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OBJECTIVES
At the end of this session learner will be able to; Review the anatomy & physiology of musculoskeletal system. Define physical activity,exercise,immobility ,joint mobility, body alignments & mechanics. Discuss benefits of exercise & mobility. Describe four basic elements of normal movement. Differentiate isotonic, isometric, isokinetic, aerobic, and anaerobic exercise. Identify the principle of gravity that affect balance.
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CONTD.
Compare the effects of exercise and immobility on body systems. Identify factors influencing a mobility. Apply nursing process while planning for client with altered musculoskeletal system
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CONTD
Physical activity Bodily movements produced by skeletal muscles that require energy expenditure and progressive health benefits Joint Mobility is the ability to move a limb through the full range of motion with control. Body Mechanics Body mechanics is the utilization of correct muscles to complete a task safely and efficiently, without undue strain on any muscle or joint.
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NORMAL MOVEMENTS
Body movement requires coordinated muscle activity and neurologic integration. It involves four basic elements: Body alignment (posture) Joint mobility Balance Coordinated movement
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Body alignment
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TYPES OF EXERCISES
Isotonic Isometric Isokinetic Aerobic Anaerobic
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BENEFITS OF EXERCISES
Effect on the Musculoskeletal System Exercise
Maintain size, shape, tone, and strength of muscles Nourishes joints Increases joint flexibility, stability, and ROM Maintains bone density and strength
Immobility
Disuse osteoporosis Disuse atrophy Contractures Stiffness and pain in the joints
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Immobility
Diminished cardiac reserve Increased use of the Valsalva maneuver Orthostatic (postural) hypotension Venous vasodilation and stasis Dependent edema Thrombus formation
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Immobility
Decreased respiratory movement Pooling of respiratory secretions Atelectasis Hypostatic pneumonia
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Immobility
Decreased metabolic rate Negative nitrogen balance Anorexia Negative calcium balance
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Immobility
Constipation
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Immobility
Urinary stasis Renal calculi Urinary retention Urinary infection
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Positive effects on decision-making and problem-solving processes, planning, and paying attention Induces cells in the brain to strengthen and build neuronal connections Other Effects of Exercise and Immobility
Evidence that certain types of exercise increase spiritual health Immobility causes reduced skin turgor and skin breakdown
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Excessive cost
Illness or injury
Feeling uncomfortable
Lack of skill Fear of injury
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A standing person with A, good trunk alignment; B, poor trunk alignment. The arrows indicate the direction in which the pelvis is tilted.
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NURSING PROCESS
ASSESMENT; Subjective
Pts daughter states that her mother was experiencing progressive right sided weakness over 2 days prior to admission.
Objective
Diagnosis of stroke Pt demonstrates right sided paralysis Pt demonstrates decreased grips and reflexes on the left side Pt demonstrates difficulty with mobility and activity.
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DIAGNOSIS; Impaired Physical Mobility r/t musculoskeletal impairment secondary to stroke a.m.b
Pts demonstration of right sided paralysis, decreased grips and reflexes on left side & diagnosis of stroke.
GOAL:Short Term:
Pt will perform passive range of motion exercises by the end of this shift, by 1900 Hrs. Long Term:
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INTERVENTION
Apply any ordered brace before mobilizing the client. Increase independence in ADLs. Maintain or improve strength, function and compensation of the body. Demonstrate techniques/behaviors that allow the activity. Obtain any assistive devices needed for activity. Assess the pts pain by using the 10 point pain rating scale q4 hrs. Before activity, treat pain.
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CONTD
Assist with range of motion active / passive, and resistive exercises as well as isometric if possible. Provide a safe environment, for example, raise the chair, use the handrails on the toilet, use a wheelchair. Encourage patient to maintain an upright posture in sitting, standing, and walking.
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EVALUTION
Restore ability of ambulate. Avoid any complications associated with immobility. Increased tolerance for physical activity. Avoid injury from falling & improper use of body mechanics.
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NURSING INTERVENTION
SAFE PRACTICE FOR POSITIONING, MOVING, LIFTING, AMBULATING CLIENTS General Guidelines for Moving and Lifting: Before moving, assess If indicated, use pain relief modalities Prepare any needed assistive devices Plan around encumbrances Be alert to the effects of any medications Obtain required assistance Explain the procedure to the client
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ACTIVE EXERCISES
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ACTIVE
EXERCISES
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PASSIVE EXERCISES
PASSIVE
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EXERCISES
ACTIVITY & EXERCISE 39
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MECHANICAL AIDS
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