Examples of resistive isometric exercises are push-ups and hip lifting, as well as placing a footboard on the foot of the bed for patients to push against with their feet.

Fibrous Joints

fit closely together and are fixed, permitting little, if any, movement such as the syndesmosis between the tibia and fibula

Cartilaginous Joints

have little movement but are elastic and use cartilage to unite separate body surfaces such as the synchondrosis that attaches the ribs to the costal cartilage

Center of Gravity

midpoint or center of the weight of a body or object

Range of Motion (ROM)

mobility

Cartilage

nonvascular, supporting connective tissue with the flexibility of a firm, plastic material; because of its gristle-like nature, cartilage sustains weight and serves as a shock absorber between articulating bones

Muscle Tone

normal state of balanced muscle tension

Hemiplegia

paralysis of one side of the body

Hemiparesis

paralysis of one side of the body, hemiplegia; this condition causes decreased sensation which creates risk to the musculoskeletal system when lying down

Exercise

physical activity

Posture

position of the body in relation to the surrounding space

Antigravity muscles

stabilize joints; these muscles continuously oppose the effect of gravity on the body and permit a person to maintain an upright or sitting posture

Proprioception

the awareness of the position of the body and its parts; proprioceptors located on nerve endings in muscles, tendons, and joints monitor proprioception

Mobility

the degree of the ability to move; has three parts, range of motion (ROM), gait, and exercise

Gait

the manner or style of walking, including rhythm, cadence, and speed

Isometric Contractions

tightening or tensing muscles without moving body parts e.g. contraction of gluteal muscles

Tendons

white, glistening, fibrous bands of tissue that connect muscle to bone

Ligaments

white, shiny, flexible bands of fibrous tissue that bind joints and connect bones and cartilage; they are elastic and aid joint flexibility and support

Activity Tolerance

Kind or amount of exercise or work that a person is able to perform

Friction

a force that occurs in a direction to oppose movement; reduce friction by reducing surface area, for example, have patient place their arms across their chest when helping them move up in the bed

Crutch Gait

alternately bearing weight on one or both legs and on the crutches

Joint

an articulation, where and how bones connect

The nurse is providing care to a patient who is bedridden. To prevent fatigue, the nurse raises the height of the bed. The nurse understands that balance is maintained by raising the bed to a. Prevent a shift in the nurse's base of support. b. Narrow the base of support. c. Allow the nurse to bring his or her feet close together. d. Shift the center of gravity further away from the base of support

ANS: A Raising the height of the bed when performing a procedure prevents bending too far at the waist and causing a shift in the base of support. Balance is maintained by maintaining proper body alignment and posture through two simple techniques. First, widen the base of support by separating the feet to a comfortable distance. Second, increase balance by bringing the center of gravity closer to the base of support.

A structural curvature of the spine associated with vertebral rotation is known as a. Scoliosis. b. Osteogenesis. c. Osteomalacia. d. Arthritis

ANS: A Scoliosis is a structural curvature of the spine associated with vertebral rotation. Osteogenesis imperfecta is an inherited disorder that makes bones porous, short, bowed, and deformed. Osteomalacia is an uncommon metabolic disease characterized by inadequate and delayed mineralization, resulting in compact and spongy bone. Arthritis is an inflammatory joint disease characterized by inflammation or destruction of the synovial membrane and articular cartilage, and by systemic signs of inflammation

The patient weighs 450 lbs (204.5 kg) and complains of shortness of breath with any exertion. His health care provider has recommended that he begin an exercise program. He states that he can hardly get out of bed and just cannot do anything around the house. To focus on the cause of the patient's complaints, the nurse devises which of the following nursing diagnoses? a. Activity intolerance related to excessive weight b. Activity intolerance related to bed rest c. Impaired gas exchange related to shortness of breath d. Imbalanced nutrition: less than body requirements

ANS: A The diagnostic label directs nursing interventions. This requires the correct selection of related factors. For example, Activity intolerance related to excess weight gain requires very different interventions than if the related factor is prolonged bed rest. In this case, the intolerance is related to the patient's excessive weight. He is not on bed rest, although he claims that it is difficult for him to get out of bed. Shortness of breath is a symptom, not a cause, of Impaired gas exchange, making this nursing diagnosis ineffective. The patient certainly has an imbalance of nutrition, but it is more than body requirements

The patient is being admitted for elective knee surgery. While the nurse is admitting the patient, she will a. Begin to develop a discharge plan. b. Plan to wait until after the surgery to plan for discharge. c. Place a generalized discharge plan in the record for later use. d. Address immediate needs of the patient only and address other needs later

ANS: A The nurse needs to begin discharge planning when the patient enters the health care system. The nurse cannot wait until after surgery to begin to plan for discharge. In addition, the discharge plan is always individualized to the patient and directed at meeting the actual and/or potential needs of the patient

When assessing the activity tolerance of a patient, the nurse would evaluate which of the following? (Select all that apply.) a. Skeletal abnormalities b. Emotional factors c. Age d. Pregnancy status e. Race

ANS: A, B, C, D Factors influencing activity tolerance include physiological factors such as skeletal abnormalities, emotional factors such as anxiety/depression, developmental factors such as age and gender, and pregnancy status. Race is not a factor because people of all races are faced with similar factors that affect their activity tolerance.

Bones perform five functions in the body: support, protection, movement, mineral storage, and hematopoiesis. In the discussion of body mechanics, which are the most important? (Select all that apply.) a. Support b. Protection c. Movement d. Mineral storage e. Hematopoiesis

ANS: A, C Bones perform five functions in the body: support, protection, movement, mineral storage, and hematopoiesis. In the discussion of body mechanics, two of these functions—support and movement—are most important. In support, bones serve as the framework and contribute to the shape, alignment, and positioning of body parts. In movement, bones together with their joints constitute levers for muscle attachment. As muscles contract and shorten, they pull on bones, producing joint movement. Protection involves encasing the soft tissue organs in a protective cage. Mineral storage helps to strengthen bones but also helps regulate blood levels of certain nutrients. Hematopoiesis is the formation of blood cells

The patient is brought to the emergency department with possible injury to his shoulder. To help determine the degree of injury, the nurse should evaluate a. The patient's gait. b. The patient's range of motion. c. Fine motor coordination. d. Activity tolerance

ANS: B Assessing range of motion is one assessment technique used to determine the degree of damage or injury to a joint. Gait is the manner or style of walking. It may have little bearing on the shoulder damage. Assessing fine motor coordination would be beneficial in helping to assess the patient's ability to perform tasks but would not help in evaluating the shoulder. Activity tolerance refers to the type and amount of exercise or activity a person is able to perform. Damage to the shoulder would affect this, but this would not have a direct bearing on the amount of damage done to the shoulder.

The nurse is developing an exercise plan for someone diagnosed with congestive heart failure and exercise intolerance. In doing so, the nurse should a. Plan for 20 minutes of continuous aerobic activity and increase as tolerated. b. Perform 6-minute walks at the patient's pace at least 2 times a day. c. Instruct the patient that he should not take his beta blocker medication on exercise days. d. Encourage a high-calorie diet to plan for extra calorie expenditure

ANS: B For the diagnosis of exercise intolerance, the patient should begin by performing 6-minute walks at his own pace at least twice a day. The patient would not be able to tolerate 20 minutes of continuous aerobic activity. Patients should be instructed to take medications as ordered. Low-calorie, low-sodium, and high-protein diets are best for this type of patient

The nurse is ambulating a patient in the hall when she notices that he is beginning to fall. The nurse should a. Grab the patient and hold him tight to prevent the fall. b. Gently lower the patient to the floor. c. Jump back and let the patient fall naturally. d. Push the patient against the wall and guide him to the floor

ANS: B If the patient has a fainting episode or begins to fall, assume a wide base of support with one foot in front of the other, thus supporting the patient's body weight. Then extend one leg and let the patient slide against the leg, and gently lower the patient to the floor, protecting the patient's head. Grabbing the patient will shift the nurse's center of gravity and may lead to a back injury. Allowing the patient to fall could lead to head injury for the patient. Pushing the patient against the wall could also cause the patient to hit his head and cause injury.

The nurse is examining a patient who is admitted to the emergency department with severe elbow pain. Of the following situations, which would cause the nurse to suspect a ligament tear or joint fracture? a. Range of motion of the elbow is limited. b. Joint motion is greater than normal. c. The patient has arthritis. d. The elbow cannot be moved (frozen).

ANS: B Increased mobility (beyond normal) of a joint may indicate connective tissue disorders, ligament tears, or possible joint fractures. Limited range of motion often indicates inflammation such as arthritis, fluid in the joint, altered nerve supply, or contractures (frozen joints).

The nurse is developing a plan of care for a patient diagnosed with activity intolerance. Of the following strategies, which has the best chance of maintaining patient compliance? a. Performing 20 minutes of aerobic exercise daily with 10 minute warm-up and cool-down periods b. Instructing the patient to use an exercise log to record day, time, duration, and responses to exercise activity c. Instructing the patient on the evils of not exercising, and getting her to take responsibility for her current health status d. Arranging for the patient to join a gym that she will have to pay, for so that she does not need to depend on insurance

ANS: B Keeping a log may increase adherence to an exercise prescription. Cross-training (combination of exercise activities) provides variety to combat boredom and increases the potential for total body conditioning as opposed to daily aerobic exercise. "Blaming" a patient for his or her health status is usually counterproductive. Instead, the nurse should instruct the patient about the physiological benefits of a regular exercise program. Developing a plan of exercise that the patient may perform at home may improve compliance

In planning a physical activity program for a patient, the nurse must understand that a. Isotonic exercises cause contraction without changing muscle length. b. The best program includes a combination of exercises. c. Isometric contraction involves the movement of body parts. d. Resistive isometric exercises can lead to bone wasting

ANS: B The best program of physical activity includes a combination of exercises that produce different physiological and psychological benefits. Isotonic exercises cause muscle contractions and changes in muscle length. Isometric exercises involve tightening or tensing of muscles without moving body parts. Resistive isometric exercises help promote muscle strength and provide sufficient stress against bone to promote osteoblastic activity

The patient is eager to begin his exercise program with a 2-mile jog. The nurse instructs the patient to warm up with stretching exercises. The patient states that he is ready and does not want to waste time with a "warm-up." The nurse explains that the warm-up a. Allows the body to readjust gradually to baseline functioning. b. Prepares the body and decreases the potential for injury. c. Should not involve stretching exercises because they can lead to injury. d. Should be performed with high intensity to prepare for the coming challenge

ANS: B The warm-up activity prepares the body for activity and decreases the potential for injury. It usually lasts about 5 to 10 minutes and may include stretching, calisthenics, and/or aerobic activity performed at a lower intensity. The cool-down period allows the body to readjust gradually to baseline functioning and provides an opportunity to combine movement such as stretching with relaxation-enhancing mind-body awareness.

The patient is admitted with a stroke. The outcome of this disorder is uncertain, but the patient is unable to move his right arm and leg. The nurse understands that a. Active range of motion is the only thing that will prevent contractors from forming. b. Passive range of motion must be instituted to help prevent contracture formation. c. Range-of-motion exercises should be started 2 days after the patient is stable. d. Range-of-motion exercises should be done on major joints only.

ANS: B When patients cannot participate in active range of motion, the nurse must institute passive range of motion to maintain joint mobility and prevent contractures. Passive range of motion can be substituted for active when needed. For the patient who does not have voluntary motor control, passive range-of-motion exercises are the exercises of choice. Unless contraindicated, the nursing care plan includes exercising each joint (not just major joints) through as nearly a full range of motion as possible. Initiate passive range-of-motion exercises as soon as the patient loses the ability to move the extremity or joint.

In developing a nursing care plan for increasing activity tolerance in a patient, the nurse should (Select all that apply.) a. Use generalized therapies because they work for everyone. b. Consult with members of the health care team. c. Avoid goals published by the American College of Sports Medicine. d. Involve the patient and the patient's family in designing an exercise plan. e. Consider the patient's ability to increase activity level.

ANS: B, D, E When planning care, the nurse should consult/collaborate with members of the health care team to increase activity, involve the patient and family in designing an activity and exercise plan (especially if family members are also providers of care), and consider the patient's ability to increase activity level. Therapies should be individualized to the patient's activity tolerance. Information from the American College of Sports Medicine serves as a standard that the nurse should use when applying activity and exercise goals

The coordinated efforts of the musculoskeletal and nervous system maintain balance, posture, and body alignment. Body alignment refers to a. A low center of gravity balanced over a wide base of support. b. The result of weight, center of gravity, and balance. c. The relationship of one body part to another. d. The force that occurs in a direction to oppose movement

ANS: C Body alignment refers to the relationship of one body part to another body part along a horizontal or vertical line. Body balance occurs when a relatively low center of gravity is balanced over a wide, stable base of support. Coordinated body movement is a result of weight, center of gravity, and balance. Friction is a force that occurs in a direction to oppose movement.

Many patients find it difficult to incorporate an exercise program into their daily lives because of time constraints. For these patients, it is beneficial to reinforce that many ADLs are used to accumulate the recommended 30 minutes or more per day of moderate-intensity physical activity. When instructing these patients, the nurse explains that a. Housework is not considered an aerobic exercise. b. To strengthen back muscles, the patient should bend using back muscles. c. Daily chores should begin with gentle stretches. d. The patient should stick to one chore until it is done before beginning a new one

ANS: C Daily chores should begin with gentle stretches. Housework is considered aerobic exercise. To make it more aerobic, work faster and scrub harder. Bend your legs rather than your back to prevent back injury. Alternate cleaning activities to prevent overworking the same muscle groups.

Approximately what percentage of all back pain is associated with manual lifting tasks? a. 10% b. 25% c. 50% d. 75%

ANS: C Half of all back pain is associated with manual lifting tasks

Unlike arthritis, joint degeneration a. Occurs only from noninflammatory disease. b. Occurs only from inflammatory disease. c. Involves overgrowth of bone at the articular ends. d. Affects mostly non-weight-bearing joints

ANS: C Joint degeneration, which can occur with inflammatory and noninflammatory disease, is marked by changes in articular cartilage combined with overgrowth of bone at the articular ends. Degenerative changes commonly affect weight-bearing joints.

In assisting the patient to exercise, the nurse should a. Expect that pain will occur with exercise of unused muscle groups. b. Set the pace for the exercise class. c. Force muscles or joints to go just beyond resistance. d. Stop the exercise if pain is experienced

ANS: D Assess for pain, shortness of breath, or a change in vital signs. If present, stop exercise. Let each patient exercise at his or her own pace. Assess for joint limitations, and do not force a muscle or a joint during exercise.

The nurse is preparing to position an immobile patient. Before doing so, the nurse must understand that a. Manual lifting is the easier method and should be tried first. b. Following body mechanics principles alone will prevent back injury. c. Body mechanics can be ignored when patient handling equipment is used. d. Body mechanics alone are not sufficient to prevent injuries

ANS: D Body mechanics alone are not sufficient to prevent musculoskeletal injuries when positioning or transferring patients. The use of patient-handling equipment in combination with proper body mechanics is more effective than either one in isolation. Body mechanics cannot be ignored even when patient handling equipment is being used. Manual lifting is the last resort, and it is only used when it does not involve lifting most or all of the patient's weight

The nurse is developing an exercise program for elderly patients living in a nursing home. To develop a beneficial health promotion program, the nurse needs to understand that when dealing with the elderly a. Exercise is of very little benefit because the patients are old. b. It is important to disregard their current interests in favor of exercise. c. No physical benefit can be gained without a formal exercise program. d. Adjustments to exercise programs may have to be made to prevent problems.

ANS: D Exercise is extremely beneficial for older adults, but adjustments to an exercise program may have to be made for those of advanced age to prevent problems. When developing an exercise program for any older adult, consider not only the person's current activity level, range of motion, muscle strength and tone, and response to physical activity, but also the person's interests, capacities, and limitations. Older adults who are unable to participate in a formal exercise program are able to achieve the benefits of improved joint mobility and enhanced circulation by simply stretching and exaggerating movements during performance of routine activities of daily living.

The nurse is working with the patient in developing an exercise plan. The patient tells the nurse that she just will not participate in a formal exercise program. The nurse then suggests that exercise activities can be incorporated into activities of daily living. The patient seems to be agreeable to that concept. Of the following activities, which would be considered a moderate-intensity activity? a. Doing laundry b. Making the bed c. Ironing d. Folding clothes

ANS: D Low-intensity ADLs include doing the laundry, making the bed, ironing, and washing dishes. Moderate-intensity ADLs include sweeping the kitchen or sidewalk, washing windows, folding clothes, and vacuuming.

An active lifestyle is important for maintaining and promoting health. In developing an exercise program, the nurse understands that a. Physical exercise is contraindicated for patients with chronic illnesses. b. Regular physical activity is beneficial only for the body part that is exercised. c. Physical exercise has no effect on psychological well-being. d. Physical activity enhances functioning of all body systems.

ANS: D Regular physical activity and exercise enhance the functioning of all body systems, including cardiopulmonary functioning, musculoskeletal fitness, weight control and maintenance, and psychological well-being. It is also essential in treatment for chronic illness.

The patient has been in bed for several days and needs to be ambulated. Before ambulation, the nurse a. Removes the gait belt to allow for unrestricted movement. b. Has the patient get up from bed before he has a chance to get dizzy. c. Has the patient look down to watch his feet to prevent tripping. d. Dangles the patient on the side of the bed.

ANS: D Some patients experience orthostatic hypotension—a drop in blood pressure that occurs when the patient changes from a horizontal to a vertical position. Assist the patient to a position of sitting at the side of the bed, and dangle for 1 to 2 minutes before standing. The nurse needs to provide support at the waist so that the patient's center of gravity remains midline. This is achieved with the use of a gait belt. A gait belt encircles the patient's waist and may have handles attached for the nurse to hold while the patient ambulates. The patient should maintain as normal a walking posture as possible with the head erect.

Which of the following exercise activities would most likely provide the opportunity for mind-body awareness? a. Warm-up activity b. Resistance training c. Aerobic exercise d. Cool-down activity

ANS: D The cool-down period allows the body to readjust gradually to baseline functioning and provides an opportunity to combine movement such as stretching with relaxation-enhancing mind-body awareness. The warm-up activity prepares the body and decreases the potential for injury. Aerobic exercise includes running, bicycling, jumping rope, and so forth, and is the main portion of exercise activity; it precedes the cool-down period. Resistance training increases muscle strength and endurance and is associated with improved performance of daily activities but not with enhancing mind-body awareness.

The patient has been bedridden for several months owing to severe congestive heart disease. In determining a plan of care for this patient that will address his activity level, the nurse formulates which of the following nursing diagnoses? a. Fatigue related to poor physical condition b. Impaired gas exchange related to decreased cardiac output c. Decreased cardiac output related to decreased myocardial contractility d. Activity intolerance related to physical deconditioning

ANS: D When activity and exercise are problems for a patient, nursing diagnoses often focus on the individual's ability to move. The diagnostic label directs nursing interventions. In this case, physical deconditioning must be addressed relative to activity level, perhaps leading to 6-minute walks twice a day. Physical deconditioning is the cause of fatigue as well, so it would take priority over that diagnosis. Decreased cardiac output and myocardial contractility are serious concerns that must be addressed before activity intolerance to keep the patient safe and to help determine the level of exercise that the patient can tolerate, but reconditioning of the patient's body will help improve contractility and cardiac output

Activities of Daily Living (ADLs)

Activities usually performed in the course of a normal day in the patient's life such as eating, dressing, bathing, brushing teeth, or grooming.

Footboards

boards placed on the end of beds; patients push against them to move up in bed; helps prevent drop foot

Isotonic Contractions

cause muscle contraction and change in muscle length e.g. walking, swimming, dancing, aerobics, etc.

Synergistic Muscles

contract to accomplish the same movement, for example, when the arm is flexed the strength of the contraction of the biceps brachii is increased by contraction of the synergistic muscle, the brachialis